Early Neurological Rehabilitation

Early Neurological Rehabilitation

Early neurological rehabilitation is defined as the earliest possible combination of acute and rehabilitation treatment in a hospital, combining intensive treatment with medical and therapeutic means as well as activating and stimulating care. The goal is to recover basic functions such as stabilization, consciousness/awareness, communication abilities, and swallowing. Further recovery goals include mobility, cognition, coordination, sensibility, and the ability to execute activities of daily living.

At Kliniken Schmieder, close attention is paid to early rehabilitation, which is aimed at restoring the functionality of the patient’s body, as well as preventing the development of disability.

Our specialists develop an individual rehabilitation treatment program for each patient. Only in this way can positive results be obtained, even in the most severe, almost hopeless cases.

When does early neurological rehabilitation start?

Early neurological rehabilitation is the earliest phase of neurological rehabilitation, designed for the most severely impacted patients. It is intended to prevent illness-related limitations and impending disabilities with measures that start immediately after the acute care treatment has been completed and the patient is stable. Patients who are usually admitted from intensive care units have a Barthel Index Score below 25. They depend entirely on third-party help and often suffer from a disorder of consciousness, e.g., coma, vegetative state, or minimally conscious state. The Barthel Index (values from 0 to 100) is an internationally recognized assessment and evaluation tool to determine how well a person can still care for themselves daily.

Early neurological rehabilitation at Kliniken Schmieder developed 25 years ago and has been continuously developed ever since. Our strong scientific background and numerous international cooperation enable us to deliver our patients the highest quality of care.

Why is it important to start rehabilitation as early as possible?

The strength of early neurological rehabilitation lies in the temporal proximity to the acute event. Research has shown that the earlier patients start rehabilitation, the higher the possibility of a partial or full recovery from the effects of, e.g., a stroke, traumatic brain injury, or a critical illness polyneuropathy.

Among the main reasons why our experts recommend starting rehabilitation treatment as early as possible:

  • The first six months are of great importance: With the help of various rehabilitation measures, it is possible to build new connections between damaged cells of the nervous system and healthy neurons. A properly designed early rehabilitation program contributes to the accelerated process of regenerating damaged structures of the nervous system.
  • Maximum recovery of physical abilities, particularly movements in the arms and legs: With the right approach to rehabilitation therapy, healthy brain areas take on some of the functions damaged areas of the central nervous system cannot perform. This is especially true in diseases and traumatic conditions affecting different brain areas.
  • Prevention of development of irreversible consequences: Early rehabilitation helps to avoid disability in patients with disorders of the musculoskeletal system and speech disorders after neurological pathologies. In addition, in most cases, the possibility of returning to work depends on how early rehabilitation is started.

Who needs early neurological rehabilitation?

Early neurological rehabilitation usually starts when patients are unconscious or have impaired consciousness or other severe functional limitations. It is performed, for example, for patients with the following symptoms:

  • Effects of cerebral infarction
  • Critical illnesses polyneuropathy
  • Traumatic brain injury
  • Intracerebral hemorrhage
  • Hypoxic-ischaemic encephalopathy
  • Injuries to the spinal column
  • Encephalitis
  • Myelitis

and many others.

When are patients ready to start with early neurological rehabilitation?

Early rehabilitation treatment at Kliniken Schmieder can start once the acute treatment is completed. That means the patient:

  • Does not need further surgical interventions
  • Does not have a sepsis
  • Is cardiopulmonary stable
  • Does not require dialysis
  • Has been weaned from ventilation

5 doctors in a hospital's hall discuss early rehabilitation assessment in front of a computer screen.

Our expertise in early neurological rehabilitation: assessment process

At Kliniken Schmieder, every rehabilitation treatment starts with the so-called “assessment process.” Schmieder has developed this approach, and it has been used since 2009. In addition to the treatment (medicine, therapy, and nursing care), our interdisciplinary team uses the first two to four weeks to carry out a thorough clinical examination and diagnostics (e.g., electrophysiology, imaging, lab test, etc.) along with a review and adjustment of medication as well as an evaluation of deficits, the determination of a prognosis and the definition of the main focus of therapy. It also is used to identify potential complicating and risk factors. Based on the assessment result, the treatment process is adjusted to fit the individual needs of our patients.

During the early rehabilitation, a multidisciplinary and multi-professional team of doctors, psychologists, nurses, and therapists closely monitors all indicators of the patient’s health and, if necessary, corrects the applied restorative measures.

Among the most relevant and popular methods of rehabilitation in the phase of early rehabilitation are:

  • Pharmacotherapy
  • Speech and swallowing therapy
  • Psychotherapy
  • Physiotherapy
  • Occupational therapy
  • Brain stimulation (according to indications)

How much time does early neurological rehabilitation require?

Early rehabilitation lasts for different lengths of time, depending on the patient’s diagnosis and progress. On average, patients in Germany spend 60 days in early rehabilitation before:

  • Moving to the next phase of
  • Are discharged to their home
  • Go back to the hospital for further treatment
  • Move to a long-term care facility


Prof. Dr. med. Anastasios Chatzikonstantinou

Medical Director Acute Neurology and Early Rehabilitation


Prof. Dr. med. Mircea Ariel Schoenfeld

Medical Director – Neurorehabilitation