Main methods of rehabilitation in Germany

Rehabilitation program is conducted considering disease phase. Barthel index is used (Barthel Index calculation) to determine the phase of neurorehabilitation.

  • Phase A: acute phase of the disease, patient stays in the intensive care unit
  • Phase B: early rehabilitation,
    Barthel-Index <25
  • Phase C: follow-up rehabilitation (further need for intensive care)
    Barthel-Index <35-65
  • Phase D: final rehabilitation (maximum independence)
    Barthel-Index <70-100

There are many methods that neurorehabilitation specialists use:

The Affolter method a technique based on accompanying the patient in his/her daily activities. Therapist performs necessary actions with patient's body or hands and thus, helps him/her to establish contact with the environment.

Synergetic reflexotherapy by Pfaffenrot this method combines various forms of reflexotherapy, acupuncture, manual therapy and osteopathy. Simultaneous application of these techniques leads to overall enhancement of treatment's effectiveness. With synergetic reflexotherapy it is possible to increase the range of patient's movements by 45-60%.

Basal stimulation this method is used for various severe motor disorders. Special sensory exercises are based on touching different parts of the body to stimulate one`s own perception of the body. They help the patient not only to navigate in space and time, but also reduce to a minimum fear and anxiety.

EMG-trigger electrostimulation this technique is mostly used for treatment of post-stroke paralysis. The activity of certain muscle groups is measured with special electrodes attached to the skin. Electrical impulses stimulate decreased electrical activity of a certain muscle, thus, helping person to perform full-range movements.

The Bobat method according to Bobat, the body functions as a wholesome unit and any motor disorder develops due to the damage of the central nervous system. The main aim of this therapy is to put the body into special positions which allow the physiotherapists to stimulate movements by stretching short muscles, mobilizing or moving joints, and strengthening weak muscles. This allows to reduce the imbalance of the body.

Bruegger's method this technique is based on maintaining a certain position of the body in order to help the patient achieve comfort and relief pain. Thanks to this therapy, the patient learns how to keep a straight posture, thereby adjusting the whole body's posture and reducing muscle contractions.

Craniosacral therapy is a modern alternative medicine, which stimulates the bones of the back and the skull to stabilize the work of central nervous system. This therapy aims to restore normal circulation of cerebrospinal fluid in the spinal canal. By gently pressing the back, skull bones, diaphragm and fascia, the clamps or jamming of the nervous endings loosen and cerebrospinal fluid begins to circulate better. As a result, bones that were misplaced restore their position.

Alexander's method according to Alexander the misuse of the body muscles, especially incorrect position of the head and neck, can lead to many diseases. Alexander's method comprises of gradually mastering the more effective use of the body to get rid of unnatural and involuntary clamps in the cervical spine.

Feldenkrais technique the aim of this technique is to teach a person to move the right way. This is achieved by a combination of motor exercises and the light hand-touching by the therapist. Feldenkrais exercises can reduce excess pressure by simple actions, for example, standing, which releases the muscles. This technique helps to achieve the necessary range of movements.

Brain-Gym this is a technique developed by Paul Dennison. It is also called gymnastics for the brain. This method allows the patients to improve memory, concentration, and reduce stress with the help of selected physical exercises.

Kinesiology is a science that studies interconnection between skeletal muscles tone and function of various organs. Kinesiology examines a certain muscle which can be an indicator to identify the existing stress and, afterwards, to correct and recover all levels of energy in a person.

Perfetti's method this technique aims to help the patients who have suffered a stroke. Perfetti rehabilitation is a series of cognitive exercises that improve the neurological organization of the brain.The main purpose of such exercises is to train small motor movements, that are clearly delineated from simple to complex ones.

The Castillo Morales method this is a neuro-oriented concept for treating children and adults who have communicative senso-motor and orofacial disorders. Castillo Morales method was the first to combine orofacial and neuromotor therapy where proprioceptive sensations are enhanced by special movements, vibration and pressure on certain areas of the body.

Vojta-therapy Vojta-therapy aims to create an impact on certain parts of the body at a certain positions. This creates unconsciously repeated motor reactions on certain limbs and body of the patient. Vojta-therapy is particularly recommended for people with musculoskeletal disorders. It helps to restore natural movement.

Ayres sensory integration this technique is recommended for neurological disorders based on the inability of the brain to process impulses received through sensory stimuli, such as hearing, vision, smell, etc. The technique was developed by Anna Jean-Ayres who used various types of stimulation to strengthen and develop sensory stimuli of the central nervous system.

Petё method developed by Hungarian doctor Petё, is taught individually or in small groups. This technique combines elements of orthopedics, neurology and psychotherapy. It aims to help the patient to achieve maximum independence from ancillary facilities or individuals. It also improves the person's perception of the world and teaches him/her how to behave in the society.

The PNF method of proprioceptive neuromuscular simplification the PNF method is based on stretching of painful, strained muscles of the body. Series of exercises effect on the so-called proprioceptors which are responsible for stretching and contracting the muscles and, thus, for correcting the wrong posture.

Ergotherapy this therapy aims to restore the motor activity of people with disabilities. In this case, special attention is paid to the development of practical motor functions of the upper extremities. The aim of ergotherapy is to help the patient to function normally in everyday life. This is not just about restoring physical and mental functions, but also about achieving maximum independence in everyday life and professional activities.

The Klein-Vogelbach method a special set of exercises using an inflatable ball which helps the patient to restore lost flexibility and mobility without putting stress on joints and spine. This exercise is especially recommended for patients with pain syndrome or motor disorders of the spine, hip, knee, shoulder and elbow joints.

Klappa Gymnastics exercises which require the patient to crawl on all of his/her four extremities, thus helping them to straighten the curvature of the spine, improve chest defects and wrong positions of the body. The main principle is to strive to unload the pressure from the spine. The position on all fours frees the muscles of the trunk, leads to mobility of the spine and strengthens the muscle tone of the back. Klappa often achieves straightening of the curvature of the spine.

Doman-Delacato method or "patterning" this method is designed for the rehabilitation of children who have severe diseases of the nervous system. The main purpose of this program is to activate the mental activity of sick children through training.The technique is based on the use of cards that act as irritants and stimulate healthy brain cells.

Hippotherapy this technique involves the use of horses in the rehabilitation of patients with various physical and mental diseases. Hippotherapy is a complex treatment in which muscle tone, rhythm and coordination of movements are normalized and balance is improved. The symmetry of movements and various motor functions are corrected as well.

Tamo therapy tamo therapy is a new method for the rehabilitation of children with neurological and orthopedic motor disorders. It is based on the development of special movements that coordinate the connection between the external and internal forces of the organism. These forces influence the right movements and exclude unnecessary movements. Tamo therapy helps children to independently undergo each phase of their rehabilitation.

Zilgray therapy this technique was developed by the German physician Graysing and his patient Zillo.This therapy is a complex of exercises that is based on movements performed simultaneously with special breathing techniques. This exercise helps to eliminate pain in the back and cervical spine. Because it is easy to perform, it is therefore recommended for patients of any age.

Hydrotherapy hydrotherapy includes a variety of water-using techniques for medical purposes. Treatment in Germany consists of body wrapping, applying splashes, dousing and taking hot and cold baths. Water can also be used to remove toxins from the body. Hydrotherapy is particularly recommended for the treatment of muscle and joint pain and also for treatment of inflammation, headaches, digestive disorders, and pelvic pain.

Different types of massages massage not only loosens muscles and joints, but also affects the biologically active parts of the body. Thanks to massage pain can be partially or completely relieved, so that there isan acceleration of the recovery processes in case of damage or changes in muscles that located near the damaged nerve. Massage makes the muscle fibers more flexible and elastic. It also slows the atrophic processes.

Lymphatic drainage lymphatic drainage is a complex of therapeutic procedures that aims to normalize the flow of lymph through the blood vessels. This method not only stimulates the vascular tone, but it also increases the exchange processes between tissues and blood.

Pelvic muscle training a number of special exercises that were developed by Dr. Kegel. These exercises are used in treating the disorders of the urinary functions in both men and women, such as urinary incontinence, prostatitis, as well as in diseases of the rectum.

Music therapy since ancient times music has had a beneficial effect on the human body. The positive effect of music is often used to treat many neurological defects. This method helps the patient to relax or the opposite to achieve the necessary concentration of attention.

Art therapy this is a method of psychotherapy that uses different types of art, such as drawing, modeling, photography, creating stories for treatment. Method of art therapy is based on the belief that the inner self of a person is reflected in the visual images. Art therapy is widely used in treating neurotic and psychosomatic disorders.

Fangotherapy a method of mud treatment. Sea mud contains a lot of useful substances: enzymes, microelements, hormone-like substances, and mineral salts. Fangotherapy has a multifaceted effect and is successfully used in the treatment of neuropsychic disorder. It also relieves pain in diseases of bones, joints and muscles.

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