Rehabilitation in trauma surgery

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The main task of rehabilitation in trauma surgery is to restore or significantly improve functional health after an accident . This definition is based on the biopsychosocial model of the World Health Organization (WHO), which is set out in the international classification of functional capacity, disability and health (ICF). The consequences of accidents are strongly influenced by personal factors and environmental conditions (so-called context factors) and must therefore be the focus of rehabilitation efforts.

Rehabilitation goals

The reintegration into the social and professional environment is the primary goal of rehabilitation and poses a special challenge for those injured in accidents. The selection of specific rehabilitation measures and the definition of realistic goals require knowledge of the consequences of accidents in the physical, psychological and social areas. Knowing which parameters can influence these consequences is crucial for planning, organizing and carrying out rehabilitation after injuries. The rehabilitation of those injured by an accident differs significantly from orthopedic rehabilitation after planned operations, such as the implantation of an artificial hip or knee joint. The goal of rehabilitation measures must be determined individually by the doctor. The active participation of the injured person in the rehabilitation process and in setting the therapy goals is crucial for the success of the rehabilitation.

Indication

Rehabilitation is indicated if the injury is severe and there is a threat of long-term impairment of activity and participation. In addition, are required

  • an existing need for rehabilitation,
  • an existing rehabilitation ability,
  • sufficient motivation or recognizable motivation, as well
  • a positive rehabilitation prognosis.

Forms of rehabilitation

The medical rehabilitation in trauma surgery is divided into:

  • Early rehabilitation
  • Post-acute rehabilitation
  • Further rehabilitation

Early rehabilitation is the earliest possible onset combined acute and rehabilitation medical treatment of patients, particularly after trauma . It takes place within the framework of acute medical treatment in the trauma center with the participation of many different therapeutic professional groups and must be differentiated from post-acute or further rehabilitation. When transferring to the rehabilitation facility, the patient must be mobilized early on (i.e. able to wash, eat without assistance, move around on ward level), be sufficiently resilient, motivated and able to actively participate in rehabilitation.

The post-acute rehabilitation directly adjoins an acute care hospital treatment on or is at least in close temporal relationship to it. Since the consequences of accidents are often psychological and social as well as physical injuries, intensive care by various professional groups is necessary. This is where rehabilitation in trauma surgery differs from regular physiotherapeutic follow-up or further treatment after operations.

After the post-acute phase, special further rehabilitation measures may be required, for example medical-professionally oriented rehabilitation (MBO rehabilitation), multimodal pain therapy or rehabilitation for psychiatric, psychological and psychosomatic processes such as reactive depression or post-traumatic stress disorders .

Structural requirements

In order to achieve the best possible reintegration into everyday and professional life, a comprehensive biopsychosocial treatment approach in trauma surgical rehabilitation is necessary. This requires the use of various specialized professional groups, such as physical and occupational therapists, nurses, social services, etc. under the direction of a rehabilitation doctor who works closely with the trauma surgeon. The accident injured person is the focus of a multifaceted, networked rehabilitation process. For multiple trauma patients, the early consultation of rehabilitation specialists with trauma surgery experience, who can fall back on the necessary infrastructure in special trauma rehabilitation centers, is crucial.

literature

  • Joint working group DRG (gAG-DRG) of the Federal Working Group of Acute Hospitals with departments for interdisciplinary early rehabilitation of the professional association of rehabilitation doctors and the German Society for Physical Medicine and Rehabilitation: Position paper on interdisciplinary early rehabilitation. ( PDF, 190 kB )
  • S. Simmel, V. Bühren: Multiple trauma survived - and what comes next? The rehabilitation of the seriously injured. Trauma surgeon 2009 (112): 965-974 doi : 10.1007 / s00113-009-1686-y
  • C. Gutenbrunner, J.-J. Glaesener: Rehabilitation. In: Rehabilitation, Physical Medicine and Naturopathic Treatment. Heidelberg 2007. pp. 113ff. ISBN 978-3540334118
  • Volkmar Stein: Rehabilitation in orthopedics and trauma surgery. Methods - therapy strategies - treatment recommendations . Springer, Berlin Heidelberg 2015.