CENTRE FOR MUSCULOSKELETAL AND NEUROLOGICAL REHABILITATION GHENT UNIVERSITY HOSPITAL

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1 CENTRE FOR MUSCULOSKELETAL AND NEUROLOGICAL REHABILITATION GHENT UNIVERSITY HOSPITAL

2 Historical background The centre was established in 1964 by Professor Hendrik Claessens, MD. Its primary goal was the rehabilitation of patients with severe musculoskeletal disabilities In 1970 the current facilities were ready for occupation

3 Historical background Over the years the CLNR has increasingly focused on the rehabilitation of patients with severe musculoskeletal and/or neurological disorders. In the nineties neurorehabilitation was considerably expanded, because of the increasing number of patients with acquired brain injuries.

4 The CLNR is located on the campus of Ghent University Hospital

5 Generally The CLNR is part of the University Hospital, which has a capacity of 1100 beds and a staff of more than 4000 employees. At university level the centre belongs to the Ghent University Department of Physical Medicine and Orthopaedic Surgery.

6 Within the Ghent University Hospital the CLNR is part of the Physical Medicine and Rehabilitation Department (Head: Head: : Professor Guy Vanderstraeten,, MD, PhD) This department comprises the followings sections pediatric and adult rehabilitation, electromyography, ultrasonography, movement analysis and a sports medicine centre

7 Capacity 62 beds for inpatients, distributed over 2 units A 31-bed unit for patients with spinal cord injuries. A 31-bed unit for patients with acquired brain injuries.

8 All rooms have an internet connection. The rooms for high tetraplegics are equipped with hands-free environmental control.

9 Outpatients The centre also offers outpatient services. These rehabilitation programmes are provided on a daily basis for a maximum of 40 patients per day.

10 Children Children under 15 years of age are treated in a separate setting and are hospitalized in the pediatric department. The majority are outpatients.

11 Acquired brain injuries The centre has 5 beds for patients with an acquired brain injury in MRS of PVS (minimally responsive state, persistently vegetative state). For the care of these patients cooperation protocols with a number of rest and nursing homes have been concluded.

12 Duration and intensity of rehabilitation are dependent on the nature of the disability E.g. paraplegia: : maximum 9 months tetraplegia: : maximum 15 months severe brain injury: : maximum 24 severe CVA: : maximum months 12 months severe multiple injuries: : maximum months Rehabilitation is only continued for as long as there are realistic rehabilitation goals, and is usually much shorter than the maximum duration.

13 Goal The primary goal of the centre is to improve the quality of life of patients with impairments and disabilities. Specific treatment protocols have been developed to achieve the highest degree of functional independence.

14 The patients are encouraged to take an active part in their rehabilitation. During the rehabilitative process the focus is on the return to the home environment. To this end, the team members work closely together with the family and the other parties involved Optimal social, occupational or school integration is aimed at.

15 Target groups 1. Paraplegia or paraparesis 2. Tetraplegia or tetraparesis 3. Traumatic brain injuries 4. CVA (hemiplegia) 5. Amputations 6. Multiple orthopaedic injuries Each target group is treated by its own specialized multidisciplinary team

16 Specialized rehabilitation teams Separately operating teams, each supervised by a rehabilitation specialist, attend to our patient clusters. Team for spinal-cord injured patients Team for brain-injured patients supervised by A. Viaene, MD supervised by K. Oostra, MD Team for multiply injured patients or amputees supervised by S. Vertriest, MD

17 Patients are transferrred by General practitioners by hospitals by insurance companies at the patient s and/or family s request

18 Intake Rehabilitation is only started after examination of the patient and an intake interview with the family. Appointments can be made through the CLNR secretariat tel: fax:

19 The CLNR aims at providing an evidence-based therapeutic approach, with use of highly advanced rehabilitative techniques eg. functional electrical stimulation, Ergys bicycle with electrical stimulation and BWS (body weight support) for gait rehabilitation

20 facilities

21 Remedial therapy hall Sports hall Remedial therapy rooms

22 Swimming pool Small baths Sauna Adapted showers

23 BTE info & documentation ERGOS fitness training

24 physiotherapy occupational therapy rooms

25 work set 1 working surface and table with moveable top therapeutic kitchens work set 2 working surface and cupboard adjustable in height

26 obstacle course

27 polyvalent room

28 Multidisciplinary team members: Rehabilitation specialists PMR residents Rehabilitation nurses Physiotherapists Occupational therapists Psychologists Psychology assistants Speech therapists Social nurses Technician

29 therapy

30 To optimize the treatment programmes, therapeutic phases are incorporated within the various disciplines, which clearly illustrate the progress in both the rehabilitation and the treatment programmes. phase 1 : phase 2 : phase 3 : phase 4 : activation-stimulation mobility functional performance integration The rehabilitative process is also based on the IFC model

31 physiotherapy

32 Examples of therapeutic services (1) fitness training gait rehabilitation mechanotherapy

33 (2) breathing techniques hydrotherapy

34 sports ranging of joints (3) muscle strengthening exercises physiotherapy

35 occupational therapy

36 therapeutic services (1) Transfer training Sitting posture & positioning Prevocational training ADL training

37 Use of aids Wheelchair training and advice (2) Evaluation tests Training in adapted multimedia use

38 Functional training Sensibility training (3) Info & advice housing alterations

39 Provision of psychological services General services psychological counseling of patient and family personality testing and other psychometric evaluations training of social skills behavioural modifications Neuropsychological services neuropsychological examination (e.g. computer-controlled) cognitive rehabilitation strategy training neglect training reality and orientation training diary training music therapy

40

41 Psychological services Industrial psychological services ergological examination job application training case management organization of job trials support in the workplace contacts and consultation with employer, national health service, insurance companies.. collaboration with training centres and supported employment services

42 Nursing All nurses have completed complementary training in rehabilitation nursing. The CLNR has a trained nursing team for the spinal-cord unit and the brain-injury unit.

43 Social services Information and advice (rehabilitation, administration, social reintegration,..) Administrative assistance (application for allowances, benefits, exemptions, documents Flemish Agency for Disabled Persons,.) External contacts (NHS, insurance, local authority, social service, Flemish Agency for Disabled Persons, outlying hospitals, social service centres, homecare services,..) Coordination homecare aiming at social integration Family counseling home visits

44 Speech therapy language and speech examination individual language and speech therapy group therapy for language and speech disorders training of functional communication skills training in the use of communication aids training in the use of alternative communication systems for supportive communication swallowing and eating training

45 Info sessions Rehabilitation takes place in close collaboration with the patient s family or care providers. The CLNR organizes weekly group sessions for the patient s family members. The info sessions always focus on a specific topic of rehabilitation or living with a disablility. Hands-on experts also participate in these sessions

46 Extramural activities cultural trips movies, concerts, exhibitions, theatre, fairs sports bicycling, canoeing, riding, swimming, bowling... ADL activities shopping, banking, public transport..

47 Centre for Evaluation and Rehabilitation of Capacity for Work

48 Goals of CERAC Standardized, objective and reliable examination of physical capacity for work Progressive training directed at job preservation Evaluation of the rehabilitative effect ERGOS BTE

49 Workshop for technical orthopaedics In the workshop for technical orthopaedics, located in the CLNR and belonging to the Centre for Technical Orthopaedics (CTO), orthoses and prostheses are manufactured by a specialist team.

50 Self-help As soon as possible, spinal-cord injured patients are introduced to former patients in order to learn from their experience. To this end, CLNR collaborates with the self-help group for spinal-cord injured patients n.p.a. Piekernie

51 For patients with an acquired brain injury, the CLNR actively collaborates with the umbrella organization n.p.a. Coma which groups numerous self-help groups and associations Afasie A similar organization, n.p.a. Afasie exists for patients with aphasia

52 Flemish Fund The CLNR is recognized by the Flemish Fund for Social Integration of the Disables for the filing of documents relating to: - Care demands - Work and vocational retraining - Assistive devices (IMB- individual material benefits) - Personal assistance budget (PAB)

53 Expert assessments and reports The centre provides expert assessments and reports concerning: disability economic loss need for outside help need for assistive devices wheelchair use housing alterations

54 Data management and team meetings The entire rehabilitative process is based on multidisciplinary team work and communication. All disciplines have their own data set, which can be consulted through a local area network.

55 Educational and scientific activities systematic continuing education of all team members rehabilitation sciences library organization of workshops and meetings lectures scientific research

56 Realisation M. De Ganck Supervision G. Vanderstraeten,, MD, PhD W. Brusselmans, PhD the kind collaboration of patients and staff of the CLNR Is gratefully acknowledged

57 Thank you for your attention

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