Rehabilitation In Eastern Europe

(The following is an abstract of an article, "Experts in Rehabilitation Use Universal Concepts," which appeared in the January 16-17, 1965 issue of MEDICAL TRIBUNE.)

An International Symposium on Rehabilitation held in Halle, East Germany recently, was attended by 120 experts from East Germany, Poland, Czechoslovakia, Hungary, Romania, and Bulgaria. Professor Dr. Karlheinz Renker, director of the Institute for Social Hygiene at Martin Luther University, Halle, and president of the East German Society for Rehabilitation, was chairman of the symposium.

Dr. Renker contended that the purposes of rehabilitation in Communist societies differed from those in non-Communist countries. "Rehabilitation," he said, "is a system of measures to enable physically or psychically disabled persons to take an active part in life. It is a system which requires the cooperative application of medical, pedagogic, psychotherapeutic, social and economic help." Dr. Wiktor Dega, director of the Orthopedic Clinic at Poznan, Poland, defined rehabilitation as "a procedure that leads the disabled or the chronically ill patient to a specific, previously outlined goal. That goal is to restore the patient, insofar as possible, to society and a productive, satisfying life. But the precondition for all rehabilitation is complete psychic acceptance of the disability and internal reconciliation and harmony."

From these and other statements at the meeting it would appear that, polemics aside, Communist concepts of the purposes of rehabilitation differ very little from those current in other parts of the world.

Rehabilitation in Poland

In Poland, rehabilitation is considered a separate medical specialty. Dr. Janina Tomaszewska, who holds the chair for medical rehabilitation at the Poznan Medical Academy, reported on the sports activities included in the Polish rehabilitation program. See Fig. 1 and Fig. 2 .

In 1949 swimming was introduced as a rehabilitation measure for arm amputees, leg amputees, paralytic polio patients, and flaccid and spastic paralytics. "We discovered that these patients felt very well in water, which became an element in which they could give vent to their energy," Dr. Tomaszewska said.

Skiing, introduced in 1956, has proven so popular with amputees that skiing classes and winter camp programs have been staged annually since then. Last winter more than 100 leg amputees were taught to ski at a center in Bucovina.

Summer camp programs where patients are taught to row (with special terminal devices for arm amputees), to canoe, and to swim are also conducted.

Dr. Tomaszewska commented that while the sports program cannot yet be evaluated scientifically, the reactions of patients indicate that athletic training helps increase the capacity to maintain balance and helps disabled people cultivate adroitness, orientation and courage.

Invalid Cooperatives

Dr. Aleksander Nauman, of the Hanka Sawicka TB Rehabilitation Sanitorium in Otwock, Poland, described the close relationship between clinical therapy and rehabilitation at his institution. An interesting feature was the system of "invalid cooperatives" for patients and convalescents; with an employment program involving shortened work hours, dietary programs, and specially suited working surroundings for the participants.

A further report on the "invalid cooperatives" was given by Tomasz Lidke, director of rehabilitation in the Polish Health Ministry. These cooperatives were established immediately after the war, primarily to employ war invalids. Today they serve almost every type of invalid, fulfilling the double purpose of employing the disabled and training those who can later be absorbed into industry outside the cooperatives.

The cooperatives receive benefits, such as tax exemptions, from the Government, but otherwise are competitive with outside industry and operate to meet local economic needs. For example, in rural areas, they might provide repair services (radios, television, watches, household appliances).

Controversial Issue

One of the most controversial issues at the symposium, stimulated primarily by the Polish reports, was the question as to whether rehabilitation should be considered a specialty. Both Dr. Wassil T. Zontschev of Sofia, Bulgaria, and Dr. Vladimir Janda, of the Neurological Clinic at Charles University in Prague, Czechoslovakia, argued against this concept.

"In view of its complex objectives," said Dr. Zontschev, "rehabilitation seems to me to be a complex system involving medical and nonmedical processes that can be carried out only by the close cooperation of various specialists." Dr. Janda added, however, that "We consider it essential that specialists who are interested in rehabilitation be given as much support as possible in adding to their knowledge of rehabilitative processes and methods."