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Inpatient Rehabilitation Criteria and Treatment

Following discharge from the acute care setting, there are criteria for the type of setting patients will be discharged to as given below. Patients may be admitted to:
An intensive rehabilitation program
:
  • if it is felt they will benefit from the therapy;
  • they are not yet safe to return home; and
  • they are capable of tolerating and participating in a minimum of three hours of daily therapy.
A sub-acute rehabilitation facility:
  • if they cannot tolerate the minimum amount of therapy;
  • they require a considerable amount of care both day and night; and
  • it is not yet safe to return to a home setting.
Their home environment:
  • If they are making good progress;
  • it is safe to return to a home setting; and
  • they can receive necessary out-patient services and adequate follow-up care.
As therapy proceeds, they may go from a sub-acute setting to an intensive setting as they become more capable of tolerating and participating in therapy, or from an intensive setting to home rehabilitation as they require less care and are making progress.
Selecting an inpatient rehabilitation program
  • Inpatient rehabilitation will usually last 2 weeks to 2 months.
  • Access to a rehabilitation program may be insurance dependent.
  • To meet insurance requirements, a rehabilitation program generally needs to provide a daily minimum of three hours of physical, occupational, and speech therapy, and at least 2 of these 3 therapies.
  • In addition, cognitive retraining, recreational therapy, augmentative technology, and education should be available.
The rehabilitation program should :
  • match the particular medical, rehabilitation, social, family, and educational needs relevant to the age of the child and be modified as those needs change over time;
  • be interdisciplinary and comprehensive;
  • include cognitive and behavioral assessment and intervention;
  • include substance abuse evaluation and treatment where appropriate;
  • include community-based, non-medical services (support groups, social skills development, etc.);
  • include support for family and care-givers;
  • provide for patients and families to play an integral role in the planning and design of the individualized programs; and
  • be accessible through the entire course of recovery, which may last for many years after the injury.

Roles of the rehabilitation team

  • Physiatrist - the physician who directs the rehabilitation program and team, including monitoring agitation, irritability, sleep patterns, need for splinting or spasticity intervention with medications, injections, or a baclofen pump.
  • Occupational therapists - focus on activities of daily living (eating, toileting, bathing, dressing, grooming), small motor skills, upper extremity strength, visual perception, and handwriting. May also work on cognitive issues such as memory and comprehension.
  • Physical therapists - work on range of motion, mobility, and strength to re-establish balance, coordination, and walking.
  • Speech pathologists - initially assess swallowing to establish feeding safety. Later focus may move to problems with phonation, aphasia, and verbal apraxia. Also evaluates cognitive and language skills, and will work with the child on memory, comprehension, sequencing, and new learning.
  • Educational specialist - assesses the learning needs and skills. Coordinates with the school.
  • Social worker - helps the family to access community resources and cope with necessary changes and emotional needs.

Procedures/treatments/tests the patient may experience in rehabilitation

  • Physical, occupational, and speech therapy for several hours a day
  • Swallowing fluoroscopy (swallow study or modified barium swallow)
  • Tracheostomy, if necessary
  • Gastrostomy tube placement, if necessary
  • Extensive cognitive testing
  • Use of alternate communication aids

Feelings/experiences the patient/family may encounter in rehabilitation

  • A loss of perception of time;
  • Isolation from friends, family, community;
  • Serious discomfort or difficult-to-control pain;
  • One or more emotional outbursts;
  • Feelings of complete helplessness or despair; and
  • An alteration in family income and/or resources.

Authors

Author: Teresa Such-Neibar, DO - 11/2008