From Coma to Community Comprehensive Model for Rehabilitation of Patients with TBI יום עיון 23 ביוני 2006 Zeev Groswasser, M.D., M.P.H. Department of Brain Injury Rehabilitation Loewenstein rehabilitation Hospital, Raanana Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv Israel

UNDERSTANDING THE SEQUELAE OF TBI Motor control and behavior + Communication disorders: (Language and speech disorder) +Cognitive deficits +Behavioral disturbances (Allocation of attention, metacognition and social behavior) _____________________________ All aspects of human life

Understanding Traumatic Brain Injury IDEAL SITUATION: A patient with a known condition, treated with known intervention towards a known outcome. TBI TREATMENT STATUS: A patient with only partial knowledge of their condition, with partial knowledge of the effects of intervention, and with imperfect knowledge of outcome (L. Diller, 1994). Results: Uncertainty

EPIDEMIOLOGY TRAUMATIC BRAIN INJURY Peak occurrence in young adult life Children Senior citizens Moral and Social implications.

ASSESSMENT OF OUTCOME BY WHOM? Specialists in Rehabilitation and Physical Medicine and in Neuro-Rehabilitation : Late phase, Integrative approach. Main concern : Social reintegration Methods of treatment How to measure ? Glasgow Outcome Scale Actual work placement. Vocational rehabilitation. Main concern : Quality of Life Patients functioning in society according to their optimal residual capacity.

POST ACUTE PHASE, Who is involved? TREATMENT OF TBI POST ACUTE PHASE, Who is involved? PROVIDERS AND CONSUMERS Providers Staff directly involved Direct providers of Health-care and Insurers Consumers Families and friends The patient himself.

Community General Hospital TBI at the LRH Coma Unit TBI Rehab. Dep. TBI Day Care New TBI Patients Clinic Vocational Rehabilitation Medical Consultants Allied Health Prof. Follow-up treatment Community elements: Physicians Social workers TRAUMATIC BRAIN INJUY SERVICE

Patient oriented approach Occupational Therapy Speech therapy Social work Physiotherapy Medical consultants Psychology Neuro- psychology Art therapy Community Rehabilitation officers Remedial teaching Vocational rehabilitation Physicians PM&R Nursing Psychiatriststs Structure of TBI Service

Community General Hospital TBI at the LRH Coma Unit TBI Rehab. Dep. TBI Day Care New TBI Patients Clinic Vocational Rehabilitation Medical Consultants Allied Health Prof. Follow-up treatment Community elements: Physicians Social workers TRAUMATIC BRAIN INJUY SERVICE

Medical supervision (PM&R) Consultants Psychiatry Physiotherapy Occupational Therapy Psychology Neuropsychology Art therapy Laboratory services Sexual consultations Social Work Day Center Pre-vocational evaluation Pre-vocational treatment

מה נשתנה..... " בזמן הזה...." אשפוז קצר 34 % חוזרים לעבודה בשוק פתוח " בימים ההם..." אשפוז ארוך 56 % חוזרים לעבודה בשוק פתוח מסקנה : יצא שכרו בהפסדו.... תשלומי אבדן כושר השתכרות לכל החיים לעומת עלות אשפוז של שלושה חדשים

השוואת תוצאות אין מחקרים לונגיטודנליים רבים המצב בישראל " בימים ההם " דומה למצב בשבדיה. קיים קושי בהשוואה לארה " ב

מסקנות צרכי חולה בקרה עלויות לטווח קצר עלויות לטווח ארוך שתוף פעולה בראייה כוללת