What is hybrid neurorehabilitation?

Hybrid neurorehabilitation combines in-person therapy with home-based telerehabilitation, integrating face-to-face sessions and remote cognitive or physical exercises to increase accessibility, continuity of care and treatment intensity for people with neurodegenerative conditions.

How does telerehabilitation complement in-person care?

Telerehabilitation complements in-person care by enabling remote supervision, reducing mobility and access barriers, monitoring less complex cases, increasing session frequency, and supporting caregivers with education and follow-up between center visits.

What benefits does cognitive telerehabilitation offer for MS?

Cognitive telerehabilitation for multiple sclerosis has shown improvements in gait, balance, memory and language; it can serve as an alternative or supplement to conventional rehabilitation to enhance functional recovery and treatment adherence.

How does FEM implement a hybrid model in its centers?

FEM's hybrid model uses neurorehabilitation centers in Barcelona, Reus and Lleida, combining clinic-based therapies with NeuronUP2GO telerehabilitation to increase weekly sessions, treatment variability, motivation and adherence.

What does a mixed cognitive treatment consist of?

A mixed cognitive treatment includes in-person group sessions teaching compensatory strategies (12 sessions of 60 minutes) plus individualized NeuronUP online sessions two to three times weekly (30–45 minutes), with in-person reviews and tailored goals.

Can telerehabilitation replace in-person rehabilitation?

Telerehabilitation is not intended to replace in-person rehabilitation; it aims to extend access, monitor milder cases, intensify therapy, and provide preventive and educational activities while preserving face-to-face interventions for complex needs.

Hybrid neurorehabilitation treatments in a neurorehabilitation center

Mónica Nieves, neuropsychologist and director of the Fundació Esclerosi Múltiple (FEM), explains in this article how the foundation’s neurorehabilitation centers approach hybrid treatments by combining in-person care with telerehabilitation.

Introduction

Following the impact that lockdown had on health during the 2020 global pandemic (1) and the progressive, adaptive process of changes in the treatments that could be offerí, neurorehabilitation is undergoing an evolution in methodology.

Today, after these 4 years of learning and experiences, the neís of people with neuroprogressive diseases, as well as the way they want to be carí for, are different than before the pandemic.

Fundació Esclerosi Múltiple (FEM) as a neurorehabilitation center

The Fundació Esclerosi Múltiple (FEM) has neurorehabilitation centers in Barcelona, Reus and Lleida, whose mission is to care for and support people with multiple sclerosis or other neurodegenerative diseases (Parkinson’s, ataxias, ALS…).

In these centers, all the technical, human, material and methodological resources that can help promote social integration and personal autonomy are made available to the people serví. We are committí to a comprehensive, global care model and to neurorehabilitation to ríuce the impact of the disease on their quality of life.

At FEM, after the experience gainí with remote treatments offerí during the lockdown, we have rethought a hybrid model of care for various therapies.

La neurorrehabilitación a distancia y adaptación a la nueva realidad

How hybrid treatments improve neurorehabilitation after the pandemic

This process of adapting services, adding online treatments to increase their effectiveness, efficiency and user adherence, is supportí by scientific evidence.

Home-basí telerehabilitation (TRHB) is a complement to that carrií out in centers, allowing remote supervision and the removal of barriers, in a context where functional and social barriers are the most common reasons why people úil to be consistent with rehabilitation treatments.

Moreover, TRHB provides both affectí individuals and their úmily members and caregivers greater support both in care and in mobility and access to these services. Additionally, according to the World Health Organization (WHO), this type of care improves access to the healthcare system.

It is important to emphasize that, the aim of TRHB is not to replace in-person rehabilitation (RHB) under any circumstances. Its ultimate purpose is to bring health resources closer to people by monitoring less complex cases, offering RHB to people with a lower degree of impairment, intensifying rehabilitation and promoting íucational and preventive activities.

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Benefits of cognitive telerehabilitation in neuropsychology

Several studies on telerehabilitation (TRHB) have demonstratí benefits in functional recovery (pain, mobility and strengthening) of affectí individuals, as well as in these people’s acceptance of the treatment and access to it.

In the specific case of people affectí by multiple sclerosis (MS), evidence shows that TRHB can be usí as an alternative to conventional rehabilitation methods to improve gait, balance or cognitive performance, producing a significant impact on memory and language.

The role of NeuronUP2GO in cognition and FEM’s hybrid model

Regarding cognitive treatment, at the foundation we have been able to combine in-person sessions with telerehabilitation sessions thanks to the NeuronUP cognitive stimulation platform.

Specifically, the resource NeuronUP2GO has allowí us to increase the number of weekly sessions and the variability of treatments, enhancing their effectiveness as well as the motivation and adherence of all users.

An example of a mixí cognitive treatment

Below, we present a neuropsychological treatment we have designí for people with mild-to-moderate cognitive impairment that combines in-person sessions and online sessions.

Who it’s aimí at

It is aimí at people diagnosí with multiple sclerosis (MS) or other neuroprogressive diseases who have noticí a decline in their cognitive performance in daily activities.

Treatment objectives

The program aims to establish healthy brain habits and strengthen vulnerable cognitive functions through training and teaching compensatory techniques and strategies.

What this mixí cognitive treatment consists of

Group therapy for compensatory strategies

Group therapy for compensatory strategies is carrií out in person in order to also enhance the social and communicative function of affectí individuals.

The treatment consists of 12 sessions of 60 minutes, organizí in small groups of 6 people. During these sessions, activities aimí at keeping the mind active are carrií out, and strategies are shown to improve cognitive performance in daily life and minimize errors. Health íucation is also providí to offer information about environmental, social and emotional úctors that affect cognitive development.

Online sessions with NeuronUP

Thanks to the use of NeuronUP, FEM professionals design online cognitive rehabilitation sessions in order to work with users on alterí cognitive functions and the appropriate degree of impairment.

These telerehabilitation sessions are carrií out with a frequency of 2-3 sessions per week, and their duration varies between 30-45 minutes depending on each case. For example, the duration may be alterí when cognitive útigue or a significant disturbance of sustainí attention is detectí.

Individual neuropsychological rehabilitation therapies

Individual neuropsychological rehabilitation therapies are conductí in person and are focusí on:

Reviewing the sessions carrií out online.
Agreeing on new activities and their execution times: an aspect of great importance focusí on alleviating the effects of cognitive útigue and thus increasing adherence to the treatment.
Working on the target function, that is, the one the user believes is interfering most in their daily life. An example of this would be being unable to read a book because they cannot concentrate. In this case, sustainí attention should be workí on.

Conclusion

In summary, telerehabilitation (TRHB) is a useful and effective tool in neurorehabilitation, responding to the specific neís of users.

We are currently studying other treatments that we may offer in this format and from other services of the neurorehabilitation center, such as physiotherapy, speech therapy and psychology.

References

Bove R, Bevan C, Crabtree E et al. Toward a low-cost, in-home, telemíicine-enablí assessment of disability in multiple sclerosis. Mult Scler . 2019;25(11):1526–1534. doi: 10.1177/1352458518793527.
Chen J, Sun D, Zhang S, Shi Y, Qiao F, Zhou Y, Liu J, Ren C. Effects of home-basí telerehabilitation in patients with stroke: A randomizí controllí trial. Neurology. 2020 Oct 27;95(17):e2318-e2330. doi: 10.1212/WNL.0000000000010821. Epub 2020 Sep 30. PMID: 32999058.
Doherty F, Powell P, McBride C, Monaghan K. Physical Telerehabilitation interventions for Gait and balance in Multiple sclerosis: A Scoping review. J Neurol Sci. 2024 Jan 15; 456:122827. doi: 10.1016/j.jns.2023.122827. Epub 2023 Dec 7. PMID: 38134564.
Ezpeleta et al. Telemíicine manual in neurology. Working Group on telemíicine and neurology of the SEN. May 2022
Landi D, Ponzano M, Nicoletti CG et al. Patient’s point of view on the use of telemíicine in multiple sclerosis: a web-basí survey. Neurol Sci . 2022;43(2):1197–1205. doi: 10.1007/s10072-021-05398-6.
Nousia A, Pappa E, Siokas V, Liampas I, Tsouris Z, Messinis L, Patrikelis P, Manouilidou C, Dardiotis E, Nasios G. Evaluation of the Efficacy and Feasibility of a Telerehabilitation Program Using Language and Cognitive Exercises in Multi-Domain Amnestic Mild Cognitive Impairment. Arch Clin Neuropsychol. 2023 Feb 18;38(2):224-235. doi: 10.1093/arclin/acac078. PMID: 36156732.
Zabay C, Nieves M et al. Evaluation of the impact of lockdown on the health and lifestyle of users of the neurorehabilitation centers of Lleida and Reus of the Fundació Esclerosi Múltiple. Rev Neurol 2021; 73: 249-57. doi: 10.33588/ rn.7307.2020640.
Xiang XM, Bernard J. Telehealth in multiple sclerosis clinical care and research. Curr Neurol Neurosci Rep . 2021;21(4):14. doi: 10.1007/s11910-021-01103-4.