Patients and families from abroad may consider restoration after cerebrovascular disease in Thailand when they want a private service or care that is systematic. Travelling to receive restoration is not automatically better than care near home. The decision should consider medical stability, the needs in respect of restoration, the quality of the programme, the burden from the travel, the cost and the conditions of the insurance, as well as the continuity when returning to the country
Restoration should hold to the needs of the patient and be planned individually. According to the state of each person, it may consist of training of movement and balance, the restoration of the arm and the hand, the care of swallowing and of communication, restoration in the field of cognition or of the mind, training of the daily routine, and technology selected according to the indication. No programme can guarantee the level or the speed of the recovery
This guide summarises the clinical and travel questions that should be considered, but it cannot confirm that the patient is ready to travel by air or suits any particular medical establishment in place of an individual assessment
Why families may consider restoration abroad
Families may look for a service outside the country when the service in the area is not enough, there is a long wait, or a place or a timetable of restoration that is different is wanted. These reasons do not show that a programme abroad has a clinical result that is superior
When comparing programmes, it should be asked who is responsible in respect of medicine, which fields of professionals of restoration there are, how swallowing and other risks are assessed, what approach there is if the patient becomes acutely ill, how the intensity of the training and the indicators are set, as well as how the carer is trained, the discharge planned, and the result followed
Travelling to Thailand also increases the burden in respect of management. The family may have to prepare wheelchair services, travel and accommodation that can be accessed, reserve medicine, travel insurance, a carer, and an emergency plan. The convenience should be considered after the clinical suitability and the safety in travelling have been confirmed
What restoration after cerebrovascular disease should emphasise
Cerebrovascular disease may affect movement, balance, coordination, seeing, speaking, swallowing, cognition, mood, sensation, excretion, fatigue, and independence in daily life. The pattern of the problems differs according to the position and the severity of the lesion, the length of time since the disease arose, the medical stability, the complications, and the restoration that has already been done
Restoration should therefore not be sold as a fixed package. A person whose main goal is in respect of walking certainly needs a plan different from a person whose main problem is in respect of the hand, swallowing, communication, concentration, or fatigue. The priorities should be set together with the patient and the family, and reviewed when the needs change
Walking, balance, and movement
The training may cover transferring the body, the control of the standing posture, the transfer of weight, stepping, walking, endurance, the skills of using a wheelchair, and the management of the risk of falling. The approach may consist of task-specific training, strengthening, balance, walking with an assistant, equipment to help movement, and technology when it supports the goals that have been set
The working of the arm and the hand
The goals of the arm and the hand may be related to dressing, eating, caring for hygiene, writing, working, or other meaningful activities. The training may emphasise reaching, picking up and holding, coordinating the movement, strengthening, receiving sensation, and doing real tasks. Doing an exercise better does not transfer to the routine automatically, so both sides should be measured
Swallowing, communication, cognition, and mental health
Some patients may have a state of difficulty in swallowing, a state of deficiency in language, problems of speaking, changed concentration or memory, reduced executive functioning, a state of depression, anxiety, or the showing of emotions that is difficult to control. The assessment should connect each problem with safety and participation, such as eating and drinking, saying what one needs, managing medicine, making decisions, or going home
Multidisciplinary care that has coordination
Recovery after cerebrovascular disease usually must rely on coordination from several professions. The restoration resources of the American Stroke Association (opens in a new tab) speak of multidisciplinary assessment, training for real use, medical management, the handing on of the care, and the communication between the patient, the family, and the team
The composition of the team depends on the needs. There may be a physician, a nurse of restoration, a physiotherapist, an occupational therapist, a speech correction specialist, a psychologist, a dietitian, a pharmacist, and a social worker. A larger team is not automatically better, but the roles, the goals, the communication, and the person responsible must be clear
Complex states, such as great weakness, symptoms of spasticity, poor balance, the risk of difficulty in swallowing, changed cognition, pain, exhaustion, the risk of cerebrovascular disease again, or having several accompanying diseases, require increasing the level of the training carefully, and there must be a route into emergency care if the symptoms change
Before travelling by air: from the review of the documents to the planning of the programme
The planning should begin before travelling. The family may have to prepare a medical summary, the record of the cerebrovascular disease and of the treatment in hospital, the report of the brain imaging, the list of current medicines, the record of the restoration, the recommendations on the matter of swallowing or food, information on movement and transferring the body, the equipment used, and the main goals of the patient
The review of the documents before travelling
The review of information remotely may help identify the documents that are missing and prepare for the consultation in person, but it cannot confirm the readiness to fly, guarantee that it will be possible to take part in the programme, replace a physical examination, or set the final intensity of the training
The readiness to fly and the management of the travel
The physician treating should assess whether the cerebrovascular disease and the underlying disease have medical stability or not, while the airline should confirm whether a medical information form, a certificate, the arranging of oxygen, an accompanying person, or help in respect of movement is required or not. The recommendation of the UK Civil Aviation Authority (opens in a new tab) separates a state of disability that is stable from a medical state that is not yet stable, but the requirements of each airline and country differ
The family should plan the matter of preventing pressure sores, the use of medicine across time zones, water and food, transferring the body, excretion, help in communication, and the way of dealing with it if there are symptoms of a new cerebrovascular event or an emergency during the travel
The assessment in person and the setting of goals
After arriving, the assessment in person may cover movement, balance, the tone of the muscles, strength, coordination, sensation, seeing, swallowing, communication, cognition, mood, pain, endurance, the skin, and the daily routine. The result of the assessment should be used in order to set goals that can be measured, the order of the training, the intensity, the precautions, and the date of review together
Technology helping restoration within the clinical plan
Technology may help increase the repeated practice, give assisting force, or record the result, but it is not a solution on its own. Equipment should be chosen for a clear goal, and adjusted to suit the medical state, the ability in movement, the cognition, the skin, and the tolerance of the patient
Some patients may suit technology helping the training of walking or of the arm, while some may get more benefit from task training that a therapist directs, ordinary equipment, or methods that can be continued at home. Having the equipment is not an indication to use it
Both the results and the undesirable symptoms should be reviewed, and the technology adjusted or stopped when it does not support the goals, creates problems, or crowds out training that is more important
The assessment of a private programme of restoration for complex needs
Some patients have passed the acute stage of treatment but still have needs of restoration in several respects. Some need a further assessment because the progress has slowed, the original plan does not match the goals, or a new obstacle has been found
A private programme may have a different timetable or environment, but the suitability still depends on the medical stability, the ability to take part, the safety, the personnel, and the continuity. The word "intensive" should not mean a fixed number of sessions or forcing through fatigue. The amount of training must be adjusted according to the response
Before deciding to travel, the family should ask what can reasonably be assessed or trained within the length of time available, and how the progress will be recorded. Recovery differs greatly, and a skill that improves in a medical establishment may require training with continuous support after discharge
What the family should prepare
The information on the diagnosis and the date the disease arose should be brought, the report of the brain imaging and the discharge letter, the list of medicines and the history of allergy to medicine, the accompanying diseases, the record of the previous restoration, the status of walking and of transferring the body, the needs in respect of swallowing and of communication, the changes in respect of cognition or behaviour, the history of falls, problems of the skin, the equipment, the carer, and the important goals
The accommodation and the travel that can be accessed should be confirmed, the help from the airline, the coverage and the exclusions of the insurance, access to medicine, the list of emergency contacts, the need for an interpreter, and the plan of handing on to the team treating at home. The patient or the carer should carry copies of the important documents safely
Frequently asked questions
How should families compare programmes of restoration?
Compare the person clinically responsible, the qualifications of the personnel, the steps of assessment and of safety, the training that matches the goals, the measurement of the result, access to urgent care, the training of the carer, the cost, and the continuity after discharge. A list of equipment and testimonials alone is not enough
How long after cerebrovascular disease is it possible to travel for restoration?
There is no universal period of time. The length of time depends on the kind of cerebrovascular disease, the medical stability, the complications, the movement, the need for oxygen or for nursing, the recommendation from the physician treating, and the requirements of the airline. Care in the acute stage should not be stopped in order to travel
What may a programme of restoration after cerebrovascular disease consist of?
It may consist of training of movement, balance, walking, the arm and the hand, the daily routine, swallowing or communication, care in respect of cognition and of the mind, the giving of knowledge, the reducing of the risk of the disease arising again, the training of the carer, and technology selected according to the indication
Is technology necessary for the recovery or not?
It is not necessary. Technology may be of benefit when it supports a clear goal, but it does not replace assessment by a specialist, task-specific training, the giving of knowledge to the carer, or continuity
Does restoration abroad guarantee a better result or not?
It does not guarantee it. The result depends on the character of the cerebrovascular disease, the complications, the time, the amount of training, the participation, the support, and many other factors. Travelling changes the place, but does not guarantee a better result
A summary
Restoration after cerebrovascular disease in Thailand may be a choice for some foreign patients, but the decision should rest on medical reasoning and be compared with the suitable services near home. A responsible plan must connect the assessment, meaningful goals, a suitable amount of training, the following of safety, the planning of the travel, and the following of the result, without guaranteeing the recovery