A- SERVICES FOR INTERNAL PATIENTS:

The patients from rehabilitation departments (UGC-US, MFeR), acute department (Orthopaedics, General Surgery, Pediatrics, Resuscitation, Neurology and others), can benefit from SMFR treatments after assessment of physiatrician. All the professionals in the rehabilitation team collaborate to define the patient’s disability profile. The Physiatrician has the task of summarizing and drawing up an individual rehabilitation project by a series of assessments:

•· Functional assessments: addressed to understand the patient’s state of disability and function correlated to the pathology. They are carried out by the physiatrician during the examination.

•· Cognitive assesments: they aim to document by some tests and/or psychological interviews the level of patient’s mental functioning.

•· Prosthetic assessments: they identify the possible aids needed by patient and help to prescribe the last ones by the Italian National Healthcare System (SSN).

•· Psychological assessments : they outline the psychological profile of patient and, possibly, of his/her family and identify specific areas of intervention or support.

Therapies

It is difficult to outline which services are provided to inpatients. Rather than single service or type of therapy, in rehabilitation it is good to think in terms of rehabilitative project. This concept means all the procedures to carry out for achieving a functional improvement. The most significant activities provided are:

•· Motor therapy: consists of all procedures that a physiotherapist carries out to recover articulation, movement in order to restore functional autonomy. The complexity of surgeries varies depending on whether the disability is orthopaedic or neurological.

•· Respiratory physiotherapy: consists of procedures that the physiotherapist carries out in order to improve the respiratory function.

•· Cognitive behavioural therapy: consists of procedures and pathways aiming to improve the cognitive functions, speech and management of behavioural disorders.

•· Psychologic and/or psychotherapy support : is directed by the Psychology team and supports the patient and his/her family in a delicate phase of existential change.

•· Occupational therapy: it has the dual purpose to restore autonomy in daily activities and stimulate the patient to discover creative resources through “doing”. The pathway of art therapy is within the occupational therapy.

•· Physical therapies: consist of physiotherapeutical-instrumental therapies addressed mostly to control various painful situations. A list of these therapies is provided in the section “Services for external users, under outpatient system”.

The definition of rehabilitation programmes is under assessment of damage and potential of people recovery. One feature that must be kept in mind is that not always and not all patients need intensive treatments. On the basis of a series of data processed over the years, the SMFR aims to  implement the F.R.G. (Function Related Groups) system, that is calibrating the rehabilitation intensity on the basis of functional severity and progress of recovery over time. 

Communication, involvement and training of relatives

When the disability is relevant and recovery times continue the rehabilitation équipe has the task of involving the relatives in the pathway in order to:

•· understand difficulties and making that patient can reveal;

•· find out information and procedures useful to manage the patient once he/she got home.

To realize this double aim the SMFR organizes informational and educational meetings for relatives and/or patients admitted in the Intensive Rehabilitation and Physical Medicine and Rehabilitation wards.

Such meetings are hold by the SMFR physicians or other staff with weekly frequency (on average). They are announced by notices placed on the doors of stay rooms.

• Spinal cord injury

•· Spasticity

•· Sphincteric problems

•· Disability and return home

•· Aids

•· Rights of disabled person

•· Role of sport

•· Sexuality in spinal cord injury

Furthermore the SMFR secretariat has brochures and books available for detailed study.

Therapeutic exits

The therapeutic exits are part of programmes for admitted patients. They aim to allow patients to try out their skills and progresses during the rehabilitation. The exits regularly take place at the presence of therapist and after Director’s authorization. Even the defined “adapted sport” activities are part of the ones carried out during therapeutic exits. It’s about sport acitivities mainly performed at the Don Calabria’s Multipurpose Center of Verona (“Centro Polifunzionale Don Calabria”).

During the summer the Association “EOS la vela per tutti” organizes sailing trips.

Social worker

It is a cross service among various units of the Department. The intervention of social worker takes place within a project defined by the responsible physicians. The social worker receives the patients and relatives in the following days:

MONDAY-WEDNESDAY and FRIDAY  9.00am-12.00pm / 2.00pm-5.00pm  (preferably on appointment calling the number +39.0456014622 or the switchboard +39.0456013111) at the Service of Physical Medicine and Rehabilitation (first floor of Ospedale Don Calabria building) to give indications and consultation on:

•· activation of procedures for the recognition of disability;

•· social security paths (INAIL, INPS);

•· legal disability;

•· activation of home care services;

•· identification of social-welfare and social-healthcare facilities and services;

•· legal protection and any legal measures.

 

B- SERVICES FOR EXTERNAL PATIENTS, UNDER OUTPATIENT SYSTEM:

Examinations

The SMFR manages the specialized outpatient examinations, carried out at the Outpatient Clinics (“Poliambulatori”) at basement of Casa Nogarè building.

The examinations may be booked at the Booking Center of Poliambulatori. Over time the following outpatient clinics have been structured and diversified:

  • divisional clinic (osteoarticular, muscle and degenerative diseases): Monday afternoon, Wednesday afternoon and Friday morning
  • pelvic floor clinic: male Thursday afternoon, female Tuesday afternoon
  • pediatric clinic: Tuesday afternoon
  • rheumatic disease clinic: Friday morning
  • botulin toxin inoculation clinic: Wednesday afternoon
  • endoarticular infiltration clinic: Tuesday morning and Thursday morning

Access to divisional outpatient clinics takes place after phone booking calling the number (+39) 0456013257.

The patients discharged by inpatient wards of Intensive Rehabilitation and Physical Medicine and Rehabilitation can book check-up examinations during the discharge and the date is also reported in the letter of discharge. In any case it is appropriate that patients access the Outpatient Clinics (“Poliambulatori”) for check-up examinations in order to monitor the condition.

The patients accessing the divisional clinics must present the GP’s authorization (physiatric examination).

After examination therapeutic programmes will be activated and for these, the physician who examinated, will issue the authorization of SSN (Italian Healthcare System – rose one) for the booking and carrying out of therapies. Many kinds of treatment, as provided by the Veneto Region decree on the Italian Essential Levels of Assistance (LEA – Livelli Essenziali di Assistenza) are fully paid.

The private practice examinations are allowed only by booking at the Outpatient Clinics (“Poliambulatori”) phone booking (+39) 0456013257

Outpatient services

Per effettuare i programmi terapeutici è necessaria la prenotazione presso la segreteria del Servizio di Medicina Fisica e Riabilitazione al primo piano dell’edificio Don Calabria secondo i seguenti orari:

•· prenotazioni allo sportello: dal martedì al venerdì dalle ore 9:00 alle 12:00

•· prenotazioni telefoniche al num. 045 6013437: dal martedì al venerdì dalle ore 13:30 alle ore 15:00

Per disposizioni regionali l’erogazione delle terapie mutuabili può avvenire esclusivamente nel centro in cui è stata effettuata la visita fisiatrica.

Attualmente il SMFR può erogare le seguenti prestazioni:

– Terapie fisiche

– TENS *

– Laserterapia *

– Ionoforesi **

– Correnti Diadinamiche*

– Correnti Interferenziali *

– Elettrostimolazione

– Ultrasuonoterapia*

– Idrogalvanoterapia (bacinelle galvaniche)*

– Pressoterapia *

– Agopuntura **

– Mesoterapia **

– Ginnastica di gruppo per la colonna

– Massoterapia **

– Linfodrenaggio

– Kinesiterapia (trattamento manuale con varie metodologie)

– Riabilitazione del pavimento pelvico (riabilitazione uroginecologica)

– Infiltrazioni endoarticolari

– Inoculazione di tossina botulinica

– Paraffinoterapia

– Terapia robotica per arto superiore

– Esoscheletro**

– tDCS (stimolazione transcranica a corrente diretta)

– Magnetoterapia**

 

* Terapie soggette a LEA ( Livelli Essenziali di Assistenza) Erogabili in regime di convenzione solo per determinate patologie

** Terapie a pagamento completo

TEMPI DI ATTESA

Il SMFR e il Centro Don Calabria di Verona

La logica nella quale si muove tutta l’attività riabilitativa all’interno del Dipartimento è quella di realizzare un sistema integrato che corrisponda a percorsi riabilitativi appropriati alle esigenze dei pazienti, ma che al tempo stesso sia attento ad un utilizzo corretto delle risorse.

A questo scopo, il SMFR individua, in accordo con gli utenti, i familiari e i responsabili delle altre Unità Operative, i pazienti che possono proseguire il trattamento riabilitativo presso la struttura di Verona.

I criteri sono ispirati a tre tipologie di percorsi :

–Percorso mielolesioni

–Percorso Stroke

–Percorso GCA