Department of Rehabilitative Medicine.

The Department of Rehabilitative Medicine at MNH is one of the departments of the Directorate of medical services.

It is situated right after the main entrance to the hospital. The department provides comprehensive Physiotherapy and Occupational Therapy services for a wide range of conditions for both inpatients and outpatients who are referred from various clinics of the hospital, other hospitals around and beyond Dar es Salaam.

1.1 The Core Functions of the Department.

1. Consultations for patients with functional disabilities.
2. Physical assessments including assessment in muscle strength, joints range of motion analysis, ambulation, neuro - musculoskeletal level, cognitive abilities, work skills, leisure activities, and the ability to carry out the activities of daily living.
3. Treatments designed to restore / improve functions, prevent disability or its progression, relieving pain, provide adaptive equipment, ambulation aids, and education about disability.
4. Research and research support, independent or collaboration with other institutions.
5. Special programs of the patients with developmental, congenital disorders and sportsmen.
6. Counseling e.g. on acceptance of acquired new body image, condition etc.

The department has two units, Physiotherapy and Occupational Therapy that provide comprehensive services for a wide range of conditions for both inpatients and outpatients who are referred from various clinics of the hospital, other hospitals around and beyond Dar es Salaam.

1.2 Goal

To improve our patients’ level of independence and quality of life of persons who have functional disabilities resulting from illness, injury or congenital abnormalities.

1.3 Core Functions of the Department

• Consultations for patients with functional disabilities i.e.
  • Health education on disabilities and nutrition.
  • Counseling e.g. on acceptance of acquired new body image/ condition
• Physical assessments including assessment in muscle strength, joints range of motion analysis, ambulation, neuro-musculoskeletal level, cognitive abilities, work skills, leisure activities and the ability to carry out the activities of daily living.
• Treatments designed to restore / improve functions, prevent disability or its progression, relieving pain, provide adaptive equipment, ambulation aids.
• Training: - conducts regular continuing professional development or medical education e.g. case presentation and also supervision of local and elective students from various countries during field praxis.
• Research and research support, independent or collaboration with other institutions.
• Special programs of the patients with developmental and congenital disorders.

1.4 Physiotherapy Unit

The physiotherapy unit provides inpatient and outpatient services for adults and pediatrics.

1.4.1 Out-patient

This clinic runs separate outpatient services for adults and children to:-

• Follow up patients who have been discharged from the wards and need to continue with physiotherapy and rehabilitation.
• First-time new patients referred from various clinics of the hospital, other hospitals or individuals.

At this clinic patients are evaluated, treatment planned and managed. These patients will continue to receive treatment as planned as follow-up. After sometime such patients are re-evaluated and treatment may continue, adjusted or terminated as advised.

1.4.2 Inpatient

This service is available to patients from all departments including Intensive Care Unit. The service is optional, provided only to those patients who need to restore or improve their functional capabilities.

In order to share ideas with other medical experts, physiotherapists attend major ward rounds. This also offers a chance to identify patients for early physiotherapy intervention.

1.5 Occupational Therapy Unit

The Occupational therapy as both an art and a science that has a focus on adult and children enabling the engagement in occupation in order to promote health and well being intervention are directed at the individual, group, community and population level in order to address barriers effectively that interfere with occupational engagement or performance. Recovery post an injury to your hand, wrist, elbow or shoulder can be difficult. Occupational Therapy helps a patient/client to return to work, sporting and home activities.

1.5. 1 Inpatient

After receiving a doctor’s consultation or referral from other professionals, the Occupational Therapist completes a comprehensive evaluation/ assessment and treatment of patients which includes client goals, and functional ability and deficit in:-

• Occupational performance areas activities of daily living.
• Develops a unique individual treatment program that may include ROM exercises, muscle strengthening exercises, massage and or use of modalities to decrease pain and swelling; and sensory integration.
• Splinting to support injury.
• Wound and skin care.

1.5.1.1 Discharge Planning from Hospital

Occupational therapy is instrumental in predicting levels of function and indicating how the patient is likely to cope on returning home. For this reason it is important that occupational therapist is consulted when planning for discharging patients from the hospital.

1.5.2 Outpatient

Occupational Therapists carry out assessment of patients who have been referred to the unit from other team members.

At this clinic personal education and counseling on the importance of involving the not affected and the affected part in all aspects of occupation namely self care, productivity/work and leisure. Also making adaptive equipments/aid and train adaptive skills to patients.

Occupational therapist is unique and has specific roles in dealing with Cerebral palsy children. One of the roles is to guide the parents on how to modify the normal care by giving activities, so that each daily task whether it is bathing, feeding or dressing etc is used to reinforce or improve motor patterns the child has learnt during the therapy session.

Also Occupational therapists address issues relating to learning difficulties/ cognitive / perceptual and sensory impairments that affect the clients’/patients’ participation in self care, productivity or leisure.

For pediatrics, PLAY is used as a media of treatment and stimulates cognition.

1.5.3 Community

Occupational therapist we have a consultant role that is often valued by teachers and parents. We undertake consulting roles in various ways, e.g. carrying out classroom and home assessments and implementing carefully designed programs for the teachers. The Occupational Therapists may intervene on behalf of the client to obtain items, resources which the client requires. Therefore we involve direct provision of other professionals’ voluntary and statutory agencies, commercial organizations, cares and other providers.

1.5.4 Home Visit

There are three types of home visits for occupational therapy namely: pre-discharge home visit, on-discharge home visit and post discharge home visit (follow up home visit). All these visits are carried out by Occupational Therapists depending on the condition of the client. Occupational therapists do home visits to clients/patients’ home, work place, or other relevant environment to assess, advise, teach, treat, adapt or provide other interventions in the client’s usual environment.

During home visit caregivers are also taught about home program for individual client according to the condition and environment. Also therapist does discus suitable aid/ design adaptive aids and changes of environment at home or school for adaptation.