CENTRE FOR

MUSCULOSKELETAL AND NEUROLOGICAL REHABILITATION

GHENT UNIVERSITY HOSPITAL

HistoricalHistorical backgroundbackground

The centre was established in 1964 byProfessor Hendrik Claessens, MD.

Its primary goal was the rehabilitation of patientswith severe musculoskeletal disabilities

In 1970 the current facilities were ready for occupation

The centre was established in 1964 byProfessor Hendrik Claessens, MD.

Its primary goal was the rehabilitation of patientswith severe musculoskeletal disabilities

In 1970 the current facilities were ready for occupation

Over the years the CLNR has increasingly focused on the rehabilitation of patients with severe

musculoskeletal and/or neurological disorders.

In the nineties neurorehabilitation was considerably expanded, because of the increasing number of

patients with acquired brain injuries.

Over the years the CLNR has increasingly focused on the rehabilitation of patients with severe

musculoskeletal and/or neurological disorders.

In the nineties neurorehabilitation was considerably expanded, because of the increasing number of

patients with acquired brain injuries.

HistoricalHistorical backgroundbackground

The CLNR is located on the campus of Ghent University Hospital

GenerallyGenerally

The CLNR is part of the University Hospital, whichhas a capacity of 1100 beds and a staff of more

than 4000 employees.

At university level the centre belongs to the Ghent University Department of Physical Medicine and

Orthopaedic Surgery.

The CLNR is part of the University Hospital, whichhas a capacity of 1100 beds and a staff of more

than 4000 employees.

At university level the centre belongs to the Ghent University Department of Physical Medicine and

Orthopaedic Surgery.

Within the Ghent University Hospital the CLNR is part of the Physical Medicine and Rehabilitation

Department (Head: Professor Guy Vanderstraeten, MD, PhD)

This department comprises the followings sectionspediatric and adult rehabilitation, electromyography,

ultrasonography, movement analysis and a sports medicine centre

WithinWithin the the GhentGhent UniversityUniversity HospitalHospital the CLNR is the CLNR is part of the part of the PhysicalPhysical MedicineMedicine and and RehabilitationRehabilitation

DepartmentDepartment((HeadHead: Professor : Professor GuyGuy VanderstraetenVanderstraeten, MD, , MD, PhDPhD))

ThisThis departmentdepartment comprisescomprises the the followingsfollowings sectionssectionspediatricpediatric and and adultadult rehabilitationrehabilitation, , electromyographyelectromyography, ,

ultrasonographyultrasonography, , movementmovement analysisanalysis and a and a sportssports medicinemedicine centrecentre

CapacityCapacity

A 31-bed unit for patients with spinal cord injuries.

A 31-bed unit for patients with acquired brain injuries.

A 31-bed unit for patients with spinal cord injuries.

A 31-bed unit for patients with acquired brain injuries.

62 beds for inpatients, distributed over 2 units62 beds for inpatients, distributed over 2 units

All rooms have an internet connection.The rooms for high tetraplegics are equipped with

hands-free environmental control.

All rooms have an internet connection.The rooms for high tetraplegics are equipped with

hands-free environmental control.

The centre also offers outpatient services.These rehabilitation programmes are provided

on a daily basis for a maximum of 40 patients per day.

The The centrecentre alsoalso offers offers outpatientoutpatient services.services.These These rehabilitationrehabilitation programmes are programmes are providedprovided

onon a a dailydaily basis basis forfor a maximum of a maximum of 40 40 patientspatients per per dayday..

Outpatients

Children under 15 years of age are treated in a separate setting and are hospitalized in the

pediatric department.

The majority are outpatients.

ChildrenChildren underunder 15 15 yearsyears of of ageage are are treatedtreated in a in a separate setting and are separate setting and are hospitalizedhospitalized in the in the

pediatricpediatric departmentdepartment. .

The The majoritymajority are are outpatientsoutpatients..

Children

The centre has 5 beds for patients with an acquired brain injury in MRS of PVS (minimally responsive state,

persistently vegetative state).

For the care of these patients cooperation protocols with a number of rest and nursing homes have been

concluded.

The The centrecentre hashas 5 5 bedsbeds forfor patientspatients withwith anan acquiredacquired brainbrain injuryinjury in MRS of PVSin MRS of PVS ((minimallyminimally responsiveresponsive state, state,

persistentlypersistently vegetativevegetative state).state).

ForFor the care of these the care of these patientspatients cooperationcooperation protocolsprotocols withwith a a numbernumber of rest and of rest and nursingnursing homes have been homes have been

concludedconcluded..

Acquired brain injuries

Duration and intensity of rehabilitationare dependent on the nature of the disability

E.g.

paraplegiaparaplegia: maximum : maximum 9 9 monthsmonthstetraplegiatetraplegia: maximum : maximum 15 15 monthsmonthsseveresevere brainbrain injuryinjury: maximum : maximum 24 24 monthsmonthsseveresevere CVACVA: maximum : maximum 12 12 monthsmonthsseveresevere multiple multiple injuriesinjuries: maximum : maximum 12 12 monthsmonths

Rehabilitation is only continued for as long as there are realisticrehabilitation goals, and is usually much shorter than the maximum duration.

Rehabilitation is only continued for as long as there are realisticrehabilitation goals, and is usually much shorter than the maximum duration.

The primary goal of the centre is to improve the quality of life of patients with impairments and disabilities.

Specific treatment protocols have been developed to achieve the highest degree of

functional independence.

The primary goal of the centre is to improve the quality of life of patients with impairments and disabilities.

Specific treatment protocols have been developed to achieve the highest degree of

functional independence.

GoalGoal

The patients are encouraged to take an active part in their rehabilitation.

During the rehabilitative process the focus is on the return to the home environment. To this end, the team members work closely together with the family and the other parties involved

Optimal social, occupational or school integration is aimed at.

The patients are encouraged to take an active part in their rehabilitation.

During the rehabilitative process the focus is on the return to the home environment. To this end, the team members work closely together with the family and the other parties involved

Optimal social, occupational or school integration is aimed at.

Target groupsTarget groups

Each target group is treated by its own specializedmultidisciplinary team

Each target group is treated by its own specializedmultidisciplinary team

1. Paraplegia or paraparesis1. 1. ParaplegiaParaplegia oror paraparesisparaparesis

3. Traumatic brain injuries3.3. Traumatic Traumatic brainbrain injuriesinjuries

4. CVA (hemiplegia)4.4. CVACVA ((hemiplegiahemiplegia))

5. Amputations5.5. AmputationsAmputations

6. Multiple orthopaedic injuries6.6. Multiple Multiple orthopaedicorthopaedic injuriesinjuries

2. Tetraplegia or tetraparesis2. Tetraplegia or tetraparesis

Specialized rehabilitation teams

Separately operating teams, each supervised by a rehabilitation specialist, attend to our patient clusters.Separately operating teams, each supervised by a

rehabilitation specialist, attend to our patient clusters.

Team for spinal-cord injured patientssupervised by A. Viaene, MD

Team for spinal-cord injured patientssupervised by A. Viaene, MD

Team for brain-injured patientssupervised by K. Oostra, MD

Team for brain-injured patientssupervised by K. Oostra, MD

Team for multiply injured patients or amputeessupervised by S. Vertriest, MD

Team for multiply injured patients or amputeessupervised by S. Vertriest, MD

Patients are transferrred

by hospitalsby hospitals

by insurance companiesby insurance companies

by General practitionersby General practitioners

at the patient’s and/or family’s requestat the patient’s and/or family’s request

Rehabilitation is only started after examinationof the patient and an intake interview with the family.

Rehabilitation is only started after examinationof the patient and an intake interview with the family.

tel: 09.33242 37- 09.3324689fax: 09. 332 38 88e-mail: hubert.devisscher@ugent.be

vanja.francois@ugent.be

Intake

Appointments can be made throughthe CLNR secretariat

The CLNR aims at providing an evidence-based therapeutic approach, with use of highly advanced rehabilitative techniques

eg. functional electrical stimulation, Ergys bicycle with electricalstimulation and BWS (body weight support)

for gait rehabilitation

facilitiesfacilities

Remedial therapy hall Sports hall

Remedial therapy rooms

Swimming pool Small baths

Sauna

Adapted showers

fitness traininginfo & documentation

BTE ERGOS

occupational therapy rooms

physiotherapy

therapeutic kitchens

work set 1working surface and table with moveable top

work set 2working surface and cupboard adjustable in height

obstacle courseobstacle course

polyvalent room

MultidisciplinaryMultidisciplinary teamteammembersmembers::

Rehabilitation specialistsRehabilitationRehabilitation specialistsspecialistsPMR residentsPMR PMR residentsresidentsRehabilitation nursesRehabilitationRehabilitation nursesnursesPhysiotherapistsPhysiotherapistsPhysiotherapistsOccupational therapistsOccupationalOccupational therapiststherapists

Speech therapistsSpeech Speech therapiststherapists

PsychologistsPsychologistsPsychologistsPsychology assistantsPsychologyPsychology assistantsassistants

Social nursesSocialSocial nursesnursesTechnicianTechnicianTechnician

44433339393916.7516.7516.7511.7511.7511.75

3.75 3.75 3.75

444

2.52.52.5111

444

therapytherapy

phase 1 : phasephase 1 : 1 :

phase 2 : phasephase 2 : 2 :

phase 3 : phasephase 3 : 3 :

phase 4 : phasephase 4 : 4 :

mobilitymobility

integrationintegration

functional performancefunctional performance

activation-stimulationactivation-stimulation

To optimize the treatment programmes, therapeutic phasesare incorporated within the various disciplines, which clearly

illustrate the progress in both the rehabilitationand the treatment programmes.

The rehabilitative process is also based on the IFC model

physiotherapyphysiotherapy

ExamplesExamples of of therapeutictherapeutic services (1)services (1)

fitness training mechanotherapygait rehabilitation

hydrotherapy

breathing techniques

(2)(2)

sports ranging of joints

physiotherapymusclestrengtheningexercises

(3)(3)

occupationaloccupationaltherapytherapy

therapeutic services (1)therapeutic services (1)

Sitting posture & positioning

ADL trainingPrevocational

training

Transfer training

Use of aids Wheelchair training and advice

(2)(2)

Evaluation tests Training in adapted multimedia use

Functional trainingSensibility training

Info & advice housing alterations

(3)

ProvisionProvision of of psychologicalpsychological servicesservices

General servicesGeneralGeneral servicesservices

Neuropsychological servicesNeuropsychologicalNeuropsychological servicesservices

• psychological counseling of patient and family• personality testing and other psychometric evaluations• training of social skills• behavioural modifications

• psychological counseling of patient and family• personality testing and other psychometric evaluations• training of social skills• behavioural modifications

• neuropsychological examination (e.g. computer-controlled)• cognitive rehabilitation• strategy training• neglect training• reality and orientation training• diary training• music therapy

• neuropsychological examination (e.g. computer-controlled)• cognitive rehabilitation• strategy training• neglect training• reality and orientation training• diary training• music therapy

Industrial psychological servicesIndustrial psychological services

ergological examinationjob application trainingcase managementorganization of job trialssupport in the workplacecontacts and consultation with employer,

national health service,insurance companies..

collaboration with training centres and supportedemployment services

ergological examinationjob application trainingcase managementorganization of job trialssupport in the workplacecontacts and consultation with employer,

national health service,insurance companies..

collaboration with training centres and supportedemployment services

PsychologicalPsychological servicesservices

All nurses have completed complementary training in rehabilitation nursing.

The CLNR has a trained nursing team for the spinal-cord unitand the brain-injury unit.

All nurses have completed complementary training in rehabilitation nursing.

The CLNR has a trained nursing team for the spinal-cord unitand the brain-injury unit.

Nursing

SocialSocial servicesservices

Information and advice (rehabilitation, administration, socialreintegration,..)InformationInformation and and adviceadvice ((rehabilitationrehabilitation, , administrationadministration, , socialsocialreintegrationreintegration,..),..)

Administrative assistance (application for allowances, benefits,exemptions, documents Flemish Agency for Disabled Persons,.)AdministrativeAdministrative assistanceassistance ((applicationapplication forfor allowancesallowances, , benefitsbenefits,,exemptionsexemptions, , documentsdocuments FlemishFlemish AgencyAgency forfor DisabledDisabled Persons,.)Persons,.)

External contacts (NHS, insurance, local authority, socialservice, Flemish Agency for Disabled Persons, outlyinghospitals, social service centres, homecare services, ..)

ExternalExternal contactscontacts ((NHSNHS, , insuranceinsurance, , locallocal authorityauthority, , socialsocialservice, service, FlemishFlemish AgencyAgency forfor DisabledDisabled Persons, Persons, outlyingoutlyinghospitalshospitals, , socialsocial service service centrescentres, , homecarehomecare services, ..)services, ..)

Coordination homecare aiming at social integrationCoordinationCoordination homecarehomecare aimingaiming at at socialsocial integrationintegration

Family counseling – home visitsFamily counselingFamily counseling –– home home visitsvisits

Speech therapy

language and speech examinationlanguagelanguage and speech and speech examinationexamination

individual language and speech therapyindividualindividual languagelanguage and speech and speech therapytherapy

group therapy for language and speech disordersgroupgroup therapytherapy forfor languagelanguage and speech disordersand speech disorders

training of functional communication skillstraining of training of functionalfunctional communicationcommunication skillsskills

training in the use of communication aids training in the training in the useuse of of communicationcommunication aids aids

training in the use of alternative communication systems forsupportive communicationtraining in the training in the useuse of of alternativealternative communicationcommunication systemssystems forforsupportivesupportive communicationcommunication

swallowing and eating trainingswallowingswallowing and and eatingeating trainingtraining

Rehabilitation takes place in close collaboration with the patient’s family or care providers.

The CLNR organizes weekly group sessions for the patient’s family members.

The info sessions always focus on a specific topic of rehabilitation or living with a disablility.

Hands-on experts also participate in these sessions

RehabilitationRehabilitation takestakes place in close place in close collaborationcollaboration withwith the the patientpatient’’ss familyfamily oror care providers.care providers.

The CLNR The CLNR organizesorganizes weeklyweekly groupgroup sessionssessions forfor the the patientpatient’’ss familyfamily membersmembers..

The info The info sessionssessions alwaysalways focus focus onon a a specificspecific topic of topic of rehabilitationrehabilitation oror living living withwith a a disablilitydisablility..

HandsHands--onon experts experts alsoalso participateparticipate in these in these sessionssessions

Info sessions

Extramural activitiesExtramuralExtramural activitiesactivities

cultural tripsmoviesmovies, concerts, exhibitions,

theatre, fairs …

sportsbicycling, canoeing, riding, swimming,

bowling...

ADL activitiesshopping, banking, public transport..

Centre Centre forfor EvaluationEvaluation and and RehabilitationRehabilitation of of CapacityCapacity forfor WorkWork

Goals of CERACGoals of CERAC

BTE

Standardized, objective and reliable examination of physical capacity for work

StandardizedStandardized, , objectiveobjective and and reliablereliable examinationexamination of of physicalphysical capacitycapacity forfor workwork

Progressive training directed at job preservationProgressiveProgressive training training directeddirected at at job job preservationpreservation

Evaluation of the rehabilitative effectEvaluationEvaluation of the of the rehabilitativerehabilitative effecteffect

ERGOS

Workshop Workshop forfor technicaltechnical orthopaedicsorthopaedics

In the workshop for technical orthopaedics, located in the CLNR and belonging to the Centre for Technical Orthopaedics (CTO),

orthoses and prostheses are manufactured by a specialist team.

In the workshop for technical orthopaedics, located in the CLNR and belonging to the Centre for Technical Orthopaedics (CTO),

orthoses and prostheses are manufactured by a specialist team.

Self-help

As soon as possible, spinal-cord injured patients are introduced to former patients in order to learn from

their experience.

To this end, CLNR collaborates with the self-help group for spinal-cord injured patients

As soon as possible, spinal-cord injured patients are introduced to former patients in order to learn from

their experience.

To this end, CLNR collaborates with the self-help group for spinal-cord injured patients

““PiekerniePiekernie””n.p.an.p.a..

For patients with an acquired brain injury, the CLNR actively collaborates with the umbrella organization

n.p.a. Coma which groupsnumerous self-help groups and associations

For patients with an acquired brain injury, the CLNR actively collaborates with the umbrella organization

n.p.an.p.a.. ComaComa which groupsnumerous self-help groups and associations

A similar organization, n.p.a. Afasie exists for patients with aphasia

A similar organization, n.p.a. Afasie Afasie existsexists forfor patientspatients withwith aphasiaaphasia

Flemish Fund

The CLNR is recognized by the ‘Flemish Fund for Social Integration of the Disables’ for the filing of

documents relating to:

- Care demands- Care demands

- Work and vocational retraining- Work and vocational retraining

- Assistive devices (IMB- individual material benefits)- Assistive devices (IMB- individual material benefits)

- Personal assistance budget (PAB)- Personal assistance budget (PAB)

Expert assessments and reports

The centre provides expert assessments and reports concerning:

• disability• disability• economic loss• economic loss• need for outside help• need for outside help• need for assistive devices• need for assistive devices• wheelchair use• wheelchair use• housing alterations• housing alterations

Data management and team meetingsThe entire rehabilitative process is based on multidisciplinary team

work and communication.All disciplines have their own data set, which can be consulted

through a local area network.

Educational and scientific activities

systematic continuing education of all team members

rehabilitation sciences library

organization of workshops and meetings

lectures

scientific research

the kind collaboration of patients and staffof the CLNR

Is gratefully acknowledged

the kind the kind collaborationcollaboration of of patientspatients and and staffstaffof the CLNRof the CLNR

Is Is gratefullygratefully acknowledgedacknowledged

RealisationRealisationRealisationM. De GanckM. De M. De GanckGanck

SupervisionSupervisionSupervision

W. Brusselmans, PhDW. W. BrusselmansBrusselmans, , PhDPhDG. Vanderstraeten, MD, PhDG. G. VanderstraetenVanderstraeten, MD, , MD, PhDPhD

ThankThank youyou forfor youryourattentionattention

www.clnr.bewww.clnr.be