A082 the importance of sport in rehabilitation after traumatic injuries the concept of the vbg

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

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

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


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Activity-orientated objectives of sports


�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)


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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


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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)


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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


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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


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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:


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)


� 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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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


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Participation-orientated objectives of sports


�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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Initial Personal Contact

� Detection of social activities such as leisure-based sports and contextual factors with influence on participation


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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


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Participation Plan

� Participative rehab planning and service selection also with focus on participation in sports


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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


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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


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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


2127.10.2016

Susan Riedel & Eckehard Froese

Department of Rehabilitation

VBG Head Office, Hamburg

[email protected] & [email protected]


Presentations & Public Speaking

A082 the importance of sport in rehabilitation after traumatic injuries the concept of the vbg