cae U Tor NIVERSITI SS KC EBANGSAAN Bhi Mataysta a . The National University of Malaysia Elective Posting Report REHABILITATION DEPARTMENT, HOSPITAL SULTAN ISMAIL JOHOR BAHRU Name : Dr Siti Nur Aishah binti Jalil | Matrix no : P95115 | Posting duration : 1/9/2020-30/9/2020 ovate wiur GainS¢Clinic session = Admission clinic = Prosthesis clinic = Wheelchair assessment clinic = Botox clinic = Amputee clinic ~ Orthoses clinic = Retum to work clinic = Wound management clinic REHABILITATION MEDICINE ‘When | started my housemanship in 2009, | was given an opportunity of 2 weeks exposure to rehabilitation department. That is the very first time | heard about it. Following that in my mind rehabilitation medicine is all about providing aids for mobility, providing guided exercise for muscle strength and to regain fine motor function. With least knowiedge that I had, | regretted for not able to do the best for my patients. This 1- month elective posting is an eye opening. | came to the department with goals of recognizing cases need to be referred and learning basic principle of stroke rehab. At the end of this posting | managed not only to understand the importance role of rehabilitation in each of disability categories, incorporates on how primary care play @ role and works hands in hands with rehabilitation physician and learning basic muscle strengthening and exercise to improve circulation which is beneficial to my patients. Rehabilitation Medicine service was initiated in Hospital Sultan Ismail since 19th June 2009. It consists of Rehabilitation Medicine Unit, Physiotherapy Unit and ‘Occupational Therapy Unit. Uniquely, the clinic, gyms and seminar room strategically located at the south entrance of the hospital with ample dedicated parking for OKU, entrance with door for easy access of wheelchair. The physiotherapy gym is designed with emphasis given on therapeutic landscapes. In my opinion family medicine and rehabilitation medicine shares similar pillars whereby the goal is to provide comprehensive, continuous and person-centered care and not only focusing on disease centered care. During these 4 weeks, | have managed to help managing the inpatient's comorbid and giving some input to patients regarding care and services available in local health clinic. All the rehabilitation physician has always giving me opportunity to participate actively during consultation session. PAGE 2 ovate wiur CamSc'y consistent with the underlying disease. Their disabilities can ts Complex which requires specific and intensive exercises which they could benefit from either admission to Pusat Rehabilitasi PERKESO(PRP) in Malacca or enrollment into elected private physiotherapist. During the session | have managed to learn about Post stroke employment flow, the importance of medical certificate for the patient, equirement for admission to PRP, sharing experienced and learning from the officer regarding employment status during illness and discover services offered by PERKESO. Not only that, every Wednesday the team held interdisciplinary discussion, The meeting involved rehabilitation unit staffs, physiotherapists, occupational therapists and nurses in charge of the rehabilitation ward in order to formulate the optimal rehabilitation Plan for all inpatients. For each patient each goals and achievement revised, followed by Open discussion among all the team with regards of patients physical, psychological, Social, vocational, avocational, and educational or work potential in the future. Spasticity is one of common presentation in primary care be it as a result from Stroke, head injury, brain injury, spinal cord injury, multiple sclerosis, cerebral palsy, brain or spinal cord tumors, and other disorders of the central nervous system. A severe spasticity gave an impact to the guardians as it effects mobility, hygiene and personal care. With advancement of technology Botox therapy is used to treat patients with spasticity that restricts function. | have managed to see how the injection make a difference in patient’s daily life though it is minimal. With the knowledge gained here, | hope to be able to educate patient and refer early in order to prevent contracture. Following any brain or spinal injury, a disable person usually has the negative attitude toward disability and this one of the main factors causing deconditioning. This is where rehabilitation play a role as a team-oriented medical specialty that promotes a person's quality of life and functional outcome by making an individual ‘maximally abled’ again, through the application of rehabilitation principles and techniques. During this posting | have managed to see, learn and practice on few diseases that | have never seen throughout my career as a doctor. Among the disease are primary progressive multiple sclerosis, relapse remitting multiple sclerosis, amyotrophic lateral sclerosis, neuromyelitis optica spectrum disease and Edward syndrome, Itis also a good opportunity for me to brush my clinical skills when reviewing patient with acute stroke, From the presenting symptoms, psychosocial evaluation, clinical examination findings and reading available CT brain film, the goals fur rehabilitation of each patient is determined. Following that, education is given to the patient and family and shared decision achieved regarding on how recovery can be achieved. The team also help to clear the mind regarding assisted device needed at home, Beside modem medicine, there is also Traditional and Complementary Medicine (TCM) clinic available that offers acupuncture and Malay traditional massage. This is another aspect of managing this PAGE 3 ovate wiur LamScpatient by not only focusing of the impact of stroke and focusing on secondary stroke prevention. This short posting is indeed fruitful and beneficial. As a future family medicine specialist, | strongly suggested thal the primary care medical officer should be given & hance to attach in rehabilitation medicine department. Maybe in the future joint venture during Domiciliary Care Services among rehablitation medicine and primary care will be beneficial for the pationts. This elective posting boosts my determination to become @ doctor who treat a patient with the aim of optimizing a person's functions and wellbeing. Thank you to all consultant, specialist, medical officers, sister, nurses: occupational therapist, physiotherapist that involve in my 4-weeks journey here. “Struggle is real but passionate will make it easy with the help of The Creator.’ Sit Nw Aichah hao Lomenctalel excellent partopakes Uwenstont her peahieg . She has gerd cWuical kumotedge auc skills . She wrorkect wre wll dee wbedbis ciplnory bebo blithe fram. She bas eycellort communication chi lla s (—— DR SHARON ANNE KHOR (MMC 36788) Pakar Perunding & Ketua Jabetan Jabatan Perubatan Rehabiittasl Hospital Sultan Ismail Johor Bahru 30 a)por0 PAGE 4 ocdiIlicu Will vainS¢