Messina - Clinical service

Care pathways

Neuromuscular diseases require a highly and multifunctional intervention in rehabilitation, training and support. In the NEMO Centers, several disciplines collaborate in safeguarding patients’autonomy, maintaining social involvement, and contrasting disease progression.

Patients hosted in our Center usually expect to receive predominantly pharmacological treatment. Our approach rather involves also research trials, patient-clinician interaction, in a patient-centered approach.

Care protocols for patients with neuromuscular disorders are based on disease-specific national and international guidelines.

Outpatient clinic

Clinical assessment during an outpatient visit both for adults and children includes a detailed medical history and neurological exam: timed neuromotor functional tests are applied as needed in line with international outcome measures. Children are also subjected to  specific batteries of neuropsychological tests to determine intellectual function and to identify specific needs within the child’s family and school setting so that specific pathways can be created.

The respiratory outpatient clinics include respiratory function tests, arterial blood gas analysis, nocturnal oxymetry and other tests according to the clinical picture. 

The general outcome of the outpatient assessment is a detailed and tailored diagnostic and rehabilitation program.

Many other medical diagnostic and therapeutic interventions (i.e. neurology, physiatry, pneumology, physiotherapy, speech therapy, clinical psychology and neuropsychology) can be performed in the out-patient setting.

Outpatient clinics also include evaluation of devices (e.g. prescription and training).

Psychological interventions include:
Psychological sessions;
Cognitive and behavioral assessment with neuropsychological outcome measures;
Language disorders assessment;
Mental development assessment in childhood and adulthood.

Day Hospital

Two rooms of the Center are committed to Day Hospital service.

During Day Hospital, patients undergo diagnostic, therapeutic and/or rehabilitation procedures.

Day Hospital procedures involve various treatments, such as:
Functional and neuromotor assessment;
Respiratory treatment (e.g. NIV; lung expansion therapy; training to cough assist devices)
Nutritional assessment;
Cognitive-behavioural assessment with psycho-educational interventions and training.

Inpatient clinic

The complexity of the clinical picture is assessed and specific needs are identified on admission so that the rehabilitation program can be tailored for that specific patient. The multisystem approach includes neurological, respiratory, cardiac, nutritional, psychological and orthopedic evaluations. The rehabilitation program involves respiratory, psychological, and motor assessments. Augmentative and Alternative Communication devices are offered to patients as needed.

Neurophysiological procedures, muscle biopsy analysis and genetic testsing are conducted in collaboration with the Neurology unit in G. Martino Hospital. Specific consultations (i.e nutritionists, endocrinologists, ophthalmologists, ENTs, gastroenterologists, endoscopists, anesthetists, urologists, gynaecologists, and dermatologists) are also possible thanks to the link with G. Martino Hospital as well as access to the Emergency Department is guaranteed.

The Center hosts patients with various age ranges:
         - Infancy (< 3 years old)
         - Early childhood ( 3 – 11 years old)
         - Adolescence (12-18 years old)
         - Adulthood (>18 years old).

Messina NEMO Center has 10 in-patient beds (of which 4 are single rooms and 3 are double rooms). 10 other beds will soon be added.
Both inpatients and outpatients have access to the rehabilitation gym, where patient care is guaranteed by the use of the most effective procedures and equipment.

Multidisciplinary services

Specific diagnostic and assistance pathways (i.e. inpatient, outpatient, and day hospital) are provided throughout disease progression. According to national and international guidelines, global care is guaranteed to patients and families thanks to the synergy of several health professionals.

The most-frequently hosted people in NEMO Clinical Center are:

In adulthood
People with motor neuron diseases (e.g. Amyotrophic Lateral Sclerosis, Primary Lateral Sclerosis, Progressive Muscular Atrophy, and Spinal Muscular Atrophy);
People with muscular dystrophies (e.g. Becker Muscular Dystrophies, Facioscapulohumeral Muscular Dystrophies, and Limb-Gridle Muscular Dystrophies);
People with Myotonic Dystrophies (e.g. Steinert’s disease, Myotonic Dystrophy type 1); people with genetically determined and acquired Myopathies;

In childhood
Children with motor neuron diseases (e.g. Spinal Muscular Atrophies);
Children with Muscular Dystrophies (e.g. Duchenne Muscular Dystrophies and Congenital Muscular Dystrophies);
Children with Congenital Myopathies;
Children with Hereditary and Acquired Neuropathies

Multidisciplinary care involves different health professionals, such as:

PHYSICIANS, such as neurologists, pneumologists, and physiatrists.
THERAPISTS, such as physical and respiratory therapists, specialized in devices identification and management, speech therapists, specialized in swallowing issues and in Augmentative ad Alternative Communication (AAC) devices.
PSYCHOLOGISTS for the diagnosis of cognitive, behavioral, and emotional disorders, for counseling and support, and psychological rehabilitation.
NURSES and SOCIAL WORKERS committed to patients’ management throughout disease progression.

Multidisciplinary care aims to preserve autonomy and social inclusion through several services, such as:
Multidisciplinary rehabilitation and diagnosis procedures;
Psychological support and neuropsychological assessment;
Meetings and trainings;
Research trials;
Device-related consultancy and guidance.