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1.
Rev Gaucha Enferm ; 42(spe): e20200331, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34037186

RESUMO

OBJECTIVE: Describe the experience lived in an interdisciplinary follow-up care center for mastectomized women at a public university in São Paulo during the beginning of the COVID-19 pandemic. METHOD: Experience report on the health care provided in the health center for mastectomized women. RESULTS: The care was provided three times a week by an interdisciplinary health team. The mentioned areas that cover the women care in the center: Physical, Psychological, Social Support and Health Education. CONCLUSIONS: The attention by an interdisciplinary team becomes prevalent in the care of mastectomized women, since cancer and its treatment produce various changes in women's lives in the short and long term, so follow-up and support must be biopsychosocial, covering all areas that may be affected, especially during the pandemic.


Assuntos
Linfedema Relacionado a Câncer de Mama/reabilitação , COVID-19/epidemiologia , Mastectomia/reabilitação , Pandemias , Equipe de Assistência ao Paciente , Centros de Reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/psicologia , Terapia Focada em Emoções , Terapia por Exercício , Feminino , Educação em Saúde , Humanos , Mastectomia/efeitos adversos , Mastectomia/psicologia , Pessoa de Meia-Idade , Apoio Social
2.
Medicine (Baltimore) ; 100(18): e25125, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950915

RESUMO

ABSTRACT: Lower limb rehabilitation exoskeleton robots connect with the human body in a wearable way and control the movement of joints in the gait rehabilitation process. Among treadmill-based lower limb rehabilitation exoskeleton robots, Lokomat (Hocoma AG, Volketswil, Switzerland) has 4 actuated joints for bilateral hips and knees whereas Walkbot (P&S Mechanics, Seoul, Korea) has 6 bilateral actuated joints for bilateral hips, knees, and ankles. Lokomat and Walkbot robotic gait training systems have not been directly compared previously. The present study aimed to directly compare Lokomat and Walkbot robots in non-ambulatory chronic patients with acquired brain injury (ABI).The authors conducted a single-center, retrospective, cross-sectional study of 62 subjects with ABI who were admitted to the rehabilitation hospital. Patients were divided into 2 groups: Lokomat (n = 28) and Walkbot (n = 34). Patients were subjected to robot-assisted gait training (RAGT) combined with conventional physical therapy for a total of 14 (8-36) median (interquartile range) sessions. Baseline characteristics, including age, sex, lag time post-injury, ABI type, paralysis type, intervention sessions, lower extremity strength, spasticity, and cognitive function were assessed. Functional ambulation category (FAC) and Berg balance scale (BBS) were used for outcome measures.There were no significant differences in baseline characteristics between the groups. Baseline FAC score was 1 (0-2) in Lokomat and 1 (0-1) in Walkbot group. After the intervention, FAC scores improved significantly to 2 (1-3) in both groups (P < .05). Lokomat and Walkbot groups showed significantly enhanced BBS from 5 (2.75-24.25) and 15 (4-26.5) to 15 (4-26.5) and 22 (12-40), respectively (P < .05). Degree of improvements in both group were not significantly different with regard to balance (P = .56) and ambulatory ability (P = .74).This study indicates that both Locomat and Walkbot robotic gait training combined with conventional gait-oriented physiotherapy are promising intervention for gait rehabilitation in patients with chronic stage of ABI who are not able to walk independently.


Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Lesão Encefálica Crônica/reabilitação , Exoesqueleto Energizado , Paraplegia/reabilitação , Robótica , Adulto , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Lesão Encefálica Crônica/complicações , Lesão Encefálica Crônica/mortalidade , Terapia Combinada , Estudos Transversais , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/etiologia , Modalidades de Fisioterapia , Centros de Reabilitação , Estudos Retrospectivos , Sobreviventes/estatística & dados numéricos , Resultado do Tratamento
4.
Front Public Health ; 9: 666333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33898385

RESUMO

Children with disabilities have most potential for salvage rehabilitation, and their rehabilitation results are concerned with their entire life process. Although, the Chinese state has established a targeted Rehabilitation Assistance System for Disabled Children and has expanded the provision of rehabilitation services, a severe deviation between supply and demand remains. Existing studies have focused relatively more on policy content and less on the policy context, at the macro-structural level. However, using the case of the ZW Rehabilitation Center in City J, this study divided the deviation into exclusion errors and inclusion errors, and used the policy context approach to explore the reasons for the deviation. We found that the behaviors of the participants in rehabilitation services exist in a dynamic interaction between the regulatory context, the normative context, and the cognitive context. The joint forces of the three contexts produce both exclusion errors and inclusion errors, which are the underlying reasons for the inaccurate execution of the targeted policy. The results of this research can provide enlightenment for improving rehabilitation policy.


Assuntos
Crianças com Deficiência , Criança , China , Humanos , Políticas , Centros de Reabilitação
5.
Artigo em Inglês | MEDLINE | ID: mdl-33809052

RESUMO

Bonsai art refers to the cultivation of a miniature tree. This study was motivated by the hypothesis that bonsai art may also be an ecopsychological, therapeutic practice that can have meaningful healing qualities. An international online survey elicited the meaning of bonsai art for 255 skilled bonsai practitioners. Questionnaires and interviews were used to elicit the experiences of participants. The findings supported the hypothesis that, for skilled practitioners, bonsai art was associated with meaningful healing experiences. In particular, the evidence suggests that bonsai art facilitates improved ecological, spiritual and emotional awareness, as well as various healing dimensions, including aesthetic creativity, resilience, adaptability, and social, physical, and personal health. It is viewed as an intervention technique that requires few resources, is easy to apply, and has a minimal impact on any environmental setting. The conclusions drawn point to the ethically sound health promotion value of bonsai art in various settings, such as psychiatric hospitals, retirement homes, rehabilitation centres and prisons.


Assuntos
Criatividade , Centros de Reabilitação , Emoções , Promoção da Saúde , Humanos , Inquéritos e Questionários
6.
J Rehabil Med ; 53(4): jrm00186, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33871034

RESUMO

OBJECTIVE: To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases. METHODS: Seventeen hospital and outpatient medical centres from 13 regions of the Pilot Project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation. RESULTS: The pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients' stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017. CONCLUSION: Despite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.


Assuntos
Reabilitação Cardíaca/métodos , Centros de Reabilitação/normas , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários
7.
Unfallchirurg ; 124(5): 419-426, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33738514

RESUMO

A seamless rehabilitation of polytrauma patients starting as early as possible is the primary goal in order to ensure long-term participation and quality of life. In reality, however, there is often still a large time gap between acute care and inpatient rehabilitation, the "rehab hole".The aim of the phase model of trauma rehabilitation is to ensure a complete rehabilitation chain. After acute patient care (phase A) and a potentially required early patient rehabilitation (phase B), trauma rehabilitation should seamlessly continue on to phase C.In order to identify those patients who require specialized phase C trauma rehabilitation before discharge from acute treatment, the DGOU trauma rehabilitation working group suggests a simple assessment. The trauma rehabilitation score (TRS) is based on two parts, a prescreening and a main screening. It supports the trauma surgeon at the end of the acute treatment with the needs-based indications for further rehabilitation and serves as an argumentation aid to the payers of the rehabilitation.In addition to the early rehabilitation Barthel index (FRB) for assessing the need for care and mobility, other relevant characteristics are recorded. From a rehabilitation point of view, a special effort arises from an increased diagnostic and therapeutic needs, through specialist care and treatment in nonorthopedic areas, extensive wound management, pain therapy measures, the provision of aids and special psychological care for the seriously injured.


Assuntos
Traumatismo Múltiplo , Qualidade de Vida , Humanos , Manejo da Dor , Alta do Paciente , Centros de Reabilitação
8.
J Neurol Phys Ther ; 45(2): 101-111, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33675602

RESUMO

BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. METHODS: For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. RESULTS: Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. DISCUSSION AND CONCLUSIONS: The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).


Assuntos
Pacientes Internados , Centros de Reabilitação , Idoso , Humanos , Medicare , Alta do Paciente , Estados Unidos , Caminhada
9.
BMC Health Serv Res ; 21(1): 204, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676516

RESUMO

BACKGROUND: There is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation, and as such patient centred rehabilitation models have been developed. However, implementing evidence-based models without attending to the fit of the model to the new context could lead to an unsuccessful outcome. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care. METHODS: The study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals' perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in the facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework. RESULTS: Across the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains of the context were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure, an aspect of the geographical domain, focused on the facility's physical layout that required attention. CONCLUSIONS: The CICI framework was a useful guide to identify key factors within the context that existed and were required to fully support the implementation of the model of care in a new environment. The findings suggest that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how they interact and influence one another.


Assuntos
Disfunção Cognitiva , Pessoal de Saúde , Idoso , Grupos Focais , Humanos , Ontário/epidemiologia , Centros de Reabilitação
12.
Am J Phys Med Rehabil ; 100(5): 443-449, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538488

RESUMO

OBJECTIVE: The aim of this study was to determine the prevalence and functional impact of unilateral spatial neglect on right hemisphere stroke patients in an inpatient rehabilitation facility using a multidimensional, functionally based behavioral measure (Catherine Bergego Scale [CBS]). DESIGN: This was a retrospective cohort study of 742 consecutive admissions of patients with right hemispheric stroke to an inpatient rehabilitation facility. Spatial neglect was assessed using the CBS. Functional impact of neglect was measured by hospital length of stay, Functional Independence Measure change per day, discharge destination, and number of falls. RESULTS: As measured by the CBS, 86% of the right hemisphere stroke patients had symptoms of spatial neglect. Moderate and severe neglect was associated with less Functional Independence Measure change per day and lower rates of community discharge. The presence of neglect was not significantly associated with fall rate or length of hospital stay after controlling for admission Functional Independence Measure scores and age. The "difficulty looking left" CBS item had the strongest relationship with total CBS scores and effectively predicted Functional Independence Measure change per day and discharge destination. CONCLUSIONS: Using a sensitive measure, the CBS, rates of spatial neglect are extremely high in right hemisphere stroke patients entering inpatient rehabilitation. Both identification and determination of neglect severity are extremely important given their significant relationship to rehabilitation outcomes and discharge destinations. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) describe why carefully assessing spatial neglect in right hemisphere stroke patients is important; (2) identify multiple dimensions of spatial neglect assessed by the Catherine Bergego Scale and how this approach differs from traditional paper and pencil assessment methods; and (3) describe the relationship between spatial neglect as measured by the Catherine Bergego Scale and functional outcomes of right hemisphere stroke patients in inpatient rehabilitation settings. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Assuntos
Avaliação da Deficiência , Transtornos da Percepção/fisiopatologia , Transtornos da Percepção/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidentes por Quedas/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Prevalência , Centros de Reabilitação , Estudos Retrospectivos , Resultado do Tratamento
13.
Am J Phys Med Rehabil ; 100(3): 288-291, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595942

RESUMO

ABSTRACT: This study characterizes the demographics and durable medical equipment needs of persons with disabilities to improve utilization and management of resources at a philanthropic rehabilitation clinic. Paper charts from all encounters between 2013 and 2018 were reviewed. Data collected include sex, age, ethnicity, insurance status, diagnoses, and durable medical equipment requested/received. Paper charts that were incomplete or illegible were excluded. Among 763 individuals, there were 1157 encounters for durable medical equipment requests. Forty-six percent of individuals were uninsured. Thirty-seven percent had federal insurance such as Medicare or Medicaid, and 6% private insurance. Fifty-five percent of individuals were Hispanic, 28% African American, and 14% White. Fifty-six percent of encounters were with individuals with a neurological diagnosis, 18% medical diagnosis, 17% musculoskeletal/autoimmune diagnosis, 6% amputation diagnosis, and 3% cancer diagnosis. Of the 2680 items distributed, 34% were wheelchair parts and repair, 30% personal hygiene/incontinence supplies, 25% mobility equipment, and 11% bathroom equipment. Of the 513 unmet items requested, 49% were mobility equipment, 24% wheelchair parts and repair, 17% personal hygiene/incontinence supplies, and 11% bathroom equipment. More than a third (43%) of durable medical equipment requests were from individuals with either private insurance or federal payers, which implies lack of adequate coverage on durable medical equipment to maintain mobility and independence.


Assuntos
Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Equipamentos Médicos Duráveis/provisão & distribuição , Necessidades e Demandas de Serviços de Saúde , Seguro Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Adulto Jovem
14.
BMC Health Serv Res ; 21(1): 164, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33610174

RESUMO

BACKGROUND: Quality of care is gaining increasing attention in research, clinical practice, and health care planning. Methods for quality assessment and monitoring, such as quality indicators (QIs), are needed to ensure health services in line with norms and recommendations. The aim of this study was to assess the responsiveness of a newly developed QI set for rehabiliation for people with rheumatic and musculoskeletal diseases (RMDs). METHODS: We used two yes/no questionnaires to measure quality from both the provider and patient perspectives, scored in a range of 0-100% (best score, 100%). We collected QI data from a multicenter stepped-wedge cluster-randomized controlled trial (the BRIDGE trial) that compared traditional rehabilitation with a new BRIDGE program designed to improve quality and continuity in rehabilitation. Assessment of the responsiveness was performed as a pre-post evaluation: Providers at rehabilitation centers in Norway completed the center-reported QIs (n = 19 structure indicators) before (T1) and 6-8 weeks after (T2) adding the BRIDGE intervention. The patient-reported QIs comprised 14 process and outcomes indicators, measuring quality in health services from the patient perspective. Pre-intervention patient-reported data were collected from patients participating in the traditional program (T1), and post-intervention data were collected from patients participating in the BRIDGE program (T2). The patient groups were comparable. We used a construct approach, with a priori hypotheses regarding the expected direction and magnitude of PR changes between T1 and T2. For acceptable responsivess, at least 75% of the hypotheses needed to be confirmed. RESULTS: All eight participating centers and 82% of the patients (293/357) completed the QI questionnaires. Responsiveness was acceptable, with 44 of 53 hypotheses (83%) confirmed for single indicators and 3 of 4 hypotheses (75%) confirmed for the sum scores. CONCLUSION: We found this QI set for rehabilitation to be responsive when applied in rehabilitation services for adults with various RMD conditions. We recommend this QI set as a timely method for establishing quality-of-rehabilitation benchmarks, promoting important progress toward high-quality rehabilitation, and tracking trends over time. TRIAL REGISTRATION: The study is part of the larger BRIDGE trial, registered at ClinicalTrials.gov (Identifier: NCT03102814).


Assuntos
Continuidade da Assistência ao Paciente , Doenças Musculoesqueléticas , Indicadores de Qualidade em Assistência à Saúde , Centros de Reabilitação/normas , Doenças Reumáticas , Adulto , Benchmarking , Humanos , Estudos Multicêntricos como Assunto , Doenças Musculoesqueléticas/reabilitação , Noruega , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Reumáticas/reabilitação , Inquéritos e Questionários
16.
J Infect Dis ; 223(2): 192-196, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535238

RESUMO

At the start of the UK coronavirus disease 2019 epidemic, this rare point prevalence study revealed that one-third of patients (15 of 45) in a London inpatient rehabilitation unit were found to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but asymptomatic. We report on 8 patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral reverse-transcription polymerase chain reaction (RT-PCR) burden, and their antibody levels over time, revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS-CoV-2 showed that 100% of our asymptomatic cohort remained seropositive 3-6 weeks after diagnosis.


Assuntos
COVID-19/diagnóstico , COVID-19/imunologia , Nasofaringe/virologia , Centros de Reabilitação/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Anticorpos Antivirais/sangue , Formação de Anticorpos , Infecções Assintomáticas/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Estudos de Coortes , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/imunologia , Testes Sorológicos
17.
Semin Speech Lang ; 42(1): 64-72, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33596605

RESUMO

Telemedicine-conveying medical information virtually for planning, diagnosis, or treatment-has been a part of the American medical system for over 100 years. A constantly evolving modality, telepractice was a supplemental care delivery system for most speech-language pathologists (SLPs) until March 2020 when the COVID-19 pandemic forced clinical operations to halt in-person activities and convert as much as possible to virtual platforms. The purpose of this article is to provide an overview of the need for telepractice prior to and beyond the current pandemic, the efficacy of telepractice for the voice-specialized SLP, limitations of telepractice, and best practices for providing care over telepractice with a specific focus on voice disorder diagnosis and treatment.


Assuntos
Prática Psicológica , Centros de Reabilitação , Telerreabilitação/métodos , Interface Usuário-Computador , Distúrbios da Voz/reabilitação , Criança , Humanos
20.
Rev. argent. salud publica ; 13: 1-8, 5/02/2021.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1151957

RESUMO

INTRODUCCIÓN: La rehabilitación basada en la comunidad (RBC) busca mejorar el acceso a la rehabilitación y la inclusión social de las personas con discapacidad. Los escasos estudios realizados muestran experiencias heterogéneas en su implementación. El objetivo de este estudio fue describir las experiencias y percepciones sobre RBC de profesionales sanitarios, personas con discapacidad y familiares participantes en centros de atención primaria de la Región Metropolitana de Chile. MÉTODOS: Se realizó un estudio cualitativo exploratorio-descriptivo. A través de un muestreo de caso típico se seleccionaron profesionales sanitarios, hombres y mujeres con discapacidad física y familiares. Se desarrollaron 16 entrevistas grupales semiestructuradas, 4 por cada grupo. Se realizó análisis de contenido semántico mediante codificación inductiva y deductiva. RESULTADOS: La RBC es valorada positivamente por las personas con discapacidad y familiares. Sin embargo, los profesionales consideran que es insuficiente para lograr la inclusión social. DISCUSIÓN: Existen barreras y facilitadores para la implementación de la RBC. Su ubicación en la Atención Primaria permite flexibilidad en la atención. No obstante, se centra en intervenciones de rehabilitación física, relegando la salud integral y el trabajo intersectorial a un segundo plano. Se requiere capacitar a los equipos sanitarios para proveer una rehabilitación integral, que contribuya a la inclusión social de las personas con discapacidad


Assuntos
Atenção Primária à Saúde , Reabilitação , Centros de Reabilitação , Pessoas com Deficiência , Implementação de Plano de Saúde
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