[Challenges in Rehabilitation of People with Cognitive and/or Multiple Impairments: Insights from a Pilot Study]

The study addresses the gap in rehabilitation care of people with cognitive and/or multiple Impairments. Conventional medical care structures are often insufficiently adapted to the needs of this patient group. In this project, the rehabilitative care gap is practically closed with a social space-oriented rehabilitation concept for people with cognitive and/or multiple Impairments and to create sustainable solutions. The challenges of needs-oriented rehabilitative care for IdmD and the solutions from the experimental pilot project are presented and discussed.This study was designed as a prospective, monocentric pilot study with an exploratory character. An interprofessional team systematically documented the challenges and inhibiting factors during the implementation and intervention phase in a laboratory book.A total of 15 people with different cognitive and/or multiple Impairments and contextual factors participated in the pilot study. Even during the preparation for the intervention phase, challenging structural aspects arose, particularly in resource and process planning. During the intervention phase, organizational challenges came to the fore, such as scheduling appointments with caregivers, coordinating transport services and managing room availability. Direct interactions with patients required spontaneity and improvisation to address individual behaviors and challenging situations effectively.The social environment-oriented rehabilitation concept shows that the heterogeneous needs of people with cognitive and/or multiple Impairments can be addressed individually and that participants can be successfully supported in achieving their participation goals. The social environment-oriented rehabilitation concept is practical to implement. It appears to be a promising development in the health care system in the context of demographic changes, increase in chronic illnesses, and increased use of outpatient medical treatment.