Authors (including presenting author) :
Wong HL(1), Chung PH(1), Wong SM(1), Ng CM(1), Tai HY(1), Lau FO(1)
Affiliation :
(1)Physiotherapy Department, Tai Po Hospital
Introduction :
One of the main goals of physiotherapy in stroke rehabilitation is to help patients achieve maximal walking ability as soon as possible. This requires a careful integration of modern technologies into traditional practice. Since April 2019, a stroke rehabilitation program named “Return to Walk” was started to develop in Physiotherapy Department of Tai Po Hospital. Stroke patients from in-patient care to ambulatory care were triaged into Accelerated Stroke Ambulation Program (ASAP) 行得到, Enhanced Gait Training Program 行得好 or Community Re-walk Program 行得遠 according to their admission mobility level.
Objectives :
1. To enhance achievement of maximal walking ability of stroke patients
2. To integrate modern technologies into traditional practice of stroke rehabilitation
3. To standardize physiotherapists’ practice in stroke rehabilitation program
Methodology :
1. Accelerated Stroke Ambulation Program (ASAP) standardized intensive early ambulation training with modern technologies such as Knee-Ankle-Foot Orthoses and Lower Limb Robotic-Assisted Gait Training.
2. Enhanced Gait Training Program developed a gait analysis-based training protocol with clinical decision support system to assist therapists to identify possible gait problems and prescribe treatments for corresponding gait deficits.
3. Community Re-walk Program advanced functional mobility training for reaction, dual-task ability, walking speed and endurance, and self-confidence by developing new training systems including Non-Immersive Virtual Reality Treadmill Training and Echo Dot and Buttons tapping games.
4. Stroke Registry, a longitudinal stroke rehabilitation database to monitor functional outcomes and process compliance, and Reference MRMI Gain, a clinical prediction model based on big data concept, were developed to monitor the progress of each stroke patient proactively.
Result & Outcome :
One-year outcome before and after the Return to Walk program was compared (10/2018-9/2019 Vs 10/2019-9/2020). The functional outcomes were able to keep similar (mean difference: MRMI pre 5.26, post 5.08; MFAC pre 0.73, post 0.67; BBS pre 6.62, post 6.39) with the length of training decreased by 1.39 days. Meanwhile, it was found that the staff experience of Senior Physiotherapist and Physiotherapist I reduced 9.8 years and that of Physiotherapist II reduced 0.7 year. That is, the program was successful to promise the stroke outcomes even the staff was much more junior.
