poly-trauma|Rita Henn & Partners Rehab

Paediatric Rehabilitation

Talita Hamers — Fri, 26 Oct 2018 11:27:54 +0000

Paediatric Rehabilitation

Introduction to Paediatric Rehabilitation

Welcome to the start of your child’s rehabilitation journey. You will receive a lot of information in the coming days. Caregivers, well-meaning friends, the internet, support groups and other families are all good sources of information, but it’s a lot to take in. Don’t try to learn everything at once. Rely on your professional team to guide you through the steps, day by day.

Because recovery is unpredictable, it can be very frustrating. Answers may seem hard to come by right now and all the medical facts can be very confusing. We will do our best to support you and your child through this phase of the rehabilitation process.

You will be attended to by a full rehabilitation team which consists of:

A Doctor
Nursing staff
Physiotherapists
Occupational Therapists
Speech Therapists
Social Workers
Psychologists
A Dietician
A Rehabilitation Programme Manager (RPM)

Please note that depending on your child’s condition and the need for certain types of therapy, your child may not be seen by all the members of the rehab team.

Condition

Therapy Units

What you should bring to rehabilitation for your child?

Suitable clothing is needed for therapy. Your child is advised to wear comfortable, loose clothing such as trousers or tracksuit pants, takkies/trainers and socks. Pyjamas, boxer shorts and slippers are not suitable or safe for exercising. Please ensure your child has enough clean clothing at all times, including underwear/nappies.
With regards to shoes/ takkies/ trainers, it is often helpful to provide shoes that are one size larger than your child normally wears, to make it easy for him/her to put them on and take them off. If walking is a rehab goal, the shoes should have rubber soles to prevent slipping.
Toiletry items such as a toothbrush, toothpaste, comb, brush, shampoo, soap, deodorant and face cloths.
Bottles, teats and dummies/pacifiers
Familiar items such as photos of parents, siblings, family and friends.
Comfort items, such as a favourite pillow, blanket, toys or music with headphones (but please be cautious of bringing valuable items to hospital).

Key principles of paediatric rehabilitation

Rehabilitation is a complex process. The two major therapeutic approaches being used for children is Neuro Development Therapy and Sensory Integration Therapy. Much of the process is based on the principles of normal child development, learning to move again and acquiring a new or developmentally expected skill. The building blocks to success include:

Integrating your child’s senses in order for them to better understand the external world around them
Actively attempting to perform a variety of tasks/exercises
Using play and playfulness as a way to actively engage your child in therapy
Being motivated to persevere with training

Learning is enhanced by a lot of repetition and practise. Therapists and nurses provide the knowledge and the skills to enable your child to do particular tasks, which then need to be practised repeatedly. You will need to practise the skills learnt with your child as much as possible in your own time as well. Independent practise allows for increased social stimulation and interaction throughout the day, rather than just in your prescribed therapy sessions. Planning to practise every day is essential. Please ask the staff and therapists to assist you in fitting your own independent practise times into your daily routine.

Therapy assessment

During your child’s first three days of rehabilitation, the therapists will evaluate what your child can and cannot do by him/herself and how they engage in play. For babies and infants, this may include aspects like their ability to calm and their sleep / wake cycles. Therapy may take place in a variety of settings, including the ward, the gyms and outdoors. All of these environments are used to optimally prepare your child for the challenges ahead. The assessment is an important part of therapy and helps the team to determine how to assist your child, and you as parents in returning to your own environment as quickly and as independently as possible. The assessment is essential for setting your child’s rehabilitation goals and determining the recommended length of stay in our facility.

Therapy times

Therapy times for the week will be communicated to you, or you may be assisted to complete your child’s own timetable. Although every attempt is made to keep to the set times, they may need to be amended on the day as schedules can be affected by your child’s ability to engage at the time, emergencies and other unforeseen circumstances.

Your child’s active participation in each therapy session is very important.

Visiting hours

Visiting hours in the hospital are between 10h00 and 20h00. Please understand that should your child’s visitors arrive during their therapy times, therapy takes priority. It is, at times, beneficial for family members to be present in therapy, but it can also be very disruptive to have many visitors in the gyms. Please allow the treating team to guide when your child’s visitors are allowed to observe or participate in therapy sessions; this will also be done with your best interests in mind. Remember that resting between therapy sessions is also very important.

Family meetings

A family meeting is usually arranged in the first two weeks following admission, depending on your family’s availability. The purpose of this meeting will be to give you feedback on your child, explain the progress and goals of therapy and start planning for discharge. It is a good opportunity for you and your family to ask questions so please feel free to do so.

Special services

Apart from the two major paediatric therapeutic approches, there are a variety of additional special services available in the hospital. These are prescribed by your child’s treating therapists as and when necessary.

Home visits

A home visit will be done, when appropriate, usually prior to your child’s first day or overnight trial at home. For logistical reasons, homes outside of a 50km radius from the hospital are generally not able to be visited. The family will then be asked to provide pictures of the home environment and take measurements, as requested by the therapists.

Weekend leave

As part of the rehabilitation process, children are encouraged to visit home over the weekends. The team will decide when this is appropriate for your child and how long the visit should be. We generally do not recommend a visit in the first week of admission as we will probably not yet have an accurate picture of how safe such a visit would be. An indemnity form will need to be completed and signed prior to your child leaving the ward. In order to benefit from the full daily therapy sessions, children may not leave for a weekend before 15h00 on the Friday and must return to the hospital on the Sunday afternoon/early evening.

Weekend therapy

Weekend therapy is not a standard part of our rehabilitation programme. Weekends are an essential time for children to rest, be with their family and be involved in normal social and recreational types of activities. It is also an ideal time for your family to spend time with your child and for you to practise the skills learnt in therapy during the week. However, for certain children it is necessary to have therapeutic intervention on a Saturday and/or if there are restrictions on length of stay. This will be determined by the treating therapists who will prescribe a specific intervention for that day. The session provided will not be as intense as the therapy offered during the week. Emergency and chest physiotherapy is provided on Sundays if required.

Functional Mobility

Talita Hamers — Thu, 25 Oct 2018 08:08:20 +0000

Functional Mobility

Functional mobility is seen as the ability to move around in your environment allowing you to take part in daily activities. Functional mobility includes bed mobility, transfers from the wheelchair to the bed, floor, toilet, shower or bath as well as moving from one area to another – this can either be by walking or with the use of an assistive device, such as a walking aid or a wheelchair.

Due to injury or illness, muscles become weak or paralysed and even pain may limit movement or functional mobility.

Rehabilitation focuses on improving functional mobility, either by addressing difficulty in bed mobility and transfers and/or as gait retraining (training on standing and walking). Wheelchair skills training focus on improving one’s dexterity and confidence as a wheelchair user.

To improve functional mobility the prescription of assistive device is sometimes needed. The RHP Rehab therapists are skilled in assessing and prescribing the correct device to aid independence in functional mobility. Assistive devices include walking aids (crutches, walking frame) as well as wheelchair.

Our seating clinic makes use of dedicated expertise of rehabilitation therapists from various fields to assess posture and pressure distribution when seated in a wheelchair. Problem solving and demo setup of a seating system is used to ensure the most appropriate and cost-effective setup of a client’s seating system (wheelchair, backrest and wheelchair cushion) prior to purchase. This is done to help identify the best possible seating solution to prevent secondary complications. Wheelchairs are procured and delivered to the clinic, for the client to try out prior to purchase.

Condition

Therapy Units

Geriatric Rehabilitation

Talita Hamers — Wed, 24 Oct 2018 08:32:44 +0000

Geriatric Rehabilitation

Older Adults and Geriatric Rehabilitation

Disability, or limitation in the ability to carry out basic functional daily activities, becomes increasingly common with advancing age.

The changing demographics of our population due to improvements in healthcare services has also increased life expectancy. The increasing numbers in this population, is often associated with an apparent increase in disability related to musculoskeletal disorders, diabetes, and neurologic disorders, affecting mobility-related activities.

There are numerous factors causing an increase in disability in the older adult population, but a few of the more common causes include:

Stroke
Reduced recovery from surgical intervention
Reduced strength and mobility following hospitalization for a medical condition
Multiple chronic conditions that compound together and affect independence and wellbeing
Recovery from a fall

Using a patient centred approach, at RHP care is provided by a multidisciplinary team whose expertise includes helping participants improve their strength, mobility, balance and walking. Therapist shall provide falls prevention education and advice; carer training and certain strategies to manage changes associate with aging.

The emphasis in this area of rehabilitation is to maintain and optimize independence in activities of daily living. The more the family is involved and understand the importance of how to facilitate activity the better. The team supports participants to optimize their function, transition back to their home and community environment and provides training for families and carers. The team can also support the process of placement, should the pre-morbid home environment no longer be appropriate.

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Therapy Units

Swallowing Therapy

Talita Hamers — Thu, 13 Sep 2018 14:41:48 +0000

Swallowing Therapy

Modified barium swallows (MBS) are also known as videofluoroscopy or video swallow studies. A speech therapist will assess a person’s ability to swallow at the bedside or over mealtimes. This assessment gives some useful information but in order to get a more objective view of the person’s unique and specific swallowing abilities and difficulties, as with international standards, a modified barium swallow study is often also recommended. The videofluoroscopic study is also able to assist therapists to make appropriate recommendations as well as develop unique swallow therapy plans. The study itself is conducted at an appropriate radiology department that has the necessary equipment for the swallow study. The speech therapist attends the modified barium swallow study with the patient and uses the consistencies of food that the person seems to be able to tolerate. The speech therapist may also bring some other consistencies to trial. During the assessment, the person will be provided with food or liquid that has been mixed with contrast. The videofluoroscopy machine takes multiple rapid images while the person is eating, and these get downloaded onto a disk for the therapist to analyse. The radiology department will generate a medical report based on the findings and the speech therapist will also generate a report highlighting the causes of the swallowing difficulty and the plan for therapy. A person may need to have a repeat modified barium swallow study during the course of their therapy to assess whether the therapy has worked or is working.

Condition

Therapy Units

Swallowing Therapy

Modified barium swallows (MBS) are also known as videofluoroscopy or video swallow studies. A speech therapist will assess a person’s ability to swallow at the bedside or over mealtimes. This assessment gives some useful information but in order to get a more objective view of the person’s unique and specific swallowing abilities and difficulties, as with international standards, a modified barium swallow study is often also recommended. The videofluoroscopic study is also able to assist therapists to make appropriate recommendations as well as develop unique swallow therapy plans. The study itself is conducted at an appropriate radiology department that has the necessary equipment for the swallow study. The speech therapist attends the modified barium swallow study with the patient and uses the consistencies of food that the person seems to be able to tolerate. The speech therapist may also bring some other consistencies to trial. During the assessment, the person will be provided with food or liquid that has been mixed with contrast. The videofluoroscopy machine takes multiple rapid images while the person is eating and these get downloaded onto a disk for the therapist to analyse. The radiology department will generate a medical report based on the findings and the speech therapist will also generate a report highlighting the causes of the swallowing difficulty and the plan for therapy. A person may need to have a repeat modified barium swallow study during the course of their therapy to assess whether the therapy has worked or is working.

How can we help?

Weight-bearing Therapy

Talita Hamers — Thu, 13 Sep 2018 14:40:05 +0000

Weight-bearing Therapy

Weight bearing therapy is one of the fundamentals of both physiotherapy and occupational therapy rehabilitation for a patient with upper or lower limb impairments. Once a comprehensive assessment has been completed and appropriate goals set in conjunction with the patient, the specific exercises will be decided upon. Whether for the upper or lower limb, weight bearing is considered a mainstay of therapy.

Weight bearing for both the upper and lower limb, has many benefits including:

Sensory stimuli – including light touch, deep pressure and proprioceptive sensation
Assists with increasing level of awareness, especially in early standing with brain injured and stroke patients.
Weight bearing in sitting and standing also assists with posture correction and the perception of the midline
Management of spasticity
Repetitive UL weight bearing increases symmetry and facilitation of movement in the affected side in persons with hemiplegia. (https://www.ncbi.nlm.nih.gov/entrez)
Weight bearing also helps prevent bone loss – and can assist with bone healing post fracture.

Muscle strengthening
- Weight bearing through the upper limbs assists with strengthening initially against gravity as the patient uses their own body weight. Once you start working non weight bearing with the UL, the weight of the arm is often too much for the weak muscles
- Weight bearing allows for the development of proximal control at the shoulder in the upper limb, thus ensuring better reach and grasp ability for the patient. In the lower limb, weight bearing improves pelvic and trunk strength and stability for walking.
- People who are able to walk independently should be offered treadmill training with or without body weight support or other walking-orientated interventions at a higher intensity than usual care and as an adjunct to other treatments.
- People who cannot walk independently should be considered for electromechanical-assisted gait training including body weight support.

Condition

Therapy Units

Weight-bearing Therapy

Weight bearing for both the upper and lower limb, has many benefits including:

Sensory stimuli – including light touch, deep pressure and proprioceptive sensation
Assists with increasing level of awareness, especially in early standing with brain injured and stroke patients.
Weight bearing in sitting and standing also assists with posture correction and the perception of the midline
Management of spasticity
Repetitive UL weight bearing increases symmetry and facilitation of movement in the affected side in persons with hemiplegia. (https://www.ncbi.nlm.nih.gov/entrez)
Weight bearing also helps prevent bone loss – and can assist with bone healing post fracture.
Muscle strengthening
- Weight bearing through the upper limbs assists with strengthening initially against gravity as the patient uses their own body weight. Once you start working non weight bearing with the UL, the weight of the arm is often too much for the weak muscles
- Weight bearing allows for the development of proximal control at the shoulder in the upper limb, thus ensuring better reach and grasp ability for the patient. In the lower limb, weight bearing improves pelvic and trunk strength and stability for walking.
- People who are able to walk independently should be offered treadmill training with or without body weight support or other walking-orientated interventions at a higher intensity than usual care and as an adjunct to other treatments.
- People who cannot walk independently should be considered for electromechanical-assisted gait training including body weight support.

How can we help?

Vocational Rehabilitation

Talita Hamers — Thu, 13 Sep 2018 14:39:25 +0000

Vocational Rehabilitation

The simplest definition of vocational rehabilitation was described as “Whatever helps someone with a health problem to stay at, return to and remain in work”.

The goals of vocational rehabilitation in our practice are to:

maximize levels of function following injury and/or illness to reach the ability to return to participation in productive activities / roles
facilitate the safe and timely return of individuals to work following injury and/or illness
prevent future injury or illness

This process in rehabilitation starts right in the beginning of your journey as an inpatient and continues as an outpatient basis depending on your injury, diagnosis or disability.

The doctor, occupational therapist and social worker’s focus in the initial phase is ensuring adequate communication between yourselves / your family and your employer. It is important to keep your employer informed on expected length of hospitalisation and to provide updated sick leave forms / reports if requested. One also needs to understand your rights and benefits and the employer’s responsibility with regards to payment of your salary and accessing sick leave or disability benefits.

Your ability to return to work will depend on your progress in your rehabilitation. At times, returning to work soon after discharge is possible but if you aren’t able to return to work on discharge and need to continue with rehabilitation the process can continue as an outpatient.

Aspects of the vocational rehabilitation that the treating therapists and vocational rehabilitation therapists (usually occupational therapists) address may include:

Conducting an in-depth assessment of your abilities in relation to your job requirements / job description e.g. functional capacity evaluations or assessment as part of your rehabilitation
Conducting a work visit to assess the environment and job requirements at your work premises.
Liaison with your employer to provide recommendations on your ability to return to work and any reasonable accommodations that may be required.
Developing a work hardening program that is aimed at improving your abilities to be able to function in the work environment safely and productively.
Developing a return to work program that is negotiated with your employers to allow you to gradually return to work or for reasonable accommodations to be made and may involve a work trial.
Follow up and monitoring once within the work environment.
Assisting with referrals to resources for job seeking, reskilling and finding employment in the open labour market.

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Therapy Units

How can I get back to work?

A simple definition of Vocational Rehabilitation was described by Waddell et al in 2008 as “Whatever helps someone with a health problem to stay at, return to and remain in work”.

During your rehabilitation process, the overall goal is to ensure that you can return to being as productive as possible in all aspects of your life. So your ability to return to work / school or to be employed is a key part of your therapy.

This process in rehabilitation starts right in the beginning of your journey as an inpatient and continues on an outpatient basis depending on your injury, diagnosis or disability.

Each person’s program or process in vocational rehabilitation is individualised and multi factorial. The best practice or highest success is when there is collaboration from admission and throughout the process between yourself, your employer, any 3rd parties such as insurers and your rehabilitation team.

What can you expect in each phase?

1. Inpatient phase:

The first step is to ensure that there is communication with your employer. The social worker will assist you to ensure you are informed about your sick leave and employee benefits / compensation you may qualify for.
The doctor will assist with necessary sick leave forms.
The team will start to collect information about your job / work requirements to be able to assess your abilities and make recommendations for return to work.
Depending on your progress we will assist you to access prolonged leave or disability benefits if you are not able to return to work at discharge.

2. Inpatient or Outpatient Phase:

If you can return to work soon after discharge or during your outpatient treatment, the treating therapists and vocational rehabilitation therapists (usually occupational therapists) will be involved in the following:
- An in-depth assessment of your abilities in relation to your job requirements
- A work visit or assessment to assess the physical environment and the job requirements
- Liaise with your employer and provide recommendations on your ability to return to work and any reasonable accommodations that may be required.
- Develop a work hardening program that is aimed at improving your abilities to be able to function in the work environment safely and productively.
- Develop a return to work program that is negotiated with your employers to allow you to gradually return to work or for reasonable accommodations to be made. This may involve a work trial.

3. Outpatient Phase:

As part of your outpatient rehabilitation we will continually reassess your ability to return to work / school.
Outpatient therapy will also focus on improving all your skills to be able to return to work / school. This includes all aspects of your functioning e.g. self care, mobility and access to transport, cognition, communication, social skills and life skills
Once off assessments / reassessments are sometimes required for your employer or the insurance company managing your disability benefits. Our vocational rehabilitation therapists can conduct these and provide the necessary reports.

Things to consider

The ability to return to work / school is a complex decision that requires involvement of all parties – yourself, your family or support system, your employer, doctors, all therapists, social workers and psychologists. Teamwork and communication between all parties is necessary for success.
It is important to try avoid travelling this route on your own. Our teams have experience in understanding the complexities of this process and will support and advise you along the journey.
Adjusting to your illness / disability may take time. It is often important following inpatient rehabilitation to first readjust within the home environment before returning to work / school.
Timing your return to work is a delicate balancing act between success and failure. Respect the medical and therapy team’s recommendations – our aim is always to get you back to work at the right time.

What are your rights and responsibilities?

South African law does allow some protection and guidelines with regards to your employment if you suffer an illness or disability through the Labour Relations Act and Employment Equity Act. The law does however also ensure that employers are not under “undue hardship” to provide reasonable accommodations or alternate positions. Each case would need to be evaluated individually and the vocational rehabilitation specialists can assist you with accessing necessary information.

Your responsibility is to ensure that you or your family are updating your employer on your medical treatment according to your employment contract. If you fail to do this, you can be at risk of being dismissed. The team will assist you to provide the right type of information during your rehabilitation.

What does this mean?

Along your journey , there may be many terms you come across that don’t make sense to you – here is a brief explanation of some.

Disability benefits:

This includes insured benefits provided for by your employer (usually linked to your pension / provident fund benefits) and individual policies e.g. disability benefits as part of life policies or income protection policies. The type of benefits and whether you qualify is dependent on the policies. They may contain benefits such as temporary disability (usually for a defined period), permanent disability (usually only decided on after a reasonable time for recovering is allowed) and income replacement.

Speak to the human resources manager from your employer or your broker / insurer to find out about your specific benefits as they may not cover your full salary and additional benefits e.g. overtime, allowances etc. There may also be a waiting period before these benefits become available.

Reasonable Accommodations

This is the term used in the Labour Relations Act and refers to changes / alterations that need to be made to allow people with illness or disability to stay or be employed. These changes may be physical changes to the environment e.g. providing ramps or wheelchair accessibility or changes to the job e.g. reduced work hours, reduced work responsibilities or providing an alternate position.

The employer needs to make an effort to make reasonable accommodations but if the changes are too costly / disruptive they are not obliged to pay for them / allow them. It can be considered “undue hardship” for the employer and some costs may be borne by the person with the disability.

Compensation Commission for Injuries on Duty (COID)

If you have been injured whilst performing your usual duties at work your medical expenses related to your injury may be covered by the Compensation Fund. You may also qualify for compensation for your injury. The social worker, the human resources manager at your workplace and the Department of Labour can assist in understanding your benefits.

Work hardening program

Similar to your therapy program this is focused on gradually improving your abilities to be able to perform aspects of your job. It may also involve some re-skilling (teaching new skills to be able to perform an alternate job).

It is usually conducted over longer periods of time e.g. 2-4 hour sessions to be able to improve your physical and / or mental endurance. In the beginning you may need to do this at home as part of your outpatient therapy program.

Work trial

This is negotiated with your employers and / or insurers and involves returning to work whilst still being on insured benefits or sick leave. The aim is to “test” your skills in the workplace to see if you will cope and to assess if the employer is able provide the reasonable accommodations.

It is usually setup for a defined period and involves regular follow-up by your therapist.

Functional Capacity Evaluation / Functional Assessment

These are in-depth assessments of your overall functioning in relation to all aspects of your life. They usually are requested by the insurers and are aimed at providing recommendations with regards to your ability to return to work.

Our vocational rehabilitation therapists can perform these but the insurer may request you be assessed by an independent occupational therapist or medical practitioner. The cost may or may not be borne by the insurer.

So – When can you return to work? / How can I return to work” are tricky questions. The answers are complex and individualized but we will help you find them throughout your rehabilitation journey. Please don’t hesitate to discuss any concerns with your doctor, social worker or therapy team.

Upper Limb Evaluation / Assessments and Treatment

Talita Hamers — Thu, 13 Sep 2018 14:38:55 +0000

Upper Limb Evaluation / Assessments and Treatments

At RHP rehabilitation therapy emphasizes functional activity in training and makes use of international research guidelines for the use of therapeutic tools and principles. Both the occupational therapist and physiotherapist need to assess the upper limb (UL) for possible return of function. Therapy also focusses on teaching the patient to know how to maintain a pain free shoulder and to mobilize their UL to maintain range of movement. Our treatment does not consist of a number of exercises, but rather preparation of each patient for daily life and to be able to perform movement in real life functional positions which are meaningful.

Therapy must be motivating to the patient and within their frame of reference to maximise their participation. Working on the appropriate functional activities in daily life situations ensures that contextual factors are taken into consideration and allows the occupational therapist and physiotherapist to measure meaningful outcomes.

Occupational therapists and physiotherapists at Rita Henn and Partners use clinical reasoning in their task/movement or cognitive / perceptual analysis to enable them to identify the specific underlying impairments. During rehabilitation significant emphasis is placed on patients regaining as much functional independence as possible in all ADLs (activities of daily living) and IADLs (instrumental activities of daily living). Reasoning needs to be related to what functional activities are limited and what key impairments are impacting on this function. Therapy needs to address both the key impairment and the functional activity within appropriate environments.

Key Principles in Assessment / Evaluation and Treatment

The following are key principles in upper limb assessment / evaluation and treatment:

Patients with arm injuries and some movement should be given every opportunity to practice functional activities or participate in task-specific training. These , tasks are graded to challenge individual capabilities, practiced repeatedly, and progressed in difficulty on a frequent basis. These activities may be bilateral (using both arms) or unilateral (using one arm) depending on the task.
Strengthening exercises are reasonable to consider as an adjunct to functional task practice.
Sensory retraining to improve the ability of the patient to feel different textures, strength may be considered for patients withsensory lossPassive and active assisted range of motion (ROM) exercises to maintain a painfree ROM of the UL and to prevent hand oedema (swelling)
Sensory retraining and UL awareness
Education on care of the UL
Electrical stimulation for hand oedema (if not contraindicated).
Always train the patient to place the affected UL in a variety of positions and situations where it would normally be in a task within their visual field, so that they become more aware of the affected arm and start using it automatically.

Where absolutely no recovery is occurring, the patient should be taught compensatory techniques and environmental adaptations that enable performance of important tasks and activities with the less affected arm and hand.

Once the occupational therapist / physiotherapist has completed a comprehensive assessment of the upper limb, including (but not limited to) history, movement analysis, range of movement, sensation, muscle strength, ability to complete functional tasks, and work-related tasks, the occupational therapist / physiotherapist can then plan an appropriate treatment for the patient.

Treatment Options

The following is a list of possible treatment options for the upper limb:

Repetitive Task Training – repetitive and intense use of novel tasks
Sensori- Motor Retraining – using robotic devices, CPM(Continuous Passive Movement), deep pressure
NeuroMuscular Electrical Stimulation – Transcutaneous electrical nerve stimulation or NMES
Strength training – strength training involves progressive active exercises against resistance which may be indicated for the UL and hand, provided that the quality of movement is not affected, and tone is not worsened
Spasticity Management
Oedema Management
Shoulder Pain Management – MFR (Myofascial Release), strapping, NMES, dry needling, education and home programmes
Graded Motor Imagery: Mirror Therapy/ Mental Practice / Imagery / Virtual Reality
CIMT (Constraint Induced Therapy) – appropriate for a very select few patients
Slings and Splints – this area of rehabilitation is controversial for stroke patients. All patients (no matter their impairment) will be assessed for the appropriateness of assistive devices.

The occupational therapists and physiotherapists at RHP frequently use the GRASP and the DYOR (Drive Your Own Rehab) Programme as an approach to rehabilitation of the upper extremity, particularly in neurological disorders. These programmes both emphasize the need for the patient to direct their own rehabilitation and practice to reach the intensity required for neural plasticity and optimal recovery. Goals of these programmes include:

Strengthening the affected arm
Improving range of motion
Improving use of the affected arm in daily activities
Decreasing pain, and
Improving life satisfaction

Condition

Therapy Units

Upper Limb Evaluation / Assessments and Treatment

At RHP rehabilitation therapy emphasizes functional activity in training, and makes use of international research guidelines for the use of therapeutic tools and principles. Both the occupational therapist and physiotherapist need to assess the upper limb (UL) for possible return of function. Therapy also focusseson teaching the patient to know how to maintain a pain free shoulder and to mobilize their UL to maintain range of movement. Our treatment does not consist of a number of exercises, but rather preparation of each patient for daily life and to be able to perform movement in real life functional positions which are meaningful.

How can we help?

Spinal Cord Injury Interventions (Spinal Unit)

Talita Hamers — Thu, 13 Sep 2018 13:35:16 +0000

Spinal Cord Injury Interventions (Spinal Unit)

The back (vertebral column) consists of 24 vertebrae or bones, which is referred to by their region (e.g. cervical (C), thoracic (T), lumbar (L), and sacrum), and by number counting the bones in the region from their position to the head (i.e. C7 or T4). The sacrum and coccyx are seen as one bone, though there are 5 sacral nerve roots.

The spinal cord is an extension of the brain that runs down the back. It is surrounded and protected by the vertebral column, as well as a fluid which surrounds, and acts as a buffer to protect the delicate nerve tissue. The spinal cord is millions of nerve fibres which transmit information between the body (including organs), and the brain.

The spinal nerves come out of the spinal cord and exits the cord between two bones (vertebras) in the spinal column. They carry information to and from the spinal cord:

Cervical nerves (nerves in the neck) supply movement and feeling to the arms, neck and upper trunk
Thoracic nerves (nerves in the upper back) supply the trunk and abdomen
Lumbar and sacral nerves (from the lower back) supply the legs, the bladder, bowel and sexual organs.

There are myotomes (nerves supplying muscles) and dermatomes (nerves supplying skin). The skin regions can be depicted on the illustration below:

Definitions

Level of injury
We describe the level of the injury by referring to the last spinal cord segment where the movement and feeling are normal. For example, if your injury is called “C5” this means that you would be able to bend your elbow normally and would have normal feeling to around the level of your elbow but below that the movement and feeling would be reduced.
Tetraplegia / Quadriplegia
Injury to the spinal cord in the neck causes a condition known as tetraplegia or quadriplegia. These terms mean exactly the same thing, one is a Greek term and the other is Latin. There is injury to the spinal cord between the spinal cord segments C1 and T1. This causes paralysis and loss of feeling involving all 4 limbs as well as the bladder, bowel and sexual organs.
Paraplegia
Injury to the spinal cord below the neck causes paraplegia. There is injury to the spinal cord below the T1 cord segment. This causes weakness and loss of feeling in the trunk, legs and bladder, bowel and sex organs, but the arms and hands are not affected.
What do the terms Complete and Incomplete mean?
- Incomplete
  An incomplete injury is one in which there is some movement or feeling below the level of the injury in the genital region. This implies that the damage in the spinal cord does not involve the whole spinal cord and that some messages are getting past the area of damage. The chances of improvement and recovery are better if the injury is incomplete.
- Complete
  A complete injury is one in which there is no movement or feeling in the genital region. This means that the damage in the spinal cord involves the whole spinal cord and that no messages are getting past the area of damage. The chance of improvement and recovery if the injury is complete is much lower.

Spinal Cord Inury

A spinal cord injury occurs:

If pressure is applied to the spinal cord (e.g. spinal tumours, etc.)
If blood supply is affected (blood supplies the spinal cord with e.g. oxygen)
If the spinal cord was cut/severed (e.g. motor vehicle accident, assault, etc.)

The spinal cord injury may cause:

Paralysis (loss of movement) below the level of the injury
Loss of sensation (feeling) below the level of injury, e.g. the ability to:
- Feel touch or pain on the skino Tell the difference between hot and cold
- Know what different body parts are doing and what the position is, without looking (proprioception).
Bowel and bladder function can be altered
Sexual function can be altered, as well as fertility

Depending on the level of injury:

Temperature control and sweating may be altered
Breathing may be affected
Blood pressure and circulation may be altered
Autonomicdysreflexia may occur.

Spinal Cord Injury Rehabilitation

At RHP Rehab, we assist people with various spinal cord injuries, whether traumatic (e.g. car or diving accident, etc.) or non-traumatic (e.g. spinal cord tumours, transverse myelitis, Guillain-Barre Syndrome, spinal infarctions and multiple sclerosis, etc.).

After a spinal cord injury, you will need to attend a rehabilitation journey to recover optimally and reintegrate into your residential and community environment in a possibly adapted way. Inpatient rehabilitation is only one part of the rehabilitation journey. To achieve this, our unit uses an interdisciplinary approach, using the ICF (International Classification of Function) model from the WHO (World Health Organisation) and an outcome-based rehabilitation approach. Your team may consist of a general practitioner with a special interest in rehabilitation, physiotherapist, occupational therapist, speech therapist, nurses, care workers, social worker and psychologist, communicating and coordinating your treatment plan with you.

We offer:

Treatment plan following a 3-day assessment which includes:
- Individual therapy sessions
- Group therapy / group-based classes
- Meeting with immediate family / primary companion to facilitate optimal planning for reintegration upon discharge
- Comprehensive training and education specific to your condition / injury, with yourself, your family, and possibly caregivers
- Emotional support to yourself and immediate family members / companions
- Psychology intervention, including sexual health education and changes associated with relationship dynamics
- Equipment trialling and recommendations for yourself and your home and possibly work environment, following a seating assessment
- Home / school / work visit as necessary, where appropriate recommendations are made.
- Periods at home as part of residential integration, once cleared by the whole team, with the prescribed and required grading of time periods at home to implement therapy recommendations (home adaptations, equipment trials, education and training, home programmes, etc.)
- Introduction to local support resources
- Outpatient therapy programme as part of the recommendations upon discharge, where appropriate.
Specialised services
- A seating assessment
- Neurogenic bowel and bladder management (including e.g. a uro-dynamic study)
- Spasticity management
- Tendon and nerve transfers
- Assisted outings as part of community reintegration
- Peer support programmes
- Unweighted treadmill training
- Therapeutic electrical stimulation

General Points

A spinal cord injury not only causes major trauma to the neck and spinal cord but also effects the way the whole body functions. Other injuries can also complicate the problems. Because of this, the acute period soon after the injury is very important and there are many things that must be done in the first few weeks after the injury to ensure that you do not have other complications.

Some of these include:

Regular blood tests to check blood count and blood chemistry.
X-rays of the fracture, chest and other injuries.
Skin: Special care must be taken of the skin because of loss of feeling, especially when in bed. The nurses will assist to turn the body every 2-3 hours to prevent pressure sores.
Joints: If the limbs cannot be moved, they can become stiff and eventually would freeze in one position (a contracture). The physiotherapist and occupational therapist move the joints regularly to prevent this from happening.
Circulation: Inability to move limbs also means that the blood does not circulate as well as usual. This can lead to blood clots in the legs called Deep Vein Thrombosis or DVT. This can cause swelling and discomfort in the leg. The physiotherapist will also help to prevent this. Medication assists to prevent blood clots.
Breathing and chest: The ability to breathe may also be affected after spinal cord injuries. This applies to all people with injuries above T12 due to paralysis of the abdominal (stomach) and intercostal (between the ribs) muscles. The higher the injury above T12 the more severe the breathing difficulty will be. The ability to cough well may also be affected. The physiotherapist will assist with respiratory hygiene, including to train methods of assisted coughing.
Bladder: All activity in the bladder stops during the “spinal shock” phase of a spinal cord injury and the bladder will not empty by itself. To allow the bladder to drain an Indwelling Catheter (IDC) is put into the bladder. This will remain in place until further investigation of the bladder can occur 6 weeks after your injury and an optimal bladder regime will be implemented.
Bowel: The activity in the lower bowel and rectum may also be affected immediately after the injury. This means that medication such as tablets, suppositories or an enema will assist the bowel to work. The nurses will assist with this in bed as movement will initially be restricted to the bed.

What About Improvement and Recovery?

Initially it may be difficult for your doctors to tell you exactly how severe the injury is and therefore, what the chances of improvement and recovery are. This is particularly true if the spinal cord injury is incomplete.

Remember;

All spinal cord injuries are different and what happens with one person does not necessarily happen with another.
The nerves in the spinal cord are very delicate and when they are injured, spontaneous recovery may be limited. At present, there are few things that doctors can do to help the nerves in the spinal cord to repair themselves.
Recovery depends on how seriously the spinal cord has been damaged and whether the nerves can recover (outside the spinal cord).
Unfortunately, total recovery from a spinal cord injury is very rare. • Complete spinal cord injuries are more severe and the more time that passes after the injury the less chance there is of significant recovery.
People with incomplete injuries generally get more recovery than those with complete injuries but it is impossible to know exactly how much recovery there will be or how long it will take to happen. It is usually said that after 2 years there is little chance of further improvement.
Unfortunately, at present there is no cure for spinal cord injury but there are many doctors and researchers around the world looking for ways to help the nerves to heal themselves and recover.

Condition

Therapy Units

Spinal Cord Injury Interventions (Spinal Unit)

The spinal nerves come out of the spinal cord and exits the cord between two bones (vertebras) in the spinal column. They carry information to and from the spinal cord:

Cervical nerves (nerves in the neck) supply movement and feeling to the arms, neck and upper trunk
Thoracic nerves (nerves in the upper back) supply the trunk and abdomen
Lumbar and sacral nerves (from the lower back) supply the legs, the bladder, bowel and sexual organs.

There are myotomes (nerves supplying muscles) and dermatomes (nerves supplying skin). The skin regions can be depicted on the illustration below:

How can we help?

Physical Rehabilitation

Talita Hamers — Thu, 13 Sep 2018 13:34:01 +0000

Physical Rehabilitation

Physical Rehabilitation, defined as "a set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environments" (WHO, 2011), is instrumental in enabling people with limitations in functioning to remain in or return to their home or community, live independently, and participate in education, the labour market and civic life.

Rehabilitation measures are aimed at achieving the following broad outcomes:

prevention of the loss of function
slowing the rate of loss of function
improvement or restoration of function
compensation for lost function
maintenance of current function.

The physiatric (Physical Medicine and Rehabilitation) model of care is based on fundamental understanding of the individuals’ unique conditions as it relates to the concept of impairment, disability and handicap.

Impairment is the loss or abnormality from psychological, physiologic, and functional perspectives that results from acquiring a painful condition.
Disability is a restriction and/or lack of ability to perform activities owing to an impairment (e.g., pain).
Handicap is a disadvantage that an individual possesses due to the impairment and disability that affects his or her role in society.

Physical rehabilitation offers a unique approach in which the management of the patient is focused on the whole person rather than an isolated condition. As such, the patient is managed through a patient-centered, multidisciplinary approach in which the specialists of various disciplines (e.g., physician, occupational therapist [OT] and physical therapist [PT], psychologist, Speech Therapist [ST], dietician, nurse, social worker) contribute their expertise to ongoing patient care.

Physical Rehabilitation uses a variety of techniques to help improve, maintain or restore physical strength, cognition, communication and swallowing as well as mobility with maximized results. Physical Rehabilitation also helps people gain greater independence after illness, injury or surgery.

Physical rehabilitation is provided in acute and subacute rehabilitation settings by interdisciplinary teams consisting of therapists, doctors, nursing staff, dieticians, psychologists and social workers. We provide both inpatient and outpatient services to clients with the following conditions;

Spinal cord injury
Stroke
Acquired brain injury
Amputation
Multiple trauma
Guillain Barré
Degenerative neurological disorders
Neuropathies and other neurological conditions
Burns
Paediatric trauma and acquired childhood illnesses
Joint replacements with complicating co-morbidities or limited pre- morbid functioning
Generalised weakness post prolonged ICU stay which limits functional independence compared to pre-morbid abilities.
Patients for whom bed rest has been medically instructed e.g. patients on traction, pressure ulcer management.
Ageing population: persons with chronic medical conditions who contract an acute illness (e.g. pneumonia) which results in a decline in the level of functioning.
On-going medical interventions such as Renal Dialysis, Chemotherapy, Radiation therapy which has an effect of physical and/or functional abilities.
Acute illness or surgery in a patient with a pre-existing functional limitation leading to a decrease in their level of functional independence and as a result the incident affects their level of functional independence.

Our rehabilitation program works according to the ICF model and is outcomes-based.

Various standardised outcome measures are used to evaluate the patient’s impairments and functional status, including the FIM/FAM burden of care measure. The patient’s rehabilitation program focuses on appropriate re-integration of the patient into his/her home, community and possible return to productive activity.

As part of our service delivery an initial planning meeting is carried out for each patient within the first 48-72 hours of admission and a comprehensive individualized rehabilitation plan is developed, considering pre-existing or complicating conditions and pre-morbid level of function. Treatment is tailor made to each patient and carried out in close collaboration with the family and caregivers. Patient, family and caregiver education and training is an integral part of the rehabilitation process and resources and materials are provided as necessary. Caregiver training and family counselling are also provided. The therapists assist with equipment procurement.

Formal interdisciplinary goal setting meetings are held weekly to discuss progress and challenges, review rehabilitation goals and focus on discharge planning which includes the appropriate discharge destination, equipment needs, education and training needs, as well as psychosocial factors impacting on rehabilitation.

Each facility has an integrated unit with a dedicated space equipped with the necessary rehabilitation apparatus which includes but is not limited to:

Exercise equipment for strength and endurance training
Tilt tables, standing frames and parallel bars
Motorised assisted cycling
Treatment plinths and floor mats
Mobility equipment including wheelchairs, walking frames and crutches
Assistive devices to assist in the training of ADL’s
Cognitive/perceptual assessment and treatment tools
Speech therapy assessment and treatment tools including VitalStim® Therapy

Effective discharge planning starts on admission. Progress reports are provided to the funder and referring doctor on a weekly basis for inpatients and on a needs basis for outpatients. This report includes an appropriate outcomes scale such as the FIM/FAM burden of care measure. A full report is given to the patient and family on discharge.

We offer an outpatient service at most of our locations, enabling the consolidation of residential reintegration goals and addressing reintegration into the community and workplace with vocational training where appropriate.

Condition

Therapy Units

Myofascial Release

Talita Hamers — Thu, 13 Sep 2018 13:22:55 +0000

Myofascial Release

Myofascial Release is a safe and effective hands-on technique that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion. This important “time element” has to do with a low load (gentle pressure) applied through the skin slowly allowing the fascia to elongate.

Trauma, inflammatory responses, and/or surgical procedures create myofascial restrictions that can produce pressures on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, electromyography, etc.).

The use of myofascial release allows the physiotherapist to look at each patient as a unique individual. One-on-one therapy sessions are hands-on treatments during which the physiotherapist / physical therapist uses different myofascial release techniques and movement therapy to improve the mobility of the fascial restriction.

Each myofascial release session should be performed directly on skin without oils, creams or machinery. This enables the therapist to accurately detect fascial restrictions and apply the appropriate amount of sustained pressure to facilitate release of the fascia, thereby decreasing pain and increasing mobility.

The patient frequently complains of some / all of the following symptoms:

Tightness of the tissues that restricts motion or pulls the body out of alignment, causing the person to favour and overuse one side of the body more than the other
A sense of excessive pressure on muscles or joints that produces pain
Pain in any part or parts of the body, including headache or back pain

Myofascial release treatment can assist with the following conditions:

Bulging disc / Degenerative disc disease / Herniated disc
Bursitis
Cerebral Palsy
Cervical and Lumbar spine injuries / Back pain / Headaches / Whiplash
Chronic Fatigue Syndrome / Fibromyalgia
Chronic pain
Frozen shoulder / Adhesive Capsulitis
Myofascial Pain Syndrome
Osteoarthritis
Nerve entrapments / Carpal Tunnel Syndrome
Painful adherent scar tissue
Tendinopathies / Plantar Fasciitis
TMJ difficulties