ORTHOPAEDIC REHABILITATION

ORTHOPAEDIC REHABILITATION

Dr Maria Cinzia Iapichino, Specialist in Physical Medicine and Rehabilitation

The neuromotor-orthopaedic rehabilitation process involves various stages for each disease and condition. These include: comprehensive clinical and diagnostic evaluation, physiotherapy programme, tailored physical training, optimization of drug therapy, and assessment of nutrition and metabolic status. Patients thus work in close contact not only with physicians but also with physiotherapists, psychologists and dieticians. The goals of the rehabilitation plan, based on detailed tests and multidisciplinary observations of the patient, are the treatment of existing diseases and conditions, the prevention of morbidity factors, stimulating autonomy, providing psychological support to the patient and their caregivers and the reduction/elimination of psychotropic treatments.

Hospital Care

Treatment is delivered during ordinary hospitalization

Waiting time

Within 15 days, based on bed availability

Booking

Booking can be made either by phone (0536 42039) or in person at the Hospital Admission office

 

Diseases and Conditions Treated

Neuromotor - orthopaedic rehabilitation is designed for patients suffering from:

  • Neurological conditions: following cerebrovascular events (hemiphlegia, hemiparesis), peripheral nerve damage (neuropathies, radiculopathies), muscular diseases (dystrophies), demyelinating diseases (multiple sclerosis), extrapyramidal syndromes (Parkinson’s disease)
  • Orthopaedic conditions: resulting from traumatic damage of the locomotor apparatus (fractures), joint prostheses surgery (hip and knee arthroprostheses), amputations, dysmorphies of the rachis, osteoporosis, osteoarthritis
  • Rheumatic diseases: rheumatoid arthritis, ankylosing spondylitis
  • Obesity with motor complications

Admission

The rehabilitation team takes charge of the patient for the treatment of the case and prepares the most suitable therapeutic plan. When the patient is admitted, a series of assessment tests is performed, using, wherever possible, scales validated and/or recognized by scientific communities, which enables the team to establish the patient’s condition and develop the best possible action plan. The same tests performed when the patient is discharged will indicate the effectiveness of the rehabilitation treatment.

Main goals

The techniques and methods of treatment of the relevant diseases and conditions are defined according to the therapeutic goals and the age of the patients. The main goal of Neuromotor - Orthopaedic rehabilitation is to enable the patients to recover the impaired primary function and thus restore their state to what it was prior to the onset of the illness or improve it, so that they can enjoy a level of autonomy consistent with an independent life. The rehabilitation plan aims to speed up the process of Psychosocial readjustment. To this end, the team has designed a number of rehabilitation plans which, based on the most advanced scientific knowledge, deal with both the comprehensive diagnostic evaluation stage and the treatment stage in a multidisciplinary-interdisciplinary manner, combining traditional assessment and physical rehabilitation techniques with education and occupational therapy programmes.

Individual Rehabilitation Plan

The individual rehabilitation plan is composite, tailored to the patient’s needs, and uses various treatments aimed at achieving maximum recovery of the patient’s functional conditions and mobility, pain control, counteracting the secondary complications of immobility or rigidity, stimulating active motility, motor coordination and postural reprogramming in order to recover the body schema. The approaches adopted, particularly with elderly persons, are directly associated with the potentially dramatic consequences of protracted immobilization. Indeed, the functional repercussions of cases involving the lower limbs will be far more serious as these influence ambulation and consequently the patient’s basic autonomy. In such cases, the risks of a psycho-motor regression are so significant that the main goal is to go through the stages of the rehabilitation plan as quickly as possible so as to avoid upsetting the patient’s functional equilibrium.

 

The main activities of the rehabilitation plan are:

  • Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment
  • Medical Activity
  • Nursing care
  • Rehabilitation therapy
  • Occupational therapy

The set goals can only be achieved if the rehabilitation plan includes all these components.

Comprehensive Diagnostic Evaluation and Multidisciplinary Assessment

The clinical evaluation carried out in the first days of hospitalization analyzes not only the ongoing pathological event but also the clinical variables that may have influenced the development of the disease or condition. This patient approach is developed by the interdisciplinary team (physiatrist, internist, rehabilitation therapist, occupational therapist) which carries out an initial assessment of the patient and suggests programmes in the various relevant professional areas.

The Team reviews weekly the programmes and goals attained in order to confirm or revise them.

 

Medical Activity

The Internal Medicine physician will deal with the patient’s clinical evaluation, existing complications, drug therapies and the recovery/maintenance of the patient’s state of health. Should he deem it necessary, he can prescribe further specialist visits and tests that are not included in the routine, in order to secure the patient’s clinical stability.

 

Nursing care

The functions performed by nursing staff and care workers are essential in order to:

  • put into effect the intervention plans developed for the patient and related monitoring actions (prevention of surgical infections, treatment/prevention of skin lesions, taking charge of concomitant needs-conditions and so on)
  • comfort and support the patient in tackling minor and major everyday challenges

 

Rehabilitation Therapy

Based on the problems which emerged during the diagnostic evaluation stage, the physiatrist will prescribe the type, duration and intensity of the programmes to be undertaken.

The rehabilitation programmes are delivered by rehabilitation therapists and include:

  • PHYSICAL THERAPIES FOR PAIN RELIEF - T.E.N.S., Diadynamic Current, Interferential Current, Iontophoresis, Hydrogalvanic therapy, Infrared and Ultraviolet Rays, Ultrasounds, Magnet Therapy, Cryotherapy, Tecar Therapy, Laser Therapy, Shockwave Therapy, Kinesiology Taping
  • ELECTRICAL STIMULATION: Faradic Current, Kotz Currents, Exponential Current
  • MASSAGE THERAPY techniques: de-contracting, connectival, Manual Lymphatic Drainage
  • SIMPLE SEGMENTAL MOTOR RE-EDUCATION: Bedside treatment, Posture control, passive mobilization (manual or mechanical), active-assisted articular and full spine mobilization, active strengthening exercises with/without gym equipment, McKenzie method for cervical and lumbar spine, Pancafit Raggi method
  • NEUROMOTOR RE-EDUCATION: kabat and Bobath techniques
  • GLOBAL POSTURAL RE-EDUCATION
  • FUNCTIONAL RE-EDUCATION - Standing, Orthostatic exercises, Physiotherapy table, Balancing exercises, Coordination exercises, Stationary bike
  • AMBULATION RE-EDUCATION – Parallel bars, Weight-bearing exercises with/without biofeedback
  • Changes of direction, Ambulation and Gait Training with/without walking aids, Hurdle path
  • PROPRIOCEPTIVE RE-EDUCATION
  • GROUP MOTOR KINESIOTHERAPY
  • Identification and selection of any AIDS that may be required and subsequent prescription, supply and training on their use

Occupational therapy

Rehabilitation is further enhanced by Occupational therapy (OT). OT treatment is delivered through specific physical activities designed to help patients attain their maximum potential in terms of their functions and independence in all aspects of daily life.

Hospital Discharge and Continuum of Therapy and Care

Once the rehabilitation plan has been completed and the motor capabilities and level of autonomy attained by the patient have been assessed, the team shares the information with the patient. Together they agree on the patient’s return home or on the need for a hospital discharge under a continuing care scheme; they go through all the postural steps, walking, stairs, daily activities again and check whether there are any architectural barriers at home, in order to determine the most suitable solutions and/or whether any aids need to be prescribed. In all cases, patients will only return home when their recovery has stabilized.

The doctor fills out the hospital discharge letter, setting down the outcomes of the tests and examinations performed, the recommended drug therapy, the activities undertaken, any examinations to be carried out at home and the indications that the patient and/or the family/external carers will be required to follow.