MEDICAL DIRECTOR ACUTE NEUROLOGY AND EARLY REHABILITATION
Prof. Dr. med. Anastasios Chatzikonstantinou
Medical Director Acute Neurology and Early Rehabilitation
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
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
MEDICAL DIRECTOR NEUROREHABILITATION
Prof. Dr. med. Mircea Ariel Schoenfeld
Medical Director – Neurorehabilitation
What is early neurological rehabilitation?
Early neurological rehabilitation is the earliest possible combination of acute and rehabilitation
treatment in a hospital setting for patients who have suffered a serious neurological event, such
as a stroke or traumatic brain injury. It combines intensive medical treatment with therapeutic
interventions and activating care. The goal is to restore basic functions such as
consciousness/awareness, stabilisation, communication abilities, and swallowing, while also
working toward improved mobility, cognition, coordination, and the ability to perform 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.
treatment in a hospital setting for patients who have suffered a serious neurological event, such
as a stroke or traumatic brain injury. It combines intensive medical treatment with therapeutic
interventions and activating care. The goal is to restore basic functions such as
consciousness/awareness, stabilisation, communication abilities, and swallowing, while also
working toward improved mobility, cognition, coordination, and the ability to perform 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.
When does early neurological rehabilitation begin?
Early rehabilitation begins immediately after acute care treatment has been completed and the
patient’s condition is stabilised. It is designed for the most severely affected patients, typically
those admitted from intensive care units who have a Barthel Index Score below 25, meaning
they are entirely dependent on assistance and may suffer from disorders of consciousness such
as 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 independent a patient is in everyday life.
patient’s condition is stabilised. It is designed for the most severely affected patients, typically
those admitted from intensive care units who have a Barthel Index Score below 25, meaning
they are entirely dependent on assistance and may suffer from disorders of consciousness such
as 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 independent a patient is in everyday life.
Why is it important to start rehabilitation as early as possible?
Research shows that the earlier patients begin rehabilitation, the greater the likelihood of partial
or full recovery. The first six months after a neurological event are particularly critical—during
this period, well-designed rehabilitation programs can help build new connections between
damaged and healthy neurons, accelerate the regeneration of nervous system structures,
maximise recovery of physical abilities, and prevent irreversible consequences and disability.
In addition, early rehabilitation helps prevent complications such as muscle stiffness, infections,
swallowing problems, pressure sores, and loss of mobility.
or full recovery. The first six months after a neurological event are particularly critical—during
this period, well-designed rehabilitation programs can help build new connections between
damaged and healthy neurons, accelerate the regeneration of nervous system structures,
maximise recovery of physical abilities, and prevent irreversible consequences and disability.
In addition, early rehabilitation helps prevent complications such as muscle stiffness, infections,
swallowing problems, pressure sores, and loss of mobility.
Who needs early neurological rehabilitation?
Early rehabilitation is typically needed for patients with severe neurological conditions including
consequences of stroke, traumatic brain injury, intracerebral haemorrhage, critical illness
polyneuropathy, hypoxic-ischemic encephalopathy, spinal cord injuries, encephalitis, myelitis,
and other severe disorders affecting consciousness or causing serious functional limitations.
Many of our patients also experience disorders of consciousness, severe movement limitations,
swallowing difficulties, or communication impairments.
consequences of stroke, traumatic brain injury, intracerebral haemorrhage, critical illness
polyneuropathy, hypoxic-ischemic encephalopathy, spinal cord injuries, encephalitis, myelitis,
and other severe disorders affecting consciousness or causing serious functional limitations.
Many of our patients also experience disorders of consciousness, severe movement limitations,
swallowing difficulties, or communication impairments.
When is a patient ready to begin early rehabilitation at Kliniken Schmieder?
A patient is ready when acute treatment is complete, and they meet the following stability
criteria: no additional surgical interventions are required; no sepsis; stable respiratory function;
criteria: no additional surgical interventions are required; no sepsis; stable respiratory function;
no requirement for dialysis; and they have been weaned from mechanical ventilation. These
criteria ensure the patient can safely participate in intensive rehabilitation at Kliniken Schmieder.
What is the assessment process?
Every rehabilitation treatment at Kliniken Schmieder begins with a comprehensive assessment
process developed by the clinic and used since 2009. During the first two to four weeks, our interdisciplinary team conducts thorough clinical examinations and diagnostic assessments,
reviews and adjusts medications, evaluates deficits, determines prognosis, defines the
therapeutic direction, and identifies potential complications and risk factors. This allows
treatment at Kliniken Schmieder to be customised to individual patient needs.
process developed by the clinic and used since 2009. During the first two to four weeks, our interdisciplinary team conducts thorough clinical examinations and diagnostic assessments,
reviews and adjusts medications, evaluates deficits, determines prognosis, defines the
therapeutic direction, and identifies potential complications and risk factors. This allows
treatment at Kliniken Schmieder to be customised to individual patient needs.
What therapies are included in early rehabilitation?
Early rehabilitation employs a multidisciplinary approach, including pharmacotherapy,
physiotherapy, occupational therapy, speech and swallowing therapy, neuropsychotherapy, and
brain stimulation, as indicated. An interdisciplinary team of doctors, psychologists, nurses, and
therapists closely monitors all health indicators and adjusts rehabilitation measures as needed.
physiotherapy, occupational therapy, speech and swallowing therapy, neuropsychotherapy, and
brain stimulation, as indicated. An interdisciplinary team of doctors, psychologists, nurses, and
therapists closely monitors all health indicators and adjusts rehabilitation measures as needed.
How long does early rehabilitation typically last?
The duration varies depending on the patient’s diagnosis and progress achieved. On average,
patients in Germany undergo early rehabilitation for approximately 60 days before transitioning
to the next rehabilitation phase, being discharged home, returning to the hospital for further
treatment, or moving to a long-term care facility.
patients in Germany undergo early rehabilitation for approximately 60 days before transitioning
to the next rehabilitation phase, being discharged home, returning to the hospital for further
treatment, or moving to a long-term care facility.
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