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 Credits

Project Coordination
Ana Emilia Figueiredo de Oliveira

General Coordination of DTED/UNA-SUS/UFMA

Ana Emilia Figueiredo de Oliveira

Project Management of UNA-SUS/ UFMA

Amanda Rocha Araujo

Pedagogical Production Coordination of UNA-SUS/UFMA

Paola Trindade Garcia

Educational Offers’ Coordination of UNA-SUS/UFMA

Elza Bernardes Monier

Information Technology Coordination of UNA-SUS/UFMA

Mário Antônio Meireles Teixeira

Communication Coordination of UNA-SUS/UFMA

José Henrique Coutinho Pinheiro

Professor-Author
Denise Rodrigues Yuaso

Technical Validators – Ministry of Health / General Coordination of Health

for Persons with Disabilities (CGSPD/DAET/SAES/MS):
Angelo Roberto Gonçalves
Denise Maria Rodrigues Costa
Flávia da Silva Tavares
Cícero Kaique Pereira Silva
Diogo do Vale de Aguiar

General Coordination of the Elderly Person’s Health

(COSAPI/CGCIVI/DAPES/SAPS/MS)
Natália Vargas Patrocínio de Campos
Wendel Rodrigo Teixeira Pimentel
Maria Cristina Corrêa Lopes Hoffmann

General Coordination of Surveillance of Diseases in Elimination Process

(CGDE/DCCI/SVS/MS)
Fernanda Cassiano de Lima
Fabiana Nunes Carvalho Pisano

Pedagogical Validators
Cadidja Dayane Sousa do Carmo
Izabel Cristina Vieira de Oliveira
 Text Reviewer
Talita Guimarães Santos Sousa

Translators
Mateus Santos Braga
Victor Guilherme Nogueira Alves

Instructional Designers
Izabel Cristina Vieira de Oliveira

Graphical Designers
Carlos Haide Sousa Santos

Information Technology
Rayanne Maria Cunha Silveira
Victor Maya Nascimento Almeida

© 2021. Ministry of Health. Sistema Universidade Aberta do SUS. Fundação

Oswaldo Cruz & Universidade Federal do Maranhão. Partial or full
reproduction, distribution and utilization of this work is permitted on end-user
licensing agreements from the Collection of Educational Resources in Health
(ARES). The reference source must be quoted and sale or any commercial
purpose, without the authors' expressed consent, is prohibited, according to the
Brazilian Copyright Act-BCA (Law n°9,610 dated 19th February 1998).

 How to quote this material:

YUASO, Denise Rodrigues. Rehabilitation and life quality of the elderly with
disabilities after an EVA. In: UNIVERSIDADE FEDERAL DO MARANHÃO.
Healthcare for People with Disabilities I: Autism spectrum disorders, Down
syndrome, elderly people with disabilities, amputated people and orthoses,
prostheses and mobility aids. Healthcare for the Elderly Person with
Disabilities. São Luís: UFMA, 2021.

Rehabilitation and life quality of the elderly with disabilities after an EVA

Start

Introduction

Hi, Student!
Encephalic Vascular Accident (EVA) happens when the vessels that carry blood to the
brain get clogged or broken, causing a palsy in the cerebral region that stayed without
blood circulation. It is a disease the affect more men than women and it is one of the
main causes of death, inability and hospitalization in Brazil.
EVA’s sequelae can vary from hemiparesis (partial palsy of one of the body halves) to
cognitive deficit. Considering the variety of sequelae, the rehabilitation will require
health professionals from different areas, with a multidimensional approach.
Browsing through the infographic you will find the story of Mr. Paul that, after suffer an
EVA, will need to undergone a multidisciplinary rehabilitation process.
Let’s go?

OBJECTIVE
To understand the context of health care for the elderly person with disability that
suffered an Encephalic Vascular Accident.

Source: UNA-SUS/UFMA.

Mr. Paul, 75 years old, married, retired, with a history of Systemic Arterial
Hypertension (SAH) given 20 years ago, dyslipidemia, type 2 diabetes mellitus (T2DM)
and former smoker (30 pack-years). He lives with his wife in an apartment; they have
three married daughters and seven grandchildren that frequently visit them.

Source: UNA-SUS/UFMA.

45 days ago, Mr. Paul presented a sudden diminishing of muscle strength, changes on
sensibility and a tingling sensation on the face, arm and left leg, also an imbalance
associated to nausea and vomits.

Source: UNA-SUS/UFMA.

His wife and one of their daughters took him to an Emergency Service where he was
evaluated and examined, receiving the diagnosis for Encephalic Vascular Accident
(EVA). Mr. Paul was medicated, hospitalized for three days and then returned for his
house after hospital discharge.
The family, being very preoccupied by the EVA’s sequelae, decided to seek instructions
regarding ways to help him during the multidisciplinary rehabilitation process and to
ensure his quality of life as an elderly person, from that moment on.

Source: UNA-SUS/UFMA.
As we can see on Mr. Paul’s case, being an elderly person with disability requires
health care according to his demands and needs related to the Encephalic Vascular
Accident, in order to provide more quality to his life. From this case’s analysis,
answer the next questions. Do not worry about mistakes and successes, or even
about passing or failing criteria.

EVALUATION ACTIVITY
Question 01: The Singular Therapeutic Project (STP) can be defined as a strategy of
health care that articulates a set of actions elaborated from the dialogue and collective
construction of a multidisciplinary team and that considers the patient’s needs,
expectations, beliefs and social context. Describe the five steps for the elaboration of the
STP:

ANSWER:

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The STP must be collectively constructed following the steps:
1. Diagnosis: from the multidimensional evaluation of the elderly person, one
must elaborate a diagnosis, which combines the references and observations
of each member of the health team, allowing the exchange and share of
different perspectives, going beyond the clinical diagnosis, inside a major
view of health. The individuality comes from this process.
2. Define the goals: the team must discuss the case, point out the problems and
offer short, medium and long-term goals. The definition of the goals must be
discussed and established with the elderly person and the family and/or
caregivers, in a way that respect and their opinions and preferences, aiming
more adherence to the proposed therapeutic process.
3. Division of responsibilities: in accordance with the defined goals and
strategies to accomplish them, the role of each member on the health team,
elderly person and family/caregivers must be defined. It is important have a
project coordinator, usually the professional more connected to the elderly
person.
4. Negotiation: the project must be discussed and established along with the
elderly person or the family/caregivers, respecting their opinions and
preferences.
5. Reevaluation: the project’s execution has to be reevaluated whenever it needs
it, and adaptations can be done to serve the needs of the elderly person.
 EVALUATION ACTIVITY
Question 02: the heterogeneity of the aging process and the different health needs
presented by the elderly people must guide the organization of assistance on the part of
the health team. Therefore, it is essential to identify and stratify the health needs from
the different levels of functionality of the elderly person with disability. Regarding the
rehabilitation of the elderly person with disability in the different points of the Health
Care Network, it is right to assume that:
a) The Singular Therapeutic Project (STP) must be elaborated and coordinated by
the Secondary Care for all the elderly people of the territory of sanitary
responsibility.

INCORRECT
The Singular Therapeutic Project (STP) must be elaborated and coordinated by
the Primary Health Care for all the elderly people of the territory of sanitary
responsibility. In the case of an elderly person with functional limitation, the
STP can be elaborated along with Secondary Care or be supplemented by it.
However, before recurring to Secondary Care, it is important that all resources
available in Primary Care are depleted.

b) Rehabilitation actions of the elderly person in Secondary Care must be executed

divided by specialty, developed from the needs of the individual according to the
functional impact.

INCORRECT
The rehabilitation actions of the elderly person in Secondary Care must be
executed in a collective way by multiprofessional and interdisciplinary teams,
and be developed from the needs of each individual, according to the functional
impact.

c) Among the approaches of integral care offered in the sphere of Primary Health
Care there are the Integrative and Complementary Practices in Health (ICPH),
like ozone therapy, yoga and music therapy.

CORRECT
The Integrative and Complementary Practices in Health (ICPH) contribute to the
increase the offers of assistance and for the rationalization of the health actions,
and they are important complementary therapeutic resources available to qualify
the offer of services in the care for the elderly people.

d) Every dental attendance for the elderly person must be performed in the Centre
of Dental Specialties (CDS) due to the complex and special conditions of the
attendance.
INCORRECT
Every dental attendance for the elderly person must start in Primary Health Care
that, if necessary, will refer the cases that present complex and special needs in
the attendance to the second level (CDS) or third level (Hospital/Surgical
Center)

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