Impairment & Rehabilitation

Dr Jan Gawronski

Consultant in Rehabilitation Medicine

London Spinal Cord Injury Centre

RNOH

Rehabilitation

Survival

Health

Activity & Participation

1945 & you sustain a SCI

Chances of survival to 1 year

• 50:50

• 30:70

• <5%

Sir Ludwig Guttmann

• ‘To rescue these men & women from the human scrapheap and to return most of them.. to the community as useful & respected citizens’

SCI: Life expectancy now

• 85% • ~70%

KG 19 yr female

• C6 complete spinal cord injury diving into a

shallow swimming pool

What did we do?

• Intensive care

• Theatres

• Spinal surgery

• Nursing

• Physiotherapy

• Occupational Therapy

• Psychology/ Psychiatry

• Physician

• Social worker

• Urology

• Dietician

• SCI community nurse

• Carer training

• Lifelong follow up

Rehabilitation- attention to detail

• Skin

• Breathing

• Bladder

• Bowel

• Sexual dysfunction

• Psychology

• Modulating aberrant reflexes

• Pain

• Home

• Family

• Employer

• Travel

• Sport

• Communication

Rehabilitation

Survival

Health

Activity & Participation

International Classification of Functioning, Disability & Health

• WHO 2001

• Framework for measuring health and disability at both individual and population levels

• Puts the notions of ‘health’ and ‘disability’ in a new light

• Acknowledges that every human being can experience a decrement in health and thereby experience some degree of disability

• ‘mainstreams’ the experience of disability and recognises it as a

universal human experience

• Includes Contextual Factors, in which environmental factors are listed, ICF allows recording of the impact of the environment on the

person's functioning

International Classification of Functioning, Disability & Health

• WHO 2001

• Section ‘e’ environmental factors

• e515 Architecture and construction services

• e520 Open space planning services

• e525 Housing services

• Body function & structure; Activity & participation; Environment

• http://www.who.int/classifications/icf/en/

• http://apps.who.int/classifications/icfbrowser/

Thank you for listening

Stephanie Williamson

PFI PROJECT

Translating ‘Impairment’ into the Design Brief

A Unique Healthcare Organisation

• 124 beds including:

– Children & Young Peoples Centre with 37

beds

– London Spinal Cord Injury Centre with 38

beds

– Specialist Adult Acute Wards with 49 beds

Complex physical, mental and emotional impairment

Families and carers

Unique equipment needs

Translating the Dream• Creating presence and

establishing the tone

• Focus on restoration & rehabilitation

• Supporting the patient pathway

• Importance of outside space

• A ‘show case’ for the rehabilitation environment

The Trust provides a critical mass of world class clinicians, a

strong focus on restoration and rehabilitation and a service that

can care for the patient from cradle to grave. The hospital doesas much ‘medicine’ as it does ‘surgery’ and provides a psycho-

social cradle of care for the patient and their family / carers.

The focus on holistic

rehabilitation must be

reflected in the design

solution with a real sense

of empowerment for

patients and visitors,

spaces that provide respite

from clinical areas, a

design that encourages a

dynamic rehabilitation, not

passive, but calm and

uplifting.

Quality of the Patient Experience

•Encourage patients, carers, families and staff to develop relationships which will

enable patients to feel safe and independent, carers to feel supported and staff

to feel motivated and valued.

•Promote social interaction between all users of the building and enable patients

to have somewhere to go/something to do either on their own or in the company

of others.

•Provide different ambiances, e.g. diversionary, calming, welcoming, inspiring,

fun and provide views and access to gardens, courtyards and the surrounding

landscaping.

•Support people of all abilities; the abled and disabled, independent, partially

dependant and dependant, people with sensory impairments, mental health

problems and people with chronic conditions typical of a growing elderly

population

Two key areas

Main Entrance Facilities

It cannot just be aesthetically pleasing on the eye but must provide opportunity

for distraction, relaxation and respite.

It should draw people in so that it becomes a focal point rather than a place to

traverse.

From the moment of entering the space the visitor should understand the nature

of the organisation, including our work with children and spinal cord injury and

major disability.

This means the design must respond to the needs of patients; enhancing

freedom of movement, being truly inclusive and evoking a spirit of joy and

community.

Designers should draw on experience from elsewhere, looking for healthcarefacilities that have created a ‘wheel-based’ approach to movement design and

effective and flexible use of public space so that it can become a place to meet,be entertained or watch the world pass by.

Patient Environment

“Patient Rooms: A ChangingScene of Healing: The hospitalis still the place where patientsand their families, caregivers,and administrators cometogether for the commonpurpose of restoring a patient togood health. The issues each ofthese parties face all come intosharp focus in the patient room.It is there that the delivery ofcare is undergoing more changethan at any other point inhistory.” Herman MillerHealthcare Research

The Ward Model•The Children’s Centre could be seen as a ‘home from home’ at the same

time as being a place that supports rehabilitation through play, education

and social development

•The adult acute beds are more like a ‘hotel’ providing healthcare –

functional and efficient whilst being welcoming

•The SCIC could be viewed as a ‘conference hotel’ building on the hotel

model above with an emphasis on development and progression and the

spaces in which patients and staff ‘conference’

Orthopaedics

Stepping away from the surgical hegemony

The future will be one of multidisciplinary integration, which gives direct

benefit to patients, puts the Trust at the forefront of innovative thinking

about hospital process design and brings basic science and translational

research right into the clinical setting.

The future will integrate clinicians, academics and patients in a systemwhich has rehabilitation as its core organisational principle, not surgery.