REHABILITATION NETWORK IN
ESTONIA: A TRAUMATIC BRAIN
INJUR MODEL.
Varje-Riin Tuulik Leisi, MD
The goal of the project
to improve partnerships between brain injury
specialists in medical, social and educational
institutions
to support social involvment, participation and
activity among Estonian children and young TBI
victims.
To use information technology and video
teleconferencing to extend rehabilitation
expertise to rural communities.
Financing
The activities of TBI project is supported by the
European Economic Area Financial
Mechanism and the Norwegian Financial
Mechanism for 17 months from Aug 2009
Supporting social and economic cohesion
within the Tallinn and Jõhvi region using
telerehabilitation and new technologies makes
possible to cross barriers usual for the TBI and
other disabled people in our community.
Partners
Adeli Eesti Ltd rehabilitation center-
Tallinn
Corrigo rehabilitation center in East-
Estonia
Kristiine Local Council –Tallinn
Jõhvi Local Council – East-Estonia
Sept 2009, Tuisu 20, Talinn
Opening of seminar room in Tallinn
Sept 2009
Adeli Eesti team around one table
2010 sept – a telemedicine courses and skype conferences take place here
Courses and telerehabilitation ..
Adeli Eesti LTD PT Hille Maas and ST Kai Torim visit to
JÕHVI NEW REHABILITATION DEPARTEMENT
June 2010 in Jõhvi – room of occupational
therapy
Why TBI model?
The consequences of brain injury can be
devastating both to the individual and his
family
The survivor of brain injury must learn to live
with changed (reduced) potentials in the
physical, emotional, cognitive and social
areas.
In the process of trying to establish a “new life”
they need a lot of resources and institutions.
Background
The lack of information about rehabilitation
process among Estonian TBI survivors came
out from a study made in the Tallinn University
by dr. Riina Kallaste in 2007
The study showed, that there are a lot of young
TBI survivors in Estonia, who do not participate
in normal social life and do not know their rights
and real possibilities to get a rehabilitation and
other social services after TBI
We planned to ...
Inforce cooperation between social,
medical and educational institutions
establish professional networks in the two
regions- Tallinn and Jõhvi (East-Estonia)
work out a program for TBI based on the
International Classification of Functions
(ICF)
prepare use of ICF in reporting of data
from rehabilitation activities
The first step
Sept 2009 – a questionnaire for SW and
TBI survivors
The study showed how works co-
operation between institutions and
rehabilitation services needed for people,
who have TBI and who need a holistic
rehabilitation In Tallinn and in East
Estonia.
The results:
1. The social workers score for co-work
with client- 3,6/ 5
client family 3.2 /5
medical specialists 3,1 /5
teachers 2,6 /5
rehabilitation specialists 2,1/5
2. The biggest barriers for patients were
lack of information and transport
Meeting in the house of handicapped in Tallinn Kristiine
Jõhvi rehabilitation specialists visit to Tallinn
Educational program for specialists
There were 20 seminars for family
doctors, teachers and social workers
about TBI and holistic rehabilitation in
spring 2010 organized by the project team
2 of these seminars take place by skype
from Tallinn to Jõhvi
There will be 8 round-tables in automn
2010
PT Irena Vrecar, dr. Pavel Ptyushkin and dr. Hermina Damjan
Colleagues from Slovenia
Written information
2 articles in regional news papers
2 articles in health magazins
1 article in social care journal
1 will be in medical jounal in nov 2010
Information list for adult patients in acute care
units
Information list for children and parents of TBI
childrens
In Estonian and Russian language
TBI materials – for adults and children
Information for specialists
Visits to hospitals treating TBI patients
Meetings with teachers at schools
Meetings with social workers in local
social services and hospitals
Meetings with family doctors
Information to the patients/clients
Through doctors
Through TBI patient organization
Through web www.ajutrauma.ee about
1. post TBI health problems
2. Rehabilitation
3. Specialists who have competence in TBI
- etc
A TBI programm
The TBI experts help to build up the
best rehabilitation program for TBI
victims in Tallinn and adapt it also for
Jõhvi.
50 TBI survivors will be taken into a
holistic rehabilitation program in two
regions
Using ICF model to evaluate the
rehabilitation process holistically
Including functional testing on the
personal level
Functional tests: Nepsy, Lotca, Strebeleva ...
ICF
ICF is a valuable language to
communicate between professional
people, Health and Social services
authorities and organisations
Electronic version available
Osalus/ tegevus
Märkused sooritus suutlikkus
Sekkumine/ teraapia
d1. ÕPPIMINE JA TEADMISTE RAKENDAMINE *
d110 Vaatamine
TOPELTNÄGEMINE SEGAB,
saab telekat vaadata, üleeile
oli silmaop. 2 1 silmaarst
d115 Kuulamine n 0
d140 Lugemaõppimine
raskusi, virvendab, ei saa
kiiretsi lugeda 0 1 koostöö õpetajatega
d145 Kirjutamaõppimine n 0
d150 Arvutamaõppimine(aritmeetika) raskusi, oli ka enne traumat 1 1
d175 Probleemide lahendamine probleem 0
d2. ÜLDISED ÜLESANDED JA NÕUDED
d210 Ühe ülesande täitmine
saab hakkama, küsib kogu aeg
üle 0 tegevusteraapia
d220 Paljude ülesannete täitmine ei ole testitud 8
d3. SUHTLEMINE
d310 Suuliste sõnumite vastuvõtmine n 0
d315 Mitteverbaalsete sõnumite vastuvõtmine n 0
d330 Rääkimine n 0
d335 Mitteverbaalsete sõnumite edastamine n 0
d350 Vestlus
alustab meeleldi, kaldub
teemast kõrvale, ei suuda
lõpetada 0 1 kõneravi
d4. LIIKUVUS
d430 Esemete tõstmine ja kandmine n
d440 Käte täppisliigutused TOPELTNÄGEMINE SEGAB, 3 3 silmaarst
d450 Käimine
up and go 10 sek ,
kõnnimuster häirunud,
kannalöök olemas, jala toetus
läbi. eversiooni, hoo ja toefaas
lühenenud. 1 km käimine
väsitav 1 2 füsioteraapia
d465 Abivahenditega liikumine ei ole teema
d470 Liiklusvahendi kasutamine auto tagaistmel iiveldab 1 1
d475 Liiklusvahendi juhtimine -auto ei ole teema
Future perspectives – telerehabilitation?
phone
E-meil
Skype
/The Catholic University of America. / cabrr.cua.edu/research/Telerehabilitation.cfm
Telerehabilitation possibilities
include:
tele-counseling / neurocognitive evaluation
general tele-management, often also involving
support for a home caregiver
tele-assessment of the type performed by
OT/PT/nursing professionals
tele-supported therapy (PT, OT, speech)
tele-assessment of gait function and balance
(e.g., whether to adjust or change orthotic braces)
general tele-support for family, related to case
management
http://www.cognuse.com/products
A computer-assisted cognitive training
applications
cabrr.cua.edu/research/Telerehabilitation.cfm
Conclusion
A continuum of rehabilitation from the inpatient
to community settings is important in the case of
TBI as well other long-lasting disabilities
A specialized rehabilitation center could be the
link between brain injury survivors and local
support resources in the survivors' own
communities.
Telerehabilitation could be the method to
strengthen the families with brain injury by
promoting access to appropriate health care and
rehabilitation services