Life is launching a new clinical excellence programme for thromboembolic
disease and stroke care to ensure safer rehabilitation for patients.
Contrary to common belief, the critical survival period following a life threatening event or stroke is not limited to the first few days. During the longer period of rehabilitation or the ‘last mile’ of recovery, the patient’s health and wellbeing is still significantly at risk. Embarking on the journey towards functional recovery, a patient may still be struck by a
catastrophic or even fatal thromboembolic event, such as a pulmonary embolism or a deep venous thrombosis. The challenge for the acute healthcare and rehabilitation practitioners is therefore to ensure a close alliance to facilitate seamless transfer between stages of care and to manage
these potential threats from the outset, diligently and jointly. To this end, Life Healthcare’s Clinical Directorate have designed the Venous Thromboembolic Disease (VTE) programme with the aim of reducing death and disability from pulmonary embolism (PE) and deep venous thrombosis (DVT). The programme commenced in March 2012 and will be rolled out to all of Life Healthcare’s acute care and acute rehabilitation units by September 2012. On admission to acute care, all patients will receive a formal VTE Risk Assessment. The attending doctor will prescribe a thromboprophylaxis regimen comprising a combination of mechanical intervention and drug therapy which is designed to manage the patient’s specific level of risk.
Once the patient is transferred to acute rehabilitation, along with all records of clinical interventions, the acute rehabilitation team ensures the continuity, adequacy and recommended duration of treatment during rehabilitation as well as safe post-hospital discharge.
This comprehensive and hospital-wide programme will systematically reduce, address and manage all VTE related risk, thereby managing the morbidity or mortality from sudden pulmonary embolism in acute rehabilitation units. In addition, following on from the “100K Lives” and the Acute Myocardial Infarction (AMI) Bundle, Life Healthcare’s Clinical Directorate have designed the Life Stroke Programme with the aim of effectively reducing morbidity and mortality in patients.
The Life Stroke Programme draws
heavily on the Canadian Stroke Strategy, an audited national programme of the Canadian Department of Health, that informs us of best practice and benchmarks our own programme. The Life Stroke Programme classifies every stroke as a medical emergency requiring early assessment, treatment, and thrombolytic therapy in addition to comprehensive dysphagia screening, acute post-stroke functional assessment and secondary prevention.
In rehabilitation, establishing early relationships between patient, loved ones and future caregivers enhances patient experience and improves the efficiency of care. Forward planning and increased risk management becomes a natural part of the programme, as does integration, continuity and efficiency of care as the patient moves from acute care to acute rehabilitation. In the Canadian experience, this efficiency translated both into improved quality of outcomes and significant cost savings.
It is expected that the implementation of the VTE and Stroke Programmes will make acute rehabilitation a measurably safer last mile for all our patients.
Written by Dr Lloyd Kaseke, Clinical Directorate Life Healthcare
Page 2
New unit for Life
Vincent Pallotti
Page 3
Optimising mobility retraining
with the help of technology
Page 7
Continence management
in neurological dysfunction
15
ISSUE
winter 2012
Clinical Excellence:
International best practice comes to Life
A SAFER LAST MILE
A close alliance between the acute healthcare and rehabilitation practitioners ensures a seamless transfer between stages of care and helps to manage potential threats from the outset, diligently and jointly.
growing the service
Life Care for Mother City
Life Rehabilitation is thrilled to announce the opening of its seventh Life Rehabilitation Unit at Life Vincent Pallotti Hopsital in Pinelands, Cape Town.
The new facility accommodates 36 adult physical rehabilitation beds, taking the Life Healthcare Acute Rehabilitation network’s total bed capacity to 255. Life healthcare now manages 60% of all private acute rehabilitation beds in South Africa and 35% in total (including public beds).
The unit has attracted an excellent and accomplished team of professionals, and boasts sparkling new facilities, including an
aquatherapy pool, and a specially landscaped outdoor garden area to enjoy with their families. The unit will admit patients that require rehabilitation following stroke, spinal cord injury, amputation, or any other debilitating condition that requires intensive inpatient rehabilitation.
Dr Ed Baalbergen, well known nationally in the rehabilitation field of practice, heads the 36 bed unit, and is supported by an interdisciplinary team of rehabilitation professionals. Vice-president representing Africa on ISCOS,
Life Healthcare now provides most extensive
rehabilitation service in the country
Dr Ed Baalbergen, rehabilitation doctor for the Life Vincent Pallotti rehabilitation unit. Christo van der Merwe, contracted project manager of the
new unit; Dr Tai Seng Schierenberg, business manager clinical products; Mr Mike Flemming, CEO and Mrs Nina Strydom, clinical products support specialist.
member of the prevention committee on ISCOS and chairperson of SASCA, Dr Baalbergen works tirelessly on the scientific committees for these organisations. After spending the bulk of his early working years as a medical officer at Conradie Hospital, predominantly with spinal cord-injured patients, he then spent 14 years establishing and developing
the neurological rehabilitation unit at the University of Cape Town’s Private Academic Hospital. The Life Healthcare group is very proud to be associated with his passionate and dedicated approach to rehabilitation.
our quality care
Measuring our quality:
Electronic devices here to stay
In the Spring 2011 Life Rehabilitation Review Newsletter, LifeRehabilitation announced a ground breaking touch screen patient satisfaction device, at that stage in a piloting phase. The business is very excited that the company’s executive team has given approval for roll out and the device has now been implemented in all acute rehabilitation units. The success of the project has been such that the implementation has not been limited to Life Rehabilitation but extended to other specialist services as well.
The use of the device is invaluable in the ongoing quality management of the services delivered to our patients. The questions asked have been adjusted according to current data, which is now available by patient, unit, diagnosis and funder. This enables Life Rehabilitation to work with and feed back valuable data to their major role players. In addition, work is currently under way to translate the survey into Zulu, Tswana, and Afrikaans - thereby making it accessible to a wider patient population. Patients and staff have commented that
the device is user friendly and time efficient, resulting in minimal effort and disruption to the busy rehabilitation schedule.
The information Life Rehabilitation obtains from their patients with these devices will pave the way to ongoing improvements in service quality,
thereby enhancing the entire patient experience and ultimately assisting in the delivery of excellent patient outcomes.
Life Pasteur recently acquired the Biodex Medical System to optimise re-education of balance and weight bearing, core stability and gait retraining in their mobility-impaired patients.
Postural balance while standing is an automatic motor skill requiring complex
coordination and integration of multiple sensory, motor and biomechanical components. The Biodex Balance system provides the patient
with up to 20% of support surface tilt, which challenges the patient to maintain and relearn
their centre of gravity over their base of support as they attempt to keep the surface level. This task depends on neuromuscular mechanisms
of proprioception, strength, and power. The Biodex Gait Trainer is a treadmill that individualises gait re-training by using each
patient’s height to determine theoretical step target and step length.
Unweighing, or partial Weight-Bearing Therapy is a rehabilitation concept that uses an external device to support a variable amount of body weight and which allows the patient to perform a variety of therapeutic activities in an upright and safe environment. Used in neurological conditions, and supporting 20-60% of body weight, the device assists the patient to develop proper gait patterns and improves cardiovascular and muscular endurance with less physical demand. Early exercise in rehabilitation benefits the patient by developing neural pathways through muscular patterning. The Biodex unweighing system has enabled the Life Pasteur team to implement this therapy effectively and safely.
with the help of technology
Mr. Rafoue Panyane suffered a severe electrical shock, resulting in right upper limb and a bilateral lower limb amputations. Severe pain prevented weight bearing on the stumps and gait retraining was only possible through initial unweighing and then gradual escalation of weight-bearing in therapy. On discharge, he could walk and climb stairs independently.
our staff, their expertise and commitment
Life Rehabilitation welcomes staff development and progression, a necessary
component of any growing and dynamic healthcare team. We welcome all of the
new energy and skill in the group, embodied in our team members:
Welcome!
Life Riverfield Lodge has expanded their team with the appointment of, from left to right, Marie Bothma, dietician, Aadila Hassim, occupational therapist, Jane Young occupational therapist, Joseph Malema, physiotherapist, and Julie Monson, occupational therapist (not pictured).
The first rehabilitation management team at Life Vincent Pallotti Hospital, from left, Alicia James, rehabilitation admissions consultant; Elaine Kotze, nursing services coordinator; Dr Ed Baalbergen, rehabilitation doctor; Lida Edgar, rehabilitation practice manager; and San-Marie Stander, therapy services coordinator.
Dr Samantha Maughan (left), sessional doctor, and Angela French (right), therapy services coordinator for Life St Dominic’s Hospital. Dr Maughan has worked regularly in the unit for several years, and Angela French, resident social worker since the unit’s opening in 2007, has recently been promoted.
Fiona Heinold, a physiotherapist who has been with Life Entabeni Hospital for a number of years before she joined the Bobath Centre in Scotland. She has now returned as the therapy services coordinator.
The Life Pasteur rehabilitation team has expanded and changed with the upgrading of their facilities and the appointment of Christolene Saaiman as the therapy services co-ordinator. Pictured, from left: Back – from left to right: Corleia van der Westhuizen, rehabilitation secretary; Samantha Sawat, physiotherapist; Karen Vosloo, rehabilitation clinical specialist; Lee-Ann Uys, social worker; Magda Wessels, physiotherapist and Adri Robbetze, occupational therapist. Front – from left to right: Ben Janecke, neuro psychologist; Ilze Lombaard, physiotherapist; Christolene Saaiman, therapy services co-ordinator; Sandra Laten, social worker and Madeleen Eygelaar, physiotherapist
Ida Geldenhuys has recently taken up the position of therapy services coordinator at Life Riverfield Lodge.
Sophia Combrink, clinical psychologist, recently joined the rehabilitation team at Life Riverfield Lodge.
Dr Sammy du Preez, rehabilitation doctor at Life Eugene Marais Hospital, has worked in the Pretoria units since 2006 and knows Life Rehabilitation units well. She has a special interest in spinal and stroke rehabilitation.
Elecia van Zyl recently joined the Life Eugene Marais team as an occupational therapist, to take over from Hannelie Labuschagne, who worked in the unit since 2007 and to whom we bid farewell and best wishes.
Roezelle Marais recently joined the Life Eugene Marais team as a part-time occupational therapist.
community involvement
Life Eugene Marais’ therapy gym turned into a rugby stadium for a day with 90 people watching a rugby match.
Both Life Eugene Marais and Life St Dominic’s recently took the opportunity to brighten
up the days of their patients and families with rugby festivities and related activity in
the units. They decorated, sang, and socialised with traditional braai events with great
success, inviting families and friends to visit, join in the fun and lift the mood in the unit.
Pictured is Life Eugene Marais’ thousandth patient, Mrs Lee, with the unit’s rehabilitation admissions consultant, Paula de Beer
LIFE EUGENE
MARAIS
CELEBRATES
THEIR
PATIENT
World Stroke Day
Merrifield Mile
Pictured is Mr F. Kirsten, an acute rehabilitation patient at Life St Dominic’s, enjoying himself at the Rugby event in the unit.
Laro Fourie, Life St Dominic’s hospital manager (on the right) and Dr Patrick Hutchinson, rehabilitation doctor at Life St Dominic’s, at the Merrifield Mile, demonstrating the active lifestyle that underpins health.
“The Rehabilitators” team from Life St Dominic’s walks the extra mile in the CANSA relay. The CANSA Relay For Life is a worldwide unique event offering different communities the opportunity to participate in the fight against cancer. It is a time to celebrate survivorship, to remember those lost to cancer, and to fight back - by raising much-needed funds for CANSA to continue their services. It is
The Life St Dominic’s Cardiac and Rehabilitation teams ran a coordinated Stroke awareness day for the public at a local shopping mall, on World Stroke Day. The team offered free blood sugar and blood pressure tests, and information on Stroke, Hypertension, Heart Attacks and Diabetes.
Life St Dominic’s Hospital
National Rugby
offers an opportunity
for our units to celebrate
Life St Dominic’s team walks the
1 000
th
CANSA Relay for Life
also a time to give hope to those affected by the disease.
The Life St Dominic’s Rehabilitation Unit participated in this special event on Saturday, 24th March 2012 with the team name of the ‘The Rehabilitators.’ The Team walked through the night and were committed to keeping at least one member walking the track at all times because cancer never sleeps.
training and development
Staff active in networking and updating knowledge
Life Rehabilitation continues to be active in networking within the field of practice and in updating
knowledge and skills bases. To this end, many of our staff attended the NASA, SANDTA and SANRA
congresses held in the past months.
271 physiotherapists, occupational therapists and speech and language therapists attended the bi-annual congress of the SA
Neuro-developmental Therapy Association in Bloemfontein. The congress was hosted in association with PANDA SA (Paediatric Neurology and Development Association of South Africa).
Estelle Brown, well known Physiotherapist and tutor, led delegates through the history of SANDTA during the key note address, and gave everyone food for thought on the role of the rehabilitation professional in the ever-changing clinical, legal and physical environment.
Guest speakers included Trudy Arendtz from the Netherlands, who holds a technical Opthalmic Assistant degree, a certificate in Clinical Neuropsychology (problem analysis) and a basic qualification in sensori-motor integration. She is also trained in light illumination and design for people with visual problems. She has been involved in the assessment of visual functioning in people with severe to profound intellectual disabilities, dementia and acquired brain damage, including screening of higher perceptual
disorders. Her presentations focused on the causes of cerebral visual impairment, its influence and consequence on behaviour, and strategies for dealing with this significant impairment.
Marda Horn and Antoinette Oosthuizen, laywers from Bloemfontein addressed the legal labyrinth enhancing and/ or hampering tomorrow’s therapy, including the relevance and practical implications of recent statutory developments in the SA legal system, especially the National Credit Act (Act 34 of 2005) and the Consumer Protection Act (Act 68 of 2008). It provided therapists with understanding of common law principles applicable in the legal relationship between therapists and patients.
Interesting talks included presentations by Nina Strydom, support specialist for Life Rehabilitation, on the current paediatric outcomes measure, WeeFIM II, used in Life
Rehabilitation units, as well as goal setting within the framework of the International Classification of Functioning, Disability and Health (ICF).
A very exciting event on Stroke Rehabilitation:
what are we doing and where are we going?
was presented at Life Eugene Marais Hospital, by Professor Gert Kwakkel, chair of Neuro-rehabilitation at the Vrije Universiteit University Medical Centre in Amsterdam, senior lecturer at the Faculty of Human Movement Science in Amsterdam, president of the Dutch Society of Neuro-rehabilitation and visiting professor for the Faculty of Health, Social Work and Education at the University of Northumbria
in the United Kingdom. Professor Kwakkel who has published over 90 scientific papers in peer-reviewed journals such as Lancet and Stroke, shared his treatment strategies, experience in stroke rehabilitation, and predicted stroke outcomes in the European Union.
Lynette Pennie (rehabilitation admissions consultant for Life St Dominic’s), hands over the competition prize to Dr Johan Keyter at the NASA Congress, held at the ICC in East London in March 2012.
Pictured, from left, at the SANDTA congress in Bloemfontein: Elzette Williams (rehabilitation admissions consultant Life Pasteur); Elma Heyns (rehabilitation admissions consultant team leader Life Pasteur ); Susan Viljoen (physiotherapist); Nina Strydom (SANDTA chairperson and Life Rehabilitation support specialist); Dorothy Russell (Vice-chairperson SANDTA and chairperson: SANDTA Free State branch)
Prof. Gert Kwakkel
SANDTA congress
NASA congress in
East London
Stroke Rehabilitation
Elton Bloye, a clinical psychologist in Johannesburg, recently shared his expertise in a CPD session held at Life Riverfield Lodge, on the assessment and management of co-morbid neuropsychological conditions affecting the rehabilitation of clients with spinal cord injury and/or polytrauma.
Neuropsychological conditions
affect rehabilitation
In Feb 2012, Elsje Scheffler, a physiotherapist with many years of experience at the Western Cape Rehabilitation Centre and a seating specialist and rehabilitation consultant, held a workshop at Life Pasteur Rehabilitation on managing adults with spinal cord injuries. 30 physio- and occupational therapists attended the excellent practical demonstrations on activity-based interventions. Elsje held the same workshop for 24 rehabilitation therapists at Life St Dominic’s in East London, and 20 therapists at Life Entabeni Hospital in Durban, exploring the ICF (International Classification of Function) as a framework for practical patient assessment, therapy planning and treatment of persons with incomplete spinal cord injuries.
Incontinence is one of the most disabling aspects of disability and is a huge focus of rehabilitation teams during patients’ rehabilitation.
A full day workshop was hosted by Life Riverfield Lodge, Johannesburg, in March 2012, presented by two of our most experienced team members, Dr Ed Baalbergen, rehabilitation doctor at Life Vincent Pallotti Hospital in Cape Town and Sister Jacquiline Groenewald, nursing standards manager for Life Riverfield Lodge and Life Poortview. Valuable knowledge based on years of experience was shared by the presenters, including anatomy and physiology of the bowel and bladder, causes of incontinence, and strategies to manage incontinence, including supra-pubic catheter and intermittent catheterization options.
Dr Ed’s take-home message regarding bowel management was to have the 5 R’s in place: n Right time n Right place n Right consistency n Right amount n Reliable trigger
Sr Groenewald talks on practical strategies for continence management, goal setting and communication highlighted the role that interdisciplinary teams play in achieving positive outcomes. Her message emphasised putting yourself in the patient’s situation, taking into account the following aspects:
n Privacy
n Practical approach
n Avoiding unnecessary costs n Working SMART
n Establishing a fixed routine
training and development
Pictured at the CPD on Spinal Cord Injury at Life Pasteur Hospital is presenter Elsje Scheffler (front left), with attendees of the CPD.
Continence management in
Neurological Dysfunction
Exploring the assessment and
management of adults with
spinal cord injury
In acknowledgment of the essential roles that the extended healthcare community plays in the rehabilitation process, Life Riverfield Lodge hosted their first interactive workshop for nursing and case managers from hospitals and funders in February 2012.
Dr Estie Janse van Rensburg, a former physical rehabilitation patient at Life Riverfield Lodge, was the special guest at this event, and gave a brief account of her experience in rehabilitation and its contribution to her independence. This was supported by presentations by staff exploring her condition and intervention, as well as clarifying rehabilitation team member roles.
Sanofi-Aventis invited the region’s
specialists to the Targocid Roadshow at the newly upgraded Life Pasteur Hospital and delivered an excellent talk on the treatment of deep seated infections. In addition, Dr Adrian Brink and Dr Charl Olivier presented the latest data from the GUTS 2 Trial (The ‘Growing Up Today Study’ - an extensive trial following a large cohort of people growing up in today’s world, and studying the impact of the ‘modern lifestyle’ on future health). Guests were treated to fine dining and music by Dr Tswai Pieterse and her band.
The programme concluded the following morning with a breakfast focussing on the new VTE management guidelines. Once again many of the referring specialists took time out of their busy schedules to attend.
Life Riverfield Lodge open day
Life Pasteur Hospital
celebrates expanded
facilities with talks
– an essential CPD on a topic often ignored
Pictured at the Sanofi Roadshow event at Life Pasteur Hospital are, from left to right, Dr Adrian Brink (microbiologist), Dr. Tswai Pieterse (rehabilitation doctor, Life Pasteur Hospital), Estelle Mey (Sanofi), Deon Benjamin (Sanofi), Dr Charl Olivier (orthopaedic surgeon), Dr. Michelle van Zyl (rehabilitation doctor, Life Pasteur Hospital), Sanet Kruger (Sanofi) and Christina Fourie (rehabilitation practice manager: Life Pasteur Hospital) Sr Jacquiline
Groenewald, nursing standards manager at Life Riverfield Lodge.
Contact
us
Life Entabeni Hospital
148 Mazisi Kunene Road, Berea, Durban 4001
Tel: 031 204 1300 (ext 360) Fax: 031 261 3439
E-mail:
rehab.entabeni@lifehealthcare.co.za
Life Eugene Marais Hospital
696 5th Avenue, Les Marais,
Pretoria 0084 Tel: 012 334 2603 Fax: 086 600 8028 E-mail:
rehab.eugenemarais@lifehealthcare.co.za
Life New Kensington Clinic
23 Roberts Avenue, Kensington, Johannesburg 2094
Tel: 011 538 4700 Fax: 011 614 3037 E-mail:
rehab.newkensington@lifehealthcare.co.za
Life Pasteur Hospital
53 Pasteur Drive, Hospitaalpark, Bloemfontein 9301
Tel: 051 520 1230 Fax: 051 522 6605 E-mail:
rehab.pasteur@lifehealthcare.co.za
Life Riverfield Lodge
34 Southernwoods Road, Nietgedacht, Randburg 2194
Tel: 086 074 8373 Fax: 086 552 7308 E-mail:
rehab.riverfieldlodge@lifehealthcare.co.za
Life St Dominic’s Hospital
45 St. Mark’s Road, Southernwood, East London 5201
Tel: 043 742 0723 Fax: 043 722 6321 E-mail:
rehab.stdominics@lifehealthcare.co.za
Life Vincent Pallotti Hospital
The Park, Alexandra Road, Pinelands, Cape Town 7405 Tel: 021 506 5372 Fax: 021 506 5361 E-mail: rehab.vincentpallotti@lifehealthcare.co.za Life Rehabilitation National Office
Oxford Manor, 21 Chaplin Road, Illovo 2196 Tel: 011 219 9620 Fax: 086 686 0441 E-mail: rehab.headoffice@lifehealthcare.co.za
www.rehab.co.za
Review is published by Life Rehabilitation for distribution to rehabilitation stakeholders.
Project Leader: Franҫoise Law, Support Specialist, Clinical Products • E-mail: francoise.law@lifehealthcare.co.za • Tel 011 219 9626 Editor: Dr Julie MacLiam, Group Communications Manager E-mail: julie.macliam@lifehealthcare.co.za Tel 011 219 9148.
Life Healthcare • Oxford Manor, 21 Chaplin Road, Illovo 2196 • Private Bag X13, Northlands 2116
Dear Friends,
It’s been a long and difficult road but extremely satisfying. A road that I could not have travelled without friends and family. I came into rehab a quadriplegic. Unable to talk, eat or move my limbs. With the help of each and everyone of you all I am a normal functioning human being today. I left rehab on the 19th April and have been recovering. It has been an extremely rewarding period because of the quality time I have spent with my children. I have gone from strength to strength and will be returning to work soon. I recently participated in the Mpati Mountain Race and would like to dedicate the medal to the staff of Rehab.
Saeed Mahomedy
The reason for working in a rehabilitation setting is embodied in this heartfelt letter and medal, sent to the rehabilitation team at Life Entabeni Hospital.
Despite successful acute rehabilitation, reintegration into work and home life is often challenging. Many experience a life-changing event, intensive acute healthcare, the hard work of acute rehabilitation and discharge back home, all within 8 or 10 weeks. Subsequent
work or home-life requires many significant adjustments which are often much more difficult than expected. With this in mind, the Life Eugene Marais rehabilitation team have implemented a short-stay follow-up admission, which effectively ‘tops up’ patients’ needs for independence once the patient has gained much clearer insights into the functional deficits based on some experience of ‘real life’ with a disability. One such patient was Ms Nxumalo, pictured left, who had sustained a spinal cord injury in a work-related motor vehicle accident. Adjusting well to life in a wheelchair, she was discharged, following which she returned to work. Soon she battled with some functional challenges. A brief readmission to the unit resolved her difficulties, allowing intensive re-training and counselling her on how to manage the issues around which she had developed insight. She now takes on the challenges with fresh confidence and understanding.
Life Eugene Marais
implements
spinal follow-up admissions with success
Mr Baruni suffered a traumatic brain injury affecting his coordination and vision. His rehabilitation at Life New Kensington Clinic included retraining his great passion, football.
