Rehabilitation and Functional Recovery

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Treatment of Neurological diseases
  • Treatment of Dementia (progressive cognitive decline)
  • Neurorehabilitation
  • Neuromodulation in neurological diseases
  • Cardiological Rehabilitation

PROCEDURES PERFORMED PER YEAR:

  • 40 000 outpatient rehabilitation services (2016)
  • 500 Day Hospital admissions for intensive care outpatient activities

The San Raffaele Hospital provides, through the rehabilitation Unit, both inpatient and outpatient treatments.

In particular, there are currently three rehabilitation divisions that are part of the Rehabilitation and Functional Recovery Department: The Cognitive-Motor Rehabilitation Unit, the Cardiological Rehabilitation Unit, and the Motor Specialization Rehabilitation. The three rehabilitation departments are partly recognised as High Complexity Intensive Rehabilitation and partly as Intensive Rehabilitation. There are also some outpatient physiotherapy services, aimed at satisfying the patient’s needs. In total, more than 200 physiotherapy treatments are provided on a daily basis in the three rehabilitative divisions as well as an average of 50, individual or group, outpatient treatments. The gyms are fully equipped and offer a wide range of services for therapeutic exercise, neurological rehabilitation, rehabilitation of cardiovascular and respiratory aspects, muscle strengthening and rehabilitation of the perineal plane. The team of physiotherapists work in a multidisciplinary fashion, collaborating with various Intensive Care Units of San Raffaele.

treatmentS

Neurological Diseases – Dementia  

The Rehabilitation and Functional Recovery Department of the San Raffaele Hospital is composed of a multidisciplinary team specialized in the prevention, diagnosis, pharmacological and non-pharmacological treatments and rehabilitation of primary and acquired cognitive diseases. The main pathologies treated are neurodegenerative diseases, head trauma, sequels of ischemic and haemorrhagic stroke, cerebral tumours and chronic pain. During the hospital stay, all patients benefit from pharmacological and non-pharmacological treatments including stimulation and cognitive training (in individual and group sessions), physiotherapy, neurostimulation, rehabilitation in virtual environment, speech and nutritional rehabilitation.

Professor Iannaccone is currently leading 8 pharmacological and non-pharmacological projects on Alzheimer’s disease. He is the local Principal Investigator of the clinical trial funded by the Biogen Company entitled: “A Phase 3 Multicentre, Randomized, Double-Blind, Placebo‑Controlled, Parallel-Group Study to Evaluate the Efficacy and Safety of Aducanumab in Subjects with Early Alzheimer's Disease (AD)”. Partial results of this multicentric international trial have been published in Nature Magazine.1

Main Pathologies Treated:

  • Neurodegenerative Diseases:
    • Alzheimer’s disease
    • Parkinson’s disease and parkinsonism
    • Frontotemporal disease
    • Amyotrophic lateral sclerosis associated with cognitive deficits
  • Head Trauma
  • Ischemic and Haemorrhagic stroke
  • Cerebral Tumour
  • Chronic Pain

Top Procedures:

  • Pharmacological and non-pharmacological treatments
    • Stimulation and cognitive training
    • Physiotherapy
    • Neurostimulation
    • Rehabilitation in virtual environment
    • Speech and nutritional rehabilitation

Neurorehabilitation

Professor Iannaccone’s Unit is dedicated to the implementation and development of motor and cognitive innovative neurorehabilitative strategies. The multidisciplinary team composed of neurologists, psychologists, physiotherapists, speech therapists and biologists developed innovative strategies for motor, cognitive and speech rehabilitation.

Part of the rehabilitation is based on the use of virtual reality (VR). VR systems are able to generate augmented multisensory feedbacks (auditory, visual and proprioceptive), helping the patient to develop a real-time "knowledge of results” and "knowledge of performance”, favouring the physiological mechanism of reinforcement learning.

The area also proposes services of Telerehabilitation, which allows patients who have difficulties in benefiting from regular rehabilitation to be closely monitored at home (home-based cognitive and motor rehabilitation, training evaluation and monitoring of vital signs) in order to prevent relapses that are usually observed after hospital discharge due to the incapacity of patients to benefit from adapted cares. (photos 1, 2, 3, 4)

Main Pathologies Treated:

  • Cognitive and Motor disorders

Top Procedures:

  • Telerehabilitation
  • Virtual Reality rehabilitation

Neuromodulation in neurological disorders

The Rehabilitation and Functional Recovery area is equipped with non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These stimulation techniques can modulate neuroplasticity in order to act on various symptoms of neurological disorders. In particular, the NeuroAD system2 which is a novel, non-invasive device combining cognitive training with repetitive transcranial magnetic stimulation aims at reducing cognitive decline in patients presenting progressive cognitive deficits. tDCS is a portable device that can be applied directly at the patient’s bed in order to improve a various range of motor and cognitive symptoms. (photos 5, 6)

Main Pathologies Treated:

  • Neurological disorders
  • Cognitive deficits

Top Procedures:

  • Transcranial magnetic Stimulation (TMS)
  • Transcranial Direct Current Stimulation (tDCS)
  • Cognitive Training

Cardiological Rehabilitation

The Cardiological Rehabilitation section offers patients with heart disease dedicated medical programs, aimed at achieving faster recovery, improving their physical capacity, their psychological balance and allowing a better recovery of their family, social and work activities. The Unit offers a personalized physical activity program, useful for recovery and cardiovascular health as well as advice to encourage the adoption of correct and healthy eating and lifestyle habits. These programs are aimed at modifying risk factors, such as smoking habits, arterial hypertension, diabetes, high cholesterol values, obesity and a sedentary lifestyle.

The objectives of a rehabilitative cardiology program are to stabilize and, when possible, reverse the progression of cardiovascular disease, thus reducing the risk of new events. The long-term success of each rehabilitation and prevention program of further cardiovascular events is strongly dependant on the patient's adherence to the contents of the proposed program. To this end, Individual Rehabilitation Plans are prepared for each patient.

The achievement of the largescale objectives involves the participation of an integrated team that includes: cardiologists, cardiac surgeons, physiotherapists, psychologists, physiatrists, nutritionists and nurses.

Main Pathologies Treated:

  • Cardiologic Disorders or Post-Surgery Treatment

Top Procedures:

  • Physiotherapy
  • Dietary Program
  • Psychological support
  • Monitoring of vitals

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Virtual Reality Rehabilitation Systems (VRRS, Khymeia Group)
  • Tele-rehabilitation platform
  • MoonWalker (Khymeia Group)
  • NeuroAD (Neuronix Medical)
  • tDCS systems

 

NOTES

1(Sevigny et al, 2016)
2(Neuronix, Israel)