Neurorehabilitation in Spain

REHABILITATION AT INSTITUT GUTTMANN IN BARCELONA

Institut Guttmann University Hospital is one of the world’s leading neurorehabilitation centers.

Neurorehabilitation is a complex and highly specialized clinical process that aims to restore function and minimize alterations due to neurological injuries:

• spinal cord injury
• traumatic brain injury
• stroke
• cerebral palsy
• multiple sclerosis
• Parkinson’s disease
• amyotrophic lateral sclerosis (ALS)
• post-polio syndrome
• dysmelia
• Guillain-Barre syndrome

In other words, we are talking about a process aimed at improving the condition of patients with congenital, acquired and degenerative neurological disease.

WHAT IS NEUROREHABILITATION IN SPAIN?

Regaining lost functionality is a process that the brain begins on its own as it tries to heal itself. The human brain is extremely plastic and always tries to adapt to new circumstances, even after incurring damage. That’s where neurorehabilitation comes in: specialists try to harness this ability to “guide” the brain so that healing is targeted at regaining functionality.

Patients are monitored in Spanish hospitals to ensure that neurorehabilitation starts at the most opportune time. Once the patient is stabilized after an injury or stroke (often a week after the incident), he or she is transferred to a rehabilitation center.

The most complicated cases are sent to Institut Guttmann, the country’s top neurorehabilitation center. The patient must meet two conditions to be admitted: at least a minimum level of consciousness (for a coma patient, neurorehabilitation in the full sense of the word is impossible) and cardiopulmonary stability.

Institut Guttmann’s experience has proven that particularly significant progress after trauma or stroke can be achieved in the first six months of intensive rehabilitation, and the sooner this process begins, the better the result (and better long-term stability).

Over 5,000 patients from five continents have been rehabilitated at Institut Guttmann in Barcelona over the past five decades. The center offers an outstanding team of professionals with extensive experience, friendly and personalized treatment for each patient, the development and application of the most advanced techniques and a particular clinical model that has earned the institute widespread international recognition as one of the world’s top medical centers in its field. And no less important: the outcomes of the rehabilitation process here refer to registered figures: the hospital reaches an average of 95% of the rehabilitative objectives set by the therapeutic team when the patient is admitted. Behind these figures are the changes –sometimes massive and other times less perceptible, but always real– in the lives of patients and their families.

The main neurorehabilitation objectives at Institut Guttmann are:

• Achieve the greatest functional autonomy possible: physically, cognitively and behaviorally.
• Prevent and treat possible complications associated with serious neurological injuries.
• Restore self-esteem and promote a positive and constructive attitude, capable of enhancing the skills that have been preserved as well as to achieve the best social reintegration possible.

The hospital works with patients with particularly severe damage to the central nervous system, often paraplegics and quadriplegics, mainly younger people (under 60 years old) with severe damage. Twenty years ago, the majority of patients at Institut Guttmann were the victims of vehicle accidents; however, due to the adoption of traffic control measures and vehicle modernization, the number of these injuries has fallen by almost 70%, and the majority of patients today are people with acquired brain damage. Among this group of patients, there are increasingly more patients who have had a stroke, with a significant increase in younger patients. Institut Guttmann also admits pediatric patients, serving 400 children and adolescents (aged 0 to 18) each year in intensive rehabilitation. These are children with traumatic brain injury, spinal cord injury, stroke, and cerebral palsy.

After a complete diagnostic evaluation during the first week at Institut Guttmann, a personalized therapeutic plan is designed for each patient with explicit objectives and an estimated time period and discussed with the patient and his/her family. Throughout the stay at Guttmann, the patient and his family will work with a multidisciplinary therapeutic team: the doctor, neuropsychologist or psychologist, nurse, physiotherapist, occupational therapist and social worker. Other specialists will also be involved if the patient is going through rehabilitation, for example, urologist, speech therapist, plastic surgeon, physical education specialist or physical therapist. But it is the core therapeutic team that will be in charge of monitoring the patient’s evolution and systemizing and adapting the therapeutic plan.

Each patient will participate in different custom-designed activities throughout the day, and a lunch break is provided. These activities include physiotherapy using electromechanical and robotic systems to regain walking ability and other functions that have been lost or altered; cognitive rehabilitation, including exercises from the Guttmann Neuropersonal Trainer cognitive rehabilitation platform developed by the institute; transcranial magnetic stimulation using virtual reality; and programs to improve autonomy and functionality. The specific therapeutic plan is always designed based on the specific needs and conditions of each patient and often also includes the treatment of dysphagia, aphasia, neuropathic pain, spasticity, and (a crucial aspect for many patients) the treatment of urinary disorders and sphincter control. The rehabilitation process will be evaluated constantly throughout the patient’s entire stay at Guttmann and modified according to the patient’s evolution.

Advanced clinical procedures:

The hospital works with the most advanced rehabilitation procedures, some developed by the hospital’s specialists or with their collaboration, based on the scientific evidence:

• Neuroorthopedics: spine surgery, multilevel, hand surgery
• Neurourology for the treatment of neuropathic bladder, sphincter control
• Neuroprosthetic and neurostimulator transplants, diaphragmatic pacemakers
• Reconstructive and plastic surgery
• Specialized neurophysiology, sleep study, motion and gait analysis lab
• Study and treatment of dysphagia and neuropathic bowel conditions
• Non-invasive brain stimulation (TMS, tDCS)
• Sensory stimulation room (Snoezelen Room), music and dance therapy workshops
• Robotics applied to walking and the mobility of the arm and the hand
• Virtual reality systems and vehicle driving simulator
• “Guttmann, NeuroPersonalTrainer®” cognitive stimulation programs
• Adapted and inclusive sports initiation schools
• Mutual aid therapeutic groups (“patient/expert caregiver”)

Over 5,000 patients treated per year, clinical practice based on innovation and scientific evidence, professionalism and practical ethics, patient monitoring system and outcomes ranked on international scales – Institut Guttmann, well regarded in the scientific community, offers all this and more, along with the transparency with which the center audits and publishes its results.

Everything at Guttmann is carefully designed and adapted to the needs of each individual patient: if a patient is only able to move his eyes, for example, Guttmann will provide an adapted computer so that the patient can use his eyes to write. A patient who needs to relearn how to swallow will be assigned neurofeedback therapy. This level of personalization is what sets this neurorehabilitation center apart and makes each and every patient feel highly secure and confident in their treatment.

Institut Guttmann is the top neurorehabilitation center in both Catalonia and Spain and receives many patients from all over the world in addition to national patients (adults and children) who receive free treatment under the public health system. The center has one of the highest concentrations of neurorehabilitation cases in the world and this critical mass is the cornerstone of the ample experience of the institute’s professionals.