Dr Ng Yee Sien spent a year at the Harvard Medical School in Boston, MA, USA for his Clinical Fellowship in Neurorehabilitation. During the year, he had clinical rotations and exposure in the field of stroke, brain injury and spinal cord injury rehabilitation. He performed procedures and conducted clinics in spasticity and also participated in research work in functional outcomes in stroke.

Upon his return to SGH early this year, Dr Ng has initiated a number of changes to his department which has and will further improve care for patients needing rehabilitation after a stroke or brain injury. More specifically, these were:

a. Refine the stroke specific pathway at SGH. The pathway is a treatment and care programme put in place for patients upon their diagnosis and admission for treatment of their condition. With the refinement, all stroke patients will now be seen by a Rehabilitation Physician within four to five days upon admission. This is opposed to a more ad-hoc process before. What this means is that patients will begin their rehabilitation treatment earlier, leading to better recovery outcomes.

b. In the process of starting the Specific Spasticity Clinic at SGH. Spasticity is a very common outcome of stroke or brain injury. With Dr Ng's exposure to new forms of treatment and use of medication to treat spasticity during his HMDP training, he is working to implement these proven forms of treatment at SGH soon.

c. Continue with his functional outcomes research project upon his return and has establish the Rehabilitation Stroke Registry. This is the first of its kind in Singapore which not only lists the details of patients who had suffered from stroke, but more importantly charts their rehabilitation progress - from the moment they were first admitted to the point when they are discharged. The information in the registry will help towards better prediction of how patients recover from stroke, for example the various indicators that will determine the degree of recovery of a patient. This will improve quality of care for patients.

d. Facilitate SGH's accreditation for the use of Functional Independance Measure (FIM), an instrument which is the gold standard within the field of Rehabilitation Medicine that measures functional status and disability of a patient who has had a stroke or brain injury. It also reflects the care necessary to support a person with disability in his/her activities of daily living. The Rehabilitation Medicine department uses this tool to assess each of their patient and uses it to set goals for treatment and rehabilitation to improve their quality of life. This tool will also allow SGH to benchmark itself against other Rehabilitation Medicine centres worldwide.

Rehabilitation Medicine will become increasingly important. There will be more instances of strokes and disabilities because of our greying population, hence the need for more rehabilitation. Dr Ng has also seen an increasing number of younger people with disabilities. Rehabilitation intervention would be important in ensuring that these groups of people have improved quality of life and decrease the burden of care (e.g cost of hospitalisation).