Friday, 21 May 2010

Rehabilitation

by Susie Mallett March 2010


There are lots of different opinions


Most of my clients at some time or other go for several weeks at a time for rehabilitation at a clinic that specialises in the illness or symptoms that they have.


This is how the German health system works. There are clinics all over the country specialising in different treatments and cures for ailments. The individual health insurance companies favour certain clinics over others, even own some of them, and give their clients choices of two or three when their application for such a service is accepted.


There are also clinic where patients go for convalescence after a stay in hospital. This is prescribed by the patient’s doctor and is automatically paid for by the same health insurance companies.


Dr András Petö was the medical director in such clinics during the years that he lived in Austria. This was before he began his work in Budapest. His book Unfug der Krankheit: Triumph der Heilkunst, written under the pseudonym of Dr. Barnklau, is full of examples of the treatments that one can still find in such places. The Kneipp and Schüßler cures for example.


Back to nowadays


Children go for such a Kür with their parents, sometimes the mother or father gets treatment or therapy too, sometimes not, depending on the personal health insurance and the clinic, and the GP who is recommending it all. Mother-and-child cures, as they are called, are no longer so readily available as they were fifteen years ago when I first came to Germany. Mothers could go once a year with their disabled or not-disabled children to experience massage, psychotherapies and physical therapies of all kinds. Often this all takes place beside the sea.


The clinic is chosen by the health insurance company and they are often a long way from home. How often one is allowed to go on such a Kür depends entirely on what the insurance company is prepared to pay for and what the illness is. Sometimes people can receive this treatment annually sometimes once every two or three years. Sometimes not at all. Carers are also offered these cures by some health insurers.


Not all of my clients take up this offer of being an in-patient for a month or more. That is a month away from home in which they could receive different treatments, try out new drugs or diets and experience knew activities such as qi-gong or self hypnosis/meditation, that are both popular at the moment. They could also take the opportunity to swim daily, have massages, speech therapy, physiotherapy, take part in Nordic walking, listen to lectures, and much more.


The different client groups that I have return from such a stay at a clinic with very differing stories to tell of their experiences. I have noticed that their opinions about the quality and benefit of these stays is very much influenced by their family status and the disability that they have.


The majority of my MS clients are single. Some were married and have families but are now separated and living alone. Others are single, never having been married. Some, having discovered they had MS in their twenties or thirties, then found that socialising, meeting prospective partners, even just making new friends became very difficult. Often they have become very isolated from the social environment that they knew before. Most of these clients like go to a rehabilitation clinic once every twelve months and they usually opt for the two-week extension that they are often offered. These clients enjoy the break from looking after themselves, from cooking and organising their households, as well as the daily physiotherapy, massages and social events that they are offered. Most of them attend specialist MS clinics where they will be informed about all the latest research and different drugs and treatments being given to patients with MS. Many arrange to go each year at the same time, so they can meet up with old acquaintances.


Nearly all of my MS clients return home from their rehabilitation satisfied with what they experienced. This is also true of the clients with cerebral palsy, both the adults and the children who attend with parents. It is however not always the case with my stroke clients.


Most of these stroke clients have families and, although they realise that when they are in a rehabilitation this also gives the rest of a family a break from being carers, they are not always satisfied with what they receive there.


One of my group returned last weekend from five weeks away from his family. Although he admits that in some areas of his life he has made good progress during this time he was very pleased to get home and back to his old routine of conductive education, physiotherapy, speech therapy and living with his wife and two teenage boys.


On the one hand he realises how important this break was for his wife and his sons, who have all cared for him for over a year now since the stroke. On the other hand he know that he is fit enough to have been more active and wishes he had been offered more hours of treatment. He feels that he could have improved his abilities much more given the encouragement and the opportunity. He indicated to us that the amount of therapy and activities that he was offered on this cure was no more than he got directly after his stroke when he was still ill. He is so much fitter now and would have been able to take part in more than the two activities each day that were available to him.


When he is at home he has his family to practise his speech with but when he is in rehabilitation after his activities are over for the day, apart from meal times he felt he had no one to practise his communication skills with. He still cannot speak at all spontaneously which makes it difficult in a clinic that is full of stroke and aphasic patients, to strike up any conversations and develop friendships.


Another client was an in-patient in the clinic where she was given botulin treatment in her right arm. The clinic would not give her the treatment unless she stayed there for three weeks. The only therapy that she received each day was an hour of physiotherapy each morning. For the rest of the day she was left to her own devices, which was mostly reading as she was unable to go far on her own. Her husband worked full-time several miles away, so he was unable to visit her, except for at the weekends.


This client argues that she could have had an hour of physiotherapy each day at home for three weeks and had the practice of using her arm by doing all that needed to be done in her household instead of staying at the hospital, where she was lonely and quite unhappy with her lot. She said that the money spend on the in-patient treatment would have been enough for her conductive education sessions for the whole year!


I think that in this case it the deciding point was the huge difference in the costs that are all paid for by the health insurance companies. The clinic will only do some treatments to in-patients because they get paid so much more.


Both of these examples are instances where stroke client did not feel ill or in need of a break from their daily lives. Both were recovering their fitness and wishing, indeed expecting, to be motivated to do more to develop their motor skills and independence and in one case his speech. They really felt like their time had been wasted and that they would have been better off had they been offered more intensive, daily treatment at home. One lady always says that she would rather that the health insurance company paid for a block of conductive education for her than pay for in-patient rehabilitation again. But it will be an uphill battle to persuade it to do this.


There was a clinic during the 1990s, not too far from Nürnberg, that had conductive education as part of its provision for disabled children. I worked there on one occasion as did many of my colleges working in Bavaria. This clinic has unfortunately been closed for several years, the whole clinic not only the conductive part of it. In its time it was one of very few places where parents could receive daily sessions of conductive education for several weeks a year, all paid for by their health insurance company, including the accommodation. These were among the families who were happy with the rehabilitation cure that they were offered.


Notes


Read a little bit about Kneipp and Schüßler and you could get an idea about some of the content of Dr András Petö’s book - Bärnklau, K. O. (1965) Unfug der Krankheit: Triumph der Heilkunst, Hanau/Main, Verlag Karl Schuster


Kneipp, “Through its holistic therapy concept, the classical Kneipp treatment brings about harmony between body and soul. This comes about naturally thanks to the curative powers of water and plants, through individual exercise therapy, through a balanced diet and orderliness in one's rhythm of life.” -


Schüßler, "Schuessler came to the conclusion that missing inorganic mineral salts will cause disruption to the living processes and therefore create illnesses" -

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