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Research letterDecannulation potential after acquired brain injury in rehabilitation-oriented outpatient intensive careBy P. Woywod; A. Alagic; P. Gutschmidt; C. Bodenstein; A. Seitz and C. Dohle [Extracted from the article]

Neurorehabilitation is characterized by a structured, interdisciplinary collaboration among various professional fields, focused on achieving individualized participation goals for patients. This process considers the different levels of the International Classification of Functioning, Disability, and Health (ICF), specifically function, activity and participation. Multiple evidence-based treatment procedures targeting specific mechanisms of action are available for the rehabilitation of disorders associated with various diseases. Treatment must be administered with sufficient intensity to be effective. The neurological phase model encompasses several stages of care ranging from acute treatment in phase A to phase D for patients who are largely independent. Early rehabilitation phase B and rehabilitation phase C combine acute and rehabilitation-specific tasks. Phase E supports long-term occupational and social participation, while phase F is dedicated to long-term care for severely affected patients. In the outpatient setting, the long-term care of neurologically affected patients remains insufficient due to a lack of interdisciplinary collaboration possibilities, highlighting an urgent need for expansion and improved integration between care providers., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: Gemäß den Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben. Autorinnen und Autoren: C. Dohle: A. Finanzielle Interessen: Forschungsförderung zur persönlichen Verfügung: Innovationsfonds: Erstellung der Leitilinie „TheMoS“ (Therapie der Mobilität nach Schlaganfall). – Fortbildungshonorare als Referent durch: Diakonie Akademie Gesundheit und Soziales | Akademie für Sozialmedizin Berlin | Ärztekammer Berlin | Diaplan | Messe Leipzig | Pfizer | Westerwaldklinik | UP Transfer an der Universität Potsdam | Ipsen | Kaiserin-Friedrich-Stiftung. – Autorenhonorare von: Schulz-Kirchner-Verlag | Georg Thieme Verlag | Hippocampus Verlag. – B. Nichtfinanzielle Interessen: Leitender Arzt, P.A.N. Zentrum für Post-Akute Neurorehabilitation, Berlin | Bereichsleiter Forschung, Fürst-Donnersmarck-Stiftung zu Berlin | Gastwissenschaftler, Charité - Universitätsmedizin Berlin | Präsident der Deutschen Gesellschaft für Neurorehabilitation | Mitgliedschaften: Centrum für Schlaganfallforschung Berlin | Forschungs-, Leitlinien- und Curriculumskommission der Deutschen Gesellschaft für Neurorehabilitation | Deutsche Gesellschaft für Neurologie | Deutsche Schlaganfall-Gesellschaft | Berufsverband Deutscher Neurologen | Vorstand der Berliner Schlaganfall-Allianz. M. Schrader: A. Finanzielle Interessen: M. Schrader gibt an, dass kein finanzieller Interessenkonflikt besteht. – B. Nichtfinanzielle Interessen: Wissenschaftliche Mitarbeiterin im Bereich Rehabilitationsforschung, Fürst Donnersmarck-Stiftung zu Berlin. Wissenschaftliche Leitung: Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme . Der Verlag: erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field., (© The Author(s) 2024.)

Background: Acquired brain injuries are among the most common causes of disability in adulthood. An intensive rehabilitation phase is crucial for recovery. However, there is a lack of concepts to further expand the therapeutic success after the standard rehabilitation period. Hereafter, the characteristics of a transsectoral, multiprofessional long-term neurorehabilitation concept and its effects on outcome at different ICF levels are described., Methods: The P.A.N. Center for Post-Acute Neurorehabilitation combines living with 24/7 support of pedagogical staff with on-site outpatient therapy and medical care. A secondary data analysis was conducted on the records of all patients with completeted P.A.N. treatment between 01.01.2015 and 09.04.2022. Outcome parameters included demographic characteristics, diagnostics, Barthel Index (BI), the German scale "Hilfebedarf von Menschen mit Behinderung für den Lebensbereich Wohnen " (HMBW), the Canadian Occupational Performance Measure (COPM) and the destination after discharge. For BI and discharge destination, potential determinants of therapy success are evaluated., Results: 168 patients were enrolled in the analyses. Significant improvements were observed in the BI (p < .001), with median values increasing from 55 to 80 points. The HMBW showed a significant decrease in the need for assistance in everyday living (p < .001), individual basic care (p < .001), shaping social relationship (p = .003) and communication (p < .001). Significant improvements were reported in the COPM total score for performance (p < .001) and satisfaction (p < .001). 72% of the patients were able to move in a community living arrangement with moderate need for support. Main predictive factor for discharge destination was the initial cognitive deficit. The comparison of the third-person scales BI and HMBW with the self-reported COPM showed that individually formulated patient goals are only insufficiently reflected in these global scales., Discussion: The data show that a highly coordinated, trans-sectoral 24/7 approach of goal-oriented practice as pursued at P.A.N. is feasible and effective. We assume that the success of the intervention is due to the high intensity of therapies delivered over a long time and its interlink with real world practice. For a comprehensive analysis of rehabilitation success, it is necessary to record and evaluate individual patient goals, as these are not always reflected in the commonly used global scales., (© 2024. The Author(s).)

The consensus-based guideline "SARS-CoV-2, COVID-19 and (early) rehabilitation" for Germany has two sections: In the first part, the guideline addresses infection protection-related procedures during the COVID-19 pandemic. In the second part, it provides practice recommendations for rehabilitation after COVID-19. The specific recommendations for rehabilitation after COVID-19 as issued by 13 German medical societies and two patient-representative organizations are presented together with general background information for their development., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Platz et al.)

The consensus-based SARS-CoV-2, COVID-19, and Rehabilitation Practice Guideline provides recommendations that take both infection prevention and the pursuit of therapeutic goals in rehabilitation settings during the coronavirus pandemic into account. The Practice Guideline provides guidance how to prevent SARS-CoV-2 infections in rehabilitation settings in a first part. The guideline's second part addresses rehabilitation for patients affected by COVID-19 starting with interventions on intensive care units, during early rehabilitation, post-acute rehabilitation, in outpatient and community rehabilitation settings, as well as long-term care, e. g. for COVID-19 survivors with Long- or Post-COVID.The updated second version of the Practice Guideline (dating from 01.11.2021) is a consensus-based guideline developed by a representative panel of healthcare professionals from 15 medical societies covering various rehabilitation disciplines, infectious diseases, hospital hygiene, and epidemiology. The abbreviated version provides an overview of all recommendations given., Competing Interests: Alle Mitwirkenden an der Leitlinie haben ihre Interessenerklärungen (AWMF-Tabelle zur Erklärung von Interessen im Rahmen von Leitlinienvorhaben) beim Koordinator (TP) eingereicht. Im Tabellen-Formblatt wurden die Ausfüllenden gebeten, bei den dargelegten Interessen mit anzugeben, ob und, wenn ja, welcher thematische Bezug zur Leitlinie/zum Leitlinienthema besteht.Die Relevanz von Tätigkeiten oder Interessen für einen möglichen Interessenskonflikt wurden individuell gemeinsam eingeschätzt. Die Einschätzung und einstimmige Bestätigung erfolgte durch das Redaktionskomitee bei seiner Sitzung am 10.08.2021. Der Umgang mit Interessen wurde nachfolgend in der Konsensuskonferenz am 18.10.2021 von allen Beteiligten nochmals gemeinsam eingeschätzt und bestätigt. Im Ergebnis wurden keine relevanten moderaten oder hohen Interessenskonflikte festgestellt, weswegen das Votum aller Mandatsträger beim Konsensermittlungsverfahren für einzelne Empfehlungen berücksichtigt werden konnte., (Thieme. All rights reserved.)

Background: Virtual reality (VR) has been used as a technological medium to deliver mirror therapy interventions with people after stroke in numerous applications with promising results. The recent emergence of affordable, off-the-shelf head-mounted displays (like the Oculus Rift or HTC Vive) has opened the possibility for novel and cost-effective approaches for immersive mirror therapy interventions. We have developed one such system, ART-VR, which allows people after stroke to carry out a clinically-validated mirror therapy protocol in an immersive virtual environment and within a clinical setting., Methods: A case cohort of 11 people with upper limb paresis following first time stroke at an in-patient rehabilitation facility received three interventions over a one week period. Participants carried out the BeST mirror therapy protocol using our immersive VR system as an adjunct therapy to their standard rehabilitation program. Our clinical feasibility study investigated intervention outcomes, virtual reality acceptance and user experience., Results: The results show that the combination of an immersive VR system and mirror therapy protocol is feasible for clinical use. 9 out of 11 participants showed some improvement of their affected hand after the intervention. The vast majority of the participants (9/11) reported experiencing some psycho-physical effects, such as tingling or paraesthesia, in the affected limb during the intervention., Conclusions: Our findings show that immersive VR-based mirror therapy is feasible and shows effects comparable to those of conventional mirror therapy. Trial Registration Trial was registered with the ISRCTN Registry (ISRCTN34011164) on December 3, 2021, retrospectively., (© 2022. The Author(s).)

Background: Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously., Objective: The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT)., Methods: This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients' and therapists' experiences with RMT were captured through qualitative tools., Results: 24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p = 0.006). There were no significant differences for the MI (p = 0.108), the FMA-UE surface sensibility subscore (p = 0.403) as well as the FMA-UE position sense subscore (p = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists., Conclusions: The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting.