Journey of Neurological Rehabilitation

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Journey of Neurological Rehabilitation Project Process Journal A Project for Douglas Grant Rehabilitation Center, NHS Ayrshire & Arran Vinishree Solanki

MDes Design Innovation & Service Design Tutor: Dr. Iain Reid Glasgow School of Art

“The idea of 10 dimensions might sound exciting, but they would cause real problems if you forget where you parked your car.” Stephen Hawking The Grand Design (2010)

Illustration: Vinishree

Introduction Brain is more intriguing than the outer universe, the unrivalled complexity that beautifully simplifies the world known to us. I perceive it as the most enchanting regenerative blossom of consciousness, intelligence and creativity. Addressing the complexity of neurology has always been challenging. Healthcare itself is becoming more person-centered, considering the person and their needs as core and the rest of the system enveloping and overlapping it. Health of a person holistically includes their physical, emotional, and social wellbeing. These values guided me to understand essence of Neurological Rehabilitation.













Project Context NHS Insights Desk Research Case Studies Interviews NHS Expert Interviews Ecosystem Map EmotionalJourney Map User Journeys Affinity Map Unmet Needs Problem Statement


Ideation Paper Prototype Testing & Validation - Partcipatory Workshop Feedback & Iteration The Proposal Underlying Features The Solution Story Board Service Blueprint Impact & Viability Reflections

Process Research

Challenge by NHS





• • • • • •

• • • • • • •

Project Context NHS Insights Desk Research Case Studies Interviews NHS Expert Interviews

Ecosystem Map Emotional Journey Map User Journeys Affinity Map Unmet Needs Problem Statement

Design • • •

Ideation Paper Prototype Testing & Validation Partcipatory Workshop Feedback & Iteration


Deliver • • • • • • •

The Proposal Underlying Features The Solution Story Board Service Blueprint Impact & Viability Reflections

Discover Project Context NHS Insights Desk Research Case Studies Interviews NHS Expert Interviews


Project Context The Douglas Grant Rehabilitation Center offers neurological rehabilitation service within NHS Ayrshire and Arran. The project required the Innovation School at Glasgow School of Art to engage with the Centre to investigate the opportunities to enhance and develop service proposal by exploring the aspect of their In-patient experience. The key question provided by DGRC was to focus on: “How can the Neurological Rehabilitation Service within NHS Ayrshire & Arran communicate to, engage with and provide for the people who work there and for whom they offer their services in a way that enhances value and purpose for those people?”

Ambiguous with too many variables. I was petrified with the vagueness of the problem, and so I decided to follow my instinct to explore the vast spread of neurological situations. I started my discovery through collecting stories – of breakthroughs, failures, hope and distress.


Project Context

What is Neurological Rehabilitation? It is a medically-supervised program designed for people with degenerative diseases, injury, or disorders of the nervous system aimed at improving function, reducing symptoms, and improving the wellbeing of the patient. The patients with Neurological conditions due to brain or spinal cord injury are living at DGRC for supervised rehabilitation and care. The Centre provides specialised treatments for people with very diverse needs, including Multiple Sclerosis, stroke, Parkinson’s Disease, Motor Neurone Disease, as well as acquired brain injuries due to trauma or sudden illnesses.

2 3

NHS Insights The brief shared by Douglas Grant Rehabilitation Center (DGRC) intended to bridge the gap between the expectations and actual experiences of rehabilitation. Mapping the insights shared by Jenny and Karen (our main point of contact at DGRC), helped our team to understand the process of rehabilitation, the internal systems at DGRC, patient and staff interactions, and the problems which they had already identified within their framework.


Desk Research Kicking off the research with secondary findings, I tried to read about the context and conditions of neurological problems to gain a generic understanding of the subject. After initial online study our team identified few key areas for desk research with the objective to collect information from credible resources for example the NHS websites, support groups like headway, and research papers. It directed us to a range of medical research papers, video content and websites of various stakeholders.


Desk Research A critical evaluation of the online resources led us to initial insights into the medical condition, understanding of the stakeholders involved, inherent services and systems of NHS, demographics of the patients and the family members as well as the how people are approaching this problem across the world.

#ThankyouNHS #NeurologicalRehabilitation The boundaries are becoming blurred in terms of online resources. I found myself doing a lot of secondary research through social media platforms like twitter, facebook and Instagram.


Case Studies We came across a lot of case studies on healthcare design by service designers and by the Innovation School. Scrutinizing through them gave our team a good snapshot of their approaches, methods and outcomes. Moreover, it led me to read about people centered design approach in the healthcare sector and its importance in the current context.


Interviews Designing Engagement Tools for Remote Interviews Investigating through the patient’s videos and stories available over the websites like Headway (a support group working closely and extensively with NHS for people affected by brain injury), provided a good overview. We used this understanding to build engaging exercises in order to probe our interviewees for sharing their experiences and expertise. Our team spend considerable amount of time, designing these engagement tools, which acted as structured stimuli to recall stories. Mapping our engagement tool over the framework shared by Marianne McAra and Cara Broadley (two of the researchers in Innovation School), helped us further refine our engagement tool.



The first engagement tool used words, sounds and videos as triggers for the interviewees to share their lived experiences.

The second one involved the use of a ‘Feelings Wheel’ as a mnemonic to share their emotional associations with some of the aspects of neurological rehabilitation. 9


The third engagement tool was based on using personas as cues for further questioning. These were hypothetical archetypes representing different patient problems like multiple sclerosis, speech problem, mobility issue and memory loss. Similarly some of them represented the carers or family members falling into different category as partner, friend, child and parent.


Interviews Adopting the ethnographic methodology, we started to investigate the context by interviewing people who were somehow associated with the neurological conditions. Keeping the questions open ended enabled our interviewees to express themselves better. For example, “What does this word (neurology) mean to you?” or “How do you feel when you come across this word (Digital Tool)?” We were able to speak to a patient, a GP, a family member of a patient and a neuro science researcher. One of our team mate in China was able to visit a hospital treating brain related injuries, and shared her insights of the visit. As a resilient bunch of students, we took the opportunity the pandemic gave us, and we connected with these interviewees spread across different continents on an online format and carried out our face-to-face interview.






NHS Expert Interviews Apart from these interview, our cohort also got the chance to interact with varied experts associated with Douglas Grant Rehabilitation Center. These expert interviews allowed us to investigate their opinions, behavior, and experiences. As practitioners, they dealt with this medical condition on a daily basis. The conversations with these experts gave us an in-depth understanding of their social and emotional realities while tackling the intricacies of neurological rehabilitation.


NHS Expert Interviews


NHS Expert Interviews


Define Ecosystem Map EmotionalJourney Map User Journeys Affinity Map Unmet Needs Problem Statement


Define The discovery phase of the project overwhelmed us with vast range of information. Mapping these complexities into smaller chunks based on connections, values and roles enabled us to search for opportunities and unmet needs. Backed by ethnographic research, we were able to critically analyse the context, stakeholder experiences, and the pain points linked with neurological rehabilitation.

Mapping our learnings about people, their needs and their relationships, we saw the emergence of some obvious and some invisible connections. In this phase we captured what they said, what we saw and what it meant. It was a process where we converged to define the problem.


Ecosystem Map Bringing together the stakeholders that were directly and indirectly associated with the brief led us to contextualize the larger picture. We mapped the complexity of the service offered by DGRC by a visualization showing the patient at the center and positioning the DRGC staff, family and rest of the stakeholders in concentric circles. We went ahead to create an ecosystem map of the service by adding the touch points, tangible and intangible objects, and places. This helped us to draw the connections between each, finally connecting to the larger value that originated out of it like communication, infrastructure, accessibility, care and so on.


Ecosystem Map

Ecosystem Map with Patient at the Center Visualizing all Services & Stakeholders


Ecosystem Map

Ecosystem Map with Carer at the Center Visualizing all Services & Stakeholders


Emotional Journey Map Our interviews with two of the patients and a carer introduced us to the emotional turmoil they go through, starting from the time neurological problem starts till the rehabilitation process. The image below indicates the emotional status of the carer (Anand) at each stage, capturing his emotional experience while interacting with the patient (his sister in this case) and the staff.


User Journey Map The major challenge incurred during our ethnographic research was to have an access to our primary stakeholder, that is people having a neurological condition or who have undergone rehabilitation. The lockdown situation made it extremely difficult for the NHS as well as for our team to connect with any of the patients. Lack of observation study at the Douglas Grant Rehabilitation center, was another missing link in our research. Undeterred by the situation, my team went ahead digging information at secondary resources. We watched and read many interviews and activities of people facing neurological issues on various websites. Additionally, Jenny from DGRC gave us an overview of the place and described a typical journey of a patient at the center. We pieced all these information together to create the User Journey Map. Our journey map covered the before, during and after rehabilitation journey giving an overview of the entire spectrum of rehabilitation.


Patient & Carer Journey Map

Before Rehabilitation


Patient & Carer Journey Map

During Rehabilitation


Patient & Carer Journey Map

After Rehabilitation


Affinity Map Going through the transcripts of the interviews, we coded the key comments by the interviewees, which led us to stick them together on the miro board based on theme, following a crude process of thematic analysis. However, the themes generated through this process formed the crux of our insight generation. We went ahead to create an affinity map, a daunting task which our team collaboratively executed by sorting and grouping based on broader themes, combining the insights from our secondary and ethnographic research. This affinity map was an evidence based collection of unmet needs and pain points that our research process so far had generated. Focusing on enhancing the in-patient experience at DGRC, we converged down to few significant unmet needs.


Unmet Needs Three key findings emerged which led us to formulating our problem statement. The lack of awareness and orientation regarding the process of neurological rehabilitation process leads to a lot of distress not only to the key stakeholders like the patient and the carer, but also to the referring GPs, support groups, acute care hospitals, supporting community members, and many others that fall within the framework of rehabilitation.

Awareness & Orientation

From the patient’s perspective, they face difficulties to communicate and lack the clarity of recovery as their engagement in the planning of rehabilitation is less. This might demotivate and lead to dissatisfaction in their experience at DGRC. The family & carers have less access to the process of rehabilitation, and their difficulty in finding the right channels of communication leads to frustration.

Patient: Engagement & Unpreparedness

Carer: Accessibility & Communication


Problem Statement Through our discovery of unmet needs of the key stakeholders, we were able to formulate our problem statement :

“How might we provide the roadmap of rehabilitation for key stakeholders with effective engagement at each touch point?”


Design Ideation Paper Prototype Testing & Validation - Partcipatory Workshop Feedback & Iteration


Ideation Diverging into potential solutions, we took off to answer the question we had defined earlier. Taking the keywords from our ‘How might we’ and our main unmet needs, we started extrapolating them into visuals. The first level of ideation sketches touched upon various concepts, from physical interventions to service based apps, gaming technology to recreational activities. Sketching being my favorite part of ideation, my right brain was working at full throttle at this point. Generating ideas by putting down my thoughts on paper, encouraged me to articulate various facets of the journey of rehabilitation from the lens of improving communication between the stakeholders and increasing engagement.


Ideation Sketches


Ideation Sketches


Ideation Sketches


Paper Prototype With some simple and some crazy ideas in hand, it is only right to prototype them to quickly visualize and test these ideas. Our team got together to make some low fidelity prototypes, and through the process we started weeding out the ideas that didn’t make much sense. We were able to find solutions to personalize the physical kits by making stickers of the icons which could be used based on the patient’s needs. We also explored the idea of stickers further into developing an emotional board using images and words. The idea of the physical kit and the portal started becoming evident from our exploration at this stage.


Paper Prototype


Testing & Validation - Participatory Workshop At this stage we had many design artefacts that we wanted to test and validate. It was crucial to evaluate if our ideas and underlying values were aligned to the stakeholder’s requirement at this stage in the design process. We planned a participatory workshop with the people we had interviewed in the research phase to validate and get feedback for our proposal. Since they were aware about our project and were thus excited to see how their narratives have been translated from insights to probable solutions. We again set ourselves the task of creating engagement exercises to showcase our artefacts and get informed inputs from our participants. We planned a session with 3 participants for an hour, and dividing our session through four phases: Narrate, Create, Prioritize & Contextualize


Testing & Validation - Participatory Workshop Narrate: Here we introduced the idea of a roadmap depicting different stakeholders and touchpoints capturing before, during and after rehabilitation journey. The question posed to our participants were – “Any unforeseen touch point that you want to add/remove?” and “What are the unexpected scenarios?”


Testing & Validation - Participatory Workshop Create: This was a role play exercise. We showed our participant personas of our 4 key stakeholders (patient, carer, therapist, nurse) and we asked them to imagine themselves in the role of each of these stakeholders. The question asked to them was “If you are a patient like Jenny, what do you want to hear/read/ see?” Next, we revealed the ideas generated around language, sounds, visuals and asked them which was closest to the one that would solve their problem in their role play exercise.


Testing & Validation - Participatory Workshop Prioritize: This exercise was valuable for our validation and next level iteration. We displayed all our design artefacts randomly and explained to them the four different channels of communication i.e. email/phone, face to face, Online portal (web, phone, tablet), and physical kit/objects. Our participants were asked to link each artefact to one or more channels of communication.


Testing & Validation - Participatory Workshop Contextualize: The last exercise showcased our complete solution and we questioned our participants to share any unintended consequences they could foresee, and how and why it will benefit the users in the long term.


Feedback & Iteration

Level up kit- Add ons

Testing our proposal through a participatory workshop with our previous interviewees comprising of a carer, a neurological research doctor and a GP, gave us additional insights and validation of our design hypothesis. We gathered feedback through our workshop to create an improved iteration of our proposal. We were able to improve the first artefact (roadmap of before, during & after rehabilitation), and simplified few touchpoints. We embedded other feedbacks in our final proposal such as positive language across our service, a kit that grows along patient needs and the option of using personal devices. Positive Language and peer stories

Option of using a personal device


Develop The Proposal Underlying Features The Solution - Journey of Care Portal The Solution - Hello Kit The Solution - Emotion Diary Story Board Service Blueprint Impact & Viability Reflections


The Proposal Defining Stakeholders – The people that were directly interacting with the service regularly, played a role or were influenced by its consequences came to be our main stakeholders. These personas are representations of the key stakeholders: In-patient, carer, therapist/physician and the nurse/DGRC staff. The next level of stakeholder were either indirectly interacting with the service or using it irregularly. The GPs referring to DGRC, support group staff, extended family members of the patient formed this second layer of stakeholders.


The Proposal Journey of Care is a service design proposition which has evolved from communication and engagement values. Addressing the key unmet needs of our target stakeholders: - lack of awareness and orientation in regards to neurological rehabilitation - lack of engagement and unpreparedness at the patient’s end - the problem faced by carers regarding accessibility and communication during the journey of rehabilitation. Journey of care is a two part service proposal with a digital portal and a physical kit to cater to the varied abilities and needs of the patients


The Proposal

Journey of Care


The Proposal Journey of Care - a role based online portal to monitor, store and share information, bringing the service out of the DGRC by making it more accessible.


Hello Kit - a ‘level up’ kit that will welcome the patient and create ownership and engagement throughout the journey.

Engagement Design Intent The service aims to provide a clear roadmap and encourage effective communication at every touchpoint between the key stakeholders to create more engaging rehabilitation services.

Another intervention is through empowering the patients by giving them a medium of expression through an Emotion Diary.


Underlying Features Positive Language Shorter Sentences, Big Fonts Visual Descriptions

Use of Technology IoB for mapping behavior pattern

Our design took into consideration two key aspects of communication that is content design and visual representation. The evidences of our research repeatedly pointed towards enhancing positivity and motivation through language and visuals (colors, shapes, textures). We consciously tried to use this feature throughout the content of the online portal, hello-kit, and combination of words, shapes, colors and textures to evoke expression through the emotion diary. Another integrated feature of the online portal uses latest digital technology of IoB (Internet of Behaviour) which helps in enhancing the interaction of the portal by mapping the user behavior patterns. Research in IoB speculates its importance in the healthcare sector by mapping complex user online activity from a behavorioural psychology perspective such as of people with neurological conditions.

Personalized format based on patient’s neurological condition

Personalization is the key feature that empowers the DGRC staff to identify patient’s needs and deliver to them the content, experience, and functionality that matches their individual requirements and abilities. Since neurological conditions can range from memory loss, to mobility or speech problems, the Hello kit as well as the online portal is designed to align with the varied needs, trying to maximize accessibility for all.

Inclusive & Pleasant Visual Identity Selection of fonts & colors

The research for healthcare visual communication revealed the preffered selections for print and web communication. The design has taken into consideration people with color blindness, visibilty & readability issues and reduced reactivity. Effect of colors on emotion were also considered and thus the design used the most pleasant color combinations. 48

Underlying Features Addressing before, during and after rehabilitation journey addresses the people’s expectation of the next stages, providing access to the full spectrum of the roadmap of neurological rehabilitation. It indicates different touchpoints with notes and contact information of concerned stakeholders.


The Solution - Online Portal

Journey of Care - a role based online portal to monitor, store and share information, bringing the service out of the DGRC by making it more accessible.

For Therapist

“ Patient’s loose motivation during the process. Their small progresses give me satisfaction.”

Therapist Kavya Therapist DGRC Consultant


Therapist Login

Select - patients or request (referral/carer’s questions)

Portal Home Page & Roadmap

Select - patients dropdown names


The Solution - Online Portal For Therapist

Patient’s dashboard with info

Answer requests from carers

Patient’s personalized roadmap

Plan Schedule & add medical notes

Add notes

Add refferals for discharge

51 Add contact information on patient’s page

The Solution - Online Portal For Patient

After my brain was damaged, I felt vulnerable and didn’t want to communicate with others around me.”


Portal Home Page & Roadmap

Patient Login

Amy Road Traffic Incident. Brain Injury Mobility & Speech Problem

Emotion Diary - Colors options

Patient’s dashboard with info

Emotion Diary - select options

Emotion Diary - sketch options

Emotion Diary - upload image


The Solution - Online Portal For Carer

“I want to be my wife’s best supporter and understand everything she's doing.”

Carer Marco Wife suffered Spinal Cord Injury Website

Carer Login

Patient’s dashboard with info

Portal Home Page & Roadmap

Patient’s personalized roadmap


The Solution - Online Portal For Carer

View: Patient’s personalized roadmap - notes added by therapist

: View: contact information on patient’s page

View: Medical notes & Schedule of the patient

Receive answer from therapist

View: Patient’s emotion diary

View: Refferals after discharge


The Solution - Hello Kit For Patient

After my brain was damaged, I felt vulnerable and didn’t want to communicate with others around me.”

In-Patient Amy Road Traffic Incident. Brain Injury Mobility & Speech Problem

Hello Kit - a ‘level up’ kit that will welcome the patient and create ownership and engagement through the journey.

Tablet provided with the Hello Kit - To use the digital portal, patient can use their own device or in addition, the Center gives the option of a tablet which has to be returned back to the Center at the time of discharge.


The Solution - Hello Kit

Contact of people they will be interacting with at DGRC

For Patient

Login Credentials

Hello Kit - LEVEL 1 At the time of admission to DGRC

Weekly goal setting - to be filled along with the medical team

Personalized Roadmap

Weekly Schedules - to be filled along with the ward nurse


The Solution - Hello Kit For Patient

Hello Kit - LEVEL 2 When the patient feels low

Peer Stories

Hello Kit - LEVEL 3 At the time of discharge

Personalised tip for support after discharge


The Solution - Emotion Diary (board) For Patient

Emotion Diary empowers the patients by providing them a medium of expression through words, shapes & textures

Evidences from our research highlighted the conditions of the patients when they are in a confused state of mind, or verbal communication is inhibited. This emotion board aims to support such conditions. It will have magnetic stickers which the patients can arrange on the board hung inside each ward.


Story Board


Story Board


Service Blueprint Enhancing In-patient experience through the service proposition requires the DGRC to channelize its resources, have crossdepartmental co-ordination, and address all touchpoints throughout the span of service delivery and their association with the patients. The service blueprint for ‘Journey of Care’ at DGRC depicts the use of the physical evidences (email/phone communication, online portal, hello kit, and emotion diary), across the touchpoints covering before, during and after rehabilitation. Considering patient as the customer interacting with the service, our front stage actors comprise of the DGRC staff interacting with the patient’s like the receptionist, medical team and the nurses. The back stage actors are again at most of the times the same DGRC staff which evaluates, or reviews the interactions and working behind the line of visibility. Mapping the service blueprint we realized the crucial role of the support processes such as updating and maintaining the portal, printing and assembling the kit etc.


Service Blueprint


Impact & Viability Evaluating our service, we were able to map the values created across the system. With the person’s need at the core, our proposed service comes out of the Center and connects various stakeholders. It is inclusive and accessible, encompassing various stages of a personalized rehabilitation journey. It brings awareness while sharing relevant information. It gives clarity and orients all stakeholders and is sustainable as all physical objects are made of biodegradable paper.

Sustainable Society



DGRC & rehab touchpoints

Connecting Actors



Journey of Care Portal & Kit



In-patient & Carer

Patient Centered

Engagement Ownership Communication


Reflections The proposed service aims to provide a clear roadmap and encourage effective communication at every touchpoint between the key stakeholders to create more engaging rehabilitation journey. Evaluating it on the parameters of how it creates value for the users, the organization providing it, and the society as a whole, it was imperative that we identify its impact across the system. Working with this fundamental theory for the project, I aimed towards designing something closer to a ‘Good Service’ or at least I made an attempt towards it :) The learning came by weeding out the bad ideas, removing the unnecessary touchpoints and simplifying the approach.

“Service design is 10% design, 90% convincing people that what you’re trying to do is a good idea.” Lou Downe Scaling Good Services training (2021)

Takeaways: - I might be in the right direction when the design intent transpires from the evidences arising from the ethnographic research. -During this project, I tried to learn and understand the research methods & tools and craft them effectively to suit the project requirement.


Reflections Challenges incurred The major challenge incurred during our ethnographic research was that we had no access to our primary stakeholder, that is people having a neurological condition or who have undergone rehabilitation. The lockdown situation made it extremely difficult for the NHS as well as for our team to connect with any of the patients. Lack of observation study at the Douglas Grant Rehabilitation center, was another missing link in our research. Challenges accepted Conducting ethnographic research remotely, I learnt to frame, plan and execute online interviews. Designing and using effective engagement tools for a desired outcome, was a good training towards planning and facilitating participatory workshops in the future projects. Team dynamics Working collaboratively in the team, we learnt about each one’s super powers. Someone was great at planning & framing, the other one at hands on skills like paper prototyping, one of us was quick at analyzing and one took the role of all the graphic design. Being aware of each other’s strengths and weakness helped us in pushing ourselves continuously as a team. We worked collaboratively on the project, believing in the process. We followed the design process religiously and were delighted towards the end to see the solutions emerging out of all the chaos. Ethics in research The project required us to work with vulnerable patients and carers. We thus ensured that we always take their consent before the interview, for recording the zoom calls, and for using their picture for our presentation purpose. The filled up the consent forms are attached in the appendix. 65

Bibliography Books & Journals Downe, L. (2020). Good Services. Amsterdam: BIS Publishers. Polaine, A., Lovlie, L. and Reason, B. (2013). Service Design: From Insight to Implementation. New York: Louis Rosenfeld Colley, J., Zeeman, H. and Psych, M. (2020). Safe and Supportive Neurorehabilitation Environments: Results of a Structured Observation of Physical Features Across Two Rehabilitation Facilities. Sage Publications Freire, K and Sangiorgi, D. (2010). Service design and healthcare innovation: from consumption, to co-production to co-creation, Research Gate. Available at: Sangiorgi, D and Prendiville, A. (ed.) (2017). Designing for service, key issues and new directions. London and Newyork: Bloomsbury Plublishing Plc. Gray, D.(2004). Doing Research in the Real World, London: SAGE Publications


Bibliography Electronic Resources Service Design Tools. Available at: Miller, M and Flowers, E (2016). The difference between a journey map and a service blueprint. Available at: Frog. (2014). Bringing Users into Your Process Through Participatory Design. Available at: Headway. (2021). Brain injury, featured videos. Available at: NHS Arran & Aryshire. (2017). Neurological services implementation plan. Available at: Apps for memory loss, OT’s with Apps & Technology. Available at: Scottish Index of Multiple Deprivation. (2020). Available at: Mortimer, J. (2021). Health and Social Care design prototype. Len’s Story. Available at: French, T. and Raman, S. (2019). Future Transitions in Palliative Care, The Glasgow School of Art and the University of Dundee. Available at: Shaffer, J, 5 tips on designing colour-blind-friendly visualizations. Available at: The Print Authority. (2019). Best Fonts for Medical Printed Materials. Available at:


Appendix We shared the Project Information sheet and the consent form with each of our participants who we interviewed. Project Information sheet

Sample signed consent form

Project Links: Online collaboration work: Transcripts, Recordings & Consent forms: 68

Journey of Neurological Rehabilitation

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