Entwicklung eines modularen Rehabilitationsverfahrens für Patienten mit Zustand nach Polytrauma der unteren Extremitäten auf der Grundlage sportwissenschaftlicher Gesetzmäßigkeiten

Abstract

On the basis of the discussion of injury mechanisms at the movement apparatus, further contents relevant to the topic such as biomechanical basics, medical rehabilitation and the legal basis as well as intervention with training treatment were depicted from the point of view of medical rehabilitation. Starting with the requirement by the legislator to further develop medical rehabilitation in particular in relation to its efficiency and quality on the basis of scientific investigations, 20 original accident files were examined according to the courses of rehabilitation documented. Rehabilitation management by the service provider was initiated in various phases in the course of medical or vocational rehabilitation and with the aim of optimising the procedure. The time of commissioning is set by the personal liability insurer and cannot be influenced by rehacare. It was ascertained that the rehabilitation measures initiated by public bodies neither stood up to the criteria of scientific management of treatment nor are suitable in terms of quality and quantity to exploit the individual rehabilitation potentials of the patients with states after polytrauma of the lower extremities. The rehabilitation chain proves as a rule to have a great number of broken links. Only the employment of performance diagnostic procedures makes it possible to implement treatment management that does justice to the findings of sport science and the installation of mechanisms of quality assurance in rehabilitation training. Therapeutic effects can be objectified with a gait analysis and permit conclusions to be drawn on the effectiveness of the remedial treatment. The employment of the neutral zero method is not sufficient according to the demands on quality assurance. The initial working results of the case management approach were discussed including performance diagnostic procedures. There is a great deal of research work to be done with regard to further clarification of the problems shown It is recommendable for personal liability insurers to pass on management of the remedial procedure to a rehabilitation service as soon as possible after the accident. By involving further personal liability insurers in rehabilitation management and the subsequent increase in the number of cases, it is necessary to develop knowledge-based systems which will help make it possible to contribute to compiling rehabilitation guidelines despite the high level of individuality of the medical rehabilitation of leg injuries.