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