Intensive hospital rehabilitation model for patients with stroke in a developing country

Abstract

Intensive rehabilitation services with standardized treatment for stroke survivors are desirable once they contribute to the patients' functional improvement even in facilities with restricted financial resources. Objective: To verify whether the stroke program at our public inpatient Rehabilitation Center contributes to improvements in functional outcome. Method: This is a retrospective cross-sectional study of the first and last 100 neurological patients (2009-2010 and 2014-2015) admitted at the Lucy Montoro Rehabilitation Network (Morumbi Unit). For this study, the patients were analyzed at admission and at discharge by the modified Rankin Scale (mRS). After testing for normality, an unpaired t-test was on the patients' clinical and demographic characteristics. Intragroup analysis was performed by the nonparametric Wilcoxon test. The intergroup analysis used the Mann-Whitney nonparametric test. Functional outcome scores ≤ 3 at discharge were considered favorable. Results: The modified Rankin Scores (mRS) were assessed just before the initiation of the therapies and at the patients' discharge. Median mRS score at admission was 4 compared to 3 at discharge (p=0.0001), after 4 to 6 weeks in the stroke program. Conclusions: Short term, standardized intensive rehabilitation program with multidisciplinary therapies, in which the patient remains hospitalized, promote functional improvements of patients with stroke sequelae.

Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies

“…Also, part of the therapy includes exercises for safety and independence for activities of daily living (ADLs), and whenever prescribed, patients are also included in robotic or virtual reality therapies. 2 The inpatient physical rehabilitation program for patients with lower-limb amputation is stratified into two phases, one before fitting the prosthesis and the other after. Before the prosthesis, the rehabilitation program emphasis relates to the preparation of the residual limb for prosthesis use, pain treatment, contracture prevention, positioning instructions, adaptations to ADL, mobility enhancement, accident prevention, body awareness, and body schema.…”

“…The physiotherapy sessions usually include stretching and strengthening exercises, functional trainings with an active cycle ergometer, functional electrical stimulation (FES), orthostatism, gait and balance training, and body awareness exercises. Also, part of the therapy includes exercises for safety and independence for activities of daily living (ADLs), and whenever prescribed, patients are also included in robotic or virtual reality therapies 2 …”

“…T he Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IMREA-HCFMUSP) and the Rede de Reabilitação Lucy Montoro 1 provide multidisciplinary physical rehabilitation programs for patients with disabilities supplying the community with several options, such as the inpatient physical rehabilitation program, a category that has yielded positive results for patients with cerebral injuries. 2 The institute, which is the first Brazilian facility to be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) in 2014, has the objective to enhance therapies the institute already provides. Consequently, measuring the patients' outcomes on a timely basis, for instance, those who have benefited from an inpatient rehabilitation program, is relevant.…”

“…The Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IMREA-HCFMUSP) and the Rede de Reabilitação Lucy Montoro 1 provide multidisciplinary physical rehabilitation programs for patients with disabilities supplying the community with several options, such as the inpatient physical rehabilitation program, a category that has yielded positive results for patients with cerebral injuries 2 …”

Características do perfil de indivíduos amputados atendidos em um instituto de reabilitação

“…Este tipo de reabilitação já mostrou ser benéfica para indivíduos com sequela de Acidente vascular cerebral que tiveram sua funcionalidade aprimorada. 2 Dos diversos tipos de pacientes que o Instituto atende os amputados também recebem atenção especial. Sabe-se que a causa de uma amputação pode variar bastante.…”