An Integrated Rehabilitation Journey: from Hospital to Community · 2016. 7. 15. · New Model of...

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


E Enhance

Recovery and

outcome

H A B


Early initiation

after stroke

Enhance

Recovery and

outcome

H A B


Early initiation

after stroke

Enhance

Recovery and

outcome

Home Maximize functional

abilities A

B


Early initiation

after stroke

Enhance

Recovery and

outcome


abilities B Well-organized program with

Multi-disciplinary

Approach


Early initiation

after stroke

Enhance

Recovery and

outcome


abilities

Well-organized program with

Multi-disciplinary

Approach Back to community


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


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


Stroke patients

PYNEH

TWEH


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)


Mobility training


Standing training







Standing Training


Standing training







Walking Training


Standing training







Stroke patients

PYNEH

TWEH


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


Community

Stroke patients

Seamless Model of Community Service


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


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





Ergometer Training

Biostep training

Manual Facilitation


Early Stage Late Stage

ICRC- 1st Bridge to Community

• Neuro-facilitation • Muscle tone control • Body weight support

treadmill training • Sitting/ standing balance

training





Ergometer Training

Biostep training

Manual Facilitation


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


Stroke patients

ICRC

Community Phase


Stroke patients

Out-patient PT/OT sessions

New Model of Community Service

Stroke patients

TWEH ICRC

Community


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


Early Visit to HOHCRDC before Discharge

TWEH ICRC HOHCRDC

Updated Assessment &

Recommendation Smooth Transaction

Direct Phone Discussion


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

An Integrated Rehabilitation Journey: from Hospital to Community · 2016. 7. 15. · New Model of...

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