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| Friday, 22 October 2004 |
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Patient a team member In rehabilitating a stroke patient, the patient too becomes not just a patient but an important member of the rehabilitation team, says Dr. Lalith Wijeratne (Consultant Rheumatologist) Colombo South Teaching Hospital in this article to the Health Watch on Medical Rehabilitation of a stroke patient. Patient's role As no health professional can be an expert in all the areas to be covered in the rehabilitative treatment of a stroke patient, the patient too plays an important role in the rehabilitation team, as a team member, as he makes the final decisions when selecting procedures and making goals. The patient's family will have to play this role, if the patient is cognitively impaired. Necessity of professionals The skills required depend on the nature of the patient's neurological deficits. Persons specialised in physiotherapy, occupational therapy and speech and language pathology implement the medical rehabilitation treatment. Other professionals who commonly participate include nurses and social workers. In stroke rehabilitation, the doctors work with all the above categories of health professionals, together as an interdisciplinary team. This team is also known as a rehabilitation team. The rehabilitation services could be rendered to the stroke patient either as an in-patient facility or as an outpatient facility. Doctors responsibility The doctor in the team is responsible for providing the best possible rehabilitation and medical programmes. As a member of the rehabilitation team, the doctor advises other members of the team on the capabilities of the patient and the dangers of providing certain therapies in certain cases. The doctor also directs and modulates therapy and assesses the patient's goals and potentials. He should also establish and co-ordinate the team and ensure that the patient is receiving the best possible care. The nurse has the most frequent and the closest contact with the stroke patient. The nurse's main role is to work with the patient on body functions such as bladder and bowel, caring for the skin, teaching about skin care, positioning the body correctly and medication. The nurse should also see that the patient practises the skills taught by various therapists. Physiotherapist's responsibility The physiotherapist is responsible in restoring the disturbances of balance and coordination of the patient. He also assists the stroke patient to improve and restore the ability to transfer as well as re-education of gait. Some stroke patients need special devices like splints and walking aids, which have to be prescribed under the supervision of the physiotherapist. Occupational therapist The occupational therapist restores the patient's ability to perform the activities of daily living (selfcare activities and functions related to the homefront, at work and in the community). he also stimulates and re-educates the patient's disturbed perceptual and cognitive functions. One of the occupational therapist's very important role is to retrain the arm and mind specifically and functionally. Speech therapist The speech therapist helps the patient to regain the patient's ability to speak, communicate and swallow, if any of the above is disturbed as a result of the stroke. Social worker The social worker assists the patient to get any financial aid if the patient needs to start an income-generating project. He also gives the necessary assistance to the low-income group patients to obtain various rehabilitative aids at a low cost or free of charge from government and non-government organisations. Stroke rehabilitation is a process where a stroke patient is retrained to a maximum level of independence enabling him to lead a reasonable life back in the community. The major emphasis for stroke rehabilitation is functional enhancement by maximising the independence, lifestyle and dignity of the patient and the family. For those who survive a stroke, the recovery of neurological deficits takes place over a variable period of time. About 30 per cent of survivors will be fully independent within three weeks and nearly 50 per cent will be independent by six months. For stroke patients who do not make an immediate recovery, the first three months are critical as most of the recovery is thought to occur during this period. Rehabilitation provides the main form of intervention to assist patients through their recovery phase. Stroke rehabilitation should begin as soon as the diagnosis of a stroke is established and life-threatening problems are under control. Evidence from clinical trials suggests that early rehabilitation intervention leads to improved physical and functional outcomes. Highest priorities will be to prevent complications from the present stroke, prevent recurrent stroke and mobilise the patient and encourage resumption of self-care activities as soon as he is medically feasible. ########### Overcoming USI with TVT in women Dr. Sudeera N. Uduwela (Consultant Obstetrician and Gynaecologist) talks on Urinary Stress Incontinence (USI) in women. Many women suffer from this urinary stress incontinence condition mostly after childbirth and menapause.
Even with protective pads the smell of the urine causes problems. For this reason most women in this situation avoid company, and become mentally depressed. The causative factors of this stress incontinence of urine are multiple, but often the primary cause is the damage to the pelvic floor musculature, nerves and connective tissue which support pelvic organs such as the bladder, uterus (womb) and upper vagina and the rectum, is formed like a diaphragm at the bottom of the pelvis, and is called the pelvic floor. Vaginal childbirth could damage the pelvic floor muscles which allow the pelvic organs (bladder, womb and rectum) to descend down under gravity, primarily through the weakened vaginal orifice. Over the past several decades many corrective surgeries to overcome this condition had been done but some found their urinary condition worsening following surgery. Obviously better research and technique were necessary to improve the success rate in incontinence surgery. Uro Gynaecology With the advent of a new research area into female urinary problems together with prolapses, the subspeciality of uro-gynaecology was born. This resulted in better understanding of the problem. Little over a decade or so, this subspeciality has progressed to understanding not only the structural but also the functional intricacies of this important area of study. The development of investigative techniques which are collectively called uro-dynamic studies or cysto-metrography have helped us to identify each persons problems, thereby allowing treatment to be individualised. This individualisation of care has greatly increased the success of therapy, and reduced the incidence of unfortunate worsening of symptoms following surgery. Tension-free Vaginal Tape (TVT) At the very forefront of surgery for female stress incontinence of urine, is a method that was developed about 12 years back in Europe by Ulmsten, called Tension-free Vaginal Tape (TVT). This involves a sling like tape being placed surgically under the mid-urethral region, with the right amount of tension. This surgery has revolutionised USI therapy, as compared with previous surgeries this has minimal complications. |
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This uncontrollable urinary leakage becomes an embarrassing situation
for the women, when it happens when they laughs, coughs or sneezes or when
they bend or sit etc.
