When entering the department, each patient starts a programme, which aims to set them off towards their own independence or towards recuperation that allows them the best participation possible within their environment. This course in based on a personalised rehabilitation project created with the medical and rehabilitative team of the Physical Medicine and Rehabilitation Service.

This includes:

  1. diagnostic and prognostic evaluation;
  2. assistance in the post-acute phase;
  3. stabilisation of the vital functions;
  4. recovery of the primary functions: feeding, control and/or management of the sphincters (bladders and intestine);
  5. recovery of the secondary functions: hygiene, dressing, management of transfers;
  6. specific rehabilitation programmes: physiotherapy, cognitive rehabilitation, occupational therapy, speech therapy.

 

The Rehabilitation Project is not always the same for all and is conditioned by the seriousness of the damage and the potential for recovery of the patient. In the most serious cases, in particular in those patients transferred from Intensive Therapy with a serious and prolonged alteration of consciousness (so-called vegetative states and minimal conscious states) for which no prognosis has yet been defined, our department aims to:

 

• study further the diagnostic and prognostic evaluation;

• continue observation for an appropriate time to establish beyond reasonable doubt the immodifiability or very limited modifiability of the neurological overview and the consciousness;

• for a period of time of between three months to a maximum of six months in cases following anoxic cerebral damage (for example following heart attack), and of between six months to a maximum of 12, in the event of post-traumatic cerebral damage), ensure the assistance and treatments are given aimed at controlling and/or preventing, where possible, secondary and tertiary complications (malnutrition, neurovegetative phenomena, infections, bed sores, posture problems, spasticity, etc.);

• accompany the family in choosing the future destination of the person (“SUAP” special unit of permanent welcome, other structures on the territory, domicile) offering them the necessary psychological and organisational support.

 

A day on the ward

The day is divided according to the operations of care of the patient such as: hygiene, transfer from the bed or repositioning, functional education.

During the day, at set times established based on the organisation of the assistance, patients who show suitable general conditions are transferred by wheelchair.

There may, sometimes, be a reduction in staff, for example on Saturdays, Sundays and holidays. In this case, it will be the doctor who, depending on the assistance priorities of each patient, will direct the staff helping patients to leave their bed.

Overnight, the complexity of the pathologies of patients and, therefore, the high assistance needs that they require, may make it inevitable that staff members be present in the room performing care activities. Our department is part of an organised hospital structure, but is made up of ‘people’ dealing with other ‘people’. Ours is a complex reality, in which the frequent unforeseen events to be resolved are often linked to the rather urgent primary needs of all the patients, but may also depend on the daily programming of the diagnostic activities (TAC, magnetic resonance, radiology, ultrasounds, etc.) and the internal organisation of the staff. Every day, we work alongside our patients to fulfil, insofar as we can, their needs.

 

How the day unfolds

After breakfast, we generally start rehabilitation therapies. The various activities may be carried out in the special areas of the Rehabilitation Service or in the patient’s room. The intensity and duration of the treatment depends on the rehabilitation programme assigned, the patient’s response capacity, the state of health of the patient and the reasonable objectives set.

 

Rehabilitation nursing:

Answering the primary needs of the patient, such as posture, hygiene, feeding, evacuation, dressing, movement (these needs are known as “primary” as they come before all others), is one of the cardinal points of the rehabilitation project. Equally as important as dressing alone or using aids to communicate or move independently, learning how to use self-catheters, or programmed evacuation are also considered rehabilitation activities. Learning to organise one’s day alone is therefore the first aim of general rehabilitation: it occurs along a non-linear journey as the individual needs of patients are always different.

 

Specific rehabilitation activities:

These include all the motor, cognitive, speech therapy, etc. programmes undertaken by specific professionals. Within the logic of change, rehabilitation is a journey made up of a sequence of actions that is ordered but always variable. The planning of these activities and the management of them is the responsibility of the staff of the Physical Medicine and Rehabilitation Service (link)

 

Communication with the patient and family

Generally, after about ten days, the patient is invited with his family members to a meeting with the responsible doctors of Intensive Rehabilitation and the Physical Medicine and Rehabilitation Service. Here, they will be informed of the current situation, on the prognosis and the rehabilitation project.

The family may request appointments with the doctors of reference regarding the clinical and rehabilitation situation of the patient, respecting the set times.

For all information of a clinical nature, the Head Physician, notwithstanding obstacles which will be communicated in a timely way, is available Monday, Tuesday, Thursday and Friday from 3:00pm to 5:00pm.

If the patient does not have all his faculties or is a minor, for the exchange of information with the staff, the family should appoint one member as a reference person, so as to not lose or confuse communication between the doctors and the family. Updates on the clinical conditions or on the results of examinations may be required day by day from the doctor of reference.

The family members and patients are also invited to participate in educational meetings led by members of the medical-rehabilitation team. Appointments will be notified through announcements in the department.

 

SERVICES

Urodynamics

There is an Urodynamics service in the Department for the evaluation of the bladder, for in-patients as well as in follow-up appointments of discharged patients. Bookings are to be made directly in the department.

 

Baclofene pump recharging

Those patients who have a baclofene pump implant, are guaranteed recharges as outpatients.

Plastic surgery for Bed Sores

Upon prior agreement, we guarantee timely evaluation by the plastic surgeon, together with the department doctor, of bed sores for patients with spinal damage.

 

Social assistance

This is a transversal service of the various OUs of the Department. Patients are referred to Social Services only within a project that is well-defined by the doctors responsible. Patients and family members will be received at the following times:

MONDAY-WEDNESDAY AND FRIDAY from 9:00am to 12:00pm and from 2:00pm to 5:00pm (preferably upon booking at +39 045-6014622 or via the switchboard +39 045- 6013111) at the MFR Service (first floor of the Don Calabria Hospital) for instructions and consultation regarding:

• activation of practices to recognise the disability;

• INAIL, INPS national contributions;

• civil invalidity;

• activation of services for assistance at home;

• identification of structures and social-assistance and social-health services;

• legal protection and any juridical provisions.

 

Instructions and advice for the post-admission period:

Taking care of your intestine – basic notions

Taking care of your intestine – precautions and advice

Urinary tract infections – intermittent catheters

Urinary tract infections – catheters at home (Foley)

Female sexuality with spinal damage

Male sexuality with spinal damage

Pressure ulcers – how to prevent them

Urodynamic examinations – useful information