Scientific workshop “Principles of neurorehabilitation"
hold in Prague on 14th - 15th November, 2008
In each country, different therapeutic approaches in similar cases are applied, but with the same aim – to help the patients as effectively as possible. It seems important to define this difference and to understand the cause of the difference. The aim of the workshop is to start an open academic discussion in this field, to start long – term professional co-operation and to prepare a proposal of multi-centric study that will verify the effectiveness of each approach.
A variety of treatment methods exist. Each approach focuses on multisensory input introduced to the patient in controlled and identified sequences based on the inherent nature of synergistic patterns, the patterns observed in humans and lower-order animals, or a combination of the two.
We suppose that philosophical and cultural basis in every country has a great signification for the choice and application of rehabilitation methods. For example Peto method is widely expanded in Hungary, while Vojta reflex locomotion in the Czech Republic.
The aim of the workshop is to start an open academic discussion in this field - to define difference in therapeutic approaches in each country, to understand the cause of the difference, to present the results of own research studies that evaluate the effect of the treatment. We are convinced that it is very important to evaluate the possible effect on the influence on CNS, because one of the main aims of neurorehabilitation is to use plasticity and adaptability of the CNS by suitable stimulants and to strengthen normal synaptic chains and neuronal sets, guide axonal sprouting and facilitate unmasking of alternative or previously subservient pathways in the CNS in order to maintain normal function trough alternate routes.
This discussion could start a long-term professional co-operation of various specialists (medical doctors, physiotherapists, psychologists, physics and biologists) and a preparation of a proposal project of a multi-centric study that would verify the effectiveness of each approach. In a long term our aim would be to work out clinical guidelines to help practitioners to choose the best approach from the variety of special methods which leads to functional recovery of CNS and improves the quality of treatment and life of people with neurological diseases in general.
The aims of the workshop are following:
To start an open academic discussion on different approaches of neurorehabilitation in Europe and possibilities to use and verify a functional recovery in neurorehabilitation.
To present the results of scientific studies in this field in each country.
To start long-term professional co-operation.
To start preparation of a proposal project of a multi-centric study that would verify the effectiveness of each approach.
To publish proceedings on the topic presented in the workshop.
Target group
The workshop will be organised for specialists interested in mobility in neurological diseases, mainly for physiotherapists. Although the workshop will be open for specialists in neurorehabilitation - multidisciplinary neurorehabilitation team (e.g. medical doctors, physiotherapists, ergoterapists, psychologists) and neurological patients.
Provided will be successful in our planned aims, the quality of life of neurological patients should improved markedly.
Contribution
• An open academic discussion on the topic of the workshop should improve education of experts - we would like to accredit the workshop to the Ministry of Health and professional physiotherapy organisations (and possibly other expert groups interested in medical rehabilitation) in each of the participating countries, and professional care about the patients in the participated countries.
• The workshop will enable to start cooperation on extent research project and facilitate preparation of clinical guidelines on sustained neurorehabilitation care.
• Publishing of Proceedings would increase publicity of the topic and outcomes of the workshop.
Program of scientific workshop “Principles of neurorehabilitation"
Clinic of rehabilitation medicine and Department of neurology,
3rd Medical Faculty Charles University and Faculty Hospital Královské Vinohrady in Prague
14 – 16.11. 2008, Auditorium Chapel, Department of Pediatric, Faculty Hospital Královské Vinohrady in Prague
14.11.
9.00 – 9.30
Welcome and introduction of the experts
Zeman M., director of Faculty Hospital Royal Vineyard in Prague
Vacek J. head of Institute of post gradual studies
Jandova D., head of Department of rehabilitation, 3rd Medical Faculty Charles University and Faculty Hospital Royal Vineyard in Prague in Prague
Dolezil D., Head of Department of neurology, 3rd Medical Faculty Charles University and Faculty Hospital Royal Vineyard in Prague in Prague
Rasova K., coordinator of the meeting
Motto
In similar cases, there are different therapeutic approaches applied, but with the same aim – to help the patients as effectively as possible. It seems important to define this difference and to understand the cause of the difference.
Basic questions
What are the goals of neurorehabilitation, especially in the context of the ICF (International Classification of Function).
Do therapeutic approaches differ in between different countries or in between different concepts?
Are these differences of global origin (historical, philosophical and cultural impact on health system) or individual one (understanding of neurorehabilitation principles)?
Program
9.30-10.45
Svestkova O. ICF model in neurorehabilitation
Hogenova A. Various philosophical ways of approaching illness
Hlustik P. From neuroscience to neurorehabilitation: new concepts in motor rehabilitation
10.45-11.00 coffee break
11.00-12.30
An overview on the condition, diversity and intensity of neurorehabilitation in different European countries as follows:
1. content of rehabilitation in different countries, e.g. physiotherapy, occupational therapy, speech therapy, swallowing therapy, cognitive therapy, psychological treatment, motor training, aerobic training, neuro-urology, supplementation with aids, education, etc. staff: What are the qualifications of people working in these hospitals? What professions are working there? How many staff?
2. structure of MS rehab: one central clinic (for example Belgium, Finland), several clinics (only MS patients, mixed diagnoses), in- and/or outpatient rehab
3. costs: system of reimbursement in the different EU countries; rules of availability of rehab: mode of application, who pays? What are the indications for MS rehab?
4. measurement: what scales are used to measure efficacy of rehab and of single interventions (e.g. fatigue scale, spasticity scale, dysphagia scale, Barthel Index, FIM, …), QoL measures
Presented by:
Svestkova O., Czech Republic
Stachowiak M., Kulicka A., Jakimec R., MS Rehabilitation Centre in Borne Sulinowo, Poland
Czubak K., Kaja A., Gąsiorek H., Hasiu L. Presentation of centre in Dąbek
Fáy V, Fehér M.. Neuro-rehabilitation in Hungary
Malik M. Bratislava, Slovakia
Cattaneo D., Jonsdottir J., Italy
Feys P., Belgium
12.30-13.30 lunch
13.30-16.30
Presentation of different therapeutic concepts
Kelemen A. Cognitive deficits and its management after temporal lobe epilepsy surgery
Fehér M. Conductive education in the rehabilitation of brain damaged persons, comparative study.
Urbán J. Conductive education in the rehabilitation of MS patients
Zounková I. Vojta reflex locomotion
Valouchova P. Benefits and limits of Vojta´s principle of reflex locomotion in adult neurological patients.
Čápová J. Basic programs of locomotion
Kafková H. Is the Bobath Concept still a relevant therapy to be used with patients suffering from a lesion of the central nervous system?
Malik M. Communication with stroke patients
Tietjen T. Effects of extremely low, wide frequency range pulsed electromagnetic fields in neurorehabilitation
18:00 dinner and social program
Czech folklore dancing evening in Hotel Slavia
The evening will be introduced by “Powerful Dance” – the performance of group of people with multiple sclerosis TaPoT and folk dance group Moták.
As a result of this cooperation the people with multiple sclerosis are suddenly almost miraculously cured up at least for the period of the dance.
They move happily in the rhythm of folklore music hand in hand with healthy dancers.
15.11.
9.00–10.30
Understanding of sensory-motor learning and facilitation in different therapeutic concepts
Véle F. Role of therapist’s and patient’s personality and their relationship on effect of physiotherapy
Vacek J. Neurophysiologic mechanisms of facilitation and sensory motor learning
Sensory – motor learning and facilitation – how we understand it?
10.30-10.45 coffee break
10.45-12.30
Herbenova A. Development of the approaches in neurorehabilitation: Facilitation and task-oriented approach
Feys P. Treatment approaches and role of the patient: discussion on the rehabilitation of spasticity
Cattaneo D., Jonsdottir J. The principles of the task-oriented approach in the rehabilitation of neurological diseases
Rasova K. Does the mode of stimuli application play a role in physiotherapy in multiple sclerosis?
12.30–13.30 lunch
13.30–16.30
Consensus on aims of the multi-centric study.
Preparation of a proposal project
Social program: walking in night Prague or free program
List of participants
Czech Republic
Zeman Marek, MD, PhD
Faculty Hospital Královské Vinohrady in Prague
Dolezil David MD, PhD
Department of neurology, 3rd Medical Faculty Charles University and Faculty Hospital Královské Vinohrady in Prague
Associate Professor Jandova Dobroslava MD,
Department of rehabilitation, 3rd Medical Faculty Charles University and Faculty Hospital Královské Vinohrady in Prague
Assistant Professor Dr. Rasova Kamila, Ph.D., PT,
Department of rehabilitation, 3rd Medical Faculty Charles University in Prague
Assistant Professor Dr. Herbenova Alena, PT,
Department of rehabilitation, 3rd Medical Faculty Charles University in Prague
Assistant Professor Vacek Jan MD, Ph.D., Department of rehabilitation, 3rd Medical Faculty Charles University in Prague
Associate Professor Svestkova Olga, MD, Ph.D.,
Department of Rehabilitation Medicine, First Medical Faculty Charles University and General Teaching Hospital in Prague
Associate Professor Hlustik Petr, MD, Ph.D.
Department of Neurology and Department of Radiology, Medical Faculty and Faculty Hospital Olomouc
Associate Professor Sussova Jana, MD
Department of neurology, First Medical Faculty Charles University and General Teaching Hospital in Prague
Professor Hogenova Anna, philosopher,
Department of Philosophy and Civics, Pedagogical Faculty Charles University in Prague
Associate professor Vele Frantisek, MD,
Faculty of sports, Charles University in Prague
Professor Pfeiffer Jan, MD, Ph.D.
Department of Rehabilitation Medicine, First Medical Faculty Charles University and General Teaching Hospital in Prague
Valouchova Petra, MS, Ph.D., PT
Faculty hospital Motol
Assistant Professor Dr. Zounková Irena, PT
Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty Charles University and Faculty Hospital Motol in Prague
Čápová Jarmila, PT
Centrum of physiotherapy and education Jimramov
Kafková Hana PT, Inernational Bobath Instructor Training Association instruktor, Department of Rehabilitation, Regional Hospital of Liberec, Czech Republic.
Dr. Kretchmerova Katerina, PT
Department of rehabilitation, Monada
Macháčková Katerina, MS, PT
Faculty of Health Studies, Ostrava University
Vyskotova Jana, MS, Ph.D., PT
Faculty of Health Studies, Ostrava University
Bauko Tomas, MD, MS, PT
Faculty hospital Ostrava
Associate professor Votava Jiri, MD.
Department of rehabilitation, 1st Medical Faculty Charles University in Prague
Tietjen Thomas, dipl. Ing
BEMER Medizintechnik CZ s.r.o.
Poland
Mariusz Kowalewski, MD - neurologist, MS Rehabilitation Centre in Borne Sulinowo, Poland
Małgorzata Stachowiak, PT, MS Rehabilitation Centre in Borne Sulinowo, Poland
Anna Kulicka , PT, MS Rehabilitation Centre in Borne Sulinowo, Poland
Renata Jakimiec, PT, MS Rehabilitation Centre in Borne Sulinowo, Poland
Krzysztof Czubak, vice direktor, centre in Dąbek
Agnieszka Kaja, PT, centre in Dąbek
Honorata Gąsiorek, PT, centre in Dąbek
Łukasz Hasiu, PT, centre in Dąbek
Slovakia
Martin Malik, MS, speech therapist, Department of Neurology, Bratislava
Belgium
Prof. Dr. Peter Feys, PT, REVAL, University of Hasselt-PHL
Magyar
Dr. Anna Kelemen PhD, consultant in the National Institute for Neurosurgery, candidate for the Department of Neuro-rehabilitation in the Pető Institute
Dr. Miklós Fehér, senior adviser in Pető Institute, former president of the Hungarian Society for Rehabilitation
Judit Urbán, senior conductor in Pető Institute
Italy
Johanna Jonsdottir ScD, MS PT, Neurorehabilitation at the Don Gnocchi Foundation, Milan
Davide Cattaneo MS PT, head of Gait and Balance clinical laboratory at the Don Gnocchi Foundation, Milan
Participants of the workshop have been welcomed by the director of Faculty
Hospital Dr. Zeman and the head of Institute of post graduate studies
Assistant professor Dr. Vacek who opened the workshop officially.
Workshop was started with three presentations that should bring the basic
resources for the workshop.
By recommendation of WHO, contemporary neurorehabilitation should be based
on the ICF model which emphasizes that every disease causes problems in
physical, psychological as well as social aspects of life and that it is
necessary to find a complex and variable solution. Associate Professor
Svestkova Olga, MD, Ph.D. presented first experience with practical use of
ICF at Clinic of rehabilitation Medicine, First Medical Faculty Charles
University.
Neurorehabilitation, it is an intervention that is not clearly defined and
can contain a variety of techniques and methods. Philosophical thinking,
culture and history determine the ways of an approach to the client.
Professor Hogenova Anna presented how philosophy influences examination and
treatment in different countries.
Changing treatment practice in connection to new research findings plays an
important role in the choice of therapeutic method. Associate Professor
Hlustik Petr presented two neuroscience-inspired approaches to
neurorehabilitation.
Health systems (degree of centralization, models of financing) as well
determine neurorehabiltiation treatment. Next presentations should help us
to make an overview on the condition, diversity and intensity of
neurorehabilitation in different European countries.
Presenters from each country (Svestkova O., Stachowiak M., Malik M. Cattaneo
D., Feys P.) presented neurorehabiltiation system in their countries and
described briefly content of rehabilitation, staff, and structure of rehab,
costs and measurement.
Many therapeutic methods exist, but if I was thinking whether they have
something in common, I have found four basic therapeutic approaches.
First, so called facilitation methods focused on impairment. In this
workshop, Vojta reflex locomotion has been presented (Zounková I.,
Valouchová P.).
Second, so called task-oriented methods focused on the possibility to
influence disability, for example concept by Carr and Shepherd. Cattaneo D.
described this kind of treatment and results from scientific study. Also
"contemporary" Bobath concept was included in this category (Kafková H.).
Third, cognitive methods represented here by experts form Peto institute
(Kelemen A., Fehér M.,Urbán J.).
Fourth, approaches emphasizing the role of limbic system. This approach puts
accent on motivation (goal setting, arousal, enjoyment) and
Attention/Distraction (cost of compensation, external focus) Hlustik P.
spoke about role of emotion in rehabilitation.
Experts specialized in different concepts of neurorehabilitation presented
main ideas of each concept and how they understand principles of
neurorehabilitation.
Participants were active and did not hesitate to ask, comment, and be
critical. Outcomes of the discussion are important for potential proposal of
multi-centric study.
Information on participants
number of participants: 48 (active 34, pasive 14)
age structure: women 31, men 17
countries of origin: Czech republic 33
Poland 8
Hungary 3
Slovakia 1
Italy 2
Belgium 1
PROFESSION: neurologists 6
physiotherapists 24
pre-graduate students 5
rehabilitation medical doctors 8
physic 1
philosopher 1
speech therapist 1
The workshop brought together various specialists (medical doctors -
neurologists, rehabilitation doctors, physiotherapists, and speech
therapist) including young researchers and PhD students form the top
institutions in different European countries for an open academic discussion
on principles of neurorehabiltiation. The workshop has started cooperation
in this field. Participants agreed to establish the work group for future
network of cooperation that will prepare proposal for multi-centric study
that will verify effectiveness of physiotherapeutic approaches.
Participants have agreed upon the plan for the near future with the items as
follow:
1. To look for more other studies that compared different approaches
2. To prepare a list find out institutions involved in treatment of
neurological disorders (or in MS rehab) and submit/send them the
questionnaire mentioned below.
3. To prepare the questionnaire with the aim:
a. To find colleagues interested in cooperation at this multi-centric study
b. To get the information about the set up of each institution for the study
c. To get the information concerning/regarding the professional and
technical resources of the institutions
d. To get the information regarding the willingness to participate in a
multi-centric study
4. To cooperate with the professional on construction of the questionnaire
5. On the basis of evaluation of the questionnaire future partners will be
chosen and working group settled up/founded.
7. To submit the first raw draft to us to refine the questions and to seek
advice from reserchears that we are in contact with that habitually
construct questionnaires
8. To submit the first refined draft to trial institutions.
It was really important that participants from Visegrad countries met
together. We realised that our professional work is rather different but
also that we have much in common. Thus we have decided to meet again and
have agreed upon the future cooperation.
It was really interesting experience for all participants - professional
program and social event as well.
The folklore evening was introduced by "Powerful Dance" - the performance of
group of people with multiple sclerosis TaPoT and folk professional folklore
dance group Moták.
As a result of this cooperation the people with multiple sclerosis were
suddenly almost miraculously cured up at least for the period of the dance.
They moved happily in the rhythm of folklore music hand in hand with healthy
dancers.
Participants of the workshop have been welcomed by the director of Faculty
Hospital Dr. Zeman and the head of Institute of post graduate studies
Assistant professor Dr. Vacek who opened the workshop officially.
Workshop was started with three presentations that should bring the basic
resources for the workshop.
By recommendation of WHO, contemporary neurorehabilitation should be based
on the ICF model which emphasizes that every disease causes problems in
physical, psychological as well as social aspects of life and that it is
necessary to find a complex and variable solution. Associate Professor
Svestkova Olga, MD, Ph.D. presented first experience with practical use of
ICF at Clinic of rehabilitation Medicine, First Medical Faculty Charles
University.
Neurorehabilitation, it is an intervention that is not clearly defined and
can contain a variety of techniques and methods. Philosophical thinking,
culture and history determine the ways of an approach to the client.
Professor Hogenova Anna presented how philosophy influences examination and
treatment in different countries.
Changing treatment practice in connection to new research findings plays an
important role in the choice of therapeutic method. Associate Professor
Hlustik Petr presented two neuroscience-inspired approaches to
neurorehabilitation.
Health systems (degree of centralization, models of financing) as well
determine neurorehabiltiation treatment. Next presentations should help us
to make an overview on the condition, diversity and intensity of
neurorehabilitation in different European countries.
Presenters from each country (Svestkova O., Stachowiak M., Malik M. Cattaneo
D., Feys P.) presented neurorehabiltiation system in their countries and
described briefly content of rehabilitation, staff, and structure of rehab,
costs and measurement.
Many therapeutic methods exist, but if I was thinking whether they have
something in common, I have found four basic therapeutic approaches.
First, so called facilitation methods focused on impairment. In this
workshop, Vojta reflex locomotion has been presented (Zounková I.,
Valouchová P.).
Second, so called task-oriented methods focused on the possibility to
influence disability, for example concept by Carr and Shepherd. Cattaneo D.
described this kind of treatment and results from scientific study. Also
"contemporary" Bobath concept was included in this category (Kafková H.).
Third, cognitive methods represented here by experts form Peto institute
(Kelemen A., Fehér M.,Urbán J.).
Fourth, approaches emphasizing the role of limbic system. This approach puts
accent on motivation (goal setting, arousal, enjoyment) and
Attention/Distraction (cost of compensation, external focus) Hlustik P.
spoke about role of emotion in rehabilitation.
Experts specialized in different concepts of neurorehabilitation presented
main ideas of each concept and how they understand principles of
neurorehabilitation.
Participants were active and did not hesitate to ask, comment, and be
critical. Outcomes of the discussion are important for potential proposal of
multi-centric study.
Information on participants
number of participants: 48 (active 34, pasive 14)
age structure: women 31, men 17
countries of origin: Czech republic 33
Poland 8
Hungary 3
Slovakia 1
Italy 2
Belgium 1
PROFESSION: neurologists 6
physiotherapists 24
pre-graduate students 5
rehabilitation medical doctors 8
physic 1
philosopher 1
speech therapist 1
The workshop brought together various specialists (medical doctors -
neurologists, rehabilitation doctors, physiotherapists, and speech
therapist) including young researchers and PhD students form the top
institutions in different European countries for an open academic discussion
on principles of neurorehabiltiation. The workshop has started cooperation
in this field. Participants agreed to establish the work group for future
network of cooperation that will prepare proposal for multi-centric study
that will verify effectiveness of physiotherapeutic approaches.
Participants have agreed upon the plan for the near future with the items as
follow:
1. To look for more other studies that compared different approaches
2. To prepare a list find out institutions involved in treatment of
neurological disorders (or in MS rehab) and submit/send them the
questionnaire mentioned below.
3. To prepare the questionnaire with the aim:
a. To find colleagues interested in cooperation at this multi-centric study
b. To get the information about the set up of each institution for the study
c. To get the information concerning/regarding the professional and
technical resources of the institutions
d. To get the information regarding the willingness to participate in a
multi-centric study
4. To cooperate with the professional on construction of the questionnaire
5. On the basis of evaluation of the questionnaire future partners will be
chosen and working group settled up/founded.
7. To submit the first raw draft to us to refine the questions and to seek
advice from reserchears that we are in contact with that habitually
construct questionnaires
8. To submit the first refined draft to trial institutions.
It was really important that participants from Visegrad countries met
together. We realised that our professional work is rather different but
also that we have much in common. Thus we have decided to meet again and
have agreed upon the future cooperation.
It was really interesting experience for all participants - professional
program and social event as well.
The folklore evening was introduced by "Powerful Dance" - the performance of
group of people with multiple sclerosis TaPoT and folk professional folklore
dance group Moták.
As a result of this cooperation the people with multiple sclerosis were
suddenly almost miraculously cured up at least for the period of the dance.
They moved happily in the rhythm of folklore music hand in hand with healthy
dancers.
