The medical area of a rehabilitation center provides the following services: medical evaluation, performed by the physician and his staff; physical therapy, including hydrotherapy; occupational therapy; speech and hearing therapy It also furnishes the services of a prosthetic and/or orthotic appliance shop. The detailed character of the medical area wilt vary with the program of the center itself.
The emphases in the medical program will be determined by the needs of the patients and by already existent community medical facilities.
The medical area provides the basis for the patients' total program at the center. It must be accessible to all other areas and be well integrated with the administration and admissions services. (See Fig. 2.)
This section will contain much specialized examination, treatment, and therapy equip*
ment. Some of this will be heavy, requiring a floor designed to accommodate such concentrated loads; the electrical service to these machines is important.
Patients will be wearing lightweight examination or treatment gowns here, and the heating system will have to compensate for this. The records for all sections of this area are ex* tensive: therefore, adequate storage for them is mandatory. Conferences with patients and staff make further demands on the available space-Many different kinds of activities will be housed here and the space needs to be adjustable accordingly, Accessibility to all other areas is also essential for the medical area of activity.
Medical diagnosis is the basis for development of the patient's successful rehabilitation program.
On admission, a medical examination is essential, whether the patient is prescribed a program in one or several of the center's areas of activity: physical medicine, social adjust* ment, or vocational rehabilitation. A nurse is usually present during the examination.
Complete evaluation of the patient may require the services of consulting medicel specialists, staff specialists in the several medical therapies, psychologists, social workers, and vocational counselors. A total integrated program is developed for the patient, with medical considerations as the initial frame of reference.
Location Within Building As all patients receive medical evaluation, the physician s unit should be near the center's main entrance.
For purposes of admission, and for the keeping of records, location of the unit near the administrative department is desirable.
If an in-patient nursing unit is included, the physician should have, if possible, convenient access to the nursing unitIn smaller centers, the main waiting room for the building may serve as the waiting area for the physician's unit.
Staft-Patient Ratios The physician-patient ratio will depend entirely on the nature of the program, Centers accommodating in-patients will necessarily need a greater amount of physician service per patient than the out-patient type of center.
Physician-patient ratios can be established only on an individual basis.
Organization of Space The physician a unit should form a self-contained area, with access to the consultation room end the medical examination room by means of a subcorridor, it possible.
To make full use of the physician's time, there should be two examination rooms for each consultation room.
Recommended for the area is a toilet designed for wheelchair occupancy, accessible from the examination room.
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Fig, 1 iataiieJarions ol main els mollis of soaco of a lehabilrtstiofl contat Activities mar ba g to a pad iccording to lolativo noise levels.
Although a clinical scale is aaaantial equipment for Hie examination room, a wheelchair patient s acale constructed from a modified platform scale is very desirable- These scales should be conveniently accessible from the other parts of the building and may be pieced in the physician's unit, or near the physical therapy exercise room or gymnasium.
Watting Room Arrange the furniture to allow space for wheelchair patients. Also, include coat hanging facilities.
Secretary Include in the furnishings a secretary's desk, writing table, and letter size file cabinets.
As certain records must be available to department heads in other areas of the center, placement of such files in the central records room of the administrative area is the usual practice. However, some centers prefer to keep medical records in the physician's unit. A physician's records are traditionally privileged communications, and, if kept in the central records room, should be made available only to the responsible professional personnel.
Consultation Room Include in the furnishings for the physician's office and consultation room on executive desk and chair, bookshelves, and film illuminator, Allow space for two visitors' chairs and a wheelchair. Provide a convenient coal closet, (See Fig, 3.)
Examination Room Include in the furnishings for this room an examination table with clearance on all aides, an examination light, a lavatory and mirror, clinical scales, a film illuminator, an instrument end supply closet, a small electric pressure sterilizer (if no labmlifity room is provided), and a chair. Standing bars are optional equipment.
Llb-lltility Room If o lab-utility room is provided, equip it with a pressure steriliser, sink, piaster cart, work counter, and storage cabinets.
Radiology Radiology is usually provided for rehabilitation centers by x-ray departments of hospitals, clinics, and other institutions. If radiology is to form a part of the center s services, standard practice in the design and construction of the department should be followed, (See Fig. 4,)
cubicles; wherees the wet area includes all hydrotherapy treatment, tanks, pools, and related facilities.
Hydrotherapy equipment should be grouped in one area, separate from, bui adjacent and accessible to other treatment areas.
Space considerations for a physical therapy department must take into account circulation areas tor patients and staff. Situate the equipment for efficient and sate use, and provide storage space for equipment and supplies.
Flexibility and expansion of facilities should be considered in basic planning to meet changes in requirements-
It is advisable to consull with the chief physical therapist, the center's director, and the center's physician to determine equipment needs and the program of activity for this department.
tfu»M-PatiQfit Ratios One physical theropist can Location Within Building The place for physical treat an average of 10 to 15 patienta per day.
and occupational therapy, as well as for activities of daily living, should be in close proximity, as many patients will receive treatment and training in all three areas
Arrange the areas so that scheduled patients may proceed directly to physical therapy without interfering with circulation to other departments.
As physical therapy may take advantage of cortain outdoor activity, placo the exercise room or gym near the outdoors.
As physical theropy involves some noisy activity, this area should be removed from quiet zones, such as the place where speech end hearing therapy is administered, or the nursing unit. (See Fig. 5.)
The aroe should be convenient to the center's physician and the nursing unit (if provided).
prosthetics a OnTHCTICS
adm ini9tr atlon social adjustment vocational
Physical therapy ia administered under medical superviaion and performed by graduates of a school or course approved by the Council on Modical Education and Hospitals of the American Medical Association,
The objectives of physical therapy are to correct or alleviate bone and joint or neuromuscular disabilities. This entails a concern with alt types of physical disabilities, such as neurological diseases, arthritis, amputation, paralysis, spasticity, structural and postural malalignments. crippling accidents, postsurgical conditions, etc- Measures are used to retain or reestablish circulation, muscle tone, coordination, joint motion leading to mobility, ambulation, and activitias of daily living.
In carrying out his aim, the therapist will moko use of heat, cold, water, light, and electricity ae welt aa tho training effocts of active, pessivs, resistive, and reeducation exercises.
Organization of Specs There should be two major treatment areas, dry and wet. The dry area in-oludos the exercise room or gym and treatment
administration co n su lta1tion administration patient s r—i
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