FROX THE DEPARTMEKT OF NEUROLOGY, THE NEUROLOGICAL REHABILITATIOX CENTRE,

UNIVERSITY OF GOTEBORG, GOTEBORG, SWEDEN.

NEUROLOGICAL REHABILITATION AND LONG-TERM TREATMENT

Tore Broman and Ann-Mari Linclberg-Broman

An important consequence of the social cvolutioii in our countries is the expectation of complete care for the patients including adequate follow-up care, rehabilitation or differentiated long-term treatment. No patient should nowadays leave the hospital without a thorough exploration of such demands for further medical or social assistance, and measures should be started as early as possible for his adaptation to a future life worthy of a human being.

As a large category of the neurological clientele is in manifest need of further rehabilitation and continued contact with the specialists it is natural that the neurologists in our countries have taken a strong initiative for devel- opment of the care for the sick and disabled along these lines. In Sweden this has resulted in a recommendation to a special neurological rehabilitation organization associated with every regional hospital (calculated as a dif- ferentiated hospital with all medical disciplines necessary for a population of 1-1+ million). The neurological clientele is numerous enough - a t least in densely settled rural areas - for motivating a separate organization, although a certain coordination with other rehabilitation activities is advisable, particularly with respect to certain treatment locales, workshops, laboratories and lecture rooms.

In order to calculate the size and character of the clientele for estimation of the demand for rehabilitation and different kinds of long-term treatment it is necessary first to state certain definitions and premises. According to our experience we have based our calculations on the following premises:

1 ) Patients who need only physical therapy or simple out-patient care are not included in the rehabilitation clientele. Furthermore, psychosomatic and various niyalgic disorders are excluded. Our calculations are thus restricted to disabling neurological syndromes only. This limited scope is motivated by our aim for a separate neurological rehabilitation organization but does not mean that those other categories of the clientele should not be helped by this organization if it seems suitable.

2) Rehabilitation does not only concerns vocational problems but also any kind of treatment aiming a t the restoration of lost ADL-abilities. Therefore no dear border exists between rehabilitation activities and the long-term treatment of chronically disabled patients.

3) Patients with chronically disabling diseases or defects often need future contacts with the same rehabilitation team after leaving the hospital. Therefore this team should

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have a service organization for advice and support for the patients (as well as for their relatives). This organization should extend its activities to the homes and the working places and the means of contact should be as simple as possible, e.g. by telephone or letter, should more penetrating investigations be unnecessary. According to the actual problems, this service often can be supplied by one member alone of the rehabilitation team, e.g. the doctor, the social worker, the occupational therapist, or the physical therapist. But i t is of particular importance that i t be someone who knows the patient and his problems and that all kinds of information are collected in the same case history to ensure a comprehensive picture of the patient and all his problems.

4) I n order to arrive at an informative calculation i t is necessary also to differentiate between various demands for treatment according to the needs of the patients and the most economic and rational way of satisfying these needs in a medical and social organization for the future. It is therefore necessary to analyze every single case with this background. A mere registration of the number of patients in need of rehabilitation is rather worthless, as we know that some patients need many months or even years of qualified treatment in a clinic with high technical standards (e.g. tetrsplegics), while others can get their rehabilitation with satisfactory results at an out-patient department over a short period of time (e.g. certain peripheral nerve lesions). And we know that some patients need a periodically repeated treatment every year (e.g. many chronically disabled patients), while others only need treatment for a restricted period once (e.g. patients with a residual defect of minor importance).

5) A neurological clinic, especially if associated with a center for neurological rehabilitation, must have a special laboratory for psychological testing and evaluation and for speech therapy in order to meet the problems in a clientele including brain lesion and aphasia.

6) The medical and social rehabilitation of the epileptics is preferably carried out by a special service organization in close connection with the neurological clinic and its out-patient department and should not generally be mixed with the rehabilitation department for the motorically disabled.

TABLE I. Estiinated demand for medical care and rehabilitation among patients with chronic neurological diseases or sequelae in the age groups of 16-65 years in Goteborg (popula- tion 400 000) during a year (1963). Total number of the patients approximately 600, most of

whom need more than one kind of care or treatment.

Kind of treatment

Clinical treatment (neurological rehabilitation)

Treatment a t the out-patient dept. (neurolog. rehabilitation)

Neurological home-service

Speech therapy in aphasia (+diagnostic investigations)

~~

Number of patients

c:a 300

c:a 400

c:a 500

50(100)

Duration of treatment

c:a 3 months

c:a 2 months ( 3 times/week)

1 - 6 months

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Our investigations are based partly on collected materials of chronically disabled patients (prevalence studies), partly on a direct study of the records from all patients with neurological diagnoses in the hospitals in Goteborg, for a period of six months. Most patients have been investigated by competent neurologists and we know many of them personally. Only patients residing in Goteborg are registered, and the result is summarily reported in table I.

Comments

a) Some cases in need of clinical treatment can get sufficient ADL-training, with physical as well as psychological activation, in more simple rehabilita- tion “homes” than the highly equipped rehabilitation clinic.

b) The treatment a t an out-patient department should be complemented bj7 resources for the care of some of the patients on a +day basis.

c) The home-service should not compete with the practitioners but instead function as a service in case of demands for contacts with the specialist doctor, the social worker, the occupational therapist (for ADL-training, adaptation of technical aids and arrangement of activities in the home, etc) or the physical therapist (training programmes). It should preferably be supplemented by day-care homes for some of the severely disabled (advisably with a mixed clientele).

SUMMARY If calculated for the age groups 16-65 years in a population of 100 000,

approximately 150 patients were judged to need medical long-term care and/or rehabilitation treatment by the specialist per year. About 50 per cent of them need a more or less qualified clinical treatment for periods varying between 1-12 months (mean 3 months), which means a demand for about 18 beds, divided between a neurological rehabilitation clinic and some simpler equipped rehabilitation “homes”. If calculated for Goteborg (400 000 inhabitants) a neurological rehabilitation clinic ought to be provided with approximately 50 beds, 40 for patients from the town of Goteborg and 10 for specially complex rehabilitation treatment of patients from the surrounding districts.

Tore Broman Ann-Mari Lindberg-Broman Professor Med. lic. Neurol. klin. Sahlgrenska sjukhuset Infektionssjukhuset Goteborg SV Goteborg SV Sweden Sweden

Neurol. k1in:s rehab. avd.

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