Rehabilitation Matters

New RehaCom Price List

We published a new Price list and Order form for RehaCom software. RehaCom is Europe's leading software for cognitive rehabilitation having developed over more than 15 years in Germany.  The aim of the software is not to replace the skills of a therapist but rather to help guide and give structure to a rehabiltiation programme.  It's been slow to catch on in the UK but more and more therapists are seeing RehaCom as a valuable tool in their practice.

Open publication - Free publishing - More rehacom

New RehaCom version

RehaCom is Europe's leading software for cognitive rehabilitation.  It's pedigree is well established in the management of cognitive disorders following brain injury or stroke and it's used by therapists and neuropsychologists as well as clients training at home.  And now RehaCom Version 6.0 is ready.  Beside a new improved appearance it also offers several new functions.

BRAND NEW ARE:

• Functions: Shopping in a Do-it-Yourself-Shop, Divided Attention in 3D and many more,
• User interface & attractive design,
• additional and reworked languages,
• higher resolution and colour depth.

You can request a demo version via our contact page

Buddist Biker Beats Cognitive Decline

The Dalai Lama, watched a brain operation during a visit to an American medical school in the early 1990s and asked the surgeons a startling question: Can the mind give shape to brain matter?

When you think about it, why is it that older people drive so slowly in the outside lane of the motorway?  You can picture how it is – cloth cap, sitting close to the wheel, a white-knuckle grip and oblivious to what is happening around them.  

Wouldn’t you think that being older they would be in more of a hurry to get somewhere – less time to live and all that?  Now whenever I have offended someone with ranting about this they usually say,  “This decline you see - Its natural – its about cognitive decline – reflexes, balance, eyes etc getting poor with age.” 

I have for a long time wondered how much ageing is a natural event and how much of it is based on a belief – albeit a deeply held unconsicous one -  that we have been conditioned to turn into reality.  It seems that science is starting to agree with me.

A few years I was presenting at a conference on the topic of "orthotic management of stroke". The presentation had a few controversial elements to it.  Leaving aside the orthotic element, I mentioned the emerging science of neuroplasticity and how potentially this could be an area to watch in terms of stroke rehab.   Whatever happens, this topic will be a “Hot” one in years to come. 

My thought was – would it be possible to increase the plasticity of our cognitive processes with some form of exercise to allow much faster recovery in the event of a stroke? Or would it be possible to create some form of after-the-event exercise that would enhance stroke recovery?

 Until recently my master plan for prevention of cognitive decline was to give everyone over 50 a high powered motorcycle.  There are some other techniques being developed that might be more palatable for the majority.

 In response to the Dalai Lama's question,  neuroscientists had explained to him that since the 1980's we know that mental experiences reflect chemical and electrical changes in the brain. When electrical impulses zip through our visual cortex, for instance, we see; when neurochemicals course through the limbic system we feel.

But something had always bothered him about this explanation.

The Dalai Lama asked “Could it work the other way around?”

That is, in addition to the brain giving rise to thoughts and hopes and beliefs and emotions that add up to this thing we call the mind, maybe the mind also acts back on the brain to cause physical changes in the very matter that created it.  If so, then pure thought would change the brain's activity, its circuits or even its structure.

 One brain surgeon hardly paused. Physical states give rise to mental states, he asserted; "downward" causation from the mental to the physical is not possible.  Despite this slap down ten years ago, the Dalai Lama had put his finger on an emerging revolution in brain research.

Neuroscientists have since overthrown the dogma that the adult brain can't change.

We now know, its structure and activity can morph in response to experience, an ability called neuroplasticity.  The discovery has led to promising new treatments for children with dyslexia and for stroke patients, among others.

But the brain changes that were discovered in the first rounds of the neuroplasticity revolution reflected input from the outside world. For instance, certain synthesized speech can alter the auditory cortex of dyslexic kids in a way that lets their brains hear previously garbled syllables; intensely practiced movements can alter the motor cortex of stroke patients and allow them to move once paralyzed arms or legs.

The kind of change the Dalai Lama asked about was different. It would come from inside.

Something as intangible and insubstantial as a thought would actually rewire the brain. To the mandarins of neuroscience, the very idea seemed as likely as the wings of a butterfly leaving a dent on an armored tank.

What I know for sure - and science is reinforcing - Is that visualisation of tasks helps an athlete reach higher levels of performance.  So why should it be a surprise that stroke survivors who can visualise correct movement of their arms using Tailwind will make faster progress.  Our spinal cord injured clients should visualise their legs pedalling their FES bike if they want to make faster progress. Thoughts are things.

 

Case Study - How RehaCom is used in practice.

This a case study focusing on RehaCom.  You probably haven't heard about RehaCom which is Europe's leading software for the professional therapist or neuropsychologist involved in dealing with cognitive impairments following an acquired brain injury (whether due to trauma, stroke or other condition).   Brain injury can have a devasting effect on the person - so essential is it to all aspects of life.  Even moderate injury can result in cognitive impairments such as lack of ability to concentrate, pay attention, remember and other aspect of daily life.

The software is very strong in Germany - the home of the manufacturer - Hasomed GmbH who have developed this software since the early 1990's.  This software has never been fashionable in the UK, but is finding favour now as it supports cost-effective therapy and lends itself to care in the community.

This article is more likely to be of interest to therapists who work in the area of cognitive rehabilitation and based on an interview made by Karen J Hewitt on our behalf.  As Anatomical Concepts now represents RehaCom in the UK we are interested in how we can learn from best practice elsewhere in the world.

Introduction
Frau Wartenberg is a (PTA) PT Assistentin, which is the German equivalent of a Doctor’s sister. She is an exception in terms of her training, in that she works as an Occupational Therapist (OT), but is qualified as a Psychologist.  Frau Wartenberg has been a PTA for 20 years at the NRZ Magdeburg (www.mediankliniken.de), Neurological Rehabilitation Centre. This rehabilitation centre is based at one of 22 Median state clinics (hospitals) all over Germany, and was founded by the late Professor Hans Regel. Frau Wartenberg, therefore, has known RehaCom for a very long time.

Clinic challenges
The main constraints and challenges within the NRZ Magdeburg Neurological Rehabilitation Centre are currently as follows:
1. Financial – The government budget available for cognitive rehabilitation insurance payouts is shrinking
2. Patient demand – the number of incidents of stroke and head injury are increasing all the time in Germany, indeed worldwide, and the clinic is required, therefore, to treat more patients than ever before.
3. Human resources – The therapist will always be essential to cognitive rehabilitation.  Currently there is a limit to the number of therapists allocated by the Government to the clinic.
4. Complexity – At the NRZ Magdeburg Neurological Rehabilitation Centre, the whole spectrum of brain injuries – from stroke to aneurism to head injuries and MS – is treated. Patients are also treated across the whole spectrum of cognitive disorder severity – from acute patients to levels B and C and also day patients. The therapist’s role is therefore varied, complex and demanding, including not just cognitive rehabilitation work, but also diagnostics and group work.

The implications
The implications of the above challenges at the NRZ Centre are as follows:-
1. Repeat visits - The financial constraints described above mean that patients often have to go back to work before they are ready.   Sometimes this leads to them becoming overstretched in their jobs and having to return to the clinic for a second phase of rehabilitation.

2. Time – The financial constraints described above mean that patients cannot stay as long at the clinic as the therapists would like to be able to do their job effectively, and the latter are under pressure to deliver the same results in a shorter space of time.

3. Stress – The combined challenges of increased patient demand, reduced time to carry out therapy, the growing complexity of the therapist’s role and a limit to the number of extra therapists that can be taken on at the clinic inevitably mean that the therapist’s role is increasingly stressful.

The solution
Therapists are greatly in need of tools in general which make their jobs easier and less
stressful.

Now, more than ever, Cognitive Rehabilitation Centres and their therapists need an effective cognitive rehabilitation tool in particular which saves them time, allowing them to treat a growing volume and complexity of patients in an ever decreasing time period. Importantly, though, effective cognitive rehabilitation (effective = improved cognitive functions that are translated into everyday life) can only happen through a trained and experienced therapist. This means that any solution to the challenges described above can only ever be an “Enabler” used alongside an experienced therapist i.e. a tool which enables the therapist to carry out effective cognitive rehabilitation as quickly and easily as possible.

RehaCom the Enabler
RehaCom is not the ANSWER to cognitive rehabilitation it is THE ENABLER.

A good therapist already has the knowledge of how to work alongside the patient to improve their cognitive functions and develop strategies to translate these improvements into everyday life. What RehaCom does is provide the materials and tools for these improvements and strategies, and this makes the therapist’s life much easier.  Frau Wartenberg has known this for some time, and has found RehaCom to be a great enabler since it was first adopted back in the early 1990s. Now, more than ever, and in the face of the current challenges, a good therapist is required to use RehaCom to its full potential and realise all the benefits it is capable of.  A word of caution RehaCom has a vast capability covering more than 20 different cognitive procedures and many different difficulty levels for each. As such, it requires an experienced therapist to fully understand and exploit its capabilities.  But RehaCom is so intuitive as to be deceptively simple.