Rehabilitation Medicine

We optimise early brain recovery, maximise our patients' functional independence within realistic resources and time frames to facilitate reintegration to family, home and community.

Some common problems related to Acquired Brain Injury (ABI) include: upper and lower limb paralyses, poor balance, swallowing or speech difficulties, loss of mobility and independence and impaired vision, hearing, smell, taste and sensation.

Other hidden consequences include problems with thinking such as inability to stay awake or fall asleep, poor attention and memory, confusion, irritability, agitation, problem solving and processing and changes in personality, drive and behaviour.

Some common causes include: Traumatic Brain Injury (TBI), subarachnoid haemorrhage, arteriovenous malformations, brain tumours, cerebral anoxia, stroke, metabolic coma etc.

We offer the following comprehensive rehabilitation services:

• Specialist-led inpatient multidisciplinary rehabilitation programme
• Comprehensive outpatient rehabilitation and allied health follow ups
• Coordinated rehabilitation therapies with weekly multidisciplinary team meetings
• Early Neuromedical Functional Assessment and Management, including disorders of consciousness (e.g. minimally conscious states)
• Intensive family involvement, brain injury education, carer training, social work and psychosocial support from an early phase
• Team-led management for agitated or restless TBI or ABI patients with dedicated and safe environment (Brain Injury Monitoring Room) for agitated or restless patients, where indicated
• Active management of post-traumatic amnesia related behavioural problems with team-based goal setting, regular behaviour assessment, monitoring and modification
• Judicious neuropharmacological augmentation where indicated for agitation, behavioural problems, or depression or anxiety
• Neuropsychological assessment for new cognitive baselines, medico-legal reports with resident clinical psychologist
• Activities of daily living training, incorporating specialised wheelchair prescriptions, visual spatial assessment and training using computerised platforms
• Conventional Locomotor, balance, overground training incorporating robotic aided gait orthoses (Lokomat TM), body weight supported treadmill training
• Conventional Upper Limb Neurorehabilitation incorporating robot aided therapies with robotic exoskeletons (Armeo Power TM), sensor-based gloves, forearm neuroprostheses, various gaming platforms
• Comprehensive speech and language training, Augmentative and Assisted Communication (AAC) platforms,  dysphagia assessment and therapy for neurological swallowing disorders incorporating instrumental and radiographic-aided evaluation of swallowing disorders
• Dietary and nutritional counselling
• Comprehensive spasticity management including customised limb splinting and casting services and regional spasticity interventions: nerve and motor point blocks (Lidocaine, Ethyl alcohol), intramuscular Botulinum toxin injections using neuromuscular electrical stimulation or ultrasound guided techniques
• Group based recreational therapies and cognitive retraining activities, computer aided cognitive retraining
• Community reintegration assessment and training
• Access to a wide range of specialist services: neuropsychiatry, specialised functional neurosurgery for intrathecal Baclofen pump trial or neuroablative techniques for spasticity, neuro urology, orthotic services, etc.
• Individualised return to work assessments by a trained occupational therapist (outpatient) where suitable
• Links to community resources for post-discharge social activities, day rehabilitation centres, community rehabilitation programmes (home-based), etc

Amputee Rehabilitation Programme offers a comprehensive treatment and rehabilitation for patients who have experienced limb loss.

Other than recovering from an amputation, we offer continued therapy to promote independence by helping you get accustomed to your prosthesis and return to daily functions after an amputation.

We offer the following services:

• Assessment for suitability by a rehabilitation physician
• Wound management
• Pain control
• Care of residual limb (assisted by podiatrist from Foot Care and Limb Design Centre)
• Psychological counseling and education
• Reconditioning and mobility training
• Teaching the patient to perform activities of daily living in a safe manner
• Treatment of underlying health conditions
• Fitting of prosthesis (assisted by Prosthetist & Orthotist from Foot Care and Limb Design Centre)
• Planning for supported discharge back home and continuation of rehabilitation
• Rehabilitation towards returning to work for appropriate patients

Orthopaedic and Trauma Rehabilitation involves non-invasive treatments for musculoskeletal conditions enabling speedy return to optimal function post-surgery or injury.

You or your loved one has just been admitted with the following condition(s):

• Chronic pain with severe limitation of function or poorly controlled pain
• Hip fracture
• Impairments related to cancer or treatment
• Joint replacement surgery
• Limb amputation
• Multiple injuries

You may be experiencing the following complaints:

• Post-surgical pain or chronic musculoskeletal pain
• Loss of mobility and confidence
• Inability to care for simple daily needs
• Loss of self-image and depression

Our multidisciplinary Orthopaedic and Trauma Rehabilitation team will aid you in rehabilitation so that you can resume daily activities as soon as possible. Your length of stay is dependent on your diagnosis, potential for further recovery and the rehabilitation goals set.

Rehabilitation sessions are conducted on needs basis on the weekdays, with rest or group leisure activities over the weekend and public holidays. You may request for weekend leave to be in the care of family and friends at home if deemed suitable by the team.

• The programme is staged according to your diagnosis, weight-bearing status (how much body weight you are medically allowed to place on your legs as you stand) and your general fitness.
• Treatment goals will be reviewed at weekly intervals. This will include inputs from you and your caregiver.
• Besides emphasis on walking, mobility and self-care training, you will also be taught joint precautions (e.g. after hip replacement), skin and stump care.
• You may be prescribed an artificial limb and a prosthetic training programme.
• You may be prescribed assistive devices (e.g. walking aids) and home modifications.
• Before discharge, caregiver training, vocational and leisure assessments will be provided if necessary.
• Upon discharge, you will be advised of outpatient therapy at an appropriate facility with necessary medical follow up.
• You will be advised on injury/disability assessment report application if needed.

Besides rehabilitation, stabilisation of patients’ background conditions and prevention of post-surgical complications are also our priority especially for the elderly group of patients.

You or your loved one has just experienced an injury to the spinal cord.

This may have occurred suddenly, after an accident or gradually as a result of a disease of the spine or spinal cord. You may be having some of the following complaints:

• Inability to move your limbs
• Difficulty with walking
• Numbness in different parts of your body
• Loss of bladder or bowel control
• Feeling a sense of helplessness and despair

Our Rehabilitation team will help set you on the path towards functional recovery.

The team will set goals for you based on the standard assessment. The daily therapy program may include self-care training, wheelchair mobility training, gait training and caregiver training as appropriate. Personalised bladder and bowel training programme will be introduced to help prevent complications that can arise from changes in your bladder and bowel function.

Your progress and goals shall be reviewed regularly. Based on your condition, we may prescribe appropriate mobility and self-care aids like wheelchairs, walkers and commodes.

Before discharge, our Rehabilitation team will discuss any relevant issues or concerns of yours such as coping and transitioning from hospital to home environment, fertility and sexuality issues, home or work assessment and modification etc. with you and your family. You will also be followed up in the outpatient setting, to further optimise functional recovery for better integration into the community.

Most overuse injuries of muscles, ligaments and tendons, as well as sports and occupational related musculoskeletal injuries are not surgical problems.

The more common conditions treated are like back and neck pain, chronic pain syndromes including fibromyalgia and myofascial pain syndrome, sports injuries, tendonitis and bursitis, pinched nerve and carpal tunnel syndrome.

Our area of expertise:

• Biomechanical assessment
• Physiotherapy: Physical modalities & therapeutic exercises, performance enhancement programme
• Occupational Therapy: Braces, Orthostics & shoe wear and ergonomics & injury prevention
• Acupuncture & Myofascial injections
• Referral for X-Ray guided spinal joint injections, specialized nerve and muscle testing (Nerve Conduction Studies and Electromyography)
• Chronic Pain Management Programme

Our comprehensive rehabilitation programmes go beyond the relief of symptoms. The goal is to restore function and performance, return to normal daily activities and prevent recurrent injuries.

You or your loved one has just suffered a stroke.

You may experience a variety of physical problems ranging from limb weakness, difficulties in speaking and swallowing to cognitive difficulties of memory and mood disturbances.

The specialist-led multidisciplinary team will work closely with you to maximise your recovery and functional independence.

Key features of the inpatient Stroke Rehabilitation Programme include:

• Daily therapy with appropriate use of technology and robotics
• Weekly multidisciplinary meetings to discuss patient's progress and goals
• Provision of caregiver training, advice on assistive equipment prescription and home modification

Upon discharge, continued rehabilitation at appropriate rehabilitation centres in the community will be recommended if needed.

Community Rehabilitation Programme (CRP) is a community outreach project by TTSH Community Fund. This intermediate and long term care (ILTC) community based programme aims to provide home therapy services for patients with challenges in accessing rehabilitation due transport, mobility and /or social issues. CRP also provides caregiver training and support islandwide to help them in coping with their care-giving roles. We aim to rebuild lives, empower individuals and advocate for an inclusive community.

Our Objectives

• To provide home management and rehabilitation programmes tailored to the needs of the patients.
• To improve patients’ functional status at home and assist in gaining functional independence.
• To holistically manage patients through team approach.
• To train caregivers in assisting patients competently with daily functions and exercises.
• To integrate patients back to society within their best capabilities.

Our team of therapists, Care Coordinator, Medical Social Worker will assess your eligibility status for the programme and further financial assessment may be required to determine subsidies. Areas of need and realistic goals will be identified with you and your family members. Upon discharge from the programme, you may be referred to appropriate agencies for continuation of care.

Eligibility Criteria

• Eligible for MOH ILTC subsidy
• Medically stable
• Have rehabilitative needs such as the potential to improve functional ability
• Caregiver who requires training to manage care

Referral Procedure

All referrals must be completed by a healthcare practitioner and made through the Agency for Integrated Care (AIC).

For enquiries, please contact the CRP team at 6450 6238 or email CRPenquiries@ttsh.com.sg.

• Advanced Gait Assessment & Training
  • Patients with complex gait and balance dysfunctions will be holistically analysed using the systems approach grounded in neuroscience and motor relearning theories. This is coupled with formulation of customised gait rehabilitation programmes incorporating updated best practices and technology enhancements.
• Assessment & Management of Swallowing Dysfunction
  • Speech Therapists provide assessment of swallowing dysfunction as well as Fibreoptic Endoscopic Evaluation of Swallowing, Videofluoroscopy and Modified Evans Blue Dye Test. We provide swallowing therapy and also therapy using surface electromyography (sEMG) to manage the condition.
• Augmentative & Alternative Communication
• Bladder & Bowel Care
• Caregiver Support & Education
• Cancer Rehabilitation
• Chronic Pain Management
• Cognitive Rehabilitation
• Community & Vocational Reintegration
• Emotional and Behavioral Management
• Neuropsychological Assessment
  • A neuropsychological assessment is used to quantify brain dysfunction. Through administration of a battery of neuropsychological tests, a cognitive profile of strengths and weaknesses across various cognitive domains is obtained, which helps to guide treatment and rehabilitation. 
• Prosthetics & Orthotics
• Psychosocial Group Therapy
• Rehabilitation Consultancy
• Relaxation Therapy
• Sexual Wellness for the Disabled
• Spasticity Management
• Spinal Urology
• Sports for the Disabled
• Technologies for the Disabled
• Upper Limb Rehabilitation
  • Upper Limb Rehabilitation provides patients with affected upper limbs an opportunity to learn how to use or manage their arm/hand after a neurological disorder. We aim to maintain range of motion in joints, minimise edema, manage muscle tone and regain gainful use of the upper limb in performing function task. The multi-disciplinary team will assess and recommend varied programme such as robotics, TeleRehab, upper limb circuit and etc. according to the patient’s upper limb function.
• Urodynamic Studies
• Vestibular Rehabilitation
• Vocational Rehabilitation
• Wheelchair & Seating Assessment
• Wound Management