[Infantile acquired brain injury, a personal experience. Demands from the socio-familial point of view]. / Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.

We report on the experience of a family in which the youngest child has acquired brain injury and the struggle undertaken by the family to improve the neurorehabilitation resources in the public health service. The article outlines the main demands, from the socio-familial point of view, as regards the improvement of neurological rehabilitation and the resources needed to deliver it.

TITLE: Daño cerebral sobrevenido infantil, una experiencia personal. Reclamaciones desde el punto de vista sociofamiliar.Se describe la experiencia de una familia en la que el hijo menor tiene daño cerebral sobrevenido y la lucha emprendida por la familia para mejorar los recursos neurorrehabilitadores de la sanidad publica. Se recogen las principales reclamaciones, desde el punto de vista sociofamiliar, en cuanto a la mejora en la atencion neurorrehabilitadora y los recursos necesarios.

[Acute inpatient multimodal pain therapy and rehabilitation: Framework conditions, tasks and differentiated patient allocation]. / Akutstationäre multimodale Schmerztherapie und Rehabilitation: Rahmenbedingungen, Aufgaben und differenzierte Patientenzuweisung.

Multimodal pain treatment programs are widely accepted as the medical treatment standard in the management of patients with chronic pain syndromes. The concepts and treatment strategies are based on the biopsychosocial model of pain and programs for early restoration of function. Although this concept is primarily implemented in the curative field, i.e. in hospitals for the treatment of patients with chronic pain diseases, modified programs based on the International Classification of Functioning (ICF) can now also be found in rehabilitation clinics. Despite the assumed similarities, significant differences in, for example the aims of the therapy and relevant structural and process variables have to be kept in mind when allocating patients to a program as provided by a hospital or a rehabilitation clinic. The aim of this article is to present the framework structures of both treatment levels with respect to the implementation of multimodal pain therapy programs and to elucidate the differential diagnostic approach to the indications.

Dysphagia training after head and neck cancer fails to follow legislation and national recommendations.

INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia is lacking, but several studies indicate that early initiation is crucial. The aim of this study was to map the existing dysphagia rehabilitation programmes for HNC patients in Denmark. METHODS: Occupational therapists (OTs), oncologists and surgeons from five hospitals participated in a nationwide questionnaire-based survey, along with OTs from 39 municipal health centres. RESULTS: HNC patients rarely receive preventive occupational therapy before treatment, and hospital-based OTs mainly attend to HNC patients undergoing surgery. Far from all oncology and surgical departments complete the required rehabilitation plans upon discharge which leaves many patients untreated. There are vast differences between the municipalities' rehabilitation programmes and between the expertise employed in municipalities and hospitals. CONCLUSION: Existing HNC rehabilitation does not meet official Danish guidelines. Only a fraction of HNC patients are offered rehabilitation and often long after completing treatment. Municipal rehabilitation services vary considerably in terms of type, duration, intensity and expertise. Dysphagia-related rehabilitation requires an improved monitoration, possibly with an increase in the uptake of centralised dysphagia rehabilitation. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Organisational and legal issues of medical rehabilitation for patients with occupational diseases caused by dust].

The study based on Rehabilitation Center No 2 in Rostov region covered 100 male patients with dust obstructive bronchitis. The authors considered organisational and legal problems of medical rehabilitation for patients with occupational diseases caused by dust. The authors also specified and suggested stages of individual medical rehabilitation and efficiency criteria for rehabilitation, exeplified by dust obstructive bronchitis patients. Data show that creation and accomplishment of individual medical rehabilitation programs for dust obstructive bronchitis patients enable to optimize rehabilitation process, provide continuity of medical rehabilitation, evaluate efficiency of rehabilitation measures on each step of medical rehabilitation. Higher efficiency of rehabilitation is achieved by individual rehabilitation added by nebulizer treatment, efferent therapy, psychologic correction and specialized education for chronic patients with obstructive lung diseases.

[REDIA--impacts of DRG introduction in the acute sector on medical rehabilitation]. / REDIA - Auswirkungen der DRG-Einführung auf die Rehabilitation.

The REDIA study is the only long-term (2003-2009), prospective, multicentre study analyzing the impact of the DRG system on quality and costs in rehabilitation facilities. In 2004, Diagnosis Related Groups (DRG) were implemented on a mandatory basis in the German healthcare system as a reimbursement scheme for hospitals based on administered prices for procedures. Experiences from other countries revealed that introduction of DRG does not only have a significant impact on hospitals but also on rehabilitation facilities. The study approach ensures a comprehensive analysis as it considers major clinical, therapeutic, psychological and economic aspects. The REDIA study is the only nationwide empirical study that includes all stages of the implementation process: before DRG implementation, during the convergence phase and following implementation. An indication-specific comparison of the phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in admission of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversions of treatment efforts from the acute sector to the rehabilitative sector have been proven in terms of increased nursing efforts and potential changes in the therapeutic and medical treatments to be provided.

[Relevance of the "Wunsch- und Wahlrecht" of § 9 social code book 9 in medical rehabilitation from the patients' perspective]. / Die Bedeutung des Wunsch- und Wahlrechts des § 9 SGB IX für die medizinische Rehabilitation aus Sicht der Rehabilitanden.

OBJECTIVES: Everyone applying for medical rehabilitation (and other benefits to support participation) has a "Wunsch- und Wahlrecht" (meaning the right to individual wishes and choice relative to assessments, services and institutions as well as to the various benefits) according to § 9 of Book 9 of the German Social Code (SGB 9) concerning every aspect of the implementation of these services. This study was aimed at exploring the wishes of rehabilitants, their attitudes towards and experiences with the various aspects of the "Wunsch- und Wahlrecht" as well as their criteria in choosing a rehabilitation centre. METHODS: A total of 10 open guided focus groups were conducted with 71 male and female participants from 5 different indications and aged between 26 and 80 years. Transcripts were analyzed by means of a summary content analysis. RESULTS: Persons applying for medical rehabilitation benefits did not as a rule get information about their "Wunsch- und Wahlrecht" during the application process. Applying for post-hospital rehabilitation often meant to be faced with an only allegedly existing choice ("pseudo Wunsch- und Wahlrecht"). The participants objected only rarely to this missing share in decision-making. Most of them did not care about their rights to choose a rehab centre if only the application for rehabilitation was allowed. Various arguments were brought forward against the "Wunsch- und Wahlrecht", especially insufficient information about and time for enforcement and implementation of the "Wunsch- und Wahlrecht". Despite an explicit stipulation in § 9 SGB 9, notices of approval rarely stated reasons for ignoring the wishes expressed by the applicants. Many participants had reflected only little about choosing a specific rehab centre when applying for rehabilitation. Accordingly, most of the participants had difficulties to mention possible selection criteria. DISCUSSION: On the whole, applicants have Only little knowledge about the "Wunsch- und Wahlrecht". This complicates its implementation considerably. The preconditions for making informed and valid choices between different clinics are not given under these circumstances. Most interviewees do not attach much value to the "Wunsch- und Wahlrecht". CONCLUSIONS: From a social law perspective, it should be demanded that rehab applicants have to get better information about their "Wunsch- und Wahlrecht" and that they must be empowered to decide on their choice based on objective and valid information. The active role in the rehabilitation process that should generally be demanded from rehabilitants, should also be encouraged and fostered in choosing a rehabilitation centre.

[Implementation of quality management in medical rehabilitation--current challenges for rehabilitation facilities]. / Einführung von Qualitätsmanagement in der medizinischen Rehabilitation--aktuelle Herausforderungen für die Einrichtungen.

The legal responsibilities imposed upon rehabilitation facilities under section 20 (2a) SGB IX, necessitate fundamental decisions to be taken regarding the development of quality management systems over and above the existing framework. This article is intended to provide ideas and suggestions to assist rehabilitation facilities in implementing a quality management system, which is required in addition to participation in the quality assurance programmes stipulated by the rehabilitation carriers. In this context, the additional internal benefit a functioning quality management system can provide for ensuring a high level of quality and for maintaining the competitiveness of the rehabilitation facility should be taken into account. The core element of these observations, hence, is a list of requirements which enables assessment of the quality of consultants' performance in setting up a quality management system.

[Indication criteria for stationary psychosomatic treatment]. / Kriterien zur Indikation einer stationären psychosomatischen Behandlung (I).

In consideration of the existing possibilities in Germany, the author discusses the indication criteria and the duration of stationary psychosomatic treatment. Aside from the general criteria for hospitalisation, the traditional bio-psycho-social model of illness is emphasized as an important basic principle, to include social factors in the indication criteria for stationary psychosomatic treatment. Adjacent, backgrounds for the decision between a regional and a regionally distant treatment are proposed.

[Quality management and practice-oriented research in a clinic-network of mother-/father-child rehabilitation centres]. / Qualitätsmanagement und Praxisforschung im Klinikverbund von Mutter-/Vater-Kind-Einrichtungen.

The Research Network Prevention and Rehabilitation for Mothers and Children is an association of currently 24 rehabilitation centres for mothers, fathers and their children, and a scientific team at the Hannover Medical School. The Research Network combines practice-oriented research on mother and child health with the further development of treatment programmes and the implementation of internal quality management in mother-/father-child rehabilitation centres in accordance with DIN EN ISO 9001. The present paper describes the concept of the Research Network and the work contents addressed over the last three years. The advantages and disadvantages of this association and the changes initiated in practice were evaluated from the point of view of 19 quality managers of the participating clinics. The data were collected by means of semi-structured interviews, and a qualitative content analysis was performed in order to quantify the responses. The concept of the Research Network has proven successful. In the view of the quality managers of the clinics, implementation of DIN EN ISO 9001 has lead to structuring of the processes, improved internal communication, and increased motivation in the team. The major obstacles were the lack of time and human resources. In all clinics, the participation in practice-related research projects und scientifically monitored concept development has contributed to optimizing everyday practice. The exchange between the quality managers in external quality circle meetings was of central importance. The conjunction of internal quality management, practice-related research and concept development in a network can be recommended also for other associations of clinics, health centres or medical practices.

[Coordination in medical rehabilitation: demands on professions and institutions]. / Koordination in der medizinischen Rehabilitation: Anforderungen an Berufsgruppen und Institutionen.

Coordination of medical treatment, rehabilitation and long-term care is an important demand on the social and health care system. For rehabilitation in Germany, coordination and needs assessment have to be carried out across the responsible administrative bodies (section 10 SGB IX), and common service units (section 22 SGB IX) are to help. For long-term care, a new entitlement for Care counselling (section 7a SGB XI) in Care bases has been established recently in several German Länder (section 92c SGB XI). Hospital social services are obligatory according to the laws of most of the German Länder. Controversially discussed is the question whether responsibility for case management should be placed with the administrative bodies, the health care and social institutions like hospitals, or with third parties like self-help groups. This is regulated differently in the various sectors of the health care system. The professional law of the nursing professions allows to transfer coordination responsibilities to them, but social security law does not. Interprofessionally elaborated and accepted guidelines are an approach to establishing comprehensive standards of responsibility. Needs assessment to be carried out across the sectors should be regulated in social security law.

[Texts ruling activity in nursing homes and rehabilitation institutions in France, from the 9th March 1956 decree to the 17th April 2008 decrees. Part of physical medicine and rehabilitation]. / Les textes réglementant l'activité en soins de suite et de réadaptation du décret du 9 mars 1956 aux décrets du 17 avril 2008. Place de la médecine physique et de réadaptation.

In France, inpatient care is provided in three different sectors: "medicine, surgery and obstetrics", "follow-up care and rehabilitation" (soins de suite et de réadaptation=SSR) and "long-term care". Physical medicine and rehabilitation is involved mainly in SSR. As of April 2008, there are new regulations aiming to improve prior texts, to implement rules that will be identical for public and private sectors and to prepare for the new payment-by-the-act funding system (in place of the prior global funding). Now, all SSR structures have a common general basis in terms of purpose and means and specific rules for various specialties. For example, coordination of a multidisciplinary team in specialized facilities dealing with musculoskeletal and nervous system disorders must be conducted by a physical medicine and rehabilitation (PMR) specialist. Patient admission criteria still need to be defined, as does the assessment of therapeutic objectives. The expertise of SSR facilities is recognized by the possibility of direct admission from home for ambulatory patients. Nevertheless, many specifics are missing in these new decrees. These specifications will be elaborated on a regional basis, in future endeavours within regional healthcare organizations.

[Geriatric rehabilitation from the perspective of Book 9 of the German social code, SGB IX]. / Geriatrische Rehabilitation aus dem Blickwinkel des Neunten Buches Sozialgesetzbuch (SGB IX).

The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. The article includes a definition of "geriatric rehabilitation" in light of the SGB IX, describes the benefit carriers' obligations as well as the procedure in place for determining geriatric rehab need, in this context appraising the designation as "geriatric patient" in terms of its appropriateness as an identifying criterion in determining need. Provision of geriatric rehab benefits is contingent on a potential for attaining rehab goals as specified by SGB IX as well as on fulfillment of the benefit prerequisites. Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care.