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Thread: actual standard for rehab

  1. #1

    Exclamation actual standard for rehab

    Hi,
    we are desperately looking for information about actual rehab standard.
    My brother in law is in rehab in Germany since end of November - getting right into hospital because of severe problems with his intestine (emergency surgery). After surgery, he was brought back to rehab facility with a bedsore. He was kept in rehab facility waiting for the bedsore to get better - only staying in bed. Since two weeks, he is allowed to sit in the wheelchair - but only for one hour per day.
    We know that he gets ergotherapy for 30 minutes 4 days a week and physiotherapy one hour per day/5 days per week. We feel that this is way too less for a rehab?

    Can anybody send us official statements/information about the importance of rehab?

    Background is that the rehab facility obviously wants to kick out my brother in law from rehab now. We have no idea what the reason is - health insurance does not make problems in regard to financials. Also he IS improving is abilities in small steps (movement of feet, legs, arms, shoulder - but muscle strength is missing).
    We suspect that the rehab facility wants to hide their mistake not bringing him back to hospital because of the bedsore but keepting him waiting for healing at their facility and not being able to give him appropriate rehab.
    Even though we do not know about their rehab plan for patients being able for rehab since the rehab schedule did not change since he can sit in the wheelchair...

    Can anybody tell us how a rehab plan should look like? We are sure that therapy should be a lot more than it is at the moment.

    We will have a meeting with the doctors and therapists on Tuesday to find out their reasons for stopping the therapy. So as many useful information as possible would be appreciated.

    Thanks a lot for your help!

  2. #2
    I am not so good in this "matter" (and doing conversation in English is hard, too). So I can tell you that his spinal cord was not cut through but damaged.
    The surgeon told us after the surgery that he will never be able to walk again and that we are lucky when he can use his hands (but not even fingers).
    As of now he can sense a lot in his hands, fingers, arms, back, legs - so sensory seems to be good. He can even tuck up his legs. So we are very confident that he can improve to a much better status when he gets enough rehab.

  3. #3
    Er hat also eine Querschnittlähmung? Wie ist er verletzt worden? Hat man ihm eine Frankel oder ASIA Klassifikation gegeben?
    Last edited by Katja; 02-09-2013 at 05:04 PM.

  4. #4
    Hallo Katja,
    er ist mit einer "inkompletten Querschnittlähmung sub C4 im Sinne einer Tetraparese mit Zonen erhaltener Sensibilität und Motorik" diagnostiziert.
    Er wurde am 01.11 in die Reha verlegt, musste am 09.11. am Darm notoperiert werden, kam am 19.11 wundgelegen in die Reha zurück. Vor ca. 10 Tagen war die offene Stelle soweit abgeheilt, dass er seit dem für 1 Stunde pro Tag in den Rollstuhl kommt.
    Seine jetzige Therapie besteht in Ergo 4 x 0,5 Std./Woche und Physio 1 Std./Tag 5 x die Woche. Genau soviel, wie als er nur im Bett liegen konnte, da er wundgelegen war. Die Therapien finden jetzt auch nur im Bett statt und nicht im Rollstuhl...
    Wir denken einfach, dass das für ein Reha-Zentrum zu wenig Therapie ist...

  5. #5
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    "incomplete paraplegia sub C4 in terms of a tetra paresis with zones preserved sensitivity and motor skills"
    There is no such thing as a stupid question but there sure are a lot of inquisitive idiots. -modified from despair.com

  6. #6
    Quote Originally Posted by Berlin View Post
    Hallo Katja,
    er ist mit einer "inkompletten Querschnittlähmung sub C4 im Sinne einer Tetraparese mit Zonen erhaltener Sensibilität und Motorik" diagnostiziert.
    Er wurde am 01.11 in die Reha verlegt, musste am 09.11. am Darm notoperiert werden, kam am 19.11 wundgelegen in die Reha zurück. Vor ca. 10 Tagen war die offene Stelle soweit abgeheilt, dass er seit dem für 1 Stunde pro Tag in den Rollstuhl kommt.
    Seine jetzige Therapie besteht in Ergo 4 x 0,5 Std./Woche und Physio 1 Std./Tag 5 x die Woche. Genau soviel, wie als er nur im Bett liegen konnte, da er wundgelegen war. Die Therapien finden jetzt auch nur im Bett statt und nicht im Rollstuhl...
    Wir denken einfach, dass das für ein Reha-Zentrum zu wenig Therapie ist...
    Translation:

    He has been diagnosed with an incomplete spinal cord injury at C4 defined as tetraplegia with zones of both motor and sensory function.

    He entered rehab on November 1st, had an emergency operation on the intestines on November 9th and returned to rehab with a pressure sore on the 19th of November. By about 10 days ago the open area had healed enough that he was able to spend 1 hour per day in the wheelchair.

    Therapy up until now has consisted of Ergo (not sure of the correct translation) 4 times a week for 1/2 hour and physiotherapy 5 times a week for 1 hour. It was the same when he was bedridden with the pressure wound - the therapy was done in bed instead of in the wheelchair.

    We just think that this is too little therapy for a rehabilitation center.
    Ich bin keine Fachfrau in Querschnittlähmung (leide selber unter multiple Sklerose) aber hoffentlich werden die SCI-Krankenschwestern (und anderen) bald antworten. Wenn ich bei untersetzen helfen kann, bin ich bereit.

    Spezializiert sich die Reha auf Querschnittlähmung?

  7. #7
    Generally the standard for acute rehab in this country is3 hours of Physical Therapy and/or occupational therapy 6-7 days per week. Fo sub-acute rehab, the standard is1-2 ours per week. Given his current ability to sit up and participate in therapy, he might not be unite ready for acute rehab. I do not know the standard of care in Germany.

    Many times, people stay in the rehab setting to heal a pressure ulcer. You said he got it in the acute care hospital, so I guess I personally would ask the question, why would you want him to go back there? The rehab setting is much more in sync with his care needs.

    In our country, insurance dictates how long a patient is covered in a rehab program. They would ask the question, is he making enough gains to justify this level of care. I can not tell from you post whether or not he is making enough gains to have him stay at this level
    of care. Rehab continues at home and in the community. It may be better for him to have outpatient care, and maybe e remitted in he future.

    The days of staying in rehab for months at a time are gone in this country. Again, I am not sure about European Standards of care.

    I don't know if this is helpful or not. I would encourage you to make a list of questions for his care team. Make sure they are addressed. And feel free to post again here.

    CKF

  8. #8
    The American Spinal Injury Association (ASIA) has published a white paper on Competent Care for Spinal Cord Injury Rehab. These are complimentary to the CARF standards for accreditation as a SCSC (Spinal Cord System of Care). You can find and download (as a PDF) the ASIA standards here:

    http://www.asia-spinalinjury.org/ (left hand side bar, green box)

    I am going to move this thread to the New SCI forum.

    (KLD)

  9. #9

    Berlin

    Hi, I am helping you thru Wendy and found your post here.
    SCI Nurse, thank you.

    Mike C, can you assist? I can connect you with Berlin.

    Thanks,
    Every day I wake up is a good one

  10. #10
    Super Moderator Sue Pendleton's Avatar
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    I am sure many things have changed since I was treated acutely for incomplete tetrapersis due to a spinal infarct. There are few rehabs in the country so injured people are normally kept in acute care hospitals until a space opens in an appropriate rehab. Neurology ward area doctors and nurses are well trained in caring for skin, bladder, bowel, etc. Physical therapists are few and far between in acute hospitals but do try to get everyone up for an hour a day including tilt tables, pushing chairs outside if at all possible and range of motion. Nurses also help with ROM and skin issues. Besides the rehab Mike runs the main two I know of were in Murnau in southern Bavaria and Bayreuth.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

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