a082 the importance of sport in rehabilitation after traumatic injuries the concept of the vbg
TRANSCRIPT
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The importance of sports in rehabilitation after traumatic injuries –
RI World CongressEdinburgh, 25-27 October 2016
Susan Riedel & Eckehard Froese,
German Social Accident Insurance VBG
The concept of the German Social Accident Insurance VBG
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227.10.2016
The Importance of Sports
Acute Treatment Medical Rehabilitation Social Rehabilitation
Early mobilization
Rehab Group Training
Community-based
Sporting Activity
Sports Therapy
Recover Improve Prevent/Participate
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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327.10.2016
Structures
ServicesProcedures
VBG Concept for Promoting Sports
For promoting sports in each phase of rehabilitation it is necessary:
� to provide appropriate structures in authorized clinics and rehab facilities
� to adapt own procedures for analyzing and planning sports activities
� to offer services to enhance participation in sports
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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427.10.2016
Activity-orientated objectives of sports
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
�Therapy goals focus on improving physical fitness and mental health, including the gain in self-confidence in
one's own abilities
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Acute Treatment
� Several studies have shown the benefits of early controlled mobilization and activity during acute treatment:
� Early mobilization promotes healing and is more productive in achieving a good outcome after fracture care, knee ligament surgery, cartilage repair and spine care
� Early activity not only enhances the injured area, but it also keeps it from losing function in the non-injured parts
(Orthopedics today, Role of early motion in healing fractures and ligaments realized in last 25 years, 2005)
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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627.10.2016
Structures in Acute Treatment
DGUV-Requirements concerning mobilization:
� Each authorized hospital has to provide a qualified acute-rehab-team under constant medical supervision for
� Remedial gymnastics
� Physical therapy
� Ergo therapy
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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� Principles of rehabilitation of professional sportsmen:
� Complex course of treatment
� Whole-body-therapy
� Early and intensive intervention
� Focus on specific sport requirements
� Objectives:
� To speed up the return to full strength, endurance and range of motion
� To maintain the proper functioning of the uninjured parts of the body
� To correct risk factors of injuries such as imbalances, muscle tightness or decreased proprioception
Medical Rehabilitation (1)
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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827.10.2016
Medical Rehabilitation (2)
� Treatment as in-patients or out-patients
� Application 5 - 6 days a week, at least 2 hours (outpatient)/ 4 hours (inpatient) per day
� Combination of following elements, increasingly provided as active exercises:
� Remedial gymnastics
� Medical training therapy
� Physical therapy
� Ergo therapy
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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927.10.2016
Structures in Medical Rehabilitation
DGUV-staff requirements concerning medical training therapy:
� Physiotherapists with additional qualification in sports physiotherapy
� Qualified sports teacher with additional qualification in medical training therapy
DGUV-facility and equipment requirements:
Sufficient therapy area (at least 80 m²) with exercise equipment such as:
� Isokinetic exercise machine
� Medical exercise equipment
� Bicycle ergometer
� Wall bars
� Rowing machine
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1027.10.2016
Preventing decline in health after medical rehabilitation
� Adults with permanent disabilities have a 2 to 3 times higher prevalence of secondary conditions (Kienne et al., Am J Public Health 2004 )
� As a consequence physical activity after rehabilitation is essential for minimizing the risk of a gradual decline in health and secondary conditions:
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
Health
& F
unction
Accident 1 2 3 4 5 6 7 8 9 10 11 12 Recovery months
Minimum level of function
RehabRisk of secondaryconditions
Own representation
based on James H.
Rimmer „Getting
beyond the plateau:
Importance of
exercise, 2012
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Adapted physical activity
Vibration Training
Therapeutic Swimming
NordicWalking
Sling-Exercise-Therapy
Therapeutic Qi Gong
Therapeutic Climbing
Securing physical activity behaviour (1)
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
� The motivational effects of adapted physical activity in a rehabilitation context have been linked not only to initiating a desired exercise behavior, but mainly for maintaining it, thus increasing the probability of life-long adherence (H. Rieder: Adapted physical activity. In: Rieder H, Huber G, Werle J, editors. Sport with special groups: A textbook 1996)
� As a consequence leisure-based adapted physical activities have to be part of medical rehabilitation
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1227.10.2016
Securing physical activity behaviour (2)
VBG-requirements for rehab facilities:
� Formulation of personalized exercise recommendations to integrate
physical activity into the new daily routine after rehab and thus to maintain or
even improve rehabilitation outcome
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1327.10.2016
Participation-orientated objectives of sports
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
�Exercise goals focus on enhancing self-empowerment and full participation
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Procedures
Establishment of participation-orientated procedures:
� Initial personal contact
� Holistic case analysis
� Set up of a participation plan
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1527.10.2016
Initial Personal Contact
� Detection of social activities such as leisure-based sports and contextual factors with influence on participation
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1627.10.2016
Holistic Case Analysis
� Use of the biopsychosocial approach of the ICF in identifying factors that impact participation
� Focus on the personal and environmental barriers which may impede the engagement in physical activities
� Base for tailored services to remove potential barriers to participation
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1727.10.2016
Participation Plan
� Participative rehab planning and service selection also with focus on participation in sports
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1827.10.2016
Services: Personal and Peer Counseling
� Personalized tailored counseling during and after rehabilitation improves sports participation and daily physical activity behavior (H P van der Ploeg et. al: Counseling increases physical activity behaviour nine weeks after rehabilitation, Br J Sports Med. 2006)
� VBG Rehab Managers inform about local accessible sports facilities and plan with the client further sporting activities after medical rehabilitation
� Peer Counseling is used as empowering opportunity
� to enhance self-motivation and to promote widespread interest in physical activity
� to teach individuals with permanent disabilities how to exercise safely and effectively
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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1927.10.2016
Services: Life-long Support
� Life-long support of accident victims especially with permanent disabilities to participate in mainstream and disability-specific sports by
� assisting in searching for accessible facilities (e.g. find swimming pool with lift or ramp)
� adapting sports facilities for barrier-free access, if required
� providing adaptive sports equipment (e.g. sports wheelchair)
� offering personal assistance (e.g. for showering or changing into sport suits)
� providing transportation from and to the sports facilities
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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Conclusion
The systematic integration of elements of sports into the rehab process
� enhances recovery and minimizes or prevents permanent physical impairments and secondary conditions after traumatic injuries and
� promotes self-confidence needed to take on other life challenges such as pursuing employment
� ensures effective, comprehensive and sustainable participation and inclusion in all aspects of life
Susan Riedel & Eckehard Froese, Sports after traumatic injuries
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2127.10.2016
Susan Riedel & Eckehard Froese
Department of Rehabilitation
VBG Head Office, Hamburg
[email protected] & [email protected]
Susan Riedel & Eckehard Froese, Sports after traumatic injuries