We will look at the definition of Neuro-Rehabilitation as opposed to Palliative Care, What impairments patients have at diagnosis How good we are at

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Todd Cameron
6 years ago
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1 We will look at the definition of Neuro-Rehabilitation as opposed to Palliative Care, What impairments patients have at diagnosis How good we are at picking these up; What we need to do to change the system to allow patients better access to rehabilitation, Look at the evidence of effectiveness for neuro-rehabiitation and cognitive rehabilitation and Discussing a Multidisciplinary Meeting model and a more standard Goal Orientated Neuro-rehabilitation Intervention model 1

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3 The World Health Organization define rehabilitation as I think the main point here is long term conditions. Rehabilitation is a slow process and there may be little point in actively trying to rehabilitate patients who have a life expectancy of 3 months or less. Many rehabilitation doctors consider brain and spinal cord tumour patients to have no rehabilitation potential and do not consider oncology patients as their core business. It is time they had a wake up call! 3

Palliative Care is defined as an approach that improves quality of life ----- associated with life limiting illness where illness can be defined as progressive and fatal and I think most importantly

4 Palliative Care is defined as an approach that improves quality of life associated with life limiting illness where illness can be defined as progressive and fatal and I think most importantly cannot be reversed by treatment. So here we can see hopefully that we have patients who may benefit from rehabilitation and we need to engage early with the rehabilitation comuninty to get that message across and work in partnership to allow our patients access to their services.. We also need to engage with the Palliative Care Community early and work in partnership with them. 4

5 Some impairments are obvious to patients and medical profession and some are not! 5

6 Patients with focal problems with weakness, numbness or language problems present early, those with personality problems and mild visual field problems don t. Those where the symptom was confusion presented very early, but within that memory problems present 8-10 weeks 6

7 20% had no signs. Usually epilepsy. No need for Neuro-Rehab, but may need an epilepsy specialist nurse/neurologist and epilepsy support services. A broad range of problems that may benefit from physiotherapy asessment, speech and language assessment, neurocognitive assessment 7

8 Depending on the range of tests used problems with frontal lobe function occurs in 78% of patients and memory or understanding problems in 68% 8

remember the information given. Only 13 of these were identified by the neurosurgical team.

9 Of 100 patients admitted for neurosurgery involved in a study to assess capacity 25% lacked capacity to consent for surgery because they could not fully understand, assimilate or remember the information given. Only 13 of these were identified by the neurosurgical team. Of those who did have capacity Memory and verbal fluency had low median scores. Naming fewer than 10 9

10 On admission to the Neurosurgical wards it is important to ask relatives if the patient has problems with personality, mood and memory / cognition. 10

11 Assess post operatively and in stable treated patients in neuro-oncology outpatient departments 11

12 Neurosurgeons have a particular set of skills the focus is on the technical and safety aspects of the surgery and breaking bad news. Hospital Management is keen on efficiency, bed numbers and lengths of stay. 12

13 The patient is under the supervision of the neuro-surgeon. It is his/her role to ensure that someone is in charge of the neuro-rehabilitation. Will improve their long term results and is a sign of high quality care, not just high quality surgery. 13

14 We are quite good at engaging with physio, OT, SALT, less good at engaging with dietician, neurologist and neuropsychologist 14

15 So what is the evidence for effectiveness of neuro-rehab programmes in glioma and Cognitive rehab programmes? 15

16 A recent Cochrane Review has been performed to synthesise the literature in a systematic way. 16

17 Another recent systematic review in BMJ Supportive & Palliative Care demonstrates some evidence for

18 There are a few rehab programmes that have looked of cognitive rehabilitation Programmes 18

19 A controlled clinical trial was performed in Australia looking at the effectiveness of integrated multidisciplinary rehabilitation in stable outpatients 19

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NZ Organised Stroke Rehabilitation Service Specifications (in-patient and community)

NZ Organised Stroke Rehabilitation Service Specifications (in-patient and community) Prepared by the National Stroke Network to outline minimum and strongly recommended standards for DHBs. Date: December