1 Life Rehabilitatio The right choice for acute rehabilitatio
2 My stay at th e Life Rehab Cetre has bee a awesom e experiece. I am truly grateful to all th e staff ad th erapists for what th ey have doe for m e. I am so excited to be goig hom e tomorrow strog, full of cofidece ad quite sure I will be able to h ead a ormal life agai. Deis Nicholas stroke survivor itroductio Life Rehabilitatio is a specialised healthcare service dedicated to treatig ad rehabilitatig cliets who have become acutely disabled by a stroke, major trauma, brai ijury, spial cord ijury, or by complex orthopaedic, eurological or other medical coditios. Life Rehabilitatio forms part of the Life Healthcare Group, which is a JSE-listed compay operatig 60 private acute care hospitals i South Africa. Sice its iceptio i 1997, Life Rehabilitatio has grow to become the largest provider of acute rehabilitatio services i South Africa ad Africa as a whole with seve cetres, a total of 265 beds ad more tha 400 healthcare ad rehabilitatio professioals icludig some of the most respected acute rehabilitatio doctors ad therapists i the coutry. All seve facilities are custom built ad equipped with moder equipmet to suit the specific eeds of all our acute rehabilitatio cliets ad to meet legal criteria set by the Departmet of Health. our rehabilitatio model Acute rehabilitatio aims to address uderlyig medical issues ad restore acutely disabled cliets to a optimal level of fuctioig. The purpose of rehabilitatio is to help our cliets cope with their disabilities by achievig maximum idepedece ad miimum reliace o o-goig professioal support. We facilitate their retur as valuable cotributors to their commuities. We follow iteratioal best practice, which idicates that better cliical outcomes are achieved whe cliets with acute stroke i-ii, spial cord ijury iii or other disabilities are treated i a settig that provides co-ordiated, multidiscipliary impairmet-specific evaluatio ad services i-iii. Moreover havig acutely rehabilitated early cliets over 15 years, Life Rehabilitatio has developed a vast body of expertise ad experiece to help our cliets achieve the greatest possible beefit withi reasoable time frames. Our offerig icludes: a multi-discipliary cliical team providig comprehesive, specialised ad specific therapy ad ursig; a goal drive ad coordiated cliet jourey; a service that is focused o outcomes, quality ad cliical excellece; ad cost efficiecy.
3 acute rehabilitatio versus sub acute care Life Rehabilitatio (ad the Departmet of Health) make a clear distictio betwee acute physical rehabilitatio ad sub-acute, (also referred to as step-dow care): Cliets who suffer major medical ad fuctioal problems as a result of a acutely disablig coditio require specialised medical care ad itesive multi-discipliary therapeutic itervetios to help them address a multitude of problems ad regai as much fuctioality as possible. For istace, a stroke cliet might suffer from a combiatio of impaired swallowig, speech, metal fuctio, gait ad cotiece. Uless this cliet has access to a rage ad depth of specialised therapies, as is usually offered i a acute rehabilitatio eviromet, the chaces of restorig the quality of life are sigifi catly dimiished i-iii. Sub-acute or step-dow care, i cotrast, offers ursig ad idividual therapies that are limited i rage ad itesity ad are oly idicated if the cliet is recoverig from oe isolated problem. Idividual therapists fuctio ofte i isolatio ad there is usually a lack of a co-ordiated or team approach. our iter-discipliary team Each acute rehabilitatio cetre employs a comprehesive team of healthcare professioals solely dedicated to providig coordiated ad expert services to the cliets ad their families: Rehabilitatio doctors take overall resposibility for the cliet s safety ad wellbeig by specifi cally maagig the cliet s medical problems. They also coordiate the etire rehabilitatio process by liaisig with the referrig specialist, the family ad other stakeholders. Nurses provide daily support, medical care ad assist i fuctioal retraiig. Physiotherapists (physical ad mobility traiig), occupatioal therapists (fuctioal ad cogitive traiig). Speech therapists (swallowig ad commuicatio), psychologists (cousellig, cogitive traiig). Social workers (liaise with work ad family, pla ad prepare the discharge). Dieticias (utritio). i Laghore P, Williams BO, Gilchrist W, Howie K. Do stroke uits save lives? Lacet 1993;342: ii Idredavik B, Bakke F, Solberg R, Rokseth R, Haaheim B, Holme I. Beefi t of a stroke uit: a radomised cotrolled trial. Stroke1991;22: iii Heiema AW, Yarkoy GM, Roth EJ, Lovell L, Hamilto B, Gisburg K, et al. Fuctioal outcome followig spial cord ijury. A compariso of specialized spial cord ijury ceter vs geeral hospital short-term care. Arch Neurol 1989;46:
4 Additioal staff support the team i each uit: A holistic approach implemeted at this Rehab Uit resulted i good results. I m impressed by th e expertise ad skills applied throughout th e Rehab process that is idividually desiged for th e patiet s eeds ad takig ito cosideratio th eir ijuries Lihle Hlubi paraplegic Rehabilitatio admissios cosultats coduct iitial cliet assessmets ad liaise with referrig doctors ad uits. They also maage the admissios process ad commuicate with fuders. Maagerial ad admiistrative staff maage the uits operatios ad processes to esure cliical excellece ad high quality service delivery. Head Office support staff esure best practice ad coordiatio betwee uits ad fuders. Our rehabilitatio healthcare professioals remai abreast of ew developmets ad curret best practice by attedig iteratioal ad atioal cofereces. We also arrage special workshops ad skills semiars for euro-rehabilitatio therapists which are preseted by recogised rehabilitatio experts. Our professioal staff are accredited for cotiuous professioal developmet (CPD) by the Health Professios Coucil of South Africa. I additio, Life Healthcare s Life College of Learig offers basic rehabilitatio traiig for rehabilitatio attedats. the cliet jourey Selectio Cliets who beefit from rehabilitatio usually fall ito the followig categories: stroke; multiple trauma; brai ijury; spial cord ijury; complicated eurological; complicated orthopaedic; or complicated medical cases. Assessmet To maximise ay rehabilitatio potetial, acute care specialists are advised to refer potetial cliets for a formal fuctioal assessmet as soo as possible after the disablig icidet. Whe referrig a cliet for a assessmet, the specialist should cotact the earest Life Rehabilitatio uit, which will sed a rehabilitatio admissios cosultat to formally assess the cliet whilst he/she is still i acute care ad i a trauma, eurosurgical, orthopaedic or medical ward. The rehabilitatio admissios cosultat ad the specialist doctor will the discuss, with the cliet ad the cliet s family, what potetial beefits rehabilitatio might offer ad whe the cliet might be suitable for trasfer from the acute care ward to the acute rehabilitatio uit. Cliets ca commece rehabilitatio as soo as they are medically stable ad capable of actively participatig i a structured therapy programme. All our uits have the expertise to deal with adult cliets sufferig from a multitude of debilitatig coditios, icludig cogitive impairmet. Cliets who have tracheostomies or who require Cotiuous Positive Airway Pressure or PEG feeds ca also be admitted. Cliets sufferig from debilitatig pulmoary or complicated orthopaedic coditios will beefit from specific rehabilitatio programmes available at all our uits.
5 Cliets uder 12 years are advised to udergo highly specialised paediatric rehabilitatio therapy at the Life Rehabilitatio uits at either Life New Kesigto Cliic or Life Etabei Hospital. Timig of referral We therefore recommed that cliets are referred to acute rehabilitatio services as soo as possible. Cliets who iitiate rehabilitatio early (withi seve days after stroke) have better log term outcomes tha those who iitiate rehabilitatio later iv-v. It is recommeded that stroke rehabilitatio begis as soo as diagosis has bee established ad life-threateig coditios are uder cotrol, with care beig take to prevet complicatios from the curret stroke ad stroke recurreces. Similar research supports early rehabilitatio for cliets with spial cord-ijuries vi. Referral ad admissio If ad whe the acute care doctor refers the cliet for rehabilitatio ad depedig o bed availability, our rehabilitatio admissios cosultat (case maager) will discuss optios ad the rehabilitatio process with the cliet ad family, request fuder authorisatio ad coordiate the trasfer of the cliet to oe of our earby rehabilitatio uits. Withi 24 hours of cliet admissio, each member of the multi-discipliary team will coduct a i-depth medical ad fuctioal assessmet measurig all areas or domais of fuctio relevat to the perso s daily life, usig iteratioally prove cliical outcomes measures vii. The team members will discuss their fidigs ad agree upo a set of medical, physical, cogitive ad psychosocial treatmet goals, which are the also discussed with the cliet, the cliet s family ad carers i a formal family meetig. The goals eed to be relevat, itegrated ad focused. A idicatio will be give of the required legth of stay (usually 4-8 weeks). rehabilitatio itervetios Members of the multi-discipliary team will see the cliet daily ad provide the ecessary medical ad ursig care as well as a umber of differet therapy sessios appropriate to the agreed set of treatmet goals. The rehabilitatio team moitors cliet progress daily, ad formally scores the progress oce a week, ad adjusts the therapy accordigly to esure a optimal recovery process. iv Early ad Log-Term Outcome of Rehabilitatio i Stroke Cliets: The Role of Cliet Characteristics, Time of Iitiatio, ad Duratio of Itervetios. Musicco M, Emberti L, Nappi G, Caltagiroe C. Arch Phys Med Rehabil 2003; 84:551-8 v Rehabilitatio of Stroke Cliets- Effects of Early Itervetio of Physical Therapy o Fuctioal Outcome. Nessa J, Khaleque A, Begum S, Ahmed AH, Islam MS. Bagladesh Joural of Aatomy Jauary 2009 Vol 7 o 1; vi Mikio Sumida, Mikio Fujimoto, Akihiro Tokuhiro, Toshikatsu Tomiaga, Akira Magara, Ryusei Uchida. Early Rehabilitatio Effect for Traumatic Spial Cord Ijury. Arch Phys Med Rehabil Vol 82, March 2001 vii Fuctioal Idepedece Measure (FIM), Fuctioal Assessmet Measure (FAM), Oxford Stroke Classificatio, Amigos Los Rachos
6 I additio to the above metioed team disciplies we place emphasis o educatig ad ehacig copig skills of the cliet, the family ad carers. Family ad caregivers are ivited for traiig ad to participate i the therapy sessios, ad are give educatioal material as well as access to support groups. This eables the trasitio from beig a i-patiet to esurig log-term self-maagemet i the commuity. Th e urses ad all th e staff are just ph eomeal ad friedly, ad oe gets a sese of ease kowig that th eir loved oe is i th e best of care. Saele family member of Elle Shabae stroke survivor The discharge plaig process begis early, with social workers ad team-members coductig home visits, if required ad advisig o appropriate equipmet ad modificatios required i the home. efficiet ad effective teamwork To esure maximum effectiveess ad efficiecy, every team member is ivolved i coordiatig ad itegratig the care with each other ad with outside stakeholders throughout the cliet s jourey: Iitially, the rehabilitatio admissio cosultat cosults with the acute care doctor ad urses o uderlyig coditios ad feeds back the iitial assessmet fidigs to the rehabilitatio team. Iterdiscipliary team members meet daily ad formally every week to measure the cliet s outcomes, discuss progress, review goals, provide iput ito the progress report ad agree o how the therapy eeds to be adjusted to esure optimal outcomes. The rehabilitatio doctor cosults with the referrig acute care doctor o admissio, the regularly reports o cliet outcomes ad progress to the cliet, family, fuder ad referrig doctor, who the cliet is referred back to after discharge. Cetral to the etire therapeutic process is the ivolvemet of the cliet ad family to review goals, progress ad to maage expectatios. outcomes based rehabilitatio To esure maximum progress, the cliet is regularly moitored ad assessed usig iteratioally researched ad recogised methods icludig the Fuctioal Impairmet ad Fuctioal Assessmet Measure (FIM TM ad FAM) as well as the weefim TM for paediatric cliets, which is cetral to goals-drive ad outcomes-focused therapy. This process provides a useful baselie overview ad measuremet of a cliet s impairmets; iforms the rehabilitatio team, the cliet ad family of the potetial that ca be reached; helps set goals; forms the basis of progress reports set to referrig doctors ad fuders; ad esures cliical excellece ad costat improvemet of our teams.
7 The FIM profile Dress upper limb Adjustmet to limitatios Toiletig Ejoyability Safety judgemet Emotioal status Comprehesio Stairs Example of FIM/FAM spidergraph Progress idicated Walkig Dressig upper Swallow Bowel Trasfer chair Admissio score Discharge score Dressig Swallowig lower Our adult rehabilitatio uits are legally liceced to use the FIM TM ad our paediatric uits i the weefim TM. They udergo bi-aual accreditatio i order to maitai this licece. quality Our Life Rehabilitatio uits meet the iteratioal ISO- 9001:2008 stadard of quality maagemet systems. We are the oly rehabilitatio group certifi ed i this stadard i South Africa. This meas that our risk maagemet, geeral operatig processes as well as quality maagemet systems are of iteratioal stadard ad udergo rigorous testig through both iteral ad exteral audits to esure this is maitaied. Stadardised guidelies ad best operatig practices have bee implemeted i order to mitigate ay risks related to both cliet ad employee icidets. These icidets are moitored mothly, quarterly, aually, tracked ad treded ad maaged. It forms the core of our delivery of quality services, havig doe this sice iceptio, it makes us the market leaders. Cliet satisfactio is measured by state of the art electroic devices which collate data ad provide feedback to our uits for their maagemet. We take pride i the fact that the vast majority of our cliets report that they are satisfi ed with our service ad that we take ay egative cliet feedback very seriously, usig it as a opportuity for improvemet by implemetig chages where ecessary. fudig All Life Rehabilitatio facilities have received uique exemptio from the HPCSA ad are licesed by the Board of Healthcare Fuders as a 59 practice, which eables the paymet of oe fi xed daily/global fee that covers: the ward tariff, the acute rehabilitatio doctor s cosultatio fees, as well as idividual ad group therapy sessios viii. The global fee excludes medicatio, special tests ad ivestigatios, specialist cosultatios, assistive devices ad equipmet. These are usually all covered by the fuder. The fuder ad cliets beefi t from global billig, because it: provides trasparecy; avoids complexity; esures comprehesive high quality service delivered i a itegrated maer by oe team employed ad supervised by the hospital; ad is less costly. If you have ay further questios, please cotact us usig the details at the back of this brochure. viii Excludes costs that vary with idividual cliets ad therefore excludes medicatio, equipmet ad ay diagostics or specialist cosultatios.
8 Geograph ic locatio of acute rehabilitatio u its LIMPOPO Life Eugee Marais Pretoria MPUMALANGA GAUTENG Life Riverfield Lodge Johaesburg NORTH WEST SWAZI- Life New Kesigto LAND NORTHERN CAPE FREE STATE Bloemfotei Life Pasteur LESOTHO KWAZULU-NATAL Durba Life Etabei EASTERN CAPE East Lodo Life Vicet Pallotti WESTERN CAPE Cape Tow cotact details LIFE ENTABENI HOSPITAL (icludes separate paediatric rehabilitatio ward) 148 Mazisi Kuee Road, Berea, Durba 4001 Telephoe umber: (ext 360) Fax umber: LIFE EUGENE MARAIS HOSPITAL 696 5th Aveue, Les Marais, Pretoria 0084 Telephoe umber: Fax umber: LIFE NEW KENSINGTON CLINIC (icludes separate paediatric rehabilitatio ward) 23 Roberts Aveue, Kesigto, Johaesburg 2094 Telephoe umber: Fax umber: LIFE PASTEUR HOSPITAL 54 Pasteur Drive, Hospitaalpark, Bloemfotei 9301 Telephoe umber: Fax umber: LIFE RIVERFIELD LODGE Southerwoods Road, Nietgedacht, Johaesburg 2194 Telephoe umber: Fax umber: LIFE ST DOMINIC S HOSPITAL 45 St Mark s Road, East Lodo 5201 Telephoe umber: Fax umber: LIFE VINCENT PALLOTTI HOSPITAL The Park, Alexadra Road, Pielads, Cape Tow 7405 Telephoe umber: Fax umber: LIFE REHABILITATION NATIONAL OFFICE Oxford Maor, 21 Chapli Road, Illovo, Johaesburg 2196 Telephoe umber: