see Delirium

The apallic syndrome is a neurological condition caused by severe brain damage. It involves a functional loss of the entire cerebral cortex or large parts of it, while functions of the diencephalon, brainstem, and spinal cord remain intact. As a result, affected individuals appear awake but most likely lack consciousness and have only very limited means of communication (for example, through concepts such as basal stimulation) with their surroundings. In Germany, it is estimated that at least 10,000 people are affected.

A form of respiratory dysfunction in which gas exchange can no longer take place in a section of the lung. As a result, the oxygen level in the blood decreases. The body attempts to compensate for this condition, leading to accelerated breathing and an increased heart rate. Due to the reduced oxygen level, the skin may sometimes take on a bluish discoloration.

Autonomic dysreflexia can occur in individuals with a spinal cord injury at or above the level of T6/T7. When a stimulus occurs below the level of the lesion, it cannot be perceived. Common triggers include an overfilled bladder or a bowel distended with stool or gas. However, tight clothing and pressure sores can also be causes. Proper mobilization is necessary to prevent pressure sores.

Consequences of dysreflexia can include cardiac arrest, stroke, cerebral hemorrhage, and, in the worst case, death. If autonomic dysreflexia is detected, the patient must first be placed in an upright position, the legs lowered, and tight clothing removed.

Basal stimulation refers to all basic nursing and therapeutic interventions aimed at promoting sensory perception in individuals with physical and mental impairments.

The goal of these measures is to enhance sensory awareness, body orientation, and the patient’s ability to communicate nonverbally.

Eight forms of stimulation are distinguished:

• Somatic (body-related) stimulation, includes:
  • touch
  • washing
  • massages
• Vestibular (balance-related) stimulation, includes:
  • regular changes of position
  • rocking or swaying movements
  • verticalization to improve spatial body awareness
• Vibratory (mechanical vibration) stimulation, involves:
  • generating vibrations that stimulate surface and deep sensory receptors.
  • Examples include vibration devices (plates, mats, rods)
  • electric shavers
  • musical instruments such as drums, deep bass sounds, or singing bowls
• Oral stimulation (via the mouth), stimulates the brain through taste. Examples include
  • offering favorite foods
  • in patients fed via PEG tube, moistening the tongue with different juices, soups, or sauces.
• Olfactory (smell-related) stimulation, includes
  • aromatherapy
  • scented candles
  • essential oils.
• Auditory stimulation:
  • Using music, various sounds, or noises.
• Visual stimulation:
  • Showing patients pictures, photos, or videos
  • positioning them to look out of a window
  • using mobiles above the bed
  • varying lighting conditions
  • taking walks
• Haptic (touch-related) stimulation, involves
  • touching or grasping objects offered to the patient
  • or stroking animals

The neurogenic dysfunction of the lower urinary tract (caused by paralysis) can, for example, due to persistent strain on the affected tissue, lead to the following complications: urinary tract diseases, kidney damage, damage to internal sexual organs, and changes to external sexual organs.

If automatic blood pressure regulation fails, blood pressure disorders may occur.

Bradycardia (slowed pulse): slower heart rate, pulse drops below a value of 60 beats per minute.

Arterial hypertension: Commonly referred to as high blood pressure, it describes a chronically elevated blood pressure in the arterial vascular system. Symptoms include nausea, shortness of breath, nervousness, or sleep disturbances. Blood pressure values above 140/90 mmHg are signs of hypertension.

Hypotension: Dizziness, headaches, and a tendency to collapse can be symptoms of chronically low blood pressure. Blood pressure values below 100/60 mmHg classify hypotension.

Orthostatic hypotension: sudden drop in blood pressure when assuming an upright posture. Often occurs during rapid transfers into or out of a wheelchair. Lightheadedness, dizziness, fainting, and loss of consciousness are short-term symptoms.

The following complications may occur in connection with bowel dysfunction:

Acute abdomen: Caused by abdominal diseases such as intestinal obstruction, duodenal ulcers, pancreatitis, or acute appendicitis. It is not classified as a specific disease but rather as a collection of accompanying symptoms. Depending on the underlying cause, it can lead to severe pain, miserere (vomiting of fecal matter), nausea, paralysis, or colic.

Anal abscess: Formation of pus at the anus caused by inflammation of the tissue.

Flatulence: Swelling of the hollow organ (intestine) with gas due to digestive processes in the gastrointestinal tract.

Hemorrhoids: Dilation of individual blood vessels at the end of the rectum. So-called hemorrhoids are varicose-like enlargements or protrusions from the anus.

Incontinence: Uncontrolled discharge of urine or stool.

A respiratory dysfunction that severely restricts oxygen supply, ranging from shortness of breath to possible respiratory distress. Flu-like accompanying symptoms such as body aches and fever may occur as signs.

Abbreviated as CTS, it is a compression syndrome of the median nerve in the wrist area. Abnormal sensations and pain in the hand, wrist, and possibly the entire arm can be treated either conservatively or surgically. Repetitive activities, overuse, or metabolic disorders are considered possible causes.

In medicine, a fully developed coma (from the Greek κῶμα, meaning “deep sleep”) is the most severe form of quantitative disturbance of consciousness. In this state, the individual cannot be awakened even by strong external stimuli, such as repeated painful stimuli.

A coma is therefore a symptom (a sign of illness) and not a disease itself. In the International Classification of Diseases (ICD-10), it is categorized under section “R” (Symptoms and findings) as R40.2.

Coma represents a severe dysfunction of the cerebral cortex and is usually life-threatening. The further development (prognosis) of the comatose patient depends on the underlying disease and the quality of medical care.

Chronic obstructive pulmonary disease (abbreviated COPD; less commonly also chronic obstructive lung disease, COLD, or chronic obstructive airway disease, COAD) is a collective term for a group of lung diseases characterized by coughing, increased sputum production, and shortness of breath during exertion. Primarily, chronic obstructive bronchitis and pulmonary emphysema are to be mentioned. Both conditions are characterized mainly by an obstruction of exhalation (expiration). Colloquial terms include “smoker’s lung” for COPD and “smoker’s cough” for its main symptom.

Delirium is a sudden state of confusion that can lead to long-term impairments. Older adults are particularly at risk of developing delirium, which can result in a loss of independence in daily life.

Terms such as “altered mental state” or “transient syndrome” are often used, but the medical term is delirium.

Further information about delirium is provided, among others, by the University Hospital Halle (Saale).

The DelirCare program, developed by ZASSA, offers evidence-based measures to reduce the incidence of delirium in hospitals and care facilities. The measures are adapted to the specific features of the German healthcare system and can be implemented into routine care.

You can find more information here.

The term “early mobilisation” refers to all measures aimed at mobilizing (moving) a patient within the first 72 hours after a sudden event that limits mobility.

Such events include, for example, stroke, myocardial infarction, accidents, surgical procedures, or intensive care treatments.

S2e Guideline: Positioning therapy and early mobilization for the prevention or treatment of pulmonary dysfunctions.

Further source: https://www.springermedizin.de/fruehmobilisation-auf-der-intensivstation/17082456

Chronic tiredness, malaise, exhaustion, and lack of motivation are considered accompanying symptoms of various physical and psychological illnesses and disabilities. This cluster of symptoms is referred to as fatigue.

Inflammation of the stomach lining, which may occur either acutely or chronically. Abdominal discomfort in the upper abdomen, a feeling of fullness, or heartburn are common symptoms. It frequently occurs as a complication following spinal cord injuries.

This term refers to the process of bone formation in soft tissues and joints outside the skeletal system. Immobilization, local inflammation due to bone trauma, and venous stasis lead to the release of growth factors. Together with undifferentiated stem cells, these factors trigger the activation of osteoblasts. Ossifications manifest through pain, swelling, and localized warmth. They may develop spontaneously, after surgery, or following a neurological condition such as a spinal cord injury.

The term mobilisation refers to all measures that are suitable to activate patients whose ability to move is limited, and to promote their mobility.

https://www.springerpflege.de/mobilisation/mobilisation/mobilisation-in-der-pflege/15286314

In neurology, “neglect” refers to an attention disorder in which affected patients neglect one half of their body or space. Although their eyes and other senses work, they do not consciously perceive sensory information on that side.

https://www.schlaganfall-hilfe.de/de/verstehen-vermeiden/folgen-eines-schlaganfalls/neglect-neuropsychologische-folge-eines-schlaganfalls

Treatment is based on the phases of neurological early rehabilitation. Initially, the focus is on acute treatment (Phase A). During this period, a tracheostomy (surgical opening in the windpipe), a feeding tube through the abdominal wall (PEG), and often a urinary catheter through the abdominal wall (SPDK) are placed to maintain vital functions and ensure optimal nursing care (including nutrition). However, during this time, rehabilitation-oriented therapies—especially physiotherapy and speech therapy—should already be initiated. These help prevent contractures or pneumonia and improve swallowing function. After mechanical ventilation ends, the ability to swallow is crucial for the removal of the tracheal cannula.

After completion of acute treatment, early rehabilitation (Phase B) follows. The range of therapies is expanded to include occupational therapy and neuropsychology. Music therapy may also be used. The goal is to improve motor, cognitive, and psychological functions. Treatment must be conducted by a multidisciplinary team under medical supervision, as required and monitored by insurance providers. The concept of basal stimulation has become widely established; it aims to promote environmental perception and support basic bodily functions (e.g., movement) in a way adapted to the individual’s pattern of impairment. This phase, which can last from one month to a year, is crucial for determining the patient’s prognosis.

If there is noticeable improvement in physical and psychological performance, further phases of rehabilitation (Phases C/D/E) may follow. However, if the patient remains unconscious, care proceeds to Phase F, which involves long-term “activating nursing care.”

Obesity (Latin: adeps = fat) or obesity, obesity, obesity (rarely obesity, but in English almost only “obesity”) is a severe overweight, which is characterized by an increase in body fat above the normal level with pathological effects. According to the WHO definition, obesity exists from a body mass index (BMI) of 30 kg/m², whereby a distinction is made between three degrees of severity, for the differentiation of which the BMI is also used. Indicators for the proportion of body fat and its distribution are the abdominal circumference and the waist-hip ratio.

Our transport wheelchair Ernst is suitable for patients up to 230 kg. Ernst is available in two widths (64 and 76 cm) and is extremely robust and easy to clean. Our Mobilizer®s are suitable for patients up to 250 kg. Our field service will be happy to present the products on site and show you how to use them.

According to the classification of the World Health Organization (WHO), there are three degrees of obesity as well as a preliminary stage. These four levels are determined based on the calculation of the BMI (Body Mass Index).

Category (according to WHO) BMI (kg/m²):

• Normal weight 18.5–24.9
• Overweight (pre-obesity) 25–29.9
• Obesity Class I 30–34.9
• Obesity Class II 35–39.9
• Obesity Class III (severe or morbid obesity) ≥ 40

Osteoblasts are specialized cells responsible for the formation of bone tissue during bone remodeling. The synthesis of the collagenous bone matrix (collagen type I) is the primary function of these bone cells.

Commonly referred to as bone loss, osteoporosis causes bones to become weak and porous. The loss of bone mass significantly increases the risk of fractures. In the course of a spinal cord injury, osteoporosis often develops as a secondary condition. In this case, bone loss occurs only below the level of the lesion. The more extensive the paralysis, the faster the progression of osteoporosis.

In cases of spinal cord injury, the main causes include lack of bone loading, reduced intake of micronutrients due to malnutrition or undernutrition, and decreased oxygen supply caused by slowed blood flow in the lower limbs.

Pain is a complex sensory and emotional experience triggered by receptors of the peripheral nervous system (nociceptors). Interactions between pain perception and psychological state arise as a result of threatened or actual tissue damage.

Pain appears as a symptom but can become chronic; in such cases, it is referred to as a pain syndrome. The function of pain is to serve as a warning signal that prompts the individual to withdraw from the pain-causing situation. During the healing phase, pain is extremely important, as it induces protective behaviors that prevent further injury to body structures.

Pancreatitis is an inflammation of the pancreas that can occur either acutely or chronically. Severe upper abdominal pain, vomiting, fever, fatty stools, and weight loss are common symptoms.

Acute pancreatitis is often caused by gallstones that become lodged in the opening of the bile duct into the duodenum. Excessive alcohol consumption can also be a major trigger.

Chronic pancreatitis is primarily caused by prolonged alcohol abuse, but genetic factors, chronic kidney failure, and various medications—such as beta-blockers and antiepileptic drugs—are also considered potential causes.

Complete or incomplete paralysis affecting all or individual limbs. The nerve cells in the spinal cord are damaged and can no longer transmit signals.

Traumatic spinal cord injuries are most commonly caused by car, motorcycle, or skiing accidents. However, paraplegia can also result from diseases such as tumors or infections.

A persistent vegetative state, also known as apallic syndrome (“without cerebral cortex”), is a severe brain injury in which the function of the cerebrum is severely impaired, partially lost, or completely absent. Vital bodily functions are maintained by the brainstem, as under normal circumstances, but due to the absence of cognitive function, the patient does not regain consciousness.

As a result, the individual may appear awake but is unable to make any contact with their surroundings — neither actively nor passively.

If the cerebrum is not too severely damaged, patients in a persistent vegetative state have a relatively good prognosis of regaining consciousness, and such recoveries have been reported worldwide. However, the recovery period can vary greatly — from a few days to several years. Appropriate rehabilitation measures can significantly support this process, particularly if the patient already shows signs of emerging from the coma.

Phase A comprises the initial treatment in an acute hospital, often in a normal or intensive care unit, where acute care, diagnostics and therapy take place. A special feature from the point of view of rehabilitation is that early rehabilitation can already begin here. If there is no longer any danger to life, the patient is transferred from the acute clinic to a clinic for early neurological rehabilitation (B). Patients whose limitations are less pronounced can also be transferred directly from the acute clinic to continuing rehabilitation (C). If the patient is very independent, i.e. he should be able to move freely at least on the ward level, a follow-up treatment (AHB) immediately after the hospital treatment can also be considered. It is a type of treatment within the framework of medical rehabilitation and aims at the subsequent professional reintegration.

In most cases, there are still severe disturbances of consciousness. Early rehabilitation measures are intended to improve the patient’s state of consciousness and encourage him to cooperate. In this phase, intensive medical treatment options must still be provided. This rehabilitation phase is particularly personnel and cost intensive. For details, see early rehabilitation.

The aim of the continuing rehabilitation is to lead as independent a life as possible. There is still a high need for nursing care, but the patient cooperates in the individual therapies. The aim is early mobilisation. Early mobilisation means positioning the patient, joint mobilisation, verticalisation (sitting on the edge of the bed or chair) and raising the patient to a standing position (in a standing bed). In the case of persistent unconsciousness, the apallic syndrome, phase F rehabilitation should now follow.

If the patient is mobilised at an early stage, medical rehabilitation in the conventional sense can begin. The goals are walking as freely as possible, self-sufficiency in practical living and active participation in the rehabilitation measures with the aim of professional reintegration in the case of employed persons. In the case of pensioners, the focus is on regaining everyday competence. The rehabilitation can be completed with phase D. If occupational reintegration is planned, this can be followed by educational-occupational rehabilitation (phase E).

support courses, occupational therapy and stress testing, occupational identification and work testing or so-called adaptation measures, are available. The aim is for the patient to be integrated either in a graduated or fully educational or vocational way. If this is not possible, retraining measures are initiated or, if the consequences do not permit this, a place in a workshop for the disabled is sought. Here, further support can take place through vocational preparation courses. Especially the educational-professional rehabilitation is a difficult area, which requires a close cooperation between clinic, affected person, relatives, the responsible school and employment administrations as well as the cost units. Only in this way can undesirable developments be avoided, such as the premature application for a pension.

In some patients, severe neurological and mental-emotional disorders remain despite intensive rehabilitation measures. The disabilities range from permanent unconsciousness, the apallic syndrome, to severe impairments of mental and/or physical functions, so that independent living is no longer possible. If care in the home environment is not possible, the patient can be placed in a suitable facility with activating long-term care. At present, however, there is no nationwide offer of corresponding facilities.

Due to excessive pressure, friction, and shear forces, the skin and underlying tissue can become locally damaged. The development of a pressure ulcer, often caused by prolonged bedridden periods, is considered an indicator of care quality. Also known as a bedsore or decubitus ulcer, it can occur in patients as a result of inadequate care. Tissue necrosis and bacterial infections can be consequences of a pressure ulcer. Therefore, appropriate early mobilization of patients is especially important.

Pressure ulcers are classified by W. O. Seiler into four grades and three stages:

• Grade 1: Non-blanchable, localized redness of intact skin. Other clinical signs may include edema formation, hardening, and localized warmth.
• Grade 2: Partial loss of skin; the epidermis and parts of the dermis are damaged. The pressure injury is superficial and may appear clinically as a blister, abrasion, or shallow ulcer.
• Grade 3: Loss of all skin layers, including damage or necrosis of subcutaneous tissue, which may extend down to, but not through, the underlying fascia. Clinically, the pressure ulcer presents as a deep, open wound.
• Grade 4: Loss of all skin layers with extensive destruction, tissue necrosis, or damage to muscles, bones, or supporting structures such as tendons or joint capsules, with or without loss of all skin layers.
• Stage A: Wound is “clean,” granulation tissue present, no necrosis.
• Stage B: Wound covered with slough, residual necrosis, no infiltration of surrounding tissue, granulation tissue present, no necrosis.
• Stage C: Wound as in Stage B, but with infiltration of surrounding tissue and/or systemic infection (sepsis).

Unintentional inhalation of food or liquids due to a possible swallowing disorder (dysphagia). This can occur in cases of severe paralysis and does not trigger a coughing reflex (silent aspiration).

In medicine, somnolence refers to drowsiness or a state of abnormal sleepiness as a milder form of impaired consciousness. The patient can still be awakened, but there is usually a partial memory gap (amnesia).

Sopor (Latin for “deep sleep”) refers to a form of quantitative disturbance of consciousness in which the patient is in a sleep-like state and reacts only to strong stimuli (e.g., pain), which may trigger defensive movements. Full awakening of the patient is usually no longer possible. Reflexes are preserved, but muscle tone is reduced.

Also known as topor (Latin for “sleep of death”).
In English and French, neurologists often use the term stupor to describe this condition.

A standing bed enables patients to be brought into an upright standing position while remaining in bed. The patients are secured with straps during this process. This passive standing training supports natural body functions and positively affects both physical and psychological well-being. The upward movement and eye-level interaction also convey a sense of progress and motivation (“things are looking up”).

One of the goals of this treatment is to reduce secondary complications caused by prolonged lying or sitting (see also pressure ulcers).

The Mobilizer® product line builds on this therapeutic approach and further develops it. The Mobilizer® allows nursing staff to position patients in various postures — both to relieve breathing and for therapeutic purposes. The armrests can be continuously adjusted, and a separate table can be attached with just a few simple steps.

Therapy wheelchairs have a variety of features that make them more suitable for physiotherapy than conventional wheelchairs. For example, they have adjustable backrests and armrests that can be repositioned to meet the patient’s needs. The seats can also be adjusted forward or backward depending on the individual’s requirements and preferences.

At Reha & Medi Hoffmann GmbH, we do not just manufacture simple therapy wheelchairs. We build Curalizer® and Mobilizer® therapy products — designed with attention to every detail.

• Cushions designed to prevent pressure ulcers (decubitus) thanks to their material properties; easy to clean and wipe-disinfectable.
• Movable wheels with a central braking system.
• Accessories for patient stabilization.
• A table with a padded surface.
• Height adjustability to allow back-friendly therapy for caregivers over extended periods.
• High degree of individual customization.
• Adjustable backrest.
• Length compensation and seat tilt to prevent pressure ulcers.
• Vibration module to promote alertness (Mobilizer Medior).
• Recording of performed mobilization sessions.

Thromboembolism occurs when a blood clot (thrombus) forms in a blood vessel, leading to a blockage — for example, in a leg vein. If the thrombus detaches and travels through the bloodstream to another, narrower location — such as the lungs — it can cause a pulmonary embolism.

Consequences include a drop in blood pressure and reduced blood flow to the coronary arteries. Mild shortness of breath, coughing, a feeling of impending doom, rapid heartbeat, and loss of consciousness may indicate a thromboembolism.

Thrombosis is the formation of a blood clot (intravital) within a blood vessel. Symptoms include redness, swelling, warmth of the affected limb, and pain. Thromboses can occur in any vessel, disrupt blood flow, and thus endanger the body’s vital blood supply.

see Delirium

see Delirium

A traumatic brain injury (TBI) refers to any injury to the skull that involves the brain but does not include isolated skull fractures or scalp lacerations. Due to the risk of brain hemorrhage or other complications, hospital observation is recommended for every patient with a traumatic brain injury — even in cases of a “mild” concussion.

Due to poor circulation (usually in the lower legs), inflammation of the skin can occur. Increased pressure in the veins leads to damage of the capillaries, allowing proteins to leak into the surrounding tissue. As a result, the legs may swell, and open wounds or itchy, reddish skin can develop.

Ventilation is used when spontaneous breathing fails (apnea) or becomes insufficient. This may occur, for example:

• during anesthesia
• poisoning
• cardiac arrest
• neurological diseases
• head injuries
• spinal cord lesions
• the effects of medication.
• A variety of lung diseases or chest injuries, as well as heart disease, shock, and sepsis, can also make ventilation necessary.
• Depending on the clinical situation, ventilation may be required for just a few minutes or may need to be continued for months.
• While the return to spontaneous breathing after routine anesthesia is rarely a problem, the process of weaning an intensive care patient from prolonged ventilation can be difficult and may take days or even weeks.
• In cases of paralysis of the respiratory muscles, some patients with severe brain injuries, spinal cord injuries, or neurological disorders do not regain the ability to breathe spontaneously and therefore require long-term ventilation (home ventilation).

The term verticalisation is often used interchangeably with “mobilisation.” It refers both to the movement of raising a patient from a lying position and to the partial or complete assumption of body weight in an upright posture.

We understand verticalisation, or upright positioning, as the process during early mobilisation in which the patient is brought fully upright — aligned over their centre of gravity.

This cannot be achieved using a traditional tilt table or a standard “mobilisation and rehabilitation wheelchair.”

The Mobilizer® MEDIOR is particularly suitable for this purpose. It enables the patient to be brought from lying to standing via the seat, with the hips and knees bending in one smooth motion. This concept provides the highest level of perceived and actual safety for the patient. The individually adjustable therapy table supports upper body posture, alertness (vigilance), and breathing, while also reducing the patient’s fear of falling.

In neurological early rehabilitation (NER), verticalisation — together with intensive standing and gait training — is a key therapeutic approach for helping non-ambulant patients regain walking ability, for example after a stroke.

https://www.universimed.com/ch/article/allgemeine-innere-medizin/rehabilitation-nach-schlaganfall-2097625

Vigilance (Latin vigilantia “alertness”, “alertness”), sustained attention, or wakefulness in physiology and psychology refers to states of sustained attention. Wakefulness is a partial aspect of consciousness.

In neurology, the following terms are used for vigilance impairments:

• Somnolence (= sleepy but easily awakened)
• Soporic (= deep sleep, can only be woken by strong stimuli (e.g. pain))
• Coma (= not wakeable)

The term WEANING is used in anaesthesia and intensive care medicine to describe the phase or period during which a patient who is ventilated with mechanical support is “weaned” from a ventilator.

WEANING is usually carried out in an intensive care unit or a special weaning ward.

There are three categories of weaning:

• Easy weaning: the successful weaning of the patient on the first spontaneous breathing attempt
• Difficult weaning: it takes up to three weaning attempts to achieve spontaneous breathing
• Prolonged weaning: if more than three spontaneous breathing attempts fail or if weaning takes more than seven days after the first spontaneous breathing attempt.

S2k Leitlinie „Prolongiertes Weaning“