Roma - Clinical service

Out-patient clinics

Out-patient clinics at the Rome NEMO Center include neurology, pulmonology and phoniatry. Multidisciplinary clinics are also available. Out-patient visits may be first-opinion diagnostic visits or may be second or third-opinion visits on specific diseases. Out-patient clinics reflect the complexity of patients with high disability admitted at the Center. During the neurological assessment the patient medical history and an accurate evaluation of the neurological and respiratory aspects are carried out. Outpatient clinics include the assessment of children scholastic and familial context with the possibility of creating a personal program in these settings. In the outpatient clinic context the pneumological examinations include pulmonary assessments like complete respiratory functional tests. After an outpatient evaluation detailed indications about the follow up and certifications for home service are offered to the patients and their families.

Day Hospital

The Rome NEMO Center also offers the possibility of admitting patients on a daily basis, in the Day-Hospital Service. This is dedicated to patients in whom an in-patient admission is unnecessary but at the same time the patient requires a prolonged clinical monitoring that cannot be offered in the out-patient setting. Often the Day-Hospital service is helpful for specifying the diagnosis and the disease’s phase that the patient is going through. Such approach allows to undertake specific rehabilitative/actions that don’t require a hospitalization but need to be monitored anyway. In the course of the day the patient is subjected to functional tests of motor skills, respiratory and cardiac function, psychological status, swallowing abilities and any other diagnostic procedure or treatment that is required. The daily accesses change in relation to the patient’s clinical plan. The patient’s care takes place in a multidisciplinary context according to the Center characteristics. 

Inpatient clinic

During in-patient admission, the pathway of care changes according to the patient’s needs. As needed, patients are subjected to neuromotor, respiratory, cardiac, nutritional, swallowing and orthopedic assessments on the basis of the individual rehabilitation program planned by the multidisciplinary and multiprofessional team. The patient and his family who are taken care of at the NEMO Center are supported by the psychological service, specialized in the care of severe disability. The rehabilitation program specifically refers to the motor, occupational, respiratory /therapy and also the nutritional and speech ones when necessary. People with severe disability require an in-depth assessment of their communication skills; communication devices are discussed on a patient-by-patient basis.

During the diagnostic and therapeutic path the Rome NEMO Center works in collaboration with the Policlinico A. Gemelli. In particular the Clinical laboratory, radiological, surgical, and the emergency departments are available throughout the whole day and there is an on-call service for emergency 24 hours a day, every day. Furthermore the collaboration with the Policlinico A. Gemelli also involves other professionals like nutritionists, endocrinologists, ophthalmologists, speech therapists, gastroenterologists, anesthesiologists, urologists, and gyneacologists geneticists and bioethicists. This represents an added value.

The Center is built to host patients of different ages.
- Infancy and early childhood (0-3 years)
- Childhood  (3-11)
- Adolescence (12-18)
- Adulthood (>18)

The Center has 16 in-patients beds, and of these, 6 are pediatric beds and 10 are adult beds. 

Multidisciplinary services

At the NEMO Center there are in-patient beds, day-hospital service and out-patient clinics. A multidisciplinary and multiprofessional team allows to address the diseases from  the early diagnostic stages to the more advanced stages in which patients may have severe disability. The NEMO Center also allows to address the continuum of the disease process because both kids and adults can be taken care of at the same site: the adult and pediatric areas coexist at the NEMO Center and specialists strongly interact in the care of these patients.

People who are most frequently admitted at the NEMO Clinical Center are: among adults, people with Motor Neuron Disease (especially Amyotrophic Lateral Sclerosis), Myotonic Dystrophy, Facioscapolohumeral Muscular Dystrophy. Among children the most common treated diseases are Duchenne Muscular Dystrophy (DMD), Spinal Muscular Atrophy (SMA), Congenital Muscular Dystrophy (CMD).

The multidisciplinary care involves professionals of different areas:
Neurology
Child Neurologist
Pneumology
Clinical Nutrition
Phoniatry
Digestive Endoscopy
Medical Genetic
Intensive Care
Clinical Ethics
Physical Rehabilitation

These professionals tightly collaborate with the Clinical Psychological Service.

The motor functions, the cognitive-communicative skills, the psychological sphere and the socio-relational context are the basis of the professional multidisciplinary approach at the NEMO Center, that is highly specialized yet affordable and non intrusive.

Services offered by the Center:
- Clinical neurology, pulmonology, psychological and neurorehabilitation activities in the neuromuscular field during day hospital and in-patient admissions
- Outpatient clinics dedicated to neuromuscular diseases
- Genetic counseling
- Nurse Coaching/Case Manager services to facilitate discharge from the Nemo Center to the patients homes, to other rehabilitation units or to other local health structures
- Research and training

Care pathways

The complexity of neuromuscular diseases requires a highly specialized and multifunctional intervention of rehabilitation, education and assistance. At the Rome Nemo Clinical Center, different disciplines interact with each other throughout the course of the patient’s care. The main objective is to preserve the autonomy and the familial and social participation in line with the disease’s natural history and the evolving needs. In addition, the objective is to slow the progression of symptoms and to allow adaptation and compensation of residual muscle function to guarantee the best possible independence in the activities of daily living. It is necessary to consider the rehabilitation process as the way to accompany and support the patient and his family in everyday life, thus slowing down the development of disability and possibly improving quality of life. The main characteristic of the Rome Nemo Clinical Center is the high specialization in the neuromuscular disease diagnosis and in facing difficulties connected to the disease’s evolution, especially in the acute phase. Often patients with severe disability who are admitted at the Center expect “the Cure”, meaning ‘the pill’. Talking about ‘cure’ in neuromuscular disorders is a complex matter. It requires more time than usual because a ‘pill’ may not be available, but the Center has a patient-centered approach, and part of the ‘cure’ is also listening and interacting with the patient and his family on clinical and research matters, on national and international standards of care and on ongoing trials.