An institutional multidiscipliner approach for the rehabilitation of physical handicapped

Nurullah YÜCEL, S. Nafia ERDOĞAN, Ahmet GÜNEŞ, Aysel ELMAS, Aylin ÇİFTÇİ, Tayfun KARALİ


Introduction
This study was planned for the physical handicapped residents living in the nursing home in Kayışdağ, Kadıköy (İstanbul Darülaceze Directorate), Health Department of İstanbul Metropolitan Municipality.The aim of the study was to increase the functional capasity of the residents, to decrease the number of residents who use wheelchairs, to make their psychologies beter, to gain them into social life, to increase their mental capacity, to raise their daily activities into maximum independency level and to decrease care costs in the institution.

Materials
İstanbul darülaceze Directorate is the largest nursing home in Turkey, with its capasity of 710 residents and area of 150.000 square meters. 35 physical handicapped residents who were selected as residents whose functional capasities can be increased, were taken into study.
After making the functional definitions of the residents, the environmental and technical arrangements were completed in order to increase their functional capasities and to maximize their independent daily activities. Studies were made by the doctors, physioterapists, psychologists, health personel, care personel and other personel in an institutional multidiscipliner approach in order to increase the functional capacities of the handicapped residents.

Methods
The medical examinations and evaluations:
1. The evaluation of the brief histories of the residents: In the evaluations which were made by the doctors, it was examined whether the existing mobility impairment of the patient is because of a congenital illness, its period and the effects of it in social life.
2. The Psychological examinations: The general situation of the patient, his mental, social and emotional capasity were examined by the psychologists. Some intermediate inspection reports were prepared for the residents.
3. Physical Therapy Examinations: The general situation and functional capacity of the patient was evaluated and the physiotherapy programs were prepared. The instruments which can be used by the patients were defined and requested. They were controlled whether they are appropriate.
4. Physiotherapy examinations: The physiotherapy programs which were defined by the physiatrists were applied. The periodic controls and examinations of the patients were made. The adaptation of the patient was evaluated.
Evaluation of the existing situation: The instruments or equipments which were used by the patient was defined.
The needs of the patient (instruments or equipments) were defined and their appropriatenes were controlled. Training programs were applied for the patients, health personnel and care personnel in order to explain the usage of the instruments. The physicians were informed about all these progresses.
The functional capacities were evaluated. The mobilisation situations of the patients were reported by the physiotherapists and the target mobitisation situation was planned for every patient.
The contracture proflaxy examinations were made.
Their independent daily life activities were evaluated. The dependent individual care activities were defined. The individual care program of each patient was defined.
The therapies and the requested equepments were recorded in special forms by the physiotherapists.
The evaluations were recorded in forms. Forms were used in order to evaluate the physical and functional situation and the effect of the therapies pre and after the treatments. Some parameters for muscle tests, joint movement angles, deformities, functional levels, motor tests, pain scalas were recorded for each patient.
5. Psychiatric examinations: The adaptation of the pationts to the Project was examined. The therapy sessions of the psychologists were determined. The patients were examined in order to decide whether they can be in this project or not.
6. Applications of the health personnel and the care personnel: The patient mobilisation programs and the individual patient care programs were applied daily by the health personnel and care personnel.

Results
Results from April 2006 to July 2006:
35 handicapped residents were selected for the study. 14 of them were women and 21 were men. 4 of them were between the age of 20and 40; 15 of them were between 40 and 60; 14 of them were between 60 and 80; and 1 was at the age of 80.
Their dependency rates: 30 were dependent in bathing, 18 were in wearing lower clothes, 16 were in upper clothes, 11 were in hygiene, 4 have urinary incontinance, 13 have urinary and intestine incontinence, 1 of them is dependent in nutrition.
Mobility rates: 2 of them independent, 6 of them totally dependent, 2 of them need help, 6 are dependent in sitting, 4 are dependent in sitting and rising up, 2 need help in transfering, 5 can walk by equipments, 6 are dependent in spinnig.
Rate of equipment dependency: 1 was using crutch, 27 were on wheelchairs, 3 using walking stick, 1 using canadien, 1 using afo, 1 was using walker, 1 was using orthopedic shoes, 2 using tripods and 1 was using long leg apparatus.
Examinations and treatments:
- Physical therapy examinations: 51 examinations for 35 patients
- Psychiatry examinations: 87 examinations for 35 patients
- Neurology examinations : 48 examinations for 11 patients
- Orthopedy examinations : 17 examinations for 11 patients
- Fpysiotherapy treatments: 808 physiotherapy sessions were made for 30 patients.
- Medical instruments and apparatus: Maintained for 11 patients.
- The usage rate of medical apparatus: 15 wheelchairs, 2 walking sticks, 1 canadien, 4 afos, 7 walkers, 2 orthopedic shoes, 6 tripods, 2 long leg apparatus, 3 parallel bars.

Conclusions
In Darülaceze Directorate, in which institutional care service is given, 12 of 35 residents who were independent were mobilized in a multidiscipliner study between April and July 2006. In this program 34% success was achieved in 4 months.
This study, which was held in coordination with the physical therapist, physichiatrist, neurologist, orthopedist, physiotherapist, health personnel, care personnel is thought to be satisfying as it results in a few weeks.
These multidiscipliner institutional studies can be effective not only in patient mobilization but also in contracture proflaxy, proflaxy of falls etc.