EFNR Congress 2021

In 2021, the European Federation of Neurorehabilitation (EFNR) partnered with Die Deutsche Gesellschaft für Neurorehabilitation (DGNR) for a 4-day inspiring scientific event covering diverse topics and perspectives from biometrics, big data, Virtual reality, and robotics to motor neurorehabilitation, neuroimaging, basic and translational research, public health, neurophilosophy, pharmacology, and many more. The multidisciplinary bi-lingual event (in both English and German) was presided, over from the side of EFNR, by D. Muresanu (Romania), as the EFNR President and V. Homberg (Germany), as Vice-President; from the side of DGNR, the presidium encompassed T. Platz (Germany) as President and C. Dohle (Germany) as vice-president. The much-expected event took place from the 8th to the 10th of December, encompassing 3 full days of presentations, workshops and lively discussions. Due to the constraints of the pandemic, the event took place online.

EFNR Congress | Day 1

EFNR/DGNR Teaching Day

The first session of the Congress, entitled “Young clinician teaching day” was chaired by Heinrich Binder (Austria) and brought together distinguished international speakers on a set of inspiring presentations:

• Basic structures of rehabilitation were discussed by Heinrich Binder (Austria)
• The importance of goal setting and monitoring was highlighted by Klemens Fheodorof (Austria).
• The organization of the neurorehabilitation team was showcased in the presentation of Leopold Saltuari (Austria). Multidisciplinarity is a valuable concept that should be at the heart of developing strong neurorehabilitation teams, as varied expertise can improve both the outcome and quality of life of the patient.
• The principle of brain recovery was discussed by Dafin Muresanu (Romania). Prof. Muresanu pinpointed the factors involved in the rehabilitation process (1) the lesion and (2) the biological reserve of the patient and highlighted the particularities of the 2 sequences of post-lesional brain regulation, namely neuroprotection and neurorecovery. Furthermore, he presented the concepts in the context of the 3 levels of CNS endogenous modulation and neurorestoration, namely (1) the cellular level, (2) the circuitries level, (3) the dynamic network level, showcasing the similarities between the “teamwork” of the specialists involved in neurorehabilitation process and the “teamwork” of the neurovascular unit, showcasing the importance of collaboration for the EFNR.

The second part of “Young Clinician teaching day” included presentations on the assessment of motor problems, language rehabilitation, and design of clinical studies by speakers such as Stéphanie Clarke (Switzerland), Klaus-Martin Stephan (Germany), Pamela M. Enderby (Great Britain). In the 3rd part, Volker Homberg (Germany) approached the basics of sensory-motor learning and differential therapies in motor rehabilitation, while the 4th part of the session covered pharmacology, disorders of consciousness, disorders of attention and working memory, and memory impairment, with international speakers including Volker Hömberg, Heinrich Binder, Sonia Crottaz-Herbette, Robyn Tate.

DGNR Activities

Professional associations presentations

Representatives from the German Association of Occupational Therapists discussed prospects and opportunities, more precisely, experiences in implementing a manualized occupational therapy intervention and VR-supported Occupational Therapy. The German professional association for Nursing Professions discussed opportunities and challenges in assessing people with neurological impairments, pinpointing the importance of the scientific nursing assessment, experiences with a new assessment instrument in people with certain neurological diseases, and special requirements for assessing children and adolescents with neurological diseases. Moreover, the German Neuropsychological Society presented on neuropsychological disorders in patients post-COVID-19, showcasing the spectrum of symptoms and differential diagnostic consideration, discussing the NeuroCOVID International Neuropsychology taskforce and supporting the interdisciplinary concept in the treatment of NeuroCovid symptoms. The German Association for Social Work in Health Care discussed neurorehabilitation from the perspective of health-related social work, with insights into the role of participation and orientation. The speakers representing the German Association for Physiotherapy discussed neurophysiotherapeutic aspects, including motor learning, non-invasive brain stimulation, and walking ability post-stroke, while the German Federal Association for Speech Therapy offered a seminar on neurorehabilitation and speech therapy, showcasing the beginnings and prospects of the practice, the importance of social cognition, and communication in adults with TBI.

DGNR Modules

The first DGNR Module, “Organizational bases – therapeutic teams and payers”, introduced organizational aspects in the form of a webinar, discussing general structures of neurological rehabilitation, the peculiarities and importance of the interdisciplinary team, the legal framework and different responsibilities of social service providers, and the Quality Assurance Programs, Certifications, DRG and OPS Therapeutic Rehabilitation Care. The second module, “Neurophysiological principles and methods to support plasticity”, pinpointed on basics of plasticity and non-invasive neuromodulation and drug support for functional recovery. Module 3, “Specific therapeutic procedures in motor rehabilitation”, covered mobility rehabilitation and upper limb rehabilitation, while Module 4 introduced discussions on rehabilitation of cognitive disorders, including rehabilitation of organically caused memory disorders and the severe disturbances of consciousness. The last module of the day, Module 5, approached speech and swallowing rehabilitation and the importance of nutrition through presentations on dysphagia and tracheostomy tube management, nutrition in neurological rehabilitation and aphasia therapy.

EFNR Activities

EFNR Workshops

Several workshops have been organized throughout the day on a wide range of topics, including:

• perspectives of application of brain-computer interfaces
• the treatment of neglect with prism adaptation
• mirror therapy and new therapies of action observation, where topics such as body image distortion in stroke patients, research insights, and EEG biomarkers were highlighted by the international speakers
• ways to impairment-oriented rehabilitation with a focus on enriching stroke rehabilitation, available strategies, and the needs in further research
• spasticity and the role of intrathecal Baclofen
• practical applications of non-invasive stimulation techniques, including transcranial magnetic stimulation and neuronavigation
• long-COVID problems, including clinical practice recommendations and post-covid rehabilitation
• applications of ICF in rehab planning and monitoring
• how to create „enriched environments“ in human motor rehabilitation
• study designs, meta-analyses, from evidence to practice recommendations, and beyond. The workshop introduced various study designs for clinical research, discussed the methodology for generating evidence-based practice recommendations for service development, and highlighted the role of evidence in supporting a more profound understanding of post-stroke arm rehabilitation.

Symposiums

The day included 3 symposiums, namely:

• The first one was the  Neuroreha 2030 – Der Blick vom DACH.
• The Second DGNR Symposium addressed lesions from (post-) Covid-19, including Neurological (early) rehabilitation of the post-COVID syndrome, Post-/Long Covid and (pulmonary) rehabilitation, whether outbreaks are avoidable, and  challenges of the pandemic in neurorehabilitation.
• Lastly, the third DGNR symposium covered neuropediatric rehabilitation, highlighting the value of neuroradiology in pediatric neurorehabilitation, (Neuro) Rehabilitation of Children and Adolescents with Long Covid, and the new cost regulation for neuropediatric rehabilitation in Switzerland.

The day also included a presentation of INNOWALK – The full body movement trainer and ended with a presidential session. Here, Prof. Muresanu (Romania) led the audience through an inspiring presentation, “Advances and updates in neurorecovery after stroke”, firstly addressing the three pillars in the science and practice of brain protection and recovery (1. theory and basic research; 2. evidence-based parameters; 3. external validity). Then, prof Muresanu offered insight into the burden of neurological disorders in Europe, approached the topic of stroke treatment and neurorehabilitation while showcasing the post-stroke recovery phases, and presented early motor rehabilitation and additional pharmacological support. He also revealed the intention of EAN and EFNR – the development of neurorehabilitation guidelines based on EAN and EFNR philosophy – namely to support the clinical decision-making of healthcare professionals to improve outcomes for acute ischemic stroke patients. He compared it to the GRADE system and process in Europe, pinpointing similarities and highlighting further considerations of the guideline, such as treatment safety, steps in its development, and the summary of findings.

EFNR Congress | Day 2

EFNR Activities

EFNR Symposia

The EFNR Symposia covered a plethora of topics, including:

• “Early Rehabilitation”, which covered prognostic features in Disorders of Consciousness (DOC), early mobilization, and a presentation on probing consciousness in a sensory-disconnected paralyzed patient.
• “Time and time perception” covered presentations on the neurology of the sense of time and the brain areas involved in the subjective experience of time.
• “Neglect” discussed current approaches to neglect rehabilitation and pharmacological options.
• “Neuropediatrics” covered the efficacy of neuropediatric rehab in CP and acquired brain damage as well as pediatric stroke and therapy of children after perinatal stroke.
• “Stroke Rehabilitation” pinpointed topics such as the recovery of the quality of movement early post-stroke and the framework for studying stroke recovery.
• “The pivotal role and the importance of motivation in neurorehabilitation” showcased the role of games and application scenarios.
• “Neurorehabilitation and spirituality” addressed the religious brain and the relationship between neural plasticity and faith.
• “Neurosurgery” discussed new perspectives for neurorehabilitation, fast track in neurooncology and deep brain stimulation and its impact on neurorehabilitation.

Other activities

Other EFNR events of the day included the “SelfStudy – ePoster self-study” session, the 2nd plenary session “Neurorehabilitation – where did we come, where do we go?” discussing stroke rehabilitation from a worldwide perspective and neurorehabilitation in Africa, the “EFNR Cooperating Society 1 – World Stroke Organization (WSO)” which approached topics of brain-computer interface based stimulation device for patients with sub-acute ischemic stroke, repetitive transcranial magnetic stimulation for post-stroke motor recovery, and deep brain stimulation for post-stroke recovery. The EFNR Round Table “Chances for young neurologists in neurorehabilitation” showcased speakers’ presentations on their careers and the current career path in neurorehabilitation.  The EFNR program of the day ended with a session on oral presentations.

DGNR Activities

DGNR Symposia

Similarly, the DGNR Symposia covered a vast plethora of topics:

•  The “Where did we come” symposium discussed the development of neurorehabilitation and the phase model.
• The “Where do we go?” symposium covered experimental animal research, brain stimulation, and translational spinal cord stimulation.
• Another symposium focused on guidelines, discussing European guidelines for the diagnosis of severe DOC, guidelines for neurological rehabilitation in coma and severe consciousness impairment, COVID-19 and early rehabilitation, among others. 
• The last of the symposia discussed a plethora of topics, from the Winner of the Otto Löwenstein Research Prize 2020 to somatosensory neuroprostheses, psychotherapy after acquired brain damage, predictive factors of knee hyperextension, early mobilization of stroke patients, the efficacy of group therapy, the effect of calory restriction for obese patients in improving verbal hippocampal memory, nutritional concepts for stroke prevention, effects of choral singing for quality of life in patients with chronic aphasia.
• “Evidence syntheses – meta-analyses and more” showcased therapies for emotional and cognitive disorders after stroke, mental practice for treating upper extremity deficits in individuals with post-stroke hemiparesis, and telerehabilitation services from the perspective of recent Cochrane reviews.

Other activities

Other DGNR activities included the third plenary session, the Workshop “Expertise in neurorehabilitation” on the importance of assessment in neurorehabilitation, standards and typical mistakes in social law assessment, and typical problems in the assessment of neuropsychological consequences of accidents. Other workshops included “Transcranial direct current stimulation in neurorehabilitation”, and “Telematic outpatient neurorehabilitation / outpatient aftercare”, covering topics of telerehabilitation, tele-rehab aftercare, teletherapy and telerehabilitation in aphasia, and lastly, “Therapy of the upper extremity after a stroke”. In addition, there was a “Meet the expert” session with Katharina Brück.

EFNR Congress | Day 3

EFNR Activities

EFNR Symposia

The EFNR Symposia covered:

• “Pharmacology in neurorehabilitation” on the current state of affairs, developments in TBI clinical research, and monomodal vs multimodal drugs. 
• The Industrial Symposium covered a presentation on an eHealth platform, a medical DataMarket & the first healthcare metaverse. 
• “Long-COVID – Chimera or reality?” covered the management, clinical signs and symptoms, incidence of issues of long-COVID and digital solutions for long-COVID fatigue.
• Transcutaneous vagal nerve stimulation and its applications for stroke and Parkinson’s disease rehabilitation. 
• Advanced technologies, including brain-computer interfaces and VR.
• Neuromodulation, including transcranial direct current stimulation for motor recovery after stroke and transcranial stimulation in the Parkinson’s Disease.
•  Functional neurologic disorders, covering assessment, diagnosis and treatment.

Other activities

Other EFNR events of the day included “The impact of microRNA in brain recovery”, developed with the support of The Foundation of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), which covered presentations on synergic mechanisms in brain recovery after acute ischemic stroke, stroke and microcirculation, and new therapeutic solutions in post-stroke cognitive impairment. Here, distinguished speakers such as Michael Chopp presented on neurotrophic factors and rTPA-synergic mechanisms in brain recovery after acute ischemic stroke, highlighting the effectiveness of Cerebrolysin as a neurovascular therapy for stroke and offering transformative insight into how exosomes play a pivotal role in mediating and facilitating the therapeutic benefits. Further on, Dafin Muresanu (Romania) offered an insightful presentation on stroke and microcirculation, discussing the principal therapeutic approaches in acute ischemic stroke, brain microcirculation, the multimodal drugs mechanisms of action of Cerebrolysin, and the role of Cerebrolysin in acute ischemic hemispheric stroke. Prof. Muresanu reiterated the principle of BRAIN RESERVE and the importance of continuing investigation past the acute phase, investigating the full capacity of the brain to recover, and once again pinpointed the multidisciplinarity concept of neurorehabilitation in stroke and the need for amultidisciplinary team, and the role of societies such as WFNR and EFNR. Natan Bornstein (Israel) presented “New therapeutic solutions in post-stroke cognitive impairment”, discussing cognitive impairment and its types, the prevalence of dementia in stroke patients, and the mechanisms of post-stroke cognitive impairment. Prof. Bornstein highlighted the importance of preventing cognitive decline due to vascular changes in the brain using drug interventions and the role of complex lifestyle and multidomain interventions.

The EAN Session

The EAN Session – The EAN Session was chaired by the distinguished Dafin Mureșanu (Romania). The first presentation, from Antonio Federico (Italy), offered an incursion into the clinical heterogeneity of neurogenetic diseases. As times evolve, a new and growing class of presymptomatic patients are detected, which poses specific inquiries. Prof. Federico discussed the issue of clinical heterogeneity, and its contributing factors, taking into consideration the environmental and toxic factors. He highlighted the heterogeneity of rare neurological diseases, touching on topics such as homozygosity, mechanisms of heterogeneity, interactions of drugs on genotypes, and mitochondrial diseases. His insight aided the audience in better understanding the complexity of neurogenetic diseases and specialists in considering uncommon presentations of neurological disorders. Further on, David Vodusek (Slovenia) offered a presentation on pelvic problems, discussing the conceptualization of bladder, bowel, and sexual functions, highlighting medical and psychosocial components. He discussed the motor control of pelvic floor muscles and the positive influence of training said muscles, as well as the importance of effective communication in delivering quality patient care for pelvic problems. Further on, Prof. Dafin Muresanu (Romania) offered a glimpse into the challenges and opportunities in stroke recovery, discussing neuroplasticity – the ability of the brain to restructure itself after training or practice – in learning and behavior and reiterating the relevance of anticorrelation on all three levels, based on integration and segregation. He pinpointed the role of active learning in plasticity, discussed anticorrelation in different models, the process of neurorestoration, and the need for different recovery paradigms. Prof Muresanu restated the role of biological reserve and discussed the importance of stroke units,evidence-based guidelines, and the appropriate time to start rehabilitation. The EFNR Cooperating Society 5 by THE World Federation of Neurology (WFN) covered diagnostic methods in neuromuscular systems, surgical possibilities in cranial nerve lesions and new therapies in neuromuscular diseases. Lastly, EFNR hosted two Oral Presentation sessions.

DGNR Activities

DGNR Symposia

Similarly, DGNR covered a broad set of symposia, focused on:

• “Pivotal trials” on neurorehabilitation and stroke 
• “Neglect Rehabilitation” on bottom-up based intersensory facilitation in the treatment of neglect, video-based oculography,  acoustic movement perception in neglect patients, RCT on the effect of two prism regimens for the treatment of neglect and a presentation on prism spectacles adaptation. 
• “Health care situation and health care research” covered the certification of weaning centers in neurological-neurosurgical early rehabilitation, a Survey on the Berlin Stroke Alliance, a presentation of the OptiNIV project, and insight into telemedicine day clinics. 
• “Young scientists (masters and doctoral theses)” showcased a comprehensive set of topics, including plyometric training of the lower extremities after stroke, the role of interleukin-4 in secondary brain damage after TBI, the assessment of motor and gait function using the CatWalkXT®, oral care in intensive care and early rehabilitation wards, vestibular stimulation, randomized controlled trials in the routine operation of neurological rehabilitation facilities, patient preferences for Robotic and Assistive Technologies in Healthcare, assessment of robotic neuro-rehabilitation, and therapeutic effects of peripheral electrical stimulation. 
• “Education, training and further education” showcased the role of training and continued education of therapists in neurorehabilitation,and that of and encouraging factors and barriers in the use of LiN. 
• “The therapeutic interaction and relationship” showcased insight into creating a sustainable therapeutic relationship, the organic nature of symptoms in patients with Multiple Sclerosis (MS), the decision-making authority of the patient with MS, a short questionnaire to record perceived patient characteristics during rehabilitation therapy, and a new instrument for standardized recording of therapeutic interaction, namely THER-I-ACT (THERapy-related Inter-ACTion). 
• “Technological innovation and clinical research” highlighted topics such as a humanoid robot as therapy assistant, technology-based research, robot-assisted assessment of proprioceptive hand deficits in stroke patients, and electrophysiological and behavioral effects of anodal and cathodal transcranial direct current stimulation in stroke.

DGNR Workshops

Further on, DGNR hosted 4 workshops on the 3rd day, which included: 

• “Neurological syndromes in intensive care medicine”.
• “Current developments in the rehabilitation of neuromuscular diseases” focusing on patients with neuromuscular diseases during the pandemic, teletherapy in neurorehabilitation with EvoCare, and digital innovations for people with ASL.
• ”Change of perspective – neurorehabilitation from the patient’s point of view” highlighting patient orientation in neurological research, measurements of outcome quality in neurological and geriatric rehabilitation, and measurements of patient preference.
• “Assessment of fitness to drive in neurological rehabilitation” focused on assessing fitness to drive in neurological rehabilitation. 

Other DGNR events of the day included a series of short lectures and the 4th Plenary session, “ Achievements and limitations of cognitive neuroscience from a philosophical point of view”. Further activities included the “SelfStudy ePoster self-study” and two “Meet the Product” sessions. A joint EFNR-DGNR symposium discussed Virtual Reality, including VR4Rehab, VR applications in neurorehabilitation, immersive virtual road crossing tasks for the diagnosis of neglect, and cognitive deficits in neuroimmunological and neurodegenerative diseases. The day ended with a Special lecture on the status of the human brain project.

EFNR Congress | Day 4

EFNR Activities

The last day included two Sessions of Oral presentations, the 5th plenary session “Practice recommendations for communication disorders post-stroke and six symposia:

• “Cost-effectiveness in neurorehabilitation” discussed the economics of neurorehabilitation, the cost-effectiveness of neurotrophic factors for acute ischemic stroke, and the PRESENT Registry for traumatic brain injury. Irina Vlad (Romania) showcased a new and exciting patient registry for Traumatic Brain Injury (TBI), aiming to cover the gaps, especially for low- and middle-income countries and low-income countries (LMIC) and low-income countries (LIC), where there is a dire need of centralized quality data. The undesired effects of TBI were discussed from an epidemiological point of view, showcasing “the silent epidemic” as the main concern in LMIC and LIC. Dr Vlad discussed current trends for patient registries at the global level and showcased the structure and content of PRESENT (Patient Registry Essential Short Neurotrauma).
• Tübingen study on stroke rehabilitation prognosis and prognostic algorithms for the upper paretic limb after stroke.
• “Complex regional pain syndrome patients characteristics, clinical aspects and associated changes in Neurophysiology” addressed clinical aspects and associated changes in Neurophysiology, GMI as a tool for a transfer back into the usage of the affected limb in CRPS and other pain syndromes, and the role of Biomarkers for longitudinal studies in neuropathic pain.
• “Speech and language” pinpointed the management of aphasia in underserved or unserved populations, primary progressive aphasia in bilingualism, and paediatric aphasia. 
• “Special session: Creativity” addressed creativity as a western concept and its relationship with scientific thought.
• “Sleep and sleep disorders” presented lucid dreaming and the interrelation of sleep with neurology. 

DGNR Activities

The DGNR events of the day included six Symposia and two Workshops. The symposia focused on the following:

• “Aphasia therapy – intensified and supplemented by brain stimulation?” introduced discussions of post-stroke Intensive speech therapy, the use of non-invasive brain stimulation in intensive speech therapy, and Influences beyond treatment intensity on the relief of aphasic and depressive symptoms. 
• “Long-term rehabilitation/ Phase E” covered long-term opportunities for people with acquired brain damage, stroke aftercare, and the interface between rehabilitation and social space. 
• Industrial symposium, where German speakers discussed neurological-neurosurgical early rehabilitation and Incobotulinum toxin A in children and adolescents with chronic sialorrhea.
• Neuroplasticity and functioTMS and TMS-EEG in stroke rehabilitation, disgust recognition following stroke.
• “Outcome measurement in neurorehabilitation” highlighted Quality assurance of Hamburg phase B facilities, the circadian differential effect of fatigue in multiple sclerosis on sustained attention performance, and Cognitive fatigue as a significant predictor of employment status 3 months after discharge.
• “Beyond Motor Skills – Action & Perception”, the presentations centered around the reorganization of the brain during neurorehabilitation and the role of action re-enactment in cognition
• “Swallowing disorders and tracheal tube management”, where the speakers showcased neurotomy of the swallowing process, objectification of swallowing disorders, and observational Findings on TK Management.

Other DGNR Events included 2 workshops with insightful talks on the Multi-professional interaction in weaning, NIV in neurological diseases, and patient journey in intensive care medicine, and “ReMoS – Therapy of the lower extremities after a stroke”. Finally, some special events from the last day included the  “Selfstudy – ePoster self-study” and a “Meet the expert” session showcasing Neofect and Opportunities of digital biofeedback systems in motor neurorehabilitation. Finally, a farewell and the closing session ended the 4-day event. 

The multidisciplinarity and multimodal approach were shown through the complexity of the sessions, the plentitude of workshops, as well as the innovative dynamic sessions with international experts.

The full list of speakers and the full program can be accessed here.