A082 the importance of sport in rehabilitation after traumatic injuries the concept of the vbg

The importance of sports in
rehabilitation after traumatic
injuries –
RI World Congress
Edinburgh, 25-27 October 2016
Susan Riedel & Eckehard Froese,
German Social Accident Insurance VBG
The concept of the German Social Accident
Insurance VBG

227.10.2016
The Importance of Sports
Acute Treatment Medical Rehabilitation Social Rehabilitation
Early
mobilization
Rehab Group
Training
Community-
based
Sporting
Activity
Sports
Therapy
Recover Improve Prevent/Participate
Susan Riedel & Eckehard Froese, Sports after traumatic injuries

327.10.2016
Structures
ServicesProcedures
VBG Concept for Promoting Sports
For promoting sports in each phase of rehabilitation
it is necessary:
to provide appropriate structures in
authorized clinics and rehab facilities
to adapt own procedures for analyzing
and planning sports activities
to offer services to enhance
participation in sports

427.10.2016
Activity-orientated objectives
of sports
Therapy goals focus on improving physical fitness and
mental health, including the gain in self-confidence in
one's own abilities

527.10.2016
Acute Treatment
Several studies have shown the benefits of early
controlled mobilization and activity during acute treatment:
Early mobilization promotes healing and is more productive in
achieving a good outcome after fracture care, knee ligament surgery,
cartilage repair and spine care
Early activity not only enhances the injured area, but it also keeps it
from losing function in the non-injured parts
(Orthopedics today, Role of early motion in healing fractures and ligaments realized in last 25 years, 2005)

627.10.2016
Structures in Acute Treatment
DGUV-Requirements concerning mobilization:
Each authorized hospital has to provide a qualified acute-rehab-team
under constant medical supervision for
Remedial gymnastics
Physical therapy
Ergo therapy

727.10.2016
Principles of rehabilitation of professional sportsmen:
Complex course of treatment
Whole-body-therapy
Early and intensive intervention
Focus on specific sport requirements
Objectives:
To speed up the return to full strength, endurance and range of motion
To maintain the proper functioning of the uninjured parts of the body
To correct risk factors of injuries such as imbalances, muscle tightness or
decreased proprioception
Medical Rehabilitation (1)

827.10.2016
Medical Rehabilitation (2)
Treatment as in-patients or out-patients
Application 5 - 6 days a week, at least 2 hours (outpatient)/ 4 hours
(inpatient) per day
Combination of following elements, increasingly provided as active
exercises:
Remedial gymnastics
Medical training therapy
Physical therapy
Ergo therapy

927.10.2016
Structures in Medical Rehabilitation
DGUV-staff requirements concerning medical training therapy:
Physiotherapists with additional qualification in sports physiotherapy
Qualified sports teacher with additional qualification in medical training therapy
DGUV-facility and equipment requirements:
Sufficient therapy area (at least 80 m²) with exercise equipment such as:
Isokinetic exercise machine
Medical exercise equipment
Bicycle ergometer
Wall bars
Rowing machine

1027.10.2016
Preventing decline in health after medical rehabilitation
Adults with permanent disabilities have a 2 to 3 times higher prevalence of
secondary conditions (Kienne et al., Am J Public Health 2004 )
As a consequence physical activity after rehabilitation is essential for
minimizing the risk of a gradual decline in health and secondary conditions:
Health&Function
Accident 1 2 3 4 5 6 7 8 9 10 11 12 Recovery months
Minimum level of function
Rehab
Risk of secondary
conditions
Own representation
based on James H.
Rimmer „Getting
beyond the plateau:
Importance of
exercise, 2012

1127.10.2016
Adapted
physical
activity
Vibration
Training
Therapeutic
Swimming
Nordic
Walking
Sling-
Exercise-
Therapy
Therapeutic
Qi Gong
Therapeutic
Climbing
Securing physical activity behaviour (1)
The motivational effects of adapted
physical activity in a rehabilitation
context have been linked not only to
initiating a desired exercise behavior,
but mainly for maintaining it, thus
increasing the probability of life-long
adherence
(H. Rieder: Adapted physical activity. In: Rieder H, Huber G,
Werle J, editors. Sport with special groups: A textbook 1996)
As a consequence leisure-based
adapted physical activities have to be
part of medical rehabilitation

1227.10.2016
Securing physical activity behaviour (2)
VBG-requirements for rehab facilities:
Formulation of personalized exercise recommendations to integrate
physical activity into the new daily routine after rehab and thus to maintain or
even improve rehabilitation outcome

1327.10.2016
Participation-orientated
objectives of sports
Exercise goals focus on enhancing self-empowerment and
full participation

1427.10.2016
Procedures
Establishment of
participation-orientated
procedures:
Initial personal contact
Holistic case analysis
Set up of a participation
plan

1527.10.2016
Initial Personal Contact
Detection of social activities such as leisure-based sports and contextual
factors with influence on participation

1627.10.2016
Holistic Case Analysis
Use of the biopsychosocial approach of the ICF in identifying
factors that impact participation
Focus on the personal and environmental barriers which may
impede the engagement in physical activities
Base for tailored services to remove potential barriers to
participation

1727.10.2016
Participation Plan
Participative rehab planning and service selection also with focus on
participation in sports

1827.10.2016
Services: Personal and Peer Counseling
Personalized tailored counseling during and after rehabilitation
improves sports participation and daily physical activity behavior
(H P van der Ploeg et. al: Counseling increases physical activity behaviour nine weeks after rehabilitation, Br J Sports Med. 2006)
VBG Rehab Managers inform about local accessible sports facilities
and plan with the client further sporting activities after medical
rehabilitation
Peer Counseling is used as empowering opportunity
to enhance self-motivation and to promote
widespread interest in physical activity
to teach individuals with permanent
disabilities how to exercise safely and
effectively

1927.10.2016
Services: Life-long Support
Life-long support of accident victims especially with permanent
disabilities to participate in mainstream and disability-specific sports by
assisting in searching for accessible facilities (e.g. find swimming pool
with lift or ramp)
adapting sports facilities for barrier-free access, if required
providing adaptive sports equipment (e.g. sports wheelchair)
offering personal assistance (e.g. for
showering or changing into sport suits)
providing transportation
from and to the sports facilities

2027.10.2016
Conclusion
The systematic integration of elements of sports into the rehab process
enhances recovery and minimizes or prevents permanent physical
impairments and secondary conditions after traumatic injuries and
promotes self-confidence needed to take on other life challenges such
as pursuing employment
ensures effective, comprehensive and sustainable participation and
inclusion in all aspects of life

2127.10.2016
Susan Riedel & Eckehard Froese
Department of Rehabilitation
VBG Head Office, Hamburg
susan.riedel@vbg.de & eckehard.froese@vbg.de

A082 the importance of sport in rehabilitation after traumatic injuries the concept of the vbg

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