DEPARTMENT OF REHABILITATION MEDICINE OF THE FIRST FACULTY OF MEDICINE OF CHARLES UNIVERSITY AND GENERAL TEACHING HOSPITAL IN PRAGUE
Department of Rehabilitation Medicine
The clinical Department of Rehabilitation Medicine is an educational (undergraduate and postgraduate), scientific, research, methodological and health-care institution in the field of rehabilitation.
The clinical Department of Rehabilitation Medicine provides rehabilitation for the patients after brain lesion and other neurological conditions; after injuries and operations on the locomotor system; and in vertebrogenous and other conditions.
The aim of the rehabilitation is the patient's re-integration in the society and improvement of the quality of his/her life.
At the Department, a multidisciplinary team of specialists works: rehabilitation physicians with various background specialties (in neurology, internal medicine, surgery), physiotherapists, occupational therapists, a psychologist, speech therapist, specialist educationalist, social worker and nurse provide the diagnosis and suggest a long-term and short-term rehabilitation plans. They co-operate with specialists from other professions.
For the patients with cognitive, phatic, locomotor and other problems following a brain lesion, there is a day-care centre with an eight-hour individualized programme.
Both undergraduate and postgraduate education is provided at the Department: education in the field of General Medicine, three-year Bachelor degree programmes of Occupational Therapy and Physiotherapy. Also 8 postgraduate students work at the Department, studying in doctoral programmes. The Department provides postgraduate education for physicians, occupational therapists, physiotherapists and other professionals.
Since 2006 the Department has been an accredited institution in the field of Rehabilitation and Physical Medicine, registered by the Ministry of Health.
About the department
We provide rehabilitation in in-patient care at most wards of the General Teaching Hospital in Prague as well as extensive out-patient services. The list of out-patient facilities is given in the contacts subsection.
For the patients with cognitive, phatic, locomotor and other problems following a brain lesion, there is a day-care centre with an eight-hour individualized programme. Following an examination by the multidisciplinary team of specialists, a programme of individual and group rehabilitation is prepared. Duration of the therapy at the day-care centre is 4-6 weeks, in exceptional cases individualized. After completing the course of rehabilitation at the centre, a long-term and short-term rehabilitation plans are recommended in a conference with the client and/or family.
Indications: The Department admits patients from in-patient care from wards of other clinical departments who need rehabilitation, as well as patients from other hospitals and possibly from general practitioners and specialists, above all complicated cases who are at risk of disability and with diminished ability of self-grooming and self-catering. It works as a supercouncelling institution. The Department can also work as a Rehabilitation Centre, meeting the personnel and material standards.
Tuition: Extensive undergraduate and postgraduate education is provided at the Department. This includes tuition in the fields of General Medicine, Bachelor degree Occupational Therapy, Bachelor degree Physiotherapy, and also in some other branches of study. We provide tuition for the Faculty of Electrical Engineering of the Czech Technical University and Faculty of Physical Education and Sports of Charles University; we also teach at the University of South Bohemia at the Faculty of Social and Health Sciences. We also provide postgraduate education for other professionals in rehabilitation. Nine postgraduate students in doctoral studies work at the Department.
Scientific and research activities of the Department are described in more detail in the section science & research.
Department's activity
Multidisciplinary team
At the Department, a multidisciplinary team of the following professionals works:
- rehabilitation physicians with various background specialties (in neurology, internal medicine, surgery)
- physiotherapists
- occupational therapists
- psychologists
- speech therapists
- special educationalist
- social worker
- nurse
- Physicians
They use all diagnostic methods available to establish the patient's diagnosis and functional potential as accurately as possible. They make use of the scope of services of other clinical departments within the General Teaching Hospital as well as those of specialists in other fields. Basing on the diagnosis, they eventually suggest a long-term and short-term rehabilitation plans, also indicating further diagnostic and therapeutic procedures by other specialists.
They monitor the course of the therapy and together with other members of the team try to re-integrate the patient in normal life in the best possible way.
If necessary, they recommend some other methods and procedures of rehabilitation, or possibly refer the patient to another health care facility to continue the rehabilitation.
Physiotherapists
Basing on the attending physician's indication, they perform examination and physiotherapeutic diagnosis, which is in more detail described in the section physiotherapy, evaluate the results of their therapy and recommend a long-term and short-term rehabilitation plans.
The physiotherapeutic diagnosis is based on own examination and evaluation of the state, and is a result of clinical consideration. The implementation of the physiotherapeutic plan is by means of motion, manual and physical therapy, and also includes prophylaxis, instruction and counselling to restore the integrity of body systems vital for movement, optimization of function and acceleration of convalescence, minimization of the period of invalidity, improvement of the quality of life and fitness in both individuals and groups with disorders of motion functions in all age groups.
For their work the physiotherapists use non-specific means (fitness exercises, including breathing exercises) as well as specific ones. Each clinical branch has its own physiotherapeutic procedures, changing in keeping with the new knowledge in the branch.
By way of example, we can list some of the most common approaches and methods used in neurology and allied branches: the Bobath approach, Vojta's principle, Feldenkreis' method, Ms Schroth's method, Ms Brunkow's method, Dr. Brügger's method, Ass. Prof. Lewit's manipulation therapy, Nurse Kenny's method, Kabat's method, synergic reflex therapy, McKenzie method.
Occupational therapists
Basing on the doctor's indication, occupational therapists perform specific diagnostic and therapeutic procedures with the individual as well as in a group, such as function OT examination, training of the function, ADL (activities of daily living) training, using the Bobath approachs and other methodological approaches.
They set up a long-term and short-term rehabilitation plans, following the programme of complex rehabilitation at the Department of Rehabilitation Medicine. The main therapeutic measure in occupational therapy is meaningful, rewarding activity (or occupation) which aids the restoration of the affected functions.
The goal of occupational therapy is to achieve the maximum level of self-sufficiency and independence of the clients, and to improve the quality of their lives through purpose-aimed and meaningful education and occupation.
Further, occupational therapists perform:
Training of everyday self-care activities, both personal (personal hygiene, self-grooming, bathroom mobility, having meals) and instrumental (shopping, cooking, handling the money) in the out-patient programme of occupational therapy and in the Day-care Centre programme. They perform the training of communicative activities and cognitive functions in co-ordination with other specialists, consultation in the choice of compensation and technologic aids, counselling and instruction in the sphere of home setting adaptations (in individual home visiting, indicated by the doctor). They provide consultation service and promote the development of amateur club activities and recreation activities, also performing the specific OT examination as part of the client's pre-occupational preparation. Evaluation of the client's work potential and capacity (occupational diagnosis), choice of a suitable occupation, retraining course, etc. In the client's pre-occupational preparation, the clerical, textile, pottery and carpentry/carving OT workshops are used. They also do the function evaluation of the psychosensomotor potential.
Psychologists
Clinical psychologists establish the psychological diagnosis. In the case of neurorehabilitation, the diagnosis oscillates between classical clinical psychology and neuropsychology. Cognitive rehabilitation is performed by psychologists, or possibly by an occupational therapist and special educationalist in co-operation with a speech therapist. This is mainly about disorders of thought, memory, attention, fine motor activity and handwriting, of expressing thought in speech and writing, and of executive functions (planning and training simple activities, which is practically done by the occupational therapist). Consultation is provided in the sphere of personal and family problems, partnership, industrial relations and wider social problems in co-operation with a social worker (like in family and interpersonal relation consultations for well persons).
Psychotherapy – both individual and group, based on indications by the doctor and psychologists, is available for the patients at the clinical department as well. An important part of the psychologists' activity is reviewing, e.g. in patient referred by the Job Centre, and also evaluation of the ability to drive electric wheelchairs (for health insurance companies) in patients the Department, or possibly of the ability to drive motor vehicles.
Speech therapists
Clinical speech therapists provide the diagnosis and rehabilitation of communicative capacity, most often in aphasia (disorder or total loss of communicative abilities), apraxia (as a disorder of programming the elements of speech – sounds and syllables), dysphagia (disorder of swallowing), dysphonia (disorder of making and using the voice), and rhinolalia (disorder of resonance of the voice).
The aim of speech therapy is the maximal available restoration of the impaired functions. In a situation where no further improvement occurs, speech therapy offers assistance in the form of alternative ways of communication. By all means, the involvement of the client's “communicative environment” (family, friends, etc.) in the process of rehabilitation of his/her communicative capacity is necessary.
Special educationalist
The special educationalist in rehabilitation of patients after a brain lesion pursues that part of cognitive rehabilitation that leads to re-education of basic literacy abilities. Through specific methods, he/she helps the patients in learning to read, write and count again. Another sphere of work for the special educationalist is diagnosis and consultation concerning possible prospects of the patients' further education.
Musicotherapist
The musicotherapist performs musicotherapy. This makes use of music, rhythm, sounds, tones, and singing, often in connection with movement or fine arts. The method of the therapy consists in creating or performing music as well as listening, perception or creative processing; musicotherapy uses both verbal and non-verbal techniques.
Singing and training the control of breath has a big influence on other somatic and psychological processes. The music can produce relaxation or irritation, or stimulate energy. Last but not least, music, rhythm and sounds are means of interpersonal communication and expression of the human's inner world.
Art therapist, dance and movement therapist
The art therapist employs non-verbal techniques of diagnostic and therapeutic art therapy, dance and movement therapy. The activities are directed by an experienced therapist (graduate of Bachelor degree programme at the University of South Bohemia and three-year training in dance and movement therapy by the American Dance Therapy Association). Dance therapy and art therapy are mainly provided at the Day Care Centre.
Social worker
She makes arrangements for co-operation with the family, assists in application of special benefits and services for the disabled person. She provides information concerning the procedures to obtain the disability pension. She organizes assistance for the family members to cope with their difficult living conditions, help with the client's re-integration in the society, and prevention against social isolation following the health impairment – contacts to organizations providing activities in the sphere of hobbies, education and sports. One important aspect is co-operation with regional authorities, the job centre, and assistance in re-assuming the occupation.
Nurse
The nurse provides the common nursing interventions according to the patients' particular needs and keeps the Department's patient files.
Education
Undergraduate education
Tuition for medical students in programme of General Medicine: Rehabilitation in 5th year, part of Social Medicine in 4th year
Tuition for medical students within Physiology (lecture Neurophysiology of movement and rehabilitation)
Tuition for students in Bachelor degree programme of Occupational Therapy (94 in number): we teach 27 subjects in total, organize and provide for practical placements of all three years of studies as well as the final practical placement; we offer the topics for diploma theses, and our staff mostly act as thesis tutors and thesis examiners
Tuition for students in Bachelor degree programme of Physiotherapy; we teach 22 subjects in Prague and 6 in Mariánské Lázně, and possibly act as thesis tutors and thesis examiners
As part of co-operation with the University of Köln, Dr. Marcela Lippert Grüner takes part in teaching medical students and those in Bachelor degree programmes
Tuition for students of the Faculty of Electrical Engineering of the Czech Technical University, where we participate in tuition of the subject Clinical Diagnosis and Therapy
Tuition at the Faculty of Physical Education and Sports of Charles University, in 1st year of the Master degree programme of Physical and Work Experience Education for the Disabled, and in 2nd and 4th year of the Master degree programme of Physiotherapy
Tuition at the University of South Bohemia, the Faculty of Social and Health Sciences, in 1st and 2nd year of Master degree programmes
Postgraduate education
Education in doctoral programme: field board Physiology and Human Pathological Physiology
Education of physicians within the specialty Rehabilitation and Physical Medicine; two courses have been fully provided for by our department
Education of physicians within the specialty Occupational Medicine at the Institute for Postgraduate Education in Health Care
Education of physicians and psychologists at the Department of Neurology (or Section of Neuropsychology) at the Institute for Further Education of Physicians
Expert supervision of psychologists (with the focus on work in somatic medicine) in pre-registration specialist training in co-operation with the Institute of Humanitarian Studies in Medicine
Education in postgraduate courses at the Faculty of Philosophy and Arts of Palacký University in Olomouc – compulsory four-year courses to gain the qualification of a road traffic psychologist
At our department, 8 students of doctoral programmes work
Science and research
- Profile (main topics)
- International Classification of Functioning, Disability and Health
- Classification of functioning in rehabilitation
- Polyelectromyography
- Posture imaging
- Analysis of gait and walking training: 3D video imaging
- Rehabilitation of patients after brain lesion
- Rehabilitation of patients with chronic pain
International co-operation
6th Framework Programme of EU – Measuring Health and Disability in Europe: supporting policy development (the Department is one of principal research institutions); Clinical Application of ICF (International Classification of Functioning, Disability and Health by WHO)
The Department is one of the main partners in the Initiative Programme EU EQUAL in the project Rehabilitation – Activation – Work. Development of methodology for functional diagnosis in rehabilitation by a multidisciplinary team
Development of co-operation between the University of Köln and Charles University: co-operation between the University of Köln and Charles University; co-operation between the medical faculty of the University of Köln and the First Faculty of Medicine of Charles University (the RehaNova clinic) within the EU Socrates/Erasmus programme
Co-operation at the MATRA III international project with the Centre for Promotion of Care of Mental Health – project of promotion of education in care of mental health (Czech-Dutch project)
The Department co-operates with the interdisciplinary task group for co-operation with WHO in ICF (International Classification of Functioning, Disability and Health)
Co-operation with ENOTHE (European Network of Occupational Therapy in Higher Education)
Co-operation with the faculty in Gent (Belgium) within the EU Socrates/Erasmus programme
At the Department, the Czech-German Society for Rehabilitation is active. Prof. Thomas Rommel and Prof. K. H. Mauritz are honorary members
Co-operation with the ARGE OST-WEST company in Linz (Austria) continues
Prof. MUDr. Jan Pfeifer, DrSc., is active as the president of the Czech-French PARTNERSTVÍ-PARTNERIAT society