Patients who have sustained spinal-cord injuries usually require a rehabilitation programme. CLAIRE RENCKEN investigates what’s on offer
The aim of rehabilitation programmes is to assist people to rediscover their full potential, and to be reintegrated into their homes, work environment and community. This requires physical, functional, social, medical and in some cases cognitive rehabilitation.
Nina Strydom, clinical support specialist in acute rehabilitation and mental health for the Life Healthcare Group, describes some of the support structures offered by its various rehab centres around South Africa: “All of our facilities have psychologists, social workers and, in some instances, trauma counsellors on site who look after the patient and the family’s wellbeing and adjustment to the spinal-cord injury (SCI). It is important to note that the facilities are registered as acute rehab units – not sub-acute or step-down rehab facilities – and are all fully equipped.”
She continues: “At the beginning of the rehabilitation process, patients are assessed by all members of the rehabilitation team, including nursing staff, the resident, the on-site rehab doctor or specialist and all therapy disciplines, including physiotherapy, occupational therapy (OT), psychology, speech therapy (if required), a social worker, a psychologist and a dietician. The team then compiles a specific rehabilitation programme suited to the patient’s and family’s needs. We do not believe in a one-programme-fits-all approach.”
A family meeting takes place within the first week of admission to provide feedback on findings and, together with the patient and family, to agree on a programme, explains Strydom. “Patient progress is discussed weekly during a team meeting and the programme is amended if necessary, based on the patient’s progress and needs. Patients with SCI spend approximately 8-12 weeks in the facility as an in-patient; thereafter the patient continues rehab as an out-patient at the facility or with other private practitioners,” she adds.
The Netcare Rehabilitation Hospital in Auckland Park, Johannesburg, operates in a similar fashion, says the hospital’s general manager, Marietha van Vuuren.
At both the Life Healthcare Group facilities and the Netcare Rehab Hospital, home visits are conducted by the OT and social workers while the patient is still at the rehab centre. “The team is then able to clarify exactly what the discharge environment looks like and can give recommendations regarding alterations that need to be made, as well as what equipment will be needed,” Van Vuuren says.
“In addition, caregiver identification and training are very important to ensure that appropriate care is available upon discharge. Usually, patients are expected to return home for a day or two prior to discharge, to identify any latent challenges at home,” adds Strydom.
At some of the Life Healthcare Group’s facilities there is a pre-discharge room, equipped with a bathroom and kitchen. Here, the patient and caregiver are supported and assisted, where possible, to ensure a safe home discharge. “Community reintegration only happens much later. The focus of acute in-patient rehabilitation is to ensure a safe home discharge. Patients are invited back to the unit annually for a five-day programme to review and address any latent issues and complications,” Strydom explains.
In terms of “back to work” facilitation, both the Life Healthcare Group and Netcare Rehab Hospital assist where they can. “During the initial or acute phase of rehabilitation, contact is made with the employer, and in most instances a visit from the employer is facilitated to determine the way forward. This includes ensuring that immediate support is in place, such as disability insurance and access to bank accounts, and understanding the requirements of the job and identifying what is needed for the successful return to work. However, we do not focus on vocational rehabilitation, which is a specialised field,” Strydom says.
Van Vuuren agrees: “Where necessary, the patient is referred to a specialist vocational therapist who will perform specific functional capacity tests and do specific work with the patient in terms of task re-skilling and ‘work hardening’. The employer is usually involved in this process and often a work visit will be conducted with the patient as part of the out-patient therapy programme,” she adds.
Aquatic therapy is currently offered by three of the Life Healthcare Group’s facilities. “Our patients benefit from and enjoy aquatic therapy as an alternative to other modalities,” says Strydom. Netcare Rehab Hospital also offers this kind of therapy. “It assists in delivering therapy to patients in terms of movement and strengthening when there is pain or difficulty bearing weight. Movement and range of movement is easier in the pool, but balance is harder,” Van Vuuren says.
Another noteworthy establishment is the Western Cape Rehabilitation Centre (WCRC), which has been in operation for 11 years. It also provides specialised, multidisciplinary rehabilitation programmes for people with physical disabilities. The focus is outcome-based and promotes functional independence, with the intimate goal of reintegration into the community. The facility has 156 beds, as well as daily out-patient specialised clinics for referred patients.
The WCRC has a staff complement of around 300 members, comprising doctors, nurses, physiotherapists, occupational therapists, speech therapists as well as social workers, clinical psychologists, dieticians and support staff. The Orthotic and Prosthetic Centre has approximately 40 staff members, consisting of medical orthotists and prosthetists as well as orthopaedic footwear technicians.
The WCRC Facility Board also supports a Health and Wellness Centre, which currently houses an indoor heated hydrotherapy pool and a selection of gym equipment. The Centre is a disability-friendly gym for in- and out-patients, as well as approved community groups and disabled persons’ organisations. People with disabilities are assisted in the use of the equipment, taught how to make adaptations around their disabilities and helped in designing programmes to ensure maintenance of their health and wellness.
The WCRC has a staff complement of around 300 members, comprising doctors, nurses, physiotherapists, occupational therapists, speech therapists as well as social workers, clinical psychologists, dieticians and support staff. The Orthotic and Prosthetic Centre has approximately 40 staff members, comprising, amongst others, medical orthotists and prosthetists as well as orthopaedic footwear technicians.
Furthermore, the WCRC Facility Board supports a Health and Wellness Centre, which currently houses an indoor heated hydrotherapy pool and a small collection of gymnasium apparatuses. The Centre is a disability-friendly gym for both in- and out-patients, as well as approved community groups and disabled persons’ organisations. People with disabilities are assisted in the use of the equipment, taught how to make adaptations around their disabilities and are assisted in designing programmes to ensure maintenance of their health and wellness.
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