The outpatient therapy center of Vivantes Rehabilitation GmbH at Vivantes Auguste-Viktoria Hospital is Berlin's largest rehab facility. The dedicated team focuses on interdisciplinary cooperation and individual care.
Dietmar Lutze-Stallmann has been very active in sports all his life. Now 68, the Berlin native taught physical education and mathematics, he was a ski mountaineer and ice hockey player, and even played in the national league. Two and a half years ago - one month after his retirement - something completely unexpected happened: he suffered a severe stroke. On this Thursday in spring 2017, Dietmar Lutze-Stallmann has just finished a unit of strength training in the outpatient therapy center at Vivantes Reha: His left arm is still very weak, something he has been working on intensively here in recent weeks. 220 places are available in the therapy center for patients with orthopedic, cardiological, oncological and neurological diseases. Treatment by the interdisciplinary team is based on three pillars: on active measures such as physiotherapy or ergotherapy. On a passive block, which includes heat applications, relaxation and information, for example through lectures. And on an educational part, in which patients learn how to cope with their disease.
"Our patients are treated exclusively on an outpatient basis, which means close to home and on a day-care basis," explains Dr. Johannes Danckert, Managing Director of Vivantes Rehabilitation GmbH. "They can remain in their familiar environment during treatment and benefit from close interaction with acute clinics, physicians and therapists." Dr. Tillmann Stock, medical director of the orthopedics department, experiences this as very helpful: "We benefit greatly from the fact that doctors from other specialties are available to consult - many things complement each other." His colleagues and he get to know the patients in the first few days of rehab, decide on therapies and put together a kind of schedule: "Every patient is unique." Dietmar Lutze-Stallmann is currently in the room with the training equipment that can train and improve strength, endurance and balance. "Therapy here has made real progress for me," he reports. Sports therapist Kristin Frenkert is part of the team and assigned to the training room. She is approachable for all patients and also motivates when someone is having a difficult day. "We work out an individual program for everyone and readjust it as needed each time," she explains. Everything is documented in a folder. "That way, everyone can track their progress," adds Kristin Frenkert. Dietmar Lutze-Stallmann puts it this way: "If you don't practice, you won't get anything."
Not too much - and not too little
The patients come with very different conditions: Dieter Lutze-Stallmann, with his complaints following a stroke, is just as much a part of the group as the 20-year-old who tore his cruciate ligament playing basketball, or the woman in her mid-forties with breast cancer. "The challenge for us is to asset the state of every patient and provide optimal support," says Kristin Frenkert. "We always try not to demand too much and at the same time not too little." The visit to rehab usually runs for a total of three weeks. Patients are at the facility for at least five hours per day on average. "During this time, we want to lay the foundation for them to manage their daily live well, return to work, and become and remain mobile for old age," explains Kristin Frenkert. Three weeks is not long, but many of the patients experience what is possible during this time. "People who are particularly reluctant to exercise see how good exercise does them and that it can really make a difference," says the sports therapist. "For us, it's great that we get to witness that." In order to sustain the successes of the rehab, there is an aftercare program called "IRENA" in which patients can come to the facility twice a week for three more months and receive professional support. The rehab is also well positioned in terms of equipment. "For the success of the therapy, however, it is not decisive whether you train on high-tech machines," says Dr. Tillmann Stock. "Rather, it's the therapists and their competence and empathy that decide. You can also achieve a lot with a simple Thera-Band, and patients can use it to continue exercising at home."
Delicious and healthy cooking
Nutrition is also an important component in getting healthy again. In rehab, patients are advised on all matters relating to good food - in individual discussions and in the group. In a separate kitchen, practical tests are carried out on how to cook delicious food, with lots of vegetables or if, for example, the fish is "only" steamed instead of fried. "Many people think dieting is just for losing weight and it doesn't taste good," says dietician Andrea Tobehn. "Here, they have many an 'aha' moment." For example, when the groups look together at the ingredient lists of foods and discover a lot of sugar or artificial flavors.
At the beginning of each consultation, the patients also write a food log for a few days. "That's how we get to know their previous habits," says nutritionist Nikoletta Kaiser. Then it's a matter of taking small steps, because, "Bans don't work. They are adults, and they take responsibility for themselves."
Getting fit in the home environment
By no means all patients want to or should reduce weight. "Patients from the oncology field are often weakened by the therapies and underweight," says Nikoletta Kaiser. "Then the question is how to gain weight sensibly and which nutrients are perhaps particularly important." Nutritional counseling is therefore also very individual - and patients decide for themselves what they take away from it. Outpatient rehab also has advantages when it comes to nutritional counseling: "In the evening and on weekends, patients can directly implement what they've worked out here and see how they get on with it."
Dr. Tillmann Stock has been working at the outpatient facility for eleven years. The advantages of the outpatient concept are also clear to him: "The patients are made fit in their home environment. A lot of what we practice with them here they can try out directly at home - and not just three weeks later when they return home from an inpatient stay." Many patients also consciously opt for this option because they don't want to leave their partners, children, other relatives or pets alone for long periods of time. "Sometimes it's also cultural or language barriers that make it easier to stay in your own city," says the orthopedist. Interaction among patients is often very important, too, he said. "They can talk to each other and make contacts." The Berlin site is characterized by a strong mix of ages. "All generations meet here," says Dr. Tillmann Stock. "This can be beneficial for both be exciting for the younger patients as well as the older ones."