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Caseone

“Not being able to go home after • Postpoliosyndrome , after polio-infection 1945, weakness left • Mammacarcinoma 1988: mamma-amputation and post- • Medication: carbaspirin calcium, metformin, simvastatin, • Mobility: did walk with rollator outdoors for longer distances • Personal care: independent; shopping with neighbor/children; • Relations/occupancy: divorced in 1988, two children living • Cognition: mild short term memory loss • Hospital admittance 28th november 2009: • Diagnosis/CT: ischemic stroke right hemisphere ACM • Motor recovery starting within days: • Physical therapist: started to walk with rollator with physical Mrs. R, rehabilitation consultation • Visit by consultant rehabiliation specialist on 2nd of • Motor recovery in progress, adequate, orientated in time. place and person, motivated for rehabilitation • Indication for admittance Rehabilitation Center • Goal: return to home, regain premorbid level of disability Mrs. R, admittance to rehab center • Admittance to Rehab Center on december 15, 2009, after intercurrent admittance to nursing home.
• Mobility: mobilized with rollator, under supervision (not safe) • Personal care: dependent, Barthel 9/20 • Communication: dysarthry, poor eyesight • Cognition: still motivated, easy distractable, poor Mrs. R, admittance to rehab center • Difficulties in controlling blood sugar levels • Consultation ophthalmologist: no explanation for poor • Very slow progress mobility and personal care, distraction, • Neuropsychological assessment dd january 30 2010: • Severe dysexecutive problems: attention, planning, structure, • Home only possible with 24 hour supervision.
• Children were of the opinion that patient was unable to live at • Cognitive dysfunction not explained by cortical • With intensive rehab, gain in independence • But not enough to go home (needs constant • Currently no rehab indication anymore, but were to go to? (She is still in the rehab center, no CIZ indication • Treatment by multidisciplinary team (PT, OT, social work, speech therapist, neuro-psychologist), within stroke-team or unit.
• Stroke unit hospital; after discharge to rehab center, nursing • Indications for rehab center: patient benefits from intensive treatment (physically, mentally, cognitively); dedicated expertise (aphasia, cognition);patient is able to go home after 2-3 months • Young patients to rehab center unless… • “Elderly” patients go to nursing home, but… But life isn’t simple anymore…. • Elderly stroke patients do have multimorbidity which hamper disability/participation prognosis based on stroke itself • Sedentary young versus active old: phenotypes of young and old • This puts higher demands on assessment, prognosis, indication, • Transition of patients from home environment to hospital in case of an event: lack of information from GP/family • Multimorbidity of patients: adequate diagnosis and treatment of age related co-morbidity as malnutrition, dehydration, delirium, • System not tailored to the needs of mrs R: no flexibility • How much do we miss, i.e undertreat at the moment? • Continuity in care for elderly patients: transition from home to hospital and vice versa. (case manager?; who • Optimal assessment of physical, mental and cognitive function from early on (cannot be monodisciplinary • Flexible system: tailored care. At some stage rehab center (complex, intensive), at some stage nursing home

Source: http://www.awo-nzh.nl/nieuws/2010/meskers200410.pdf

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Mariana Rewerski rtiste éclectique, elle se produit dans des opéras, en musique de chambre et en concert, et aborde un vaste répertoire allant de la période médiévale jusqu'à la Elle reçoit une première formation musicale dans un choeur d'enfants dans sa ville natale, Buenos Aires. Suivront après ses études de piano, composition, direction et chant au Conservatoire National de

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