Bellikon Rehabilitation Clinic

BackgroundRising healthcare costs, limited resources, and fragmented systems challenge the sustainability of public health and social security. Persons with disabilities, especially those with acquired brain injury (ABI), face compounded risks due to service disconnection. In Switzerland, despite comprehensive social security schemes, fragmented service delivery, regional disparities, and rigid deadlines hamper effective coordination-especially within disability insurance, which seeks to support work capacity and prevent long-term disability.ObjectivesThis study aimed to (1) examine current service provision dynamics and interactions across sectors for persons with ABI, and (2) define key components of an optimal, lifelong service pathway supporting sustainable employment.MethodsUsing an Integrated Knowledge Translation approach, we partnered with knowledge users across healthcare, insurance, and policy to identify barriers and co-create solutions. We conducted a three-phase process-reviewing existing data, mapping the current ("As-Is") system, and envisioning an ideal pathway-drawing from prior research and new surveys with neurorehabilitation centers and disability insurance offices.ResultsThe current service landscape for ABI reveals critical gaps grouped into four domains: information, communication, coordination, and financing. Individuals and families often lack clarity about care steps and entitlements. Fragmented systems and minimal case management obstruct vocational reintegration. Financial insecurity, delayed support, and brief rehabilitation further undermine outcomes. Stakeholders underscored the need for lifelong case management and ABI-specific care guidelines.ConclusionsCoordinated service pathways enhance care by revealing structural barriers and guiding targeted action. Engaging diverse stakeholders in co-design strengthens policy relevance and implementation, helping bridge critical gaps in lifelong support for people with ABI.Key messages• Identifying key service gaps helps improve lifelong support for people with ABI and strengthens their chances of sustainable employment.• Co-designed pathways with stakeholders enhance coordination and drive practical policy change for ABI care in Switzerland.

BackgroundIn our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2).MethodsPersons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS.ResultsTwenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47–86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3–119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history.ConclusionResting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.

The effect of two-point discrimination described in this case report indicates acortical reorganization through electrical stimulation of receptive fields. The "intervention units" compared to the "baseline" show clear effects. The pain behavior in both "intervention units" showed aclear change in the phantom phenomena, which in both "wash out" phases moved back towards "baseline". Thus, electrical stimulation of receptive fields could be another therapy for the treatment of phantom pain, given the change in two-point discrimination.

Die Prognose der Frakturheilung hangt wesentlich von dem begleitenden Weichteilschaden ab. Offene Frakturen werden notfallmasig operativ versorgt, um tiefe Infekte moglichst zu vermeiden. Die Knochenheilung an der Frakturstelle benotigt immer eine ausreichende Durchblutung.

Leider sind die Erkenntnisse der aktuellen Forschung bezuglich dieser Thematik lediglich auf Stufe der „Petrischale“ und selten in Tierversuchen zu finden. Der klinische Ubertrag auf den Menschen fehlt bis jetzt ganzlich. Dies lasst somit lediglich klinische Uberlegungen kombiniert mit empirischen Erfahrungswerten zu.