Medical Evaluation for Neurorehabilitation: What to Expect

Why Medical Evaluation Matters

Neurorehabilitation is not appropriate for every patient with a neurological condition. A thorough medical evaluation is essential to determine whether an intensive rehabilitation program is suitable, safe, and likely to benefit the patient.

CIREN's medical evaluation process has two stages:

1. Pre-arrival record review — Patients submit their medical records before traveling. CIREN's medical team reviews them to determine eligibility and design a preliminary treatment plan. 2. On-arrival assessment — After the patient arrives in Havana, the team conducts a comprehensive in-person assessment to finalize the treatment plan.

This two-stage process ensures that only patients who are likely to benefit from the program travel to Cuba, and that the treatment plan is ready when they arrive.

Records Needed for Pre-Arrival Review

For the pre-arrival record review, patients should submit:

• Neurological assessment — a recent assessment by a neurologist describing the diagnosis, condition, and current status • Imaging studies — brain MRI and/or spinal MRI on CD or via secure digital transfer (within the last 12 months) • Blood work — recent laboratory results (within 6 months) including CBC, comprehensive metabolic panel, and any condition-specific tests • Current medication list — all prescription medications, over-the-counter drugs, and supplements with dosages • Medical history — summary of the condition's onset, progression, and prior treatments • Rehabilitation history — records of any prior rehabilitation, including therapy notes and functional assessments • Physician's note — a letter from the patient's current neurologist or physician summarizing the current diagnosis and treatment plan

Records should be in English or Spanish. SMC Salud can arrange translation if needed.

The Eligibility Determination

After receiving the medical records, CIREN's medical team reviews them to determine:

• Is the patient's condition appropriate for CIREN's intensive rehabilitation program? • Is the patient medically stable for international travel and an intensive daily therapy program? • Are there any contraindications (active infections, uncontrolled medical conditions, severe psychiatric conditions)? • What is the likely benefit of the program for this specific patient? • What program duration and components are recommended?

The review typically takes 5–10 business days. The result is one of:

• Eligible — the patient receives a treatment proposal with program details and cost • Conditionally eligible — the patient may be eligible after addressing certain medical issues (e.g., stabilizing blood pressure, treating an infection) • Not eligible — the program is not appropriate for the patient's condition or stage

The review is complimentary — there is no obligation to travel after receiving the determination.

The On-Arrival Assessment

Once the patient arrives at CIREN, the team conducts a comprehensive in-person assessment over the first 2–3 days:

• Neurological examination — by a neurologist to assess motor function, sensation, reflexes, coordination, and cognitive status • Functional assessment — by each therapy discipline (physical therapy, occupational therapy, speech-language therapy, neuropsychology) to establish baseline function • Imaging review — the team reviews any imaging studies the patient has brought • Medical history review — a detailed discussion of the patient's condition, symptoms, and goals • Goal-setting — the team and patient discuss realistic rehabilitation goals based on the assessment

The results of this assessment determine the final treatment plan — the specific therapy mix, daily schedule, and program duration. The plan is adjusted throughout the program based on the patient's progress.