Post on 19-Feb-2021
Alan Liu PTI TWEH
An Integrated Rehabilitation Journey: from Hospital to Community 綜合復康之旅: 從醫院到社區
25 June 2016
R E H A B
Hospital Community
Stroke Rehabilitation Journey
E R
H A B
Stroke Rehabilitation Journey
E Enhance
Recovery and
outcome
H A B
Stroke Rehabilitation Journey
Early initiation
after stroke
Enhance
Recovery and
outcome
H A B
Stroke Rehabilitation Journey
Early initiation
after stroke
Enhance
Recovery and
outcome
Home Maximize functional
abilities A
B
Stroke Rehabilitation Journey
Early initiation
after stroke
Enhance
Recovery and
outcome
Home Maximize functional
abilities B Well-organized program with
Multi-disciplinary
Approach
Stroke Rehabilitation Journey
Early initiation
after stroke
Enhance
Recovery and
outcome
Home Maximize functional
abilities
Well-organized program with
Multi-disciplinary
Approach Back to community
Stroke Rehabilitation Journey
E R
H A B
• Multi-disciplinary • Goal setting • Specific treatment programs • Early participation of family &
care-givers • Regular case conference &
outcome measurement
Team Approach
HKEC Stroke Rehabilitation
Stroke patients
PYNEH (Acute)
Community
TWEH
HKEC Stroke Rehabilitation
Stroke patients
PYNEH (Acute)
Community
Out-patient Rehabilitation
TWEH
In-patient Rehabilitation
TWEH Rehabilitation Team Members
Physician specialist Rehab.
Nursing
Physiotherapist
Occupational Therapist
Speech Therapist
Medical Social
Worker
Clinical Psychologist
Dietician
Prosthetic & Orthotic
HKEC Stroke Rehabilitation
Stroke patients
PYNEH
TWEH
HKEC Stroke Rehabilitation
Stroke patients
PYNEH (Acute)
In-patient
Out-patient
Community
In-patient Phase
Mobility Standing Walking
Home
Suspension gait training
TWEH PT In-patient Training
Walking/ Balance training
Standing training
Functional Electrical stimulation
Bed mobility training
LL Mobilization exercise
UL Mobilization exercise
UL strengthening exercise (OB pulley)
Suspension gait training
Mobility training
Walking/ Balance training
Standing training
Functional Electrical stimulation
Bed mobility training
LL Mobilization exercise
UL Mobilization exercise
UL strengthening exercise (OB pulley)
Suspension gait training
Standing Training
Walking/ Balance training
Standing training
Functional Electrical stimulation
Bed mobility training
LL Mobilization exercise
UL Mobilization exercise
UL strengthening exercise (OB pulley)
Suspension gait training
Walking Training
Walking/ Balance training
Standing training
Functional Electrical stimulation
Bed mobility training
LL Mobilization exercise
UL Mobilization exercise
UL strengthening exercise (OB pulley)
HKEC Stroke Rehabilitation
Stroke patients
PYNEH
TWEH
HKEC Stroke Rehabilitation
Stroke patients
PYNEH (Acute)
TWEH
1st Bridge
Community
Out-patient Phase
Outpatient Phase in TWEH Integrated Community Rehabilitation Centre (ICRC)
綜合社區復康中心
ICRC • Multi-disciplinary • Integrated care
pathway • post-discharge
training • Continuation of
stroke rehabilitation
TWEH • Out-patient stroke
rehabilitation
Out-patient
Traditional Service Model
Community
Stroke patients
New Model of Community Service
Community Stroke Rehabilitation
ICRC
Stroke patients
ICRC • Multi-disciplinary • Integrated care
pathway
• Post-discharge training
• Continuation of rehabilitation
Out-patient stroke Rehabilitation
Out-patient
Traditional Service Model
Community
Stroke patients
Seamless Model of Community Service
Community Stroke Rehabilitation
ICRC
Stroke patients
Integrated Community Rehabilitation Centre (ICRC) 綜合社區復康中心
Balance training Treadmill
walking training
Body Weight Support Treadmill Training
Lower limb strengthening
exercise
ICRC
Manual facilitation
Cardiovascular training
Cybex strengthening exercise Isokinetic training
Body Weight Support Treadmill Training
Advanced Balance Training
Cybex Strengthening exercise
Gait/ Balance training
Ergometer Training
Biostep training
Manual Facilitation
Kinetron Strengthening exercise
• Body weight support treadmill training
• Neuro-facilitation • Muscle tone control • Sitting/ standing balance
training
• Gait training • Strengthening exercise • Advanced balance training • Cardiovascular training • Care-giver education
ICRC- 1st Bridge to Community Early Stage Late Stage
Body Weight Support Treadmill Training
Advanced Balance Training
Cybex Strengthening exercise
Gait/ Balance training
Ergometer Training
Biostep training
Manual Facilitation
Kinetron Strengthening exercise
Early Stage Late Stage
ICRC- 1st Bridge to Community
• Neuro-facilitation • Muscle tone control • Body weight support
treadmill training • Sitting/ standing balance
training
Body Weight Support Treadmill Training
Advanced Balance Training
Cybex Strengthening exercise
Gait/ Balance training
Ergometer Training
Biostep training
Manual Facilitation
Kinetron Strengthening exercise
Early Stage Late Stage
ICRC- 1st Bridge to Community
• Gait training • Strengthening exercise • Advanced balance training • Cardiovascular training • Care-giver education
Robotic-assisted Therapy
Robotic-assisted Therapy– Indications
∗ Stroke ∗ Spinal Cord Injury (SCI)
∗ Traumatic Brain Injury (TBI)
∗ Multiple Sclerosis (MS)
∗ Parkinson`s Disease
∗ Cerebral Palsy (CP)
∗ Orthopedic problems
Ambulatory Stroke Rehabilitation
Community Stroke Rehabilitation
Stroke patients
ICRC
Community Phase
Traditional Service Model
Stroke patients
Out-patient PT/OT sessions
New Model of Community Service
Stroke patients
TWEH ICRC
Community
Community Stroke Rehabilitation
Appropriate case are selected to community service
Collaboration
Haven of Hope
Community Rehabilitation Day Centre
Tung Wah Eastern Hospital ICRC
Stroke patients
基督教靈實協會 靈實日間社區康復中心
Haven of Hope Community Rehabilitation Day Centre (HOH CRDC)
Community Partner
Seamless Collaboration
TWEH ICRC HOHCRDC
Seamless Collaboration
Early Visit to HOHCRDC before Discharge
TWEH ICRC HOHCRDC
Updated Assessment &
Recommendation Smooth Transaction
Direct Phone Discussion
Seamless Collaboration
TWEH ICRC HOHCRDC
Report back (referred cases)
Statistics
Volunteer visit
CQI project 2009 • Integrated Neurological
Rehabilitation in the Community “A Way to Enhance, Empower and Engage”
• It showed improvement in functional ability, balance performance and community integration
Outcome & Evaluation
∗ Physical : Berg’s Balance Scale (BBS)
∗ Functional: Modified Barthel Index (MBI)
∗ Social Integration: Community Integration Questionnaire (CIQ)
Outcome measurements
Modified
Berg balance Scale
Physical
Modified BI
Functional Community Integration
Questionnaire (CIQ)
Social Integration
Outcome measurements
Results
Years 2008 – 2009
No. of patients 59 (20 completed program for analysis)
Gender (Female) 6 (30%)
Mean Age 57.6 (Range: 36 – 80)
Diagnosis CVA Infarction: 13
Haemorrhage: 5
Drop-out Rate 1
Adverse Events 0
Physical ability Berg’s Balance Scale (BBS: 56)
26
26.5
27
27.5
28
Improvement in balance by 5%
Pre Post
Functional ability Modified Barthel Index (MBI total 20)
Improvement in functional ability by 8%
Pre
Social reintegration Community Integration Questionnaire
(CIQ total 29)
Pre Post
Improvement in social reintegration by 24%
Well, can the results be maintained ?
Physical ability Berg’s Balance Scale (BBS: 56)
Further Improvement in BBS by 2.5%
Functional ability Modified Barthel Index (MBI total 20)
Further Improvement in functional ability by 29.6%
Social reintegration: Community Integration Questionnaire (CIQ total 29)
Further improvement in social reintegration by 58.4 %
3 Win Situation • Continuation of rehabilitation • Early discharge to community • Social reintegration • Patient being empowered
• Effective utilization of community resources
• Engaging the community partner
• Seamless stroke care (esp. community phase)
• The growing demand is better managed
∗ Ambulatory Centre rehabilitation (ICRC) provides the first bridge
∗ Community Partner (HOHCRDC) serves the final bridge effectively for community re-integration, both physically and psychologically
∗ Seamless Rehabilitation Journey with continuous improvement
Bring Home Messages
Acknowledgement
An Integrated Rehabilitation Journey: from Hospital to Community�綜合復康之旅: 從醫院到社區Slide Number 2Stroke Rehabilitation JourneyStroke Rehabilitation JourneyStroke Rehabilitation JourneyStroke Rehabilitation JourneyStroke Rehabilitation JourneyStroke Rehabilitation JourneyStroke Rehabilitation JourneySlide Number 10Slide Number 11TWEH Rehabilitation Team MembersSlide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Outpatient Phase in TWEH�Integrated Community Rehabilitation Centre (ICRC)�綜合社區復康中心�Slide Number 20Slide Number 21Slide Number 22Slide Number 23ICRC- 1st Bridge to CommunityICRC- 1st Bridge to CommunityICRC- 1st Bridge to CommunityRobotic-assisted TherapyRobotic-assisted Therapy– IndicationsSlide Number 29Slide Number 30Slide Number 31Slide Number 32Seamless CollaborationSeamless CollaborationSeamless CollaborationOutcome & EvaluationOutcome measurementsOutcome measurementsResultsPhysical ability�Berg’s Balance Scale (BBS: 56)Functional ability�Modified Barthel Index (MBI total 20) Social reintegration �Community Integration Questionnaire �(CIQ total 29)Well, can the results be maintained ? Physical ability�Berg’s Balance Scale (BBS: 56)Functional ability�Modified Barthel Index (MBI total 20) Social reintegration: Community Integration Questionnaire (CIQ total 29)3 Win SituationBring Home MessagesAcknowledgement