S-1-02-01
HOME HEALTH CARE FOR CHRONIC PATIENTS WITH A DISABILITY
Derick T. Wade (Rivermead Rehabilitation Centre, Oxford, Great Britain).
Disability refers to the alterations in or restrictions on the qualitative and/or quantitative aspects of an individual's behaviour arsising as part of an illness. Behaviour refers to goal-directed interactions with the environment, and is greatly influenced by changes in environment. Consequently all rehabilitation must take into account a patient's own home environment. However a balance must be struck. Centre-based rehabilitation probably allows: more efficient use of scarce professional time; more easy access to the necessary range of skills; more contact with therapists; access to certain equipment; and possibly some respite for carers. Community-based rehabilitation probably: allows therapy to be more relevant; increases patient motivation; actively involves family and others in the process; and avoids mal-adaptive behaviour.
S-1-02-02
STROKE RHBILITATION - HOSPITAL, COMMUNITY OR BOTH?
E. Greve, MD: Department of Neurology, Hoistebro, Danmark
There is no longer doubt about the benefits of stroke rehabilitation in special units. However, how to organize the best rehabilitation models are still in question. In view of the great variation amongst stroke patients and their need for different rehabilitation organizations, many studies of hospital-based rehabilitation compared to domiciliary treatment have been made.
Evaluating different clinical practices it is important to ensure, that the benefits of a stroke-unit persists. This is difficult, because no one knows for sure, what provides the results from a stroke-unit compared to general medical wards. Another unknown factor is how to considerate the patients' social supports and in which way they affect the use of outpatient rehabilitation and personal care services.
An essential problem is the inconsistent poststroke rehabilitation and home help services. It may vary from one part of a country to another, most different from urban to non-urban regions. Home therapists and home caregivers should probably be involved in the decision, whether a stroke patient can be treated at home or not. It is important to establish interfaces between community - and hospital based service systems.
Coordination of rehabilitation probably is one of the important aspects of stroke- rehabilitation. The use of a case-manager and individual spouse education may be the solution of this problem. Finally, the costs of different rehabilitation settings is still unclear. Therefore, more trials are required to examine which rehabilitation organization is preferable for different stroke-patients.
