BACKGROUND: Acquired brain injuries are among the most common causes of disability in adulthood. An intensive rehabilitation phase is crucial for recovery. However, there is a lack of concepts to further expand the therapeutic success after the standard rehabilitation period. Hereafter, the characteristics of a transsectoral, multiprofessional long-term neurorehabilitation concept and its effects on outcome at different ICF levels are described.
METHODS: The P.A.N. Center for Post-Acute Neurorehabilitation combines living with 24/7 support of pedagogical staff with on-site outpatient therapy and medical care. A secondary data analysis was conducted on the records of all patients with completeted P.A.N. treatment between 01.01.2015 and 09.04.2022. Outcome parameters included demographic characteristics, diagnostics, Barthel Index (BI), the German scale \"Hilfebedarf von Menschen mit Behinderung für den Lebensbereich Wohnen \" (HMBW), the Canadian Occupational Performance Measure (COPM) and the destination after discharge. For BI and discharge destination, potential determinants of therapy success are evaluated.
RESULTS: 168 patients were enrolled in the analyses. Significant improvements were observed in the BI (p < .001), with median values increasing from 55 to 80 points. The HMBW showed a significant decrease in the need for assistance in everyday living (p < .001), individual basic care (p < .001), shaping social relationship (p = .003) and communication (p < .001). Significant improvements were reported in the COPM total score for performance (p < .001) and satisfaction (p < .001). 72% of the patients were able to move in a community living arrangement with moderate need for support. Main predictive factor for discharge destination was the initial cognitive deficit. The comparison of the third-person scales BI and HMBW with the self-reported COPM showed that individually formulated patient goals are only insufficiently reflected in these global scales.
CONCLUSIONS: The data show that a highly coordinated, trans-sectoral 24/7 approach of goal-oriented practice as pursued at P.A.N. is feasible and effective. We assume that the success of the intervention is due to the high intensity of therapies delivered over a long time and its interlink with real world practice. For a comprehensive analysis of rehabilitation success, it is necessary to record and evaluate individual patient goals, as these are not always reflected in the commonly used global scales.

[Purpose] To investigate the effects of long-term body-weight-supported treadmill training on walking ability and physical function in an elderly individual with incomplete cervical spinal cord injury. [Participant and Methods] The patient was a 68 year-old male with an incomplete spinal cord injury at the C3/C4 level, incurred when he was 56 years old. He initiated home-based body-weight-supported treadmill training using a body-weight-supported treadmill installed at his home. His walking ability was measured as the percentage of body weight load reduction, and his physical function was evaluated using manual muscle testing and measuement of the range of motion of his lower limbs. [Results] The physical function of the lower limbs was improved, maintained, or showed delayed decline until 9.5 years post-injury. [Conclusion] Long-term body-weight-supported treadmill training may improve, maintain, or at least delay the decline of the physical function of participants for several years, without causing any remarkable complications.

An approach that provides a standardized way of continuing rehabilitative care to help patients return to their lives and activities of daily living (ADL) in an economical and efficient manner is the Team Kinesiology Model (TKM). Many patients who are given a life-altering diagnosis (i.e., paralysis due to spinal cord injury, cerebral palsy, or cancer) are unable to return to employment, their family or a pre-diagnosis quality of life (QOL) given the current health care resources. This is a longstanding, and urgent problem as population aging and rising multi-morbidity is projected to negatively impact all regions of the world. Utilization of mid-level rehabilitation services is a proposed method to increase accessibility to all populations, including those of lower socioeconomic status or minority populations. Capitalizing on this idea, we describe two different programs that use the TKM to provide rehabilitative services to patients who were diagnosed with nervous system dysfunction or cancer. This model benefits the patient by improving physical fitness, psychosocial function, and QOL. Furthermore, we provide specific examples that show how this approach could have further-reaching impacts on society, education and research. Integrating kinesiologists and TKM in health care could assist in workflow, long-term health surveillance, rehabilitation and improvement of QOL.

In ancient times Hippocrates described a disease, the 3rd phthisis, which seems to correspond to COPD and is mainly treated by walking, gradually increasing the number of steps until reaching 10,000 steps a day at the end of the initial period of treatment. The recent era began in the second half of the 20th century and ended in 2015, with an unusual Cochrane Library editorial in which it was stated that the accumulated evidence (statistically significant and clinically relevant improvements in clinical signs, tolerance to exercise, quality of life, days hospitalization…) on the effects of rehabilitation programs suffice to suspend research on the subject and to justify focus on new elements in the programs. It is essential, in fact, to establish uniform practical recommendations for the prescription of routine rehabilitation (number and duration of physical activity sessions, therapeutic education, re-training intensity…). In addition, studies should be carried out on new practices: community or home rehabilitation, long-term rehabilitation, tele-rehabilitation.

Over a period of five years, three severely impaired chronic non-fluent aphasia patients with concomitant apraxia of speech (AOS) received annual treatment periods of specific rhythmic-melodic voice training SIPARI. This therapy concept focusses on improving planning, programming, and sequencing of speech movements emphasizing specifically the training of cognitive capabilities such as executive functions. Behavioral and neural data were assessed at the start of the therapy and continuously after each treatment period. As previously reported, a first major finding was that after the first treatment period, significant improvements in language and speech motor performance were measured going hand in hand with significant additional peri-lesional activation in all patients particularly in the posterior part of the left superior temporal gyrus. This activation pattern was continuously confirmed by each subsequent scan. However, assessments after the third treatment period yielded additional significant activations in dorsolateral prefrontal cortex regions, namely in the left middle and superior frontal gyri, and anterior cingulate gyrus resulting in a further statistically significant increase in speech profile level, an overall and clinically relevant measure of the severity of aphasia. On the basis of our results, we assume that even in long-term rehabilitation of severely impaired non-fluent aphasia patients the applied treatment may support coactivation with dorsolateral prefrontal regions, suggested to be particularly involved in cognitive processing. This left-lateralized dorsolateral prefrontal-parietal network is supposed to be engaged in domain-general aspects of active phonological memory. To the best of our knowledge, no comparable studies are available as yet. Therefore, we hope that our study may serve to attract more attention for the late stages of long-term rehabilitation, not at least as a challenge for therapists and researchers alike.