University Rehabilitation Institute Republic of Slovenia. Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia

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1 University Rehabilitation Institute Republic of Slovenia Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia

2 2

3 3

4 Introduction * Primary level PT only * Secondary level: General hospitals Spas * Tertiary level URI Soča

5

6 Introduction * Clinic for PRM * Centre for vocational rehabilitation (CPR) * Centre for prosthetics and orthotics * Rehabilitation engineering * Pharmacy * Research department * Library * Centre for R&D of vocational rehabilitation

7 Rehabilitation * Inpatient rehabilitation ~ 1700pt/yr * Outpatient rehabilitation ~ pt/yr

8 In patient rehabilitation * 6 wards + CPR: Following amputations Children Peripheral nerve lesion, Rheumatic and degenerative diseases TBI, MS and other neurological diseases Stroke SCI

9 Out patient rehabilitation * All that also have in patient rehabilitation * Musculoskeletal problems * Pain * Muscular and neuromuscular diseases * Pt who need prosthesis, orthosis, orth. shoes * For assistive technology * Driving abilities do people with disabilities * Vocational rehabilitation

10 Speech and language 5 Psychologists Social workers CPO High Nurses OT 37 PT 50 Nurses 85 MD Number of employees

11 Multidisciplinary work Clinic - Medical + psychosocial rehabilitation Centre for Vocational rehab. Research Patient Pacient Center for P&O Reha eng. Pharmacy

12 Shared values of the URI - * Vision Soča In the next five years URI Soča will become more recognized, enforced and powerful institution in Europe as well as in worldwide prospective.

13 Shared values of the URI - * Misssion Soča Perform comprehensive rehabilitation and informing broad community in order to increase the quality of patient s life and help them on their recovery. With research and education we are developing and modernizing rehabilitations doctrine. 13

14 Shared values of the URI - * Core values: Soča CREATIVITY AND INNOVATION Creativity and innovation of our employees are aiming in an enquiry of a new challenges and realization of effective approaches and solutions!

15 Shared values of the URI - * Core values: Soča CONSIDERATION Interpersonal consideration is a key value of our work at URI Soča. 15

16 Shared values of the URI - * Core values: Soča COOPERATION Cooperation counts as a base manner in the work place of our employees. Multidisciplinary, partners work and synergy of effects are improving the success of our function! 16

17 Shared values of the URI - * Core values: Soča EXPERTISE Is our obligation for continuous engagement and growth of professional and personal knowledge! 17

18 Shared values of the URI - Soča * Core competences

19 Sources of referral * Admission from: General hospitals Home Homes for elderly

20 Collecting information before admission Medical documentation Check: In hospital At the Institute

21 Criteria for admission stroke * Comprehensive rehabilitation: Stable health condition Problems on at least 2 fields of functioning (FIM 40 80) Cognition that allows learning At least partial preserved understanding Physical condition able to participate at least 3 hr/day in programs

22 Criteria for admission stroke * For achievement of specific rehabilitation goals: Functional assessment prior to vocational rehabilitation Fitting with medical and technical aids Special rehabilitation medicine treatments (Therapy of spasticity, chronic pain syndrome)

23 Criteria for admission SCI * Stable hemodynamic, respiratory, orthostatic and neurological conditions * Ability to participate * Adequate psycho-physical condition * Stable spine with permitted weight bearing * Treatment of the disease that caused SCI must be terminated * Previously submitted complete medical documentation

24 Exclusion criteria SCI * Permanent dependence on additional oxygen * Spinal cord impairment due to multiple sclerosis * Cervical spinal cord impairment with accompanying severe craniocerebral trauma (rehabilitation is performed at the department for head trauma).

25 Rehabilitation process admission * Medical examination * Examination of other team members * Additional diagnostic and functional tests * Rehabilitation goals and plan

26 Rehabilitation process Health condition (disease, trauma) Body function and body structure Activity Participation Environmental factors Personal factors Contextual factors

27 Rehabilitation team Doctors Work technologist Certified prosthetist orthotist Relatives, friends Pharmacologist Physiotherapists Patient person Engineers Sport therapist Occupational therapists Nurses Social workers Psychologist Speech and language therapist

28 * Admission * Discharge Evaluation

29 Evaluation * ICF checklist identification of problems * Standardised Outcome Measures (OM) Quantification of the problem Assessing outcome

30 MD Impairments of musculoskeletal system X rays US Isokynetic testing Limb length Circumferences

31 Gait / Walking * Gait pattern functions body functions * Walking activities and participation

32 Body functions

33 Body functions * Pain

34 Body functions

35 Body functions

36 Body functions * Cardio respiratory functions

37 Activities and participation * Activities of daily living ADL: Functional Independence Measure FIM Granger 1984 USA 1 Canadian Occupational Performance Measure COPM 2 1 Granger CV, Gresham CE. Baltimore: Williams & Wilkins, Law M et al. Canadian Occupational Performance Measure, 2005

38 Activities and participation * 10 m walking test * 6 minutes walking test

39 Activities and participation * Timed Up and Go test

40 LCI

41 UNB

42 Use of hand function * Southampton Hand Assessment Procedure SHAP 1 : 12 grips 14 ADL 1 Light M et al. Arch Phys Med Rehabil 2002;83:

43 Activities and participation * Communication

44 Activities and participation

45 Discharge * Reaches the long-term goals * No progress for at least 2 3 weeks * Not able to participate in the rehabilitation program due to worsening of his or her health condition or at the onset of comorbidity.

46 Discharge * % home * ~ 7 % homes for elderly * ~ 7% other hospital

47 Continuity of care * Discharge letter for GP

48 Follow - up * Regular for people following amputation * Depend on GP

49 Social integration * Sport activities during rehabilitation * Some other activiites * Visits to school * Visits of workplace and employer * Information about different organisation, associations

50 Strength * Comprehensive rehabilitation * Highly trained professionals

51 Weaknesses * Overload staff * Psychosocial part * No laboratory * Several units instead of The Institute

52 Opportunities and threatening * Better negotiations with Insurance

53 Thank you very much for your attention! 53

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