The German recommendations for post-discharge neuro-rehabiliation: aiming at inclusion in all areas of society

A074: Independent

Living after brain

injury in Germany

Maren Bredehorst, MPH, PhDBundesarbeitsgemeinschaft für Rehabilitation (BAR) e.V.German Federal Rehabilitation Council

RI World Congress, 25-27 October 2016, EdinburghParallel Session C: The future of rehabilitation, recent advances

Rehabilitation goals for brain injured persons

Source: Transferred from en.wikipedia to Commons. Author: The original uploader was Nunh-huh at English Wikipedia.

Paris as seen with full visual fields

What do I want to reach after discharge from in-patient (medical) rehabilitation?

Is this a realistic goal?How can I get there?

Rehabilitation goals for brain injured persons

Paris as seen with left homonymous hemianopsia.

What do I want to reach after discharge from in-patient (medical) rehabilitation?

Is this a realistic goal?How can I get there?

Source: Transferred from en.wikipedia to Commons. Author: The original uploader was Nunh-huh at English Wikipedia.

Phase E in neuro-rehabilitation

Neurological-neurosurgical rehab model: defines phases A – F in terms of medical entry and exit criteria for patients and of respective treatment requirements (VDR 1995) → issued by funders, to trigger new services (mainly in-patient facilities or day clinics)

Phase E: describes the transition from medical rehab into a stable arrangement with best possible participation in society → various services from various sectors are potentially relevant!

Three groups of persons described

Impairment regarding functioning, activities and participation (see ICF):- Non-visible deviation of functions:

e.g. difficulties with speech, seeing, hearing; reduced psycho-physical or cognitive capacity;changes of personality…

- Visible deviation of functions: gross motor skills, fine motor skills

1. Mild impairment→ good chance to return to work /school with specific support (primary job market)

2. Medium impairment → major efforts in occupational rehabilitation /schooling required (possibly secondary job market)

3. Considerable impairment → constantly high level of care required (possibly day care centre)

Source: BAR (2013) Empfehlungen für die Phase E der neurologischen Rehabilitation

Services for participation

in the educational

sphere

Combining different services and assistance

Services securing the results of

medical rehabilitation

Services for participation in the

social sphere

Services for participation

in the occupational

sphere

Information, counselling,

planning, initiation,

coordination Income support and

supplementary assistance

Framing individualised transitionWhat remains to be done at the individual (case) level?Both funders and providers need to develop their staff in terms of: neuro-competency

- information, counselling, coordination, case management

- different kinds of therapies, care and other aspects of service

participatory goal setting- empowering the client - involving relatives and others (e.g. employer,

colleagues) in planning and the rehabilitation process

Framing individualised transition

What remains to be done at the intra-organisational level? Providers to come forward with

concepts and cooperations for rehabilitative services in the community/in residential care

Funders to further clarify which kind and scope of services are required and will be refunded on which legal basis

1665 steps …

Inclusion+individual

participationgreater coverage,

more flexible deliverybetter integration of servicesfrom / within different sectors

develop local / regional solutions

adapt and extend available structures,involve people with acquired brain injury

(& their families) in the planning processes

Image: Benh LIEU SONG - https://commons.wikimedia.org/wiki/File:Tour_Eiffel_Wikimedia_Commons.jpg

…or 7

lifts to get up!

Thank you for your attention!References: Bundesarbeitsgemeinschaft für Rehabilitation, BAR (2013):

Empfehlungen zur Phase E der neurologischen Rehabilitation. Frankfurt/M.

Bundesministerium für Arbeit und Soziales, BMAS (2015) Rehabilitation and integration of people with disabilities. Bonn.

Deutsche Vereinigung für Rehabilitation, DVfR (2014): Phase E der Neuro-Rehabiliation als Brücke zur Inklusion. Heidelberg.

Verband Deutscher Renten-versicherungsträger , VDR (1995): Phasenmodell in der neurologisch- neurochirurgischen Rehabilitation