Rehabilitation during the Coronavirus outbreak: Clinical facilities stay flexible

Covering mouth and nose and keeping as much distance as possible to prevent the spread of disease – if physical touch is severely restricted and involves protective measures, rehabilitation becomes an especially difficult endeavor. How have rehabilitation facilities dealt with the Coronavirus pandemic in the recent past and have things changed as the country starts to open up?

In Germany, citizens are still asked to stay at home and practice social distancing wherever possible to stop or slow the spread of this contagious disease. This “Golden Rule” applies especially to anyone at higher risk of contracting the disease. We typically think of the elderly in this setting, yet forget about people of all ages with disabilities and/or chronic diseases and health conditions that are also a vulnerable and high-risk group. This includes children and young adults. And what happens if they need rehabilitation, especially in times like these?

"The response of affected persons and their families was swift the more we all became aware of the coronavirus threat," says Alwin Baumann, spokesperson for the German Alliance for Pediatric and Adolescent Rehabilitation (Bündnis Kinder-und Jugendreha e.V.). "While the number of rehabilitation applicants had steadily increased every month over the years, numbers dropped by a third in March and by more than half by April of this year. The number of visitors to the Alliance's website plummeted from over 25,000 in January to just 5,000 in April. Since then, the numbers have steadily increased again. Now the primary focus is to decide when and how the clinical facilities are in a position to see patients for appointments again."

After policy-makers decided to issue restrictions to public and professional life and only allowed urgent medical treatments and surgeries in hospitals that cannot be postponed, in March, rehabilitation facilities in Germany started to only accept patients whose rehabilitation was immediately necessary. Many facilities also agreed to make their treatment centers and medical staff available to assist in the pandemic. "The Alliance for Pediatric and Adolescent Rehabilitation took part in Germany's protective shield proceedings and supported rehabilitation facilities in applying for financial assistance to stay in operation and protect the public," reports Baumann.

Now the sector is slowly returning to a new normal. Since the end of May and early June, rehabilitation facilities have been allowed to accept children and young adults again. Needless to say, the safety of patients, their chaperones, and staff members remains the number one priority. The facilities have set out comprehensive hygiene measures based on the recommendations issued by the German Society for Pediatric Rehabilitation and Prevention (DGpRP) to prevent infection spread. Healthcare and administration managements collaborate with hygiene officers, works council members, and the top heads of departments and are responsible for the development and ongoing adaptation of these hygiene measures. Local public health departments are also involved in this process right from the start. "The facilities decide how many patients they plan to admit based on factors that include health condition, age and accompanying person," says Baumann. "The appointments are made by phone and include a written questionnaire pertaining to the person’s health status and contact tracing information. The hygiene measures and distance requirements apply to all services and during meal and leisure times. The staff members wear face masks for protection."

What will happen with the interim solutions that some facilities were able to develop at a moment’s notice? Examples include the ADELI Medical Center in Slovakia, which specializes in treating patients with neurological disorders and usually cares for patients from more than 30 countries. The international rehabilitation center is still closed (Status at the end of May 2020) with neurorehabilitation not being an option since mid-March. That’s why the Center’s medical team encourages children and adult patients to use social networks and get in touch online. The idea is to motivate each other by posting videos that chronicle their training successes at home. Many patients accepted the challenge and proved especially active on Facebook. The rehabilitation center’s Instagram account also indicates available online consultations and therapies including speech therapy for children via videophone aided by a hand puppet.

"The coronavirus crisis forced many clinical facilities and organizations to create digital services, digital communication mechanisms and work from home options for staff members," Baumann sums up the situation for the German-speaking realm. After some initial difficulties due to a lack of hardware and lack of experience in the use of platforms, the benefits of online communication became increasingly apparent. "Many of these options will continue to be available after the pandemic, albeit therapeutic communication, especially as it pertains to affected children, young adults and their families, will return to being a face-to-face process of interaction."

After being closed for six weeks, the Belgian-based neuro-rehabilitation center TRAINM was permitted to reopen in early May. Now signs at the entrance encourage visitors to wear face masks as a protection and caution family members not to linger and wait around, but to simply drop patients off or pick them up again – following the general guidance for social distancing and avoiding crowded spaces. Of course, the actual rehabilitation takes place while all parties wear protective masks and practice strict hygiene.

Although the coronavirus will probably change our lives forever, there are signs that things are gradually returning to something resembling pre-shutdown circumstances – a new normal, if you will. The coming weeks and months will show what this will look like for rehabilitation and similar facilities. However, the most important thing is that they can offer their care services again. "Germany has about 500,000 children and young adults who would benefit from rehabilitation measures. Yet only ten percent use this blend of high-quality medical and therapeutic services," says Baumann. "That is why we must continue to raise awareness about pediatric and adolescent rehabilitation among physicians, therapists, and affected families. In far too many cases, parents and physicians have limited access to low-threshold treatment programs and face problems when it comes to extending or repeating a measure. To ensure the sustainable success of rehabilitation, we must continue to expand outpatient services and aftercare options." This is an objective that applies regardless of the Coronavirus trajectory.