Introduction

The traumatologic and orthopedics rehabilitation and re-education sector deals with re-education treatments of pathologies affecting the musculoskeletal system and the spine.

The locomotor re-education deals with treatments for patients with pathologies affecting mainly the lower and upper limbs with a specific care unit of reeducation dedicated to affections of the hand. These pathologies are often of traumatic, degenerative origins or due to congenital deformities.

A multi- and interdisciplinary team, supervised by medical practicioners specialized in physical and rehabilitation medicine ensures early cares in the immediate postoperative phase or after any kind of hospital treatment. It is centered around a personalized hospitalization or ambulatory program. Repeated written reports will allow adaptations to the treatment for an optimal recovery of the patients.

The goal is to favor a quick social and professional reinsertion as well as a normal return to family life.

A special prosthesis department adapts the necessary prosthesis and orthesis for a quick recovery from an incapacity or handicap. The spinal re-education treats pathologies and affections of degenerative, traumatologic and congenitally deformed etiology of the vertebral column.

Patients are taken care of after a surgical intervention or any other hospital treatment.

The care will be either individual or collective within the Rachis Dynamism Restoration (RDR) (= Dynamic Reeducation of the Spine) group.

Re-education programs include pain medication and offer, among other things, a psychosocial support and the intervention of a professional reinsertion-oriented “back school“.

Treatments are offered very early in the therapy to prevent the establishment of a long-lasting handicap and to reduce the risk of an evolution towards a permanent work disability.

Physical Medicine and Rehabilitation

Medical staff of the traumatology-orthopedics sector is composed of:

  • Dr. Anja DEKANT
  • Dr. Jean-Marie DOUMONT
  • Dr. Joachim RENOUPREZ
  • Samuel SALAZAR
  • Dr. Jean-Pierre SAVY
  • Dr. Jean-Paul SCHMIZ

 

The Rehazenter provides treatments in the traumatology-orthopedics sector for pathologies affecting the musculo-skeletal system and the spine.

Main indications are:

  • skeletal fractures of upper and lower limbs,
  • hand tendons restorative surgery,
  • algodystrophy,
  • traumatic amputations,
  • amputations of vascular origins,
  • congenital limb deformation,
  • peripheral vascular disease of the limbs,
  • degenerative articular arthritis,
  • hip and knee prothesis surgery,
  • tendinitis,
  • fibromyalgia,
  • muscular weakness after an extended stay in intensive care,
  • pressure sores and ulcers,
  • cutaneous burns,
  • post mastectomy lymphoedema,
  • post-phlebitis syndrome,
  • arthritis of the spine,
  • disk herniation,
  • vertebral fractures,
  • rheumatic inflammatory diseases,
  • acquired or degenerative narrowing of the lumbar vertebral canal,
  • chronic pain syndrome,
  • scoliosis,
  • cardio-vascular deconditioning syndrome.

The means of diagnosis in the traumatology-orthopedics sector are:

  • conventional radiology,
  • ultrasound scanner,
  • biological laboratory,
  • electrocardiogram,
  • electrophysiology: EMG, VCN, PES, PEM,
  • vesical echoscan,
  • percutaneous oximetry,
  • urodynamic examination,
  • baropodoscopical examination,
  • walk analysis,
  • isokinetic examination,
  • submaximal cardio-vascular effort,
  • strength and spinal amplitude examination,
  • professional functional assessment ESAP,
  • driving aptitude (CLECAR).

The following treatments are available in the traumatology-orthopedics sector:

Specialized medical consultations involving the elaboration of re-education projects.
Medical hospitalization or polyclinic ambulatory cares
Pain medication
Physical treatments :

  • Balneotherapy,
  • Physiotherapy,
  • Massotherapy,
  • Radial Shockwaves therapy,
  • Manual therapy.

Functional re-education:

  • Physiotherapy,
  • Occupational therapy ,
  • Psycho-motricity,
  • Physical education,
  • Orthophony,
  • Perineal sphincter re-education.

Back School
Rachis Dynamism Restoration (RDR) program (= Dynamic Reeducation of the Spine RDR)
Prosthesis and orthesis
Psychotherapy:

    <liRelaxation

Cardio training:

  • Adapted pool gymnastics,
  • Adapted gymnastics in the gymnasium.

Walking way
Autonomy training for daily life activities
Professional multifunctional simulation workshop
Professional pre-orientation
Sports adapted for disabled people

Care Services

The care department is composed of the hospitalization service consisting of three units and three therapeutic apartments, policlinics including the outpatient clinic dedicated to the care of ambulatory patients, as well as the Nutrition and Dietetics Unit and Hospital Hygiene.

This unit specializes in the care of traumatological and orthopedic pathologies such as: polytrauma, various prostheses, amputations, etc.

It is composed of :

  • 12 rooms with 2 beds each,
  • 6 rooms with 1 bed each.

Functional and cognitive incapacities hamper independence to perform daily activities (dressing, washing, cooking), to move (getting up, laying down, going from the bed to the chair) and their walking scheme (=free moving).

Therapeutic apartments are a place of transition, of evaluation and progression between the anterior level of dependence and the return home.

Therapeutic apartments are privileged places where the patients can adapt, evaluate and confirm their project with the whole technical platform of the Re-education Center close at hand.

Specially for ambulatory patients, these services allow a continuity of cares after the end of their hospitalization period and / or to take care of punctual problems that might occur (emergencies, hydrotherapy, bandages, food…)

This unit, policlinic care services and therapeutic apartments, have a staff composed of nurses and auxiliary nurses specialized in functional re-education and rehabilitation. They work on a multidisciplinary level with other therapists and take care of hospitalized or ambulatory patients to provide them with direct and indirect cares:

  • basic proceedings of everyday’s life : hygiene, clothing, mobility, comfort cares…,
  • permanent presence to favor the coordination of cares, the motivation to complete goals and to provide assistance to the patients so they can obtain a maximum of autonomy,
  • evaluation of each patient’s capacities to help them maintain and improve these capacities depending on their needs,
  • preventing complications related to the pathologies,
  • multiple rather technical medical acts : bandages, perfusions, monitoring, gestion of the medications, isolations…,
  • follow-up of the evolution of the pain,
  • intermediary role between patients and their relatives,
  • multidisciplinary planning and  training as well as coordinating the return to an appropriate living environment with the patients’ relatives.

The rehabilitation care approach includes the assessment of the needs and capacities of the patient, the identification of the means to be implemented to allow an optimal gain of autonomy as well as the accompaniment of care in order to reach the personalized goal of the patient and his entourage, declined from the medical goal.

Since 2016, an accompanying nurse has been welcoming and following the hospitalized patient according to his needs throughout his stay. She is also involved in the preparation of his leave in collaboration with the various health professionals.
This function makes it possible to provide the patient and those around him with a referent health professional who is constantly in contact with the care units.

Comfort benefits for the hospitalized patient:

  • a patient facilitator offers occupational activities to brighten the patients’ daily lives,
  • a hairdressing service is available to patients every thursday,
  • the hospitalization service has two graduate medical pedicures; their intervention may be requested for aesthetic or medical reasons,
  • laundry service is provided when needed.

The healthcare policlinic, specialized in the care of ambulatory patients for their different care needs, is made up of nurses and care assistants specialized in rehabilitation who provide different types of care:

  • acts of daily life care: hygiene and dressing in the context of hydrotherapy, meals, mobilization, elimination, etc.,
  • acts of technical care: dressings, surveys, monitoring of parameters, drug management, management of isolations, biological samples, etc.,
  • emergency management,
  • achievement of appropriate lessons for the patient and / or the entourage,
  • relay between the patient, the entourage, home care networks, etc.

Specialized in the transport of patients in rehabilitation, the agents provide the internal transport of hospitalized and ambulatory patients.

Physiotherapie

Within the frame of its competences, the traumatology-orthopedics physiotherapy service deals with all therapeutic activities related to treatments of all the mechanical or degenerative pathologies of the spine and the musculoskeletal system. Thanks to our most advanced technology, our service can provide cares of the highest level on diagnosis and treatments of the pathologies of the musculo-skeletal system.

The missions of the traumatology-orthopedics service are :

  • trying to obtain the goals defined by the assessments,
  • propose a treatment based upon the newest scientifical facts,
  • accompany the patient in an innovative way along his treatment with a state-of-the-art technology,

Lower Limb 

Our service provides care of all the pathologies of the lower limbs. The physiotherapist accompanies the patient during his whole journey from hospitalisation to ambulatory care until the end of the treatment with an adapted program according to his pathology. The therapist uses all his means made available at our center in order to provide a treatment of quality.

The pathologies which are mostly encountered :

  • hip protheses,
  • knee prostheses,
  • polytrauma,
  • ligament lesions,
  • all types of fractures,
  • amputations,
  • burns,
  • algoneurodystrophy of the lower limbs,
  • muscular lesions.

Upper Limb 

Our service is composed of different therapists trained to give an adequate treatment to divers pathologies of the upper limb. The originality and specificity of this service lies in its multiple everyday care taking of the patient’s pathology, while working in a close collaboration with the occupational therapist. The therapist uses all his means made available at our center in order to provide a treatment of quality.

The pathologies which are mostly encountered:

  • trauma of the upper limbs,
  • algoneurodystrophies,
  • rotator cuff lesions,
  • amputation,
  • inflammatory rheumatism,
  • pathologies of the hand.

Spine

The center pays particular attention to the care given to the different pathologies of the spine because in addition to the traditional care we have set up a multi-disciplinary and interdisciplinary group therapy that allows an effective revitalization of the spine.

The pathologies which are mostly encountered:

  • operation of the spine,
  • spine Pain,
  • deformation of the spine.

Important Burns

The technical platform of the Rehazenter welcomes patients with burns. Specialized and multidisciplinary care is implemented while respecting the different stages of healing. The care provided by our team allows in a first time to avoid a maximum cicatricial complications (bridles, hypertrophy, joint limitation … etc) by various specific techniques (mobilizations, postures, orthosis, massage, … etc). Subsequently, the patient follows a progressive muscular and cardiovascular training to promote social and professional reintegration.

ATM Mandibular Disorder

The dysfunctions of the temporo-mandibular joint are treated by an experienced and specifically trained team. Before any treatment, a test is realized to guide the treatment.

Postural disorders

Postural disorders can occur following other pathologies, hence the importance of a very thorough assessment in order to direct the treatment to proper care.

Vestibular disorders

The center is equipped with two highly technical devices and therapists specially trained in this field to perform assessments and follow treatment of patients with vestibular disorders.

Chronic pain
The treatment of this pathology is often unknown and is provided by a multi-disciplinary and interdisciplinary staff and occupies a privileged place.. The therapists who are integrated in this team are specially trained in the pain management .

Pediatrics

Our Center also treats pediatric pathologies. To ensure proper care, we strive to achieve a schedule that allows our patients to follow their school hours as well as their therapies.

  • Our center has high-tech equipment (Multitest, Tergumed, Biodex, Equitest, etc…) to perform rigorous assessments and effective treatments.
  • Devices for physio-and electrotherapy, ergometrical bicycles, Kinetec devices for upper limb and lower limb, etc.
  • Our main strength lies in our motivated and competent team specialized in most domains of physiotherapy.

Physiotherapy in Pelvic Perineal Rehabilitation is for patients with:

  • vesico-sphincterical and / or anorectal dysfunction of neurological or traumatic origin,
  • pelvic pain,
  • sexological disorders,

This type of care can also be offered in pediatric cases by specially trained therapists.

Following a medical consultation with our specialized doctors and thanks to a platform allowing the evaluation of the perineal sphere as a whole, the patient receives a prescription of care coherent and adapted to his handicap.

Tests:
The assessments carried out include standardized evaluations validated as specific evaluations:

  • Muscular and sensory testing of the perineal sphere.


Methods used:

  • analytical and global strengthening of the pelvic floor,
  • proprioception,
  • physiotherapy: electrotherapy, biofeedback techniques, etc.,
  • abdominal strenghtening by appropriate techniques: Abdo MG technique, hypopressive abdominal technique (De Gasquet, Caufriez.).

Psychomotricity

The specificity of psychomotricity lies in the fact of considering the problematic of a patient, both physically and mentally; to consider the subject globally, with its possibilities and its difficulties, while listening and paying particular attention to his psycho-corporal manifestations.

Psychomotor examination, performed during a number of tests adapted to the age and the pathology of the patient, allows

  • to evaluate its difficulties as well as its possibilities, restoring them during its evolution,
  • to appreciate the quality of the kinds of relation that the patient is establishing with his entvironment.

The psychomotor examination can address all activity and body language such as:

  • coordinations,
  • the balance,
  • the tone,
  • body awareness and consciousness: the body image,
  • spatio-temporal structuring: laterality,
  • the graphic gesture,
  • the body in relation to the environment and unusual situations.

The psychomotrician has to intervene in the context of pathological manifestations of various cases: perinatal, postnatal, neurological, sensory, psychosomatic, geriatric, psychiatric.

These different manifestations can be expressed by:

  • perceptive motor disorders,
  • praxis disorders,
  • tonic emotional disorders,
  • disorders of consciousness and awareness of the body, of the body scheme or body image,
  • disorders of the temporo-spatial organization,
  • behavioral disorders,
  • personality disorders.

Rehabilitation can be done by means of techniquesof relaxation, gestural education, body or plastic expression, by rhythmic activities, games, balancing, and coordination with the support of various elements such as: water for example.

Gymnastics and Hydrotherapy Therapies

Adapted physical activity therapies (A.P.A.) and hydrotherapy are an integral part of the patient’s care management at the Rehazenter.

A medical prescription always justifies this care. Patients are supervised by six therapists in adapted physical activities, as well as by two swim instructors. The entire team works in close collaboration with the other services (physiotherapy, occupational therapy, medical team, etc.).

The goal of these therapies is to integrate physical activities into the functional treatment of the patient. The treatment during the A.P.A. can be collective or individual, based on an individual assessment. It consists in adapting all physical activities to the different pathologies of the patients and according to their personal and therapeutic goals (didactic adaptations, logistic, modifications of the regulations, etc.). The goal of this care is also a decentralization of the focus on the lesion, integrating it at the corporal level by more global activities. The specificty of pool therapies is to be able to start early an active and secure mobilization.

The proposed physical activities will allow the patient to assert himself and give him a sense of fulfilment . These group activities will allow him to find or develop a certain socialization through various interactions with others and, thus, some notions of mutual aid and cohesion. This care will allow some patients to develop or give them back an interest in an active life. For others, the interest will be in the resumption of a sport of competition whatever their level was.

The Gymnastics and Hydrotherapy Unit participates in the supervision of trainees in adapted physical activities of different international universities.
In collaboration with other professionals, we participate in several groups in the gymnasium:

• Prevention of falls
• AMR (Aktivitätstest zur Mobilität im Rollstuhl) for wheelchair patients
• Rehareck (cardio-vascular training, functional reinforcement and hydrotherapy)

Psychologie

Au Rehazenter, les psychologues dédient leurs missions à l’amélioration de la qualité de vie des patients. En effet, qu’il s’agisse de personnes présentant des atteintes cérébrales ou de l’appareil locomoteur, leur capacité à faire face aux activités de la vie journalière et de participer à la société sont mises à mal, et ce, avec une souffrance importante.

Le rôle du psychologue en réhabilitation rééducation s’axe sur plusieurs dimensions :

  • Le diagnostic : en permettant une compréhension de l’ampleur des difficultés émotionnelles, cognitives et comportementales. Ceci en utilisant une évaluation orientée, faisant l’état des lieux des difficultés mais aussi des ressources disponibles afin d’élaborer un projet de rééducation.
  • L’élaboration du projet de rééducation se fait en partenariat avec l’équipe pluri et interdisciplinaire sous la responsabilité du médecin. Il sera révisé régulièrement en fonction de l’évolution du patient et peut avoir plusieurs objectifs différents : la récupération de la fonction atteinte ou manquante, la compensation de ce qui fait défaut en fonction des compétences préservées, l’aménagement de l’environnement pour suppléer et faciliter la vie avec les déficits.
  • Le travail de réhabilitation des habiletés cognitives, comportementales et affectives du patient présentant des lésions cérébrales.
  • La prise en charge de la douleur, avec l’apprentissage de techniques comme l’autohypnose par exemple.
  • L’accompagnement des proches et familles dans l’appréhension de la différence et du handicap.
  • La prise de conscience des déficits et des moyens d’adaptation psychologique pour vivre avec le(s) changement(s).

Le rôle principal du psychologue est donc d’accompagner la personne dans ces changements tout en incluant le contexte de la rééducation, en s’articulant autour des avis des thérapeutes et des équipes soignantes, des capacités émotionnelles et des ressources du patient ainsi que son projet de vie. Aussi, le lien entre le Rehazenter et l’extérieur de la structure hospitalière est une mission primordiale qui vise une réintégration familiale, sociale puis professionnelle ou scolaire de qualité (Case Management).

Au Rehazenter, les psychologues sont tous spécialisés en neuropsychologie et sont également formés et reconnus en psychothérapie. Selon la personne et les besoins, un suivi psychothérapeutique de différent type peut être proposé aux patients (Thérapie systémique, brève, hypnothérapie, EMDR/ Traumathérapie, etc.).

Au-delà de ces missions globales, les psychologues s’orientent en fonction de leurs intérêts dans des équipes de compétences spécifiques. Certains sont spécialisés dans la prise en charge de la douleur, des dysfonctions sexuelles, les Vertiges et Instabilités (LIEN VERS SITE GROUPE), les troubles du comportement, ou encore dans le suivi des enfants, avec l’équipe des enseignants (LIEN SITE ECOLE DE L’ENFANT MALADE), et l’accompagnement des familles.

Le service est également en contact avec des partenaires externes notamment pour des bilans spécifiques, tels que l’évaluation de l’aptitude à la conduite automobile (LIEN CLECAR), la réinsertion professionnelle (LIEN PROJET COSP-HR), des bilans cognitifs motivés (aide au diagnostic, avis de prise en charge, etc.).

L’équipe des psychologues au Rehazenter reste également engagée dans l’encadrement des stagiaires, l’implication dans des programmes de recherches ou encore dans l’enseignement (LIEN CORDE).

Les thérapies d’activités physiques adaptées (A.P.A.) et hydrothérapie font partie intégrantes de la prise en charge du patient au Rehazenter.

Une prescription médicale justifie toujours cette prise en charge. Les patients sont encadrés par six thérapeutes en Activités Physiques Adaptées, ainsi que deux maîtres-nageurs. L’équipe au complet travaille en étroite collaboration avec les autres services (kinésithérapie, ergothérapie, médical, etc.).

L’objectif de ces thérapies est d’intégrer les activités physiques dans le traitement fonctionnel du patient. La prise en charge en A.P.A. peut être collective ou individuelle, basé sur un bilan individuel. Elle consiste à adapter toutes activités physiques aux différentes pathologies des patients et selon leurs objectifs personnels et thérapeutiques (adaptations didactiques, logistiques, modifications des règlementations, etc.). Le but de cette prise en charge est également une décentralisation du focus sur la lésion, en l’intégrant au niveau corporel par des activités plus globales. La particularité des thérapies en piscine est de pouvoir débuter précocement une mobilisation active et sécurisée.

Les activités physiques proposées vont permettre au patient de s’affirmer et de s’épanouir. Ces activités de groupe lui permettront de retrouver ou développer une certaine socialisation par les diverses interactions avec autrui et, ainsi, certaines notions d’entre-aide et de cohésion. Cette prise en charge permettra à certains patients de leur donner ou redonner un intérêt pour une vie active. Pour d’autres, l’intérêt sera dans la reprise d’un sport de compétition quel que soit le niveau du patient.

L’unité Thérapie gymniques et Hydrothérapie participe à l’encadrement des stagiaires en activités physiques adaptées de différentes universités internationales.

En collaboration avec d’autres métiers nous participons aux groupes

  • prévention des chutes,
  • AMR (Aktivitätstest zur Mobilität im Rollstuhl) pour les patients au fauteuil roulant,
  • Rehareck (entraînement cardio-vasulaire, renforcement fonctionnelle et hydrothérapie).

Occupational Therapy

The person may have difficulties realizing the majority of his or her daily activities such as dressing, feeding, personal hygiene, transfers, traveling, housekeeping, recreation, work, driving, etc.; the occupational therapist’s main areas of action.

The goal of occupational therapy is to maintain, restore and enable human activities in a secure, autonomous and efficient manner. It prevents, reduces or eliminates situations of disability taking into account the lifestyle of people and their environment.

At the Rehazenter, the occupational therapist intervenes in the reeducation more precisely in the “Do it better” and in the rehabilitation “Do it with” with the establishment of means of compensations, all under medical prescription.

The management of the patient is done in a multi-disciplinary and interdisciplinary team whose main goal is to put the patient at the center of the process of revalidation. He remains the main actor of his therapy to rebuild a life project, accompanied throughout its care by all medical and paramedical actors.

The neurological management of occupational therapy is spread over two rooms.

One of the advantages of the Rehazenter remains the great diversity of means available to patients.

The Occupational Therapy department within the Rehazenter re-educates patients by offering an analytical rehabilitation after a phase of assessment and evaluation. This work is built around the activity proposed to the patient and the different motor, sensory, psychological and socio-cultural requirements that compose it. The service has more specific complementary means to qualitatively support the patient in his treatment.

Orthotics

The Occupational Therapy department has an orthotic workshop located in the orthopedic traumatologic rehabilitation of the upper limb service. Specialized occupational therapists perform static and dynamic orthoses, which are tailor-made for upper limbs, for internal patients or external patients seen during a medical consultation.

Orthotics have the following therapeutic goals:

  • to reduce painful phenomena,
  • to rest or immobilize one or more joints,
  • to recover or prevent a deficit of the mobility of a joint,
  • to correct or limit a deformation,
  • to promote cutaneous healing,
  • to replace a function,
  • to allow an early mobilisation by protecting a certain structure.

The realization of these orthosis is given with an information sheet and explanations on the goals of the orthosis, as well as the instructions for wearing and an advice for its maintenance.

Ulterior further follow-up to adapt or repair the orthosis is also provided by the occupational therapy service.

Technical Aids

Depending on the severity of the motor impairment, the person may have to move in a wheelchair. The occupational therapist will determine the required characteristics of the wheelchair and will teach the person how to use it , how to move and how to do the transfers. Environmental control systems as well as technical aids which will facilitate the execution of certain activities such as dressing, meal preparation, recreation can be implemented,with the the purpose of finding some compensations to facilitate and to overcome the deficiencies of the person.

Virtual Rehabilitation

At present, virtual rehabilitation plays an important role. Devices such as Arméo, specific upper limb reeducation and more targeted E-link distal, are used in reeducation. Some other devices largely contribute to our daily care managements of our patients, with the WiiFit and also the X-Box 360 Kinect.

Rehabilitation of cognitive functions

We use specific computer software to stimulate and work memory, attention, concentration, logical reasoning, etc. A graphic reeducation can be considered as part of helping relateralisation.

Sensory rehabilitation of peripheral neuropathic pain

Sensory rehabilitation is a therapeutic approach that aims to reduce peripheral neuropathic pain. It uses the neuroplasticity of the nervous system to treat disorders of skin sensitivity and their painful complications.

The occupational therapist performs a somesthetic evaluation to map the painful skin area and the injured nerve (s).

He then defines, together, with the patient, the multi-day exercises taking a few minutes to perform, to reduce neuropathic pain and allow the person to get reappropriated to normal skin sensitivity.

With three professional occupational therapists graduated and trained in this technique, the Rehazenter is the only center to offer this innovative rehabilitation technique all around Luxembourg with convincing results.

Rehareck

It is a multi-disciplinary and interdisciplinary dynamic care management of low back pain patients during a fixed time span and in a closed collective group..

The intervention in occupational therapy is carried out in two phases: a phase of assessment at the beginning of the session and a phase of care, regular over the week, whose themes are based on theory, proprioception and spinal prophylaxis. The positions of spinal economy are then taken into concrete situations on different topics of everyday life. Exchange themes are organized regularly to answer questions and share everyone’s experience in given situations.

Spontaneous mobility activities are discussed later, as is the delivery of a reminder booklet at the end of treatment.

Prevention of falls

This is a group done   over a specific period, animated by occupational therapyists and adapted physical activity sport instructors.
The work of this group is organized around the problem of the fall: analyzing the risk factors, providing advice and recommendations, doing practical exercises related to the functions of equilibration and everyday life.

This group also aims to reduce the fear of falling and to regain pleasure in physical activity.

Group Handling wheelchairs

In collaboration with therapists in adapted physical activities, the group is aimed at patients who have to use a manual wheelchair on a daily and autonomous basis. With an evaluation sheet and specific material. They allow them to effectively learn the techniques of wheelchair use indoors and outdoors.

SNOEZELEN

It is an approach that values ​​relaxation and sensory stimulation.
The two main goals are to allow the person to relax and to get stimulated through his senses.

Occupational therapists are required to make visits to the patient’s home or workplace. Their action will be to advise and advocate specific adjustments to enable access and reduce situations creating a handicap for the patient.

Real life situations are also carried out as part of everyday life activities, related to the person e.g.: transfers, dressing, food or the preparation of meals in a therapeutic kitchen, etc., and also related to the environment ; e.g.:public transport or other places through specific assessments, such as the multiple wandering test or the Daily Life Activity profile. Other activities in the context of rehabilitation can be proposed such as working with wood in our wood workshop.

 

Ergokit

The Ergokit is a specific assessment tool of the functional capacities of the person as part of a professional orientation or reorientation. It consists of a complete physical assessment of the person and, if necessary, an evaluation of his working place. This report takes into account the patients’s feelings and participation throughout the placing.

This assessment, over a period of 4 to 8 hours for the patient, is done in the context of internal care at Rehazenter or so, following a targeted medical consultation.

CLECAR

Since 1999, the National Center for Functional Re-education and Rehabilitation has developed a unit for learning and resuming driving. Focused on people’s life concerns, it seemed obvious to meet this need for resuming or learning to drive.

The CLECAR, Luxembourg Cell of Restoring the Capacity to Drive an Automobile Rehabilitation, in collaboration with other professions of the center such as doctors, orthoptists, psychologists, social workers allows a recovery or an apprenticeship of driving.

The occupational therapy department is equipped with a quarter of a car to evaluate the transfer capacity, a driving simulator with driving aids and a suitable driving school vehicle. The occupational therapist will have to evaluate the functional abilities of the person before advising him on technical aids to drive. The person can thus regain full autonomy in his mobility, whether on private or professional basis.

The occupational therapist will ensure that the person can resume his daily activities in the most satisfactory way possible, despite the limitations that may persist.

Psychology

At Rehazenter, psychologists dedicate their missions to improving the quality of life of their patients. Indeed, whether people with brain damage or pathologies of the musculoskeletal system are concerned and their ability to cope with daily life activities and participate in society are undermined, with an important part of suffering .

The role of the psychologist in rehabilitation focuses on several dimensions:

  • diagnosis: by allowing an understanding of the extent of emotional, cognitive and behavioral difficulties. This is done using an oriented evaluation,
  • making the inventory of the difficulties but also of the available resources to develop a rehabilitation project,
  • the development of the rehabilitation project is done in partnership with the multi-disciplinary and interdisciplinary team under the responsibility of the doctor. It will be revised regularly according to the evolution of the patient and may have several different goals: recovery of the function achieved or missing, compensation for what is lacking depending on the skills preserved, the development of the environment to provide and make life easier with deficits,
  • the rehabilitation work of the cognitive, behavioral and affective skills of the patient with brain lesions,
  • the management of pain, with the learning of techniques such as self-hypnosis for example,
  • the accompaniment of relatives and families in the apprehension of difference and disability,
  • awareness of the deficits and the means of psychological adaptation to live with the change (s).

The main role of the psychologist is therefore to accompany the person in these changes while including the context of the rehabilitation, by relying on the opinions of the therapists and the care teams, the emotional capacities and the resources of the patient as well as his project of life. Also, the link between the Rehazenter and the outside of the hospital structure is a prime mission that aims at a family, social then professional or school quality reintegration (Case Management).

At Rehazenter, psychologists are all specialized in neuropsychology and are also trained and recognized in psychotherapy. According to the person and their needs, a psychotherapeutic follow-up of a different type can be proposed to the patients (Systemic therapy, briefing, hypnotherapy, EMDR / Traumatherapy, etc.).

Beyond these global missions, psychologists orient themselves according to their interests in teams of specific competence. Some are specialized in the management of pain, sexual dysfunction, dizziness and instability (LINK TO GROUP SITE), behavioral disorders, or in the monitoring of children, with the team of teachers (LIEN SITE SCHOOL OF THE SICK CHILD), and accompanying families.

The service is also in contact with external partners, especially for specific assessments, such as the assessment of driving ability (LIEN CLECAR), professional reintegration (LIEN PROJECT COSP-HR), motivated cognitive assessments ( help with diagnosis, advice of care, etc.).

The team of psychologists at Rehazenter also remains committed to the supervision of trainees, involvement in research programs or in teaching (LIEN CORDE)

Orthoptics

This discipline finds its roots in the greek language: ortho (right) and opsie (eye, vision).

Orthoptics is a paramedical profession which purpose is to detect and rehabilitate disorders of the visual function.

The majority of patients referred for an orthoptic assessment at the Rehazenter have or have had brain damage such as a stroke,a traumatic brain injury, or a neurological disease. The visual deficit then depends on the location of the damage (oculomotor palsy, visual field damage, neurovisual disorders, etc.).

The provided care can also look after problems of postural disorders, balance disorders or vertigo.

Finally, one of the missions of our service is its participation in driving aptitude assessments.

Speech Therapy

The orthophonical care consists in   the assessment and management of oral and written language disorders, of communication, voice, articulation, speech disorders and problems as well as troubles of the oral-lingual-facial muscles and of swallowing. Within the center, the speech therapist s intervention is aimed primarily at patients with neurological pathologies such as stroke, traumatic brain injury or a neurological disease.

On the recommendation of the rehabilitation practitioner, the speech therapist does a report from which will result the main goals and a therapeutic plan on which will be based the reeducational treatment.. Speech therapy t will then be integrated into the inter-disciplinary and multi-disciplinary care of the patient, respecting the individual needs, the main goal being to acquire independence and quality of life on a daily basis.

In a rehabilitation approach, the speech therapist will assist the patient to maintain his abilities as long as possible.

Sessions are mainly individual but can also be organized in groups or be computer-assisted.

Speech therapist also includes the support of the close entourage (recommandations, teaching, follow-up).

Social Assistance

Social factors influence the health of populations. The disease can aggravate psycho-social-financial problems, tilt the status and break life trajectories. Social problems can also lead to a worsening of the pathology.

The hospital approach is characterized more and more by a multi-disciplinary and inter-disciplinary functioning, where social assistance occupies an increasingly important place.

As the Rehazenter works from a perspective of excellence, its social service supports all patients hospitalized at the neurological rehabilitation department as soon as they enter in our hospital as well as all ambulatory patients, at their request or at the request of the multi-disciplinary and interdisciplinary team.
The social approach must be put in place early, as soon as the patient enters the hospital to minimize the extension of the stay for social reasons.

The actions of social assistants consist in helping those who do not succeed in managing the necessities of life. Social workers make them more able to use the resources they have got and to use the resources offered by society.

  • Analyze needs on the short, medium and long term.
  • Promote the patient’s autonomy.
  • Help reintegration in his home or in a living environment, school, work, depending on the personal project, on the expectations and the needs of the   patient and / or his family.
  • Reintegrate socially, family-related, culturally, academically or professionally with a reorganization of the social bond.
  • Orient and advise in the acts of life in society.
  • Help in the process of finding a suitable housing structure.
  • Prepare with or without the patient and / or his family his return on weekends, on his passage towards becoming an ambulatory patient as well as towards his final discharge.
  • Inform, guide, accompany the patient and / or the family in solving social, professional and administrative problems related to care.
  • The implementation of actions with or without the patient / family involving collaboration with external services and interveners (CNS, AAA, CNAP, ADEM, networks of help and home care, social assistants in the sector, specialized housing structures, etc.).
  • The development of a life project with the patient and the social and family environment.
  • Maintenance of acquired rights: completion of formalities adapted to the person’s case (application for long-term care insurance, invalidity pension, parking card, etc.).
  • Home visits, accommodation institutions and / or at the employer’s.
  • Synthesis meetings concerning the patient’s rehabilitation plan allow to identify goals for the future.
  • Family meetings with the patient’s entourage contribute to punctual and regular rehabilitation assessments and to the realization of goals to achieve for the future.
  • Meetings with different multi-disciplinary and interdisciplinary working groups, such as the chronic pain group, which allows a better management of the patient’s treatment.

Nutrition and Dietetics

The dietitian is the food specialist. He is a health professional whose mission is as well preventive as curative. It ensures the quality and nutritional balance of people according to their state of health, their lifestyle and their age.

The dietitian is part of the medical and paramedical team and is under the patronage of the doctors.

In a rehabilitation center such as ours, the dietetics associated with the catering is essential.

Indeed, a food imbalance can have important consequences in terms of mortality, morbidity, increase of the durations of hospitalization and additional costs without forgetting the impact on the quality of life.

The dietetics is associated with the curative or preventive treatment of numerous pathologies such as diabetes, obesity, renal diseases, digestive pathologies and many others.

The work of the dietitian in a center of functional reeducation and rehabilitation is made at several levels:

  • Give food advice to the patients and to their close relatives according to their needs.
  • Work in a pluri and interdisciplinary medical team(doctor, nurse, auxiliary nurse, speech therapist, pharmacist, etc.) to insure the dietary follow-up of the patient.
  • Collaborating with the service of the catering to assure the adaptation of the meals to the various pathologies, the textures, the allergies, the aversions, etc.
  • Assure the dietary state of knowledge essential to the patient, to his close environment or to the relay people for the release of the patient (return at home, placement in an institution).
  • Assure with the cook or the dietitian of catering the implementation of well-balanced menus and the acceptance of the menus according to the dietsand texture.
  • Check dishes intended for the customers and watch their acceptability.
  • Watch the food follow-up of hygiene regulations.
  • Coordinate with the food and beverage manager the purchase of the dietary products.

The dietitian assures the update of food knowledge of the medical staff as well as of the dietician responsible for the catering, who will himself look after the training of the staff in the kitchen.

He also assures trainings of group of patients (example: chronic lumbar pain patients).

  • Estimate the nutrition of the patient and adapt the nutritional contributions to all the ages and all the situations (on prescription).
  • Give food advice to the patients and to their relatives according to their needs.
  • Establish personalized documents such as food plans, food equivalences or any other document to respond to the request of the patient.
  • Work in a multi- and interdisciplinary medical team(doctor, nurse, auxiliary, speech therapist, pharmacist, etc.) to assure the dietary follow-up of the patient.

Close collaboration with the nurse hygienist concerning the food hygiene (therapeutic kitchen, central kitchen, satellite kitchen, etc.)

CLECAR

Since 1999, the National Center of Functional Reeducation and Rehabilitation developed a department concerning the learning and the resumption of driving. Centered on the preoccupation of the people, it seemed obvious to answer this need for resumption or for learning to drive. The CLECAR, Luxemburg Cell of Evaluation in the Readjusted Driving, working in collaboration with other professionals such as doctors, orthoptist, psychologist, social worker allows a resumption or a learning to drive

The occupational therapy service is equipped with a quarter of car to estimate the capacity at transfers, as well as of a driving simulator with assistance to drive and a vehicle from the adapted driving school. The occupational therapist must estimate the functional capacities of the person, before giving recommendations on the technical assistance to drive. The person can find his full independence of mobility on a private or professional level. The occupational therapist will try that the person can start over with its daily activities in the most satisfactory possible way, despite limitations which could still persist.

Group Pain Management

Rehabilitative care is frequently accompanied by painful phenomena. A survey of patients in the Rehazenter revealed a prevalence of about 78%.
Their prevention therefore remains a fundamental first step: mobilization techniques, progressive loading, the application of local physical treatments in physiotherapy, balneotherapy techniques and a medicinal aid often allow to reduce their intensity and to continue the rehabilitation program.

If necessary, it is also possible to use inhalation of gas comprising an equimolecular mixture of oxygen and nitrous oxide (MEOPA), with antalgic, relaxing and anxiolytic properties: its interest lies in its ease of use and in its rapid action and the limited duration of inhalation.

Hypnosis techniques can also be applied. Two certified psychologists of this approach intervene with patients at the request of doctors of the Rehazenter..

The coordination of the management of pain remains ensured by the medical practitioner of physical medicine and rehabilitation.

If acute pain remains a relatively simple event, the chronization of painful phenomena becomes much more complex to analyze. Pain is no longer simply sensory information about the condition of the body: it contains many emotional and affective characteristics that will at least partly determine behavioral responses.

Its management requires a different, so called bio-psycho-social approach, which will take into account the different components of pain. To carry out this process, it will be necessary to rely on a multidisciplinary and interdisciplinary team, oriented towards a coherent aim which is fixed at the beginning of the treatment. This cohesion between the patient’s goal and those presented by the team remains a priority and is essential for the therapeutical success.

It will include an initial evaluation that will try to better understand the painful mechanisms and guide the content of treatment, possibly focusing on a particular discipline. All professions are likely to intervene to participate in the achievement of theses goals: doctor, physiotherapist, psychologist, occupational therapist, social worker, sport instructors, nurse.

An individual and / or group treatment, a pooling of observations and results during multi- and interdisciplinary summaries and a redefinition of new goals will constitute the structure for these specific treatments. The establishment of the program and its coordination remain under the responsibility of the medical practitioner in physical medicine and rehabilitation: it may, if necessary, use other medical practitioners, such as the medical practitioner in anesthesia-reanimation.

Groupe of Action Pain (G.A.D) is composed of representatives of various professions working with patients treated at the Rehazenter: medical practitioners specialized in physical medicine and rehabilitation, psychologist, physiotherapist, occupational therapist, nurse, social worker, caregiver, swin instructor, etc.

The missions of Groupe Action Pain are oriented towards both patients and employees within the Rehazenter: this multi-disciplinary and interdisciplinary group must promote the following points:
1. Encourage the permanent evaluation of pain phenomena before any therapeutic approach.
2. Raise awareness of the importance of taking into account psychological and environmental factors.
3. Encourage patients to express their pain.
4. Promote a multi-disciplinary and interdisciplinary approach.
5. Participate in continuing education about algology, etc.
6. Participate actively in the management of pain in this institution..
7. Establish the position of Referent Pain within the institution.
8. Continue the development of the Chronic Pain Consultation.
9. Promote inter-hospital exchanges in the field of algology.
10. Promote the place of the Rehazenter in a national network of algology.

Any care must begin with a consultation with the referring physician: the files are then discussed in a multi-disciplinary and interdisciplinary staff, and a decision of treatment is offered to the patient.

For further information, contact the secretariat at the following number::
2698-4107 / 4108.