Page 183 - HA Convention 2016 [Full Version]

Special Topics HOSPITAL AUTHORITY CONVENTION 2016

T18.3 Collaborative Service Programmes in Allied Health 14:30 Room 423 & 424

New Advancement in Vestibular Evaluation and Rehabilitation
Poon M
Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong

Patients with vestibular dysfunctions usually present with vertigo and visual disturbance. This may lead to impaired balance
and unsteady gait, which result in falls. Evidence showed that these patients have a 12-fold increased odds of falling.
Sufferers may also experience psychological distress such as anxiety, and may develop phobic avoidance of movements.
Therefore, prompt evaluation of vestibular function and provision of effective vestibular rehabilitation are of upmost
importance to reduce patient’s vertigo and related symptoms, optimize vestibular function, improve balance ability, and
hence restore their quality of life.

Vestibular rehabilitation has been proven as a safe and effective treatment for managing vestibular dysfunctions and
related symptoms. With the emerging evidence supports and the technological advancement related to vestibular
rehabilitation in recent decades, physiotherapists incorporate up-to-date technology and evidence-based practice to
vestibular evaluation and rehabilitation regime for vestibular dysfunctions. By performing precise and objective evaluation
on vestibulocular functions, and multidimensional factors associated with balance disorders, physiotherapists target
custom-made rehabilitation programme to patients with vestibular dysfunctions. Physiotherapists make use of video
oculography for oculomotor assessment and specific positioning test for benign paroxysmal positional vertigo (BPPV).
Moreover, Computerised Dynamic Visual Acuity test is used to assess the function of vestibular ocular reflex (VOR), whereas
Computerised Dynamic Posturography is commonly used for evaluating the integrated use of visual, somatosensory,
and vestibular inputs for balance system. Also, the impacts of vestibular disorder on patients’ functional performance are
evaluated by validated assessment tools, such as Chinese Dizziness Handicap Inventory (C-DHI). According to qualitative
and quantitative assessment results, physiotherapist can then formulate customised vestibular rehabilitation regime for
attaining the goal of adaptation, habituation and substitution for the vestibular system. Specific repositioning maneuvers and
exercise will be prescribed for managing those with BPPV.

Promising results of vestibular rehabilitation service rely on detailed evaluation and rehabilitation planning, as well as closely
collaboration with ENT specialists, neurologist and audiologist. With joint effort, quality vestibular rehabilitation service for
patients with vestibular dysfunctions is guaranteed.

T18.4 Collaborative Service Programmes in Allied Health 14:30 Room 423 & 424

A Total Strategy to Facilitate Discharge through Collaboration — an Experience from Australia Trip Wednesday, 4 May
Ng S
Occupational Therapy Department, Kowloon Hospital, Hong Kong

This presentation describes the practices related to discharging patients from acute to subacute phase, from hospital to
community phase and how to interface with primary care and long term care across eight Australian public and private
general hospitals and institutions. The practices components including integrated patient care plan, assessments,
documentation, outcome reports, performance monitoring, audit, facilities, decision pathway, manpower and system-in-
place etc., are analysed under the themes of “approach”, “solution”, “policies” and “procedures”. Under the new financing
policy for medical care in Australia, there is a major paradigm shift in services of both public and private sectors since 2014.
At the same time, the providers and consumers’ expectations and behaviour changed. “Approach” refers to the shared
values in providing medical services, e.g. “push” model instead of “push” model when recruiting patients from acute to
subacute rehabilitation service; “multidisciplinary input” but single “interdisciplinary output”; triple-aim concept in healthcare
benchmarking, i.e. encouraging cost reduction, enhancing patient experience and improving health outcome, etc. These
visions are actualised through ample but comprehensive “solutions”, e.g. “excellent coach” for cultural building; rehabilitation/
care coordinators for interfacing care plans; transitional living units to promote goal oriented discharge; interdisciplinary care
plan to monitor length of stay, Flexible allied health workforce to provide tailor-made delivery mode; rehabilitation-in-home
programme, etc. Together with this, under national standards of “policies” in acute and rehabilitation care, i.e. Australasian
Rehabilitation Outcome Center (AROC), National Safety and Quality Health Service Standards (NSQHS), are overarching the
whole territory financing policies. “Procedures” in terms of outcome and process documentations, IT system development,
dash boards and audit meetings, etc. are implemented to govern providers, doctors, professionals, and managers.
Recommendations for local applications will also be discussed.

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