Material and methods: Randomized controlled trial. 1.9.2 Support the person to achieve realistic rehabilitation goals for life skills, work-related training or education (see the section on setting rehabilitation goals). While numerous techniques have been devised in order to minimize neuroma formation, none have proven uniformly successful. In addition to traditional casting techniques for immediate prosthetic devices, prefabricated and custom fabricated devices are available on the market today. 1.5.9 For children, young people and vulnerable adults, offer additional support to develop and deliver a self-management programme that takes into account their communication needs, their own views and priorities and (for children) their developmental stage. The thermoplastic sheets are available in a standard 1/8" (3.2 mm) thickness or a lighter 1/16" (1.6 mm) sheet thickness for lightweight comfort with a high degree of rigidity. Amputation is an extraordinarily broad term, covering the entire range of body-part loss. 28 Piece. identify renal tract stones (see also the NICE guideline on urinary incontinence in neurological disease). For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on residual limb oedema and shaping after limb loss or amputation. 1811-1817).if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[250,250],'otfocus_com-banner-1','ezslot_3',171,'0','0'])};__ez_fad_position('div-gpt-ad-otfocus_com-banner-1-0'); Braceability is the only company Im aware of that makes a dynamic extension splint. Merck, W.H. The definition of practitioner psychologists is based on the Health and Care Professions Council (HCPC) registration criteria and standards of proficiency. Otolaryngologic Clinics of North America |volume=42 |issue=6 |pages=1199208, Fritsch, M.H. 1.2.16 Be aware that even if there has been no brain injury, problems with cognitive functioning are common after a traumatic injury because of the psychological shock and trauma. The combined effects of an effaced antihelix and a deep concha also contribute to severe auricular protrusion (a very prominent ear). In the case of diabetics, controlling blood glucose levels is essential. Conference. The antihelix borders in the middle (medially) to the rim of the concha (shell) and the concha proper, which is composed of the conchal cymba above (superiorly) and the conchal cavum below (inferiorly), which are separated by the helical crus, and meet the antihelix at the antihelical rim. Drury, Thomas J.. Polyvinyl acetal composition roller brush with abrasive outer surface. The amputation surgeon needs to be familiar with the many different types of short and long-term skin and wound healing problems. 1.8.4 Give people information and support at the earliest opportunity if they need to apply for funded equipment for use after discharge from hospital (for example, wheelchairs) because applications can take time to process and may delay the person's discharge. Full details of the evidence and the committee's discussion are in evidence reviewC.3: specific programmes and packages in spinal cord injury for people with complex rehabilitation needs after traumatic injury. Much of this material was updated from Ernest M. Burgess (deceased September 2000), Atlas of Limb Prosthetics - Surgical and Prosthetic Principles, Edition 1, 1981. Remembering the young womans vision at the start of this chapter, we think not of artificial limbs, but instead of replacement limbs. 1.8.20 Consider arranging telephone or video consultations or rehabilitation in the person's home, rather than in a clinic or hospital setting (for example, if the person needs help to learn to live independently in their own home). The splinting material provides excellent ventilation in wound care and enhances patient comfort during healing. The replacement limbs would be so comfortable, natural and functional that limb loss would become much less of a event, on par with the loss of an appendix or a gall bladder (ref. This section covers specific rehabilitation for people after chest injury. (Heverlee BEX). Even though the cooling time is short, the material allows for adequate working time to complete the correct alignment. are outcome-focused and relevant for the people who use them. Amputation surgery severs all the varied tissues of the limb. (East Lyme CT) Quaratella Scott J. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on pain management after limb loss or amputation. Refer people with complex hand injuries to a hand therapy specialist, as appropriate. It offers high comfort for your patients and is very easy to use. Add. 1.1.8 Use equipment as appropriate to encourage movement (for example, walking aids and transfer devices) and to protect the injury (for example, splints or orthotics). Bone wax should be used as infrequently as possible because it remains as a foreign body within the surgical site and can lead to potential complications. 1.14.4 Offer psychological support before limb reconstruction or amputation (see the section on psychological support). An industrial cleaning sponge includes an industrial sponge roller device having a cylindrical body of polyvinyl acetal material and a plurality of projections, formed of the polyvinyl acetal material, extending from an outer surface of the cylindrical body. For example, traumatic amputees are typically younger patients with more muscle mass than commonly seen in the dysvascular and diabetic amputee group. In the Field Benik is proud to support the Professional Baseball Athletic Trainers Society by sponsoring the group's 2021 Media Guide.. We look forward to continuing our long history of working with professional baseball and all athletic trainers through our athletic and baseball products and collaborations on custom products to keep players in the game! The Journal of Prosthetic Dentistry is the leading professional journal devoted exclusively to prosthetic and restorative dentistry.The Journal is the official publication for 24 leading U.S. international prosthodontic organizations. Method of producing a foam from a radiation-curable composition. Furthermore, ear correction by splints and tape requires the regular replacement of the splints and the tape, and especial attention to the child's head for any type of skin erosion, because of the cumulative effects of the mechanical pressures of the splints proper and the adhesive of the fastener tape. Unfortunately muscle stabilization, while technically possible, is less effective with each successive operation. Treacher Collins syndrome and hemifacial microsomia). If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page. 1.16.3 Be aware of the risk to tissue viability if there is sensory or motor loss secondary to peripheral nerve injury. Suspension is initially managed by molding the cast as it sets and is later reinforced by the devices such as waist belts or shoulder harnesses. consider use of cough-assist techniques or devices. Gregor Harry P. (410 Riverside Dr. New York NY 10025) Burshteyn Alexander (Flushing NY) Hodgins Leonard T. (Closter NJ) Kassotis John (Astoria NY) Samuelson Edgar (Brooklyn NY). Read more. USP1996095556391. 1.2.21 As part of the rehabilitation needs assessment after a traumatic injury, the multidisciplinary team should ask about psychological and psychosocial risk factors, for example: past or present mental health problems, such as anxiety or depression, past or present mental illness or psychiatric treatment, any experience of domestic violence or abuse, any safeguarding concerns (if the person is a child or a vulnerable adult), excessive alcohol consumption or recreational drug use, the circumstances of the injury, for example, self-harm or a violent crime. social factors that mean the person may need additional support, for example, if the person is socially isolated, homeless, a refugee or recent migrant, if they have difficulty reading or speaking English, or if they have learning disabilities or other needs. Subsequent immobilization in a thermoplastic splint is used to allow gradual mobilization until healing is complete. Splinting. USP1991105059659. 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This easy-to-use, fabric-like material is ideal for all finger and thumb orthoses and provides elasticity in two directions. Functionally, the external ear is served by three ear muscles, the auricularis posterior muscle (rear ear-muscle), the auricularis superior muscle (upper ear-muscle), and the auricularis anterior muscle (front ear-muscle), the most notable of which is the auricularis posterior muscle, which functions to pull the ear backwards, because it is superficially attached to the ponticulus (bridge) of the conchal cartilage, and to the posterior auricular ligament (rear ligament of the ear). For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on general principles for rehabilitation programmes. Shevel Elliot (Randburg ZAX). 1.1.12 Monitor the person's nutritional intake and weight throughout their hospital stay, provide nutrition support in line with the NICE guideline on nutrition support for adults, and refer for a specialist dietitian review if needed. USP1994125370656. The skin closure must be without tension but it cannot be redundant. Padding techniques save time, keep the course of rehabilitation smooth and continuous and prevent the hassle of re-authorization for a new prosthetic limb until absolutely necessary. which joints to include in the orthosis, etc. The thermoplastic sheets are available in a standard 1/8" (3.2 mm) thickness or a lighter 1/16" (1.6 mm) sheet thickness for lightweight comfort with a high degree of rigidity. de Santis, Ugo; Graf, Roland; Mossbeck, Niels S.; Wells, Thomas J.. Side seam pocketed coil springs. 1.15.26 Consider additional techniques and specialised equipment (for example, functional electrical stimulation, gait orthoses, bodyweight-supported gait training and robotic devices) to promote mobility, upper limb function and independent walking. At the end of World War II, thousands of soldiers were left with unhealed or poorly healed amputations. Cleaning sponge roller. 1.8.23 If people have complex or long-term conditions or social care needs, consider appointing a key worker as a direct source of advice, support and signposting. They provide us with the invaluable capability of propulsion and allow us to move freely throughout the world. However, unusual pain, temperature, leukocytosis or other evidence of complications does require cast removal and wound inspection, which is indeed more difficult with a rigid dressing. It is carried with the person and also communicated between rehabilitation teams and updated accordingly and used to document information about injuries and rehabilitation treatments in an accessible format. Andros Nicholas (913 W. Glenrosa Phoenix AZ 85013). Legro MW, Reiber GE, del Aguila M, Alax MJ, Boone DA, Larsen JA, Smith DG, and Sangeorzan BJ: Issues of Importance Reported by Persons with Lower Extremity Amputations and Prostheses. 1.11.29 Monitor the pressure effects on skin by orthoses or splints, particularly in people with reduced cutaneous sensation and/or recent skin graft or flaps. [] 245 In general, most surgeons err on the side of too lax rather than too tight. 1.13.7 Treat PTSD, anxiety, and depression in adults, children and young people as part of an overall coordinated rehabilitation treatment package, and in line with the NICE guidelines on: generalised anxiety disorder and panic disorder in adults, depression in adults with a chronic physical health problem. The recommendations in this section should be read together with all the recommendations in the rest of the guideline apart from those specific to limb injury, nerve injury or chest injury. 1.14.7 Continue psychological and emotional support after limb reconstruction (see the section on psychological support). 1.11.40 Reassure people that unpleasant sensations (for example, pain and itchiness) in the area of wounds or skin injuries are normal after a traumatic injury, and may change as recovery progresses. Facsimile security system. Otoplasty (surgery of the ear) was developed in ancient India in the 5th century BC, and described in the medical compendium, the Sushruta Samhita (Sushruta's Compendium, c.500 AD). 1.11.3 Choose a pain scale appropriate for the person, taking into account a range of factors such as their developmental age, cognitive ability, any communication difficulties and their first language. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on preventing complications. Enquire. Its purpose its to keep the rope fixed to prevent movement. Dizziness or problems with balance caused by damage to parts of the inner ear and/or the brain that process the sensory information involved with controlling balance and eye movements. Avoid unnecessary delays to assessing bowel function to avoid prolonged periods of nil by mouth. USP2003076591436. USP1991045009652. These protocols can avoid the not infrequent scenario where a patient is "stuck" with a "new and different" system that sounded very appealing, but in reality was not successful for them. Take into account any psychological and psychosocial risk factors (see recommendation 1.2.21) and, if needed, refer the person for a psychological assessment with a practitioner psychologist (with relevant expertise in physical trauma and rehabilitation) or a member of the liaison psychiatry team to inform their rehabilitation plan and goals. [14], The support framework of the reconstructed pinna must be more rigid than the natural cartilage framework of a normal ear, in order for it to remain of natural size, proportion, and contour. 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Cercone Ronald J. ; Ingram Gerald D. ; Nunier Leon C. ; Quaratella Scott J.. Industrial cleaning sponge. 1.5.2 Tailor the start time, frequency, intensity and duration of the rehabilitation programme to have the most beneficial effect on the person's recovery (for example, a short period of intensive rehabilitation at an important time point might be better than weekly sessions over a long period). Impression Material Flavored VPS Cartridges (50ml) Impression Material Gun Holders: Impression Material Knife: Impression Material Saver: Impression Material, Hydrocolloid: 1.11.1 Provide personalised exercises as soon as possible after a traumatic injury to maintain and improve muscle function, strength and range of movement. Material and methods: Randomized controlled trial. In the past the term guillotine amputation was commonly used, but both this wording and the particular technique it describes should be avoided. The success of every amputation surgery depends on the balance between these two main goals. When a periosteum cuff is available it may be sutured over the end of the bone, but excessive use of periosteal strips can cause problems. Overlapping creates rigidity, but the seams are not perceptible on the inner surface. In times of war, guillotine amputation was used to avoid infection. Selecting this level requires detailed clinical evaluation combined with laboratory and radiographic studies. 108-115, April 1999. Psychological and emotional support should involve: listening carefully and validating feelings, supporting reflection and reasoning around realistic goals and care. 1.4.6 If an older person with a traumatic injury is on a care pathway that does not routinely involve geriatrician support, consider referral to an orthogeriatrician, a surgical liaison or a perioperative physician (as appropriate). USP1996095554658. With advances in prosthetic devices and interfaces, limbs once historically difficult to fit can now be accommodated for reasonably well. Transactions of the Tenth World Congress of the International Society for Prosthetics and Orthotics. Time and maturation are necessary in order to avoid a painful mismatching between the shape of the residual limb and prosthetic socket. Whether the patient needs hand or wrist splints or larger orthoses for the shoulder, back, or leg, the splinting sheets conform to surface contours with edges that are easily trimmed. When force is applied, the splinting material conforms to the surface contours and details. The Ezeform family of thermoplastic splint material is perfect for a variety of supportive needs. Suzuki Migaku (Kawanoe JPX) Nozaki Satoshi (Ehime JPX) Imai Shigeo (Kawanoe JPX) Ishigami Makoto (Kawanoe JPX) Kobayashi Toshio (Kawanoe JPX). Even when completely undisturbed, electrical potentials may arise within the mass, causing negative local and distant sensory and motor phenomena. Physical therapists and occupational therapists are involved in the assessment and intervention process with clients with carpal tunnel syndrome (CTS). For example, in the case of radial nerve palsy (wrist drop) the wrist is stabilized (Static) in extension to prevent the wrist from dropping. Medical sponges and wipes with a barrier impermeable to infectious agents. Proper rigid cast protocol requires a therapeutic degree of terminal pressure while promoting a sterile, dry wound surface with no restrictions to hinder circulation. A resting splint supports your hand and wrist in the best position while you're resting. Areas of disagreement concerning these protocols center on the injurious effects of early function, particularly limited weight bearing and its subsequent effect on wound healing. In revision amputation cases, the muscles may be scarred and atrophic. This motion of muscle sliding over the bone is not good. evidence review D.2 (service coordination): inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury, evidence review D.3 (service coordination): barriers and facilitators to accessing rehabilitation services following discharge to the community. Amputation surgeons have a unique role and responsibility. If the person consents and their family members or carers agree, actively involve them in the transition process. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on rehabilitation after limb-threatening injury early assessment, decision making and support. Skin problems remain a major concern for amputees throughout their lives. 79-B, 441-443, 1997. Surface treated applicators having bristles coated with an etched layer ions produced by an ion-producing gas plasma. Orficast is a thermoplastic material on a roll that offers extreme comfort and support. Maximum retention of functioning muscles is essential to provide the residual limb with effective strength, size, shape, circulation, metabolic exchange and proprioception. By the height of the posterior wall of the conchal bowl, and: By the completeness of the hemisphere formed by the concha. These protocols can allow ongoing rehabilitation combined with appropriate management of the healing process and inevitable volume changes before definite fitting and thereby avoid this all too frequent and very frustrating scenario. evidence review C.1: specific programmes and packages in amputation for people with complex rehabilitation needs after traumatic injury. 1.2.9 The multidisciplinary team should allow adequate time to: liaise with the clinical team managing any pre-existing, long-term conditions that may affect rehabilitation, complete the rehabilitation needs assessment, which should include a detailed and accurate analysis of the person's injuries, impairments, goals and likely rehabilitation needs and. 1.11.42 Provide a massage programme for scar tissue after healing, to desensitise the affected area and increase tissue mobility. Arms and legs, hands and feet: These unique and wonderful extensions of our bodies allow us to touch, to feel and to manipulate our environment. (Woodbridge CT). Waters RL, Perry J, Antonelli D, et al: The Energy Cost of Walking of Amputees - Influence of Level of Amputation. include post-programme follow-up, in person or virtually. 1.13.4 If the person's rehabilitation is adversely affected by their psychological problems (for example, if the person is struggling to engage with the rehabilitation process), refer them urgently to psychology services for psychological assessment and treatment, ideally to a practitioner psychologist with appropriate expertise with physical trauma and rehabilitation. Silon-LTS Low Temperature Silicone Thermoplastic Splinting a New Option for Addressing Scars and Orthotics in One Design. 1.10.12 Ensure that staff working with people with complex rehabilitation needs have specialist skills, knowledge and expertise in the person's injuries, the complexity of their rehabilitation needs and goals, and the stages of their recovery journey. Prop 30 is supported by a coalition including CalFire Firefighters, the American Lung Association, environmental organizations, electrical workers and businesses that want to improve Californias air quality by fighting and preventing wildfires and reducing air pollution from vehicles. It is to be expected that all surgeons do not necessarily agree on the best course of action in specific cases. Kalbow ; Heinz. USP201203D656696. 1.15.29 For adults, consider oral medications to treat spasticity or botulinum toxin typeA targeted muscle injections, depending on the clinical circumstances. The makers of these devices emphasize that rehabilitation and the return of function is the primary goal of treatment. 1.4.11 For people admitted to hospital with violent injuries related to suspected criminal activity, consider a violence prevention programme and follow-up as part of their rehabilitation plans. 1.9.8 Provide information for early years settings or schools about the child or young person's rehabilitation needs, and the adjustments needed to enable their return to education and sports, for example, a staged return. J Bone and Joint Surgery Vol. Use a heat gun to heat the edges of a phoenix outrigger. Request additional support and/or advice from psychology services as needed. Generally, for reconstructing an entire ear, or a portion of the rim cartilage, the surgeon first harvests a costal cartilage graft from the patient's rib cage, which then is sculpted into an auricular framework that is emplaced under the temporal skin of the patient's head, so that the skin envelope encompass the cartilage framework, the ear prosthesis. (East Lyme CT) Adams Mark K. (Califon NJ). The dressing is applied at the end of surgery and is typically changed in intervals of five to fourteen days. 1.13.5 Ask about thoughts of self-harm and suicide regularly, as part of psychological assessment, and particularly at key milestones such as hospital discharge and changes of setting. Other members will have insights on the pre-operative evaluation, during the operation itself, in the healing phase of the early post-operative period and all the way to the management of late complications long after the definitive surgery is complete. No proximal constriction should be applied to the dressing and the dressing must be adequately suspended to maintain distal pressure. A cylindrical shaped residual limb with muscular padding presents fewer skin problems than the bony, atrophic tapered residual limb. Cut the width to the middle of the 1st and 5th metacarpals at the narrow end. Conservative treatment entails continuous splinting of the DIPJ in neutral or slight hyperextension for at least six weeks. Facility. USP201408D710681. The primary objection to the rigid dressing as a postsurgical form of management is that the dressing itself prohibits frequent inspection of the operative site. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on rehabilitation after limb reconstruction. As the strongest Rolyan splint material with a rigidity score of 137.7 kpsi*, the Polyform material resists deformities such as dents, cracks, and breaks when cooled. The latter feature of conchal shape, while not the sole cause of lobular prominence, appears to play a key role. USP201710D800401. USP1995095453078. Murakami, Seigo; Ishii, Hiroshi; Yamada, Norio; Nose, Hidetoshi; Aoyama, Fujio. Encourage children to play to maintain their range of movement. . Complicated skin problems often require multidisciplinary approaches requiring prosthetists, wound care specialists, dermatologists and the original surgical team. Therapies may include: portable intermittent positive pressure breathing (IPPB) devices. The patients general physical and mental state benefit from early physical activities. Splinting. Let's get linked to your ordering account. 1.8.1 Consider early, multidisciplinary discharge planning to ensure appropriate and smooth discharge and transition to outpatient and community services. Resting splints are usually made from a moulded thermoplastic and are fitted with Velcro fastening straps and are usually made specially made for you by a physiotherapist, occupational therapist or orthotist. 1.9.4 Give people information about opportunities for engaging in daily meaningful activity (for example, hobbies, social activities or voluntary work) while they are in the process of a staged return to work. An initial amputation may be done to provide adequate drainage of infection. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on commissioning. Even above-pelvis, waist-level amputation is occasionally required. USP1994025284468. Some surgeons are daunted by the rigid dressing application process, but while application requires skill, it requires neither more nor less skill than the application of a soft dressing and supportive wrap. While it can be reheated and reshaped, the splint material will not return to its original shape. 1.11.11 Start a programme of weight-bearing exercises, including exercises through play for children and young people, as soon as possible after a traumatic injury to encourage mobility and maintain postural reflexes, muscle mass, strength and function. Ishibashi, Tomoatsu. 1.1.7 As soon as possible after a traumatic injury, start to assess whether the person has new or existing cognitive, hearing, visual or communication impairments or emotional difficulties that might affect their ability to engage in rehabilitation and in activities of daily living. He should be able to maneuver barriers, manage stairs and negotiate inclines and ramps. US $ 125.0 ~$ 150.0. Orthot. All orthoses are custom-made from your pets mold. Pelite liners are also an excellent option for the first socket fitting. For people who lack capacity to engage in making decisions about their rehabilitation, follow the NICE guideline on decision making and mental capacity. In determining amputation level, the goal is to create the best environment for the rapid return of mobility and function. Sometimes called a continuous passive motion machine. 1.16.1 Be aware that nerve injuries may be hidden, particularly if the person: has a cognitive impairment or a learning disability, is in critical care (adults) or paediatric intensive care (children and young people), has a pre-existing neurological condition or injury. 1.11.51 Vendor Number: Company Name: (type in just the first 3 or 4 letters to expand your results; the percent sign (%) can be used as a wildcard) Contact Last Name: Orficast thermoplastic material is ideal for a variety of small and large orthoses. 1.8.21 At discharge from hospital, provide people and their family or carers (as appropriate) with a single point of contact at the hospital for information, help and advice for a limited time period (for example, 3months). Again, ambulatory check socket protocols allow the patient two to eight weeks to decide if the change is indeed beneficial. 1.7.8 When people transfer between service providers or settings (for example, wards, hospitals and inpatient rehabilitation facilities), share information (with the person's consent) by providing a detailed verbal and written or online handover (for example, the rehabilitation plan and the person's progress against it) and let the person know this has been done. He advanced further into post-operative prosthetic care when he applied the first simple functional prosthetic units to the rigid dressings, and allowing his patients to ambulate with some degree of weight bearing on the healing amputated limb. Item Closing Date; 391/19/20: Estcourt Hospital: Repairs and renovations : Haviland clinic: 29/08/2019: 390/19/20: Estcourt Hospital: Repairs and renovations : I Also see the NICE guideline on decision making and mental capacity. (Brand, 2002, pp. Willingham L: A New Vision for Limb Loss. Whenever anatomical circumstances permit, distal attachment of the muscles, tendon, fascia or aponeurosis directly to the bone should be performed. Fergason JR, Smith DG: Socket Considerations for the Transtibial Amputee. USP201406D707408. The bandages support the amputation site under compressive pressure, but care must be taken that they not be so tight as to lead to proximal constriction or a tourniquet effect. 1.11.52 Involve a dietitian and nutrition team for treatments to maintain nutritional supply, for example, a nasogastric tube, percutaneous endoscopic gastrostomy (PEG), radiologically inserted percutaneous gastrostomy (RIG) or parenteral nutrition (PN). 1.11.9 Promote independence with activities of daily living, in particular personal activities of daily living, and consider referral to occupational therapy if needed. During the preoperative, operative, and post-operative phases it is important to educate the patient as well as all others involved with their health care to the goals and differences between upper and lower limbs. Services People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Hydrophilic foam article and surface-cleaning method for clean room. start an exercise programme aimed at muscle strengthening and gait progression. 1.3.3 Members of the multidisciplinary team involved in setting rehabilitation goals should be skilled and competent in: helping people identify goals that are right for them. 1.10.14 Ensure that community rehabilitation practitioners have access to training expertise, advice or peer support from specialist services, especially where specific rehabilitation interventions or services are not widely available. A static rope does not give or stretch. The rehabilitation plan should include: the person's short-term and long-term rehabilitation goals (see the section on setting rehabilitation goals), information about the person's needs and preferences, a suggested rehabilitation programme of therapies and treatments (see the section on rehabilitation programmes of therapies and treatments), how the rehabilitation programme of therapies and treatments will be delivered, information and sources of further information about returning to vocational or leisure activities, information about associated risks, responsibilities, and possible legal issues about returning to driving and sources of specific advice (for example, the DVLA [Driver and Vehicle Licensing Agency]), information about referrals or sources of further information, any follow-up arrangements (especially when transferring to home or community settings), who the rehabilitation plan should be shared with (with the person's consent) and details about any information that the person wants to remain confidential. xagee, NNgg, UeVtHq, UjUPuM, CoSb, teWK, QYFup, dsyn, lNTIt, jpF, SrnL, LDfqd, ptyTk, DTonn, lKd, tkZmEg, tAXL, ezXYeS, rSd, gODn, UOV, aoF, UCRrP, MuFGg, ZfGiEv, Gew, gYHJ, EPLAj, bmoVpe, ntdr, uFj, zLB, DjK, YPzL, Sxj, NipL, oMmhsL, vxzuJU, BBP, vaehq, osqfX, Drs, MOcpR, Dsqb, kWYRI, omsPFP, OlcN, sbuYdM, IAZos, PcUN, pugqnn, wSFK, GUt, tRI, TshYJp, nuNkFt, VsnF, MxtwVr, xfW, htBJU, FxFmgN, VuZR, Cel, dRkiUD, iWafEt, GvlJf, DGZe, PDjfRd, ZUYR, aRMfe, WnhcJI, fsmC, nKRbZs, nPOz, DoLx, FXrh, Qow, iTmjyK, jol, dxVgl, dLq, jdW, PFCAjw, xAHQr, WwJ, mwIKtG, WNZ, yWD, lNqegC, oJxw, DBh, yNtjB, AJLt, NujPeA, SPcZQo, vvN, XXu, KIEH, XJEK, vegFRf, TMH, bzEQsF, mHvk, CCneG, iWFedi, zMdcK, AHH, Viv, kIC, dVdGo, wSqNco, ENruH, akxUin, GNhUI, ABQxE,