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“Due to deficiency of post-stroke services, stroke survivors leave for psychiatric hospitals or institutions for mentally handicapped people. The support or assistance provided is very low, and there is a complete exhaustion and often the disintegration of these families. At present there are very limited possibilities of specialized and comprehensive rehabilitation in the Czech Republic. Cerebrum responds to this situation and seeks to create a system of aftercare in the scope and volume as allowed by current grants and funds” says Jana Dobrkovská, the CEO of CEREBRUM – Sdružení osob se získaným poškozením mozku a jejich rodin, Czech organisation that is member of SAFE.

SAFE: What is one issue related to the life after stroke in your country that you think needs special attention?
JD: In the Czech Republic we have an excellent system of acute care for stroke. Our stroke centers are high-end facilities that provide the best acute stroke assistance. However Czech health insurance system is limited by volume of support for people after stroke in non acute phase. When the paid physical treatment ends, the survivors no longer continue in any rehabilitation cover by insurance action, although their physical condition would allow them to do so. Also our current system of long-term care for this target group of people is a disjointed with lack of continuity and interconnection of services for the patient after acquired brain injury. Due to deficiency of services, these people leave for psychiatric hospitals or institutions for mentally handicapped people. However, these types of devices are neither identified nor able to provide adequate assistance. If the family decides to take care of themselves, the support or assistance provided is very low, and there is a complete exhaustion and often the disintegration of these families.

SAFE: What would be the solution, i.e. what is your organisation’s position regarding this issue?
JD: We currently help clients who need help from psychologist, speech therapist, physiotherapist. The arrangement of assistance is non-acute care in the form of individual and group therapies. We provide advice in this area and map services that are intended for people after this injury. We also perform our own therapeutic activities and occupation therapy in the home environment. Our team is a psychologist, an occupational therapist, a speech therapist. Our clients are people after a stroke (stroke), injuries (accidents, sports falls and the like) or with consequences after treatment of malignant diseases. We also try to provide help and advice to the clinic’s family, carers and relatives This year we launched a project in selected hospitals in Prague, where, we provide support for families of patients who leave for home care. Our coordinator provides advice and support in everything that home returns often represents; where to buy compensation aids, how to ergonomically adjust housing, where to go for help in the social sphere and more. Another priority of the project is relief and mental support for carers.The aftercare segment has been waiting for the adoption of the Rehabilitation Act for many years to unify post-stroke aftercare procedures. Our activity is also to draw attention to this situation and to influence the general and professional public and raise the awareness o about the wide range of consequences of brain injury and the possibilities of rehabilitation.

SAFE: Please tell us more about your organisation.
JD: We currently help clients who need help from psychologist, speech therapist, physiotherapist. The arrangement of assistance is non-acute care in the form of individual and group therapies. The main objective is to raise the awareness of the Czech public about the wide range of consequences of brain injury and the possibilities of rehabilitation. We provide advice in this area and map services that are intended for people after this injury. We also perform our own therapeutic activities and ergotherapy in the home environment. Our team is a psychologist, an occupational therapist, a speech therapist, physiotherapist. Our clients are people after a stroke (stroke), injuries (accidents, sports falls and the like) or with consequences after treatment of malignant diseases. We also try to provide help and advice to the clinic’s family, carers and relatives.
Size of our organisation is 16 employees,with a 45.000 EUR turnover in 2017.

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Brief description of Stroke situation in Czech Republic

Statistic

Hospitalized and deceased for cerebral vascular disease in the Czech Republic (2003-2010)

The number of hospitalizations for cerebral vascular disease from 64,399 cases in 2003 to 57,484 of cases in 2010 decrease by 10.7%

In stroke hospitalizations between 2003 and 2010 there has been a decrease by 7.8% from 44,585 to 41,111 cases (after conversion to 100,000 inhabitants, the trend is also falling Looking at the cerebral vascular disease group in detail, there has been a steep decline in the number of hospitalizations for unspecified patients stroke from 21 037 cases (in 2003) to 10 762 (in 2010), i.e. by half.
In contrast, ischemic attack was diagnosed in 23,871 cases in 2010 compared to 18,055 cases in 2003, ie an increase of about 32%.

Despite the modest increase in other cerebral vascular diseases types, there is an overall gradual decline in all cases. However, the treatment period is lower for stroke (14.1 days in 2003 at 13.6 days in 2010). The average age of hospitalized patients in 2010 ranges from 66.2 to 76.6 years. Compared to 2003, the average age of all cerebral vascular diagnoses was moderate hospitalized in accordance with the increasing demographic aging of the population mortality rates 11.1 deaths per 100 hospitalizations in 2010 compared to 14.5 deaths in 2003 A total of 11,567 people died in the Czech Republic for cerebral vascular disease in 2010, which represents 10.8% of all deaths in a given year. Compared to 2003, this is a decrease of 31%.

Social situation of people who suffer from stroke and other cerebral vascular diseases

The awareness of the importance of health-enhancing physical activity among stroke patients in Czech country is very low. To keep effective social inclusion, the information campaign and knowledge training about such disabilities is crucial. This social inclusion is very poor in Czech Republic. To set up participation in social and public activity for cerebral disease survivors including stroke patients, is very important. This activity needs to be arranged not only for wide population , but it is more important to present the importance of such activities to the survivors themselves.
Cerebrum has experience with clients who show good progress in physiotherapy, but do not have the courage to resume normal social daily activities like they did before stroke. These people also have no calls from public events to join. On the other hand event providers do not offer services with conditions to participate these people in their limitations. And likewise here are very good activities for disabled people in the Czech Republic, which, however, do not often involve people without disabilities.
We want to increase the knowledge of the public in Czech republic and create the link between usual daily living and brain damage survivors. Cerebrum´s employees and association partners are professional therapists, who understand physical limitation of stroke survivors and therefore can act as a mentor for such methodology and trainers education.
Czech health insurance system is also limited by volume of support for people after stroke. When the paid physical treatment ends, the survivors no longer continue in any rehabilitation cover by insurance action, although their physical condition would allow them to do so. We see an opportunity in this area too.