Iceland, 29 - 30 November 2010

1. www.sstefano.it Iceland, 29 - 30 November 2010

2. CONTENTS: • Introductionover the KOS group, S.StefanoRehabilitation and the RehabilitationInstituteS.Stefano • Descriptionof the job rolesinvolved in the rehabilitationactivity, whichget the supportoftrainees

3. The S.Stefanorehabilitationhasbecome part of a groupnamed KOS is a leadingItalianhealth group founded in 2002. It operates in the fields of social-health assistance, chronic invalid, rehabilitation, psychiatry, advanced technology applied to medicine and medicine for acute conditions.

4. The KOS groupoperatesthrough4 instituteswhichare dedicate todifferentfieldsofactivity: Residenze Anni Azzurri>> social-helthassistanceforelderly people The Rehabilitation Institute S. Stefano (head center) Santo StefanoRiabilitazione >> Rehabilitation Ospedale di Suzzara >> medicine for acute conditions(experimental partnership) Medipass>> supplyofadvancedtechnologyforHospitals Redancia>> Psychiatry

5. Elderly people Rehabilitation Health-care KOS’ growth – Beds per activity

6. Elderly people Rehabilitation Health care KOS’ growth – Facilities per activity

8. The rehabilitation institute S. Stefano (head center) Itissituated in the Marche Region in Porto Potenza Picena, on the adriaticcoast(central Italy). 11% of the populationof Porto Potenza Picenaisdisabled. Itissituatedby the sea and occupies 35200 squaremetres. Ithasgot 450 beds in fourbuildings, withgardens, a coffee shop, a sports center and a private beach. Itcarries out activitiesofRehabilitationdividedintoanHospital Area and anExtra-Hospital Area.

9. Porto Potenza Picena (MC) Staff: 600 employees Trainees: 50 students Citizens: 12.000 people

10. It is a leader in the field of rehabilitation. • Currently, Santo Stefano offers • rehabilitation to people of all ages who • are facing problems resulting from: • Cerebral illnesses that caused a period of • time in a coma • Cerebrovascular Accidents (Stroke) • Congenitaldisabilities • Disabilities due to a muscular/ skeletal trauma or chronic-degenerative, • even in serious and complex comorbidity conditions or following an articular prosthesis implantation

11. Some Centres also offer rehabilitation for other specific conditions: • alcohol-related • cardiological • neurodegenerative diseases (such • multiple sclerosis, amyotrophic • lateral sclerosis, Parkinson Disease) • rheumatic • respiratory • child development Manyoftheselesions and pathologiesdetermine a degreeofdisalibitythat can bepermanent

12. Life-longTraining Center Aims: • Promote the awarenessof cultural, social, • and medicalissuesthatregardpeople • withdisabilities • Organizeseminars, conferences, meetings • and training courses • Promote and encouragesscientific • researchin the rehabilitation • field, in this way assistingthe • identificationofnewsectors and • newmethodsofintervention

13. Our life-long training center took part tofourEuropeanprojects: • Helios • Horaizon • LLP-Grundtvig • Minerva Ithasalmost 20 partners in over 10 Europeancountries. Thisis the first European project we are involved in as the RehabilitationInstituteS.Stefanoas a whole!

14. Santo Stefano Riabilitazione organises and coordinates a broad series of initiatives in the community in which it is active. The goal is to collaborate with different entities in order to create value in the community and offer concrete solutions that are not limited to the therapeutic sphere, but embrace the social one as well. These are our main initiatives: • programmes in collaboration with schools ranging from screening children to promoting road safety courses for them • relations with family and volunteer associations, • exhibits and conferences as well as social activities for patients in the community.

15. Rehabilitation is managed by a multi-professional and interdisciplinary team (INCLUDING TRAINEES) sponsibility for all aspects of the patients’ disabilities and setting up a personalized rehabilitation project: • Doctor • Nurses • Health care assistants • Psychologist • Physiotherapist, Speech Therapist, Occupational Therapist, Musictherapist • Social worker • Professional Educator

16. Doctor The doctor supplies for the clinical benefit of the patients, the diagnosis and the therapy of interim and basic pathologies. The rehabilitation procedure iscoordinated by the physiatristin every department and rehabilitationsector. He/sheprescribesorthoses and necessary aids as well as different kinds ofrehabilitationinterventions (neuromotor, speechtherapy, cognitive, occupationalones etc.). Specialistssuchasneurologists, gastroenterologists, internists, cardiologists, endocrinologists, geriatricians, dermatologists work intothe structure to support and integrate clinical and rehabilitationactivities.

17. Externalconsultants, suchasanaesthetist-reanimators, neurosurgeons, urologists, lungspecialists, otorhinolaryngologists, speech therapists, are also active. Specialist figures cope with the diagnosis, therapy and monitoring of severalspecificpathologies. The medical activity is connected to some services: · Neuropsychologyand Cognitive Rehabilitation · Evaluationand RehabilitationforDysphagia · Evaluationand Treatment ofSpasticity · Neurophysiology* * throughElectromyographiesElectroneuronographies, Electroencephalographies, EvokedPotentialCorrelatesofStimulusUncertainty · Service ofCardiology and CardiovascularDiagnostic · Service ofRadiology and Neuroradiology (RX,TC,RM)

18. Nurses Nursesprovide general nursing assistance.In the rehabilitation sector, they take care of the patient and they provide support to the rehabilitation program in order to achieve the desired medical effects.

19. Nurses – according to the different settings (hospital departments for neurology, orthopaedics, spinal cord damage and coma; other departments forpermanent vegetative state, long-lastingconfinement, disabled people residence) - also evaluate and provide medical assistance such as hygienic care, programs to make the patient achieve nutrition, bladder and intestinalautonomy, steps to prevent and minimize the immobilityeffects, steps to maintain skin integrity and to heal bedsores, monitoring, use of medical device to compensate nutrition, mobility, evacuation, deambulation and otherdailyfunctions, any other activity promoting the patient autonomy and supporting his/her family

20. Health care assistant Health care assistants (a new role in the Italian National Service) carry out activities in order to satisfy the primary needs and to promote the autonomy and well-being of a patient. Their activities can be divided into: directassistance(supporttonon-autonomouspatients or those in bed for their daily functions and personal hygiene), and medical-hygienicsupport(hygieniccarof the environment).

21. Psychologist The Psychologist collaborates with the whole rehabilitation team in order to create a global rehabilitation project for the single patient, involving the family. The work consists in diagnostic methods based on the formulation of a psychological/neuropsychologicaldiagnosis, and on psychologicalsupportactivities for patients and/or familiar members. He/Shework is carried out through: • individualpsychological and interviewspairinterviews • information groups with the familiar membersof the hospitalizedpatients • supportgroupsaddressedtofamiliarmembers • cognitive and neuropsychologicalevaluations • psychological and psychodiagnosticsessions • individualpsychologicalsupportto the patient groupsupporttopatients

22. Physiotherapist The Physiotherapist is a specialized operator who carries out preventive interventions, cure and rehabilitation of the motor system, of upper cortical functions and visceral ones, which result from pathological events and various aetiology, congenital or acquired.

23. Referring to the doctor’s diagnosis and prescriptions, in his/her area ofexpertise, the physiotherapist: • defines, even in a multidisciplinary team, the rehabilitationprogramaiming at spotting and overcoming the health needs of disabled individuals • practicesautonomouslytherapeuticactivitiesfor the functionalre-educationof motor, psychomotor and cognitive disabilities, byusingphysical, manual, mass therapeutic and occupationaltherapies • proposes the adoption of prothesis and aids, he does not teach their use nor verifies their effectiveness • checks the conformity of the rehabilitation • methodappliedtofunctionalrecoverygoals. The physiotherapist carries out sport - therapyaswell

24. SpeechTherapist The speech therapy and cognitive rehabilitationservices involve people withproblems in communicating, swallowing and in all those functions related to the upper cortex. The mainactivities are:

25. The mainactivities are: • Evaluation and treatment of aphasia and its related disorders of reading, • writing, calculating, usingnumbers and makingvoluntarymovements. • Rehabilitationofotherneuropsychologicalfunctions: e.g. toorientoneself, to • pay attention, to memorize, to adapt oneself, to explore the space, tobeaware • Evaluation and treatment ofcommunication and linguisticalterations, e.g. • dysarthria, aphony, dysphonia, etc. • Evaluation and training over the use of devicesfornon-verbalcommunication • Evaluation and treatment of the swallowingfunction • Training for the patient and for his/her family (if needed) about the problems • relatedtocommunicating and swallowing.

26. Occupational Therapist The Occupational Therapist is a profession which promotes health and well-beingthroughoccupation. The activities carried out at the centre of occupationaltherapy are:

27. functionalre-educationof the upper art • functionalactivity • ADL training (ActivityDaily Life) • training on computer use with aids • advice on house modification/aids for the discharge to home • aid manufacturing or advice on purchase of aids in commerce, training on theiruse • laboratoryof alternative communication • training of family members for the patient’s management afterdischarge

28. Musictherapist A musical experience provided by an expert of music-therapy is a tool for expressing one’s ownemotionsusingnon-verbalcommunication (sounds and music). In the field of rehabilitation for cerebro injured patients, it is possible to make a connection with people suffering of altered awareness using sound and music. In fact, that involves mainly his/her emotional sphere, but also – directly or indirectly – his/her cognitive process, sensorial faculty and motor ability.

29. A music-therapist aims to ease the interaction between the patient and the world reality using non-verbal communication (sounds and music) empathically, in order to find together a sharedexpression code. The main objectives of this therapy are relaxation, re-establishing a connection with the external world, expressing one self’s emotions and controlling it, promoting creativity and personal initiatives, in order to achieve a complete autonomy, and fostering social integration. The main techniques used are music improvisation (both vocal and instrumental) and musiclistening.

30. Professional Educator The Professional Educator or Trainer elaboratesspecificrehabilitationprograms, coordinated and integrated with other educators, aiming at steadilydevelopingpersonalityskillswithrelational and educational goals in a context of participation to everyday life. He/she operates in close relationship with the user, sharing the project, in a generic sense of prevention, care and rehabilitation.

31. He/she carries out the following activities: · providesstrategiestomanage the difficult balancebetweensupport and autonomy · focuses on time management · supports and promotes the developmentof social and network relations for a better community integration · analyzes the needs and detects the resources of familiar and socio-environmentalcontexts in order to reinforce the project goals · encourages the rediscovery/discoveryof a person’s interests and predispositions

32. Social worker TheSocial worker is a professional figure who promotes the reintegration of the individuals in various social contexts. He intervenes to guarantee continuity between the hospital and the community aiming at social integration, by collaboratingwith the rehabilitation staff.

33. Activity Report: • social consultancy (orientationinterviewswithfamilies) • bureaucraticproceduresaiming at economic, living autonomyand personal mobility of the individual • network work and “case transmission” toterritorialservicesdealingwith the planning of house, family, social and work reintegration and activationofallavailableresourcesand environmentmodificationtoreceive the individualwithnewfeaturescomparedtoprevious life experiences in view of the realisationof a “caring community” • care for “hard cases”, not replaceable in house environments and research on adequate structures to move in

34. Trainees • Mainlyyoungstudentscomingfromlocaluniversities, vocationalschools, etc. fortheircompulsorytrainershipperiod(2 months – 1 year) • No salary, only work insurance • The numberoftraineesisgrowing

35. “People serving People”

36. Ester Stefoni : e.stefoni@sstefano.it estergiretti@tin.it Stefania Pepegna: srpc@sstefano.it mastero@alice.it ThankYoufor the attention!