Scope of Services
The Brain Injury Team is committed to ensuring that each individual’s needs are addressed by:
- Providing rehabilitation through an interdisciplinary approach that emphasizes communication, collaboration and cooperation
- Lessening limitations of activities by focusing on the individual’s capabilities and utilizing compensatory strategies and devices
- Providing the highest quality, patient focused rehabilitation
- Removing or lessening restrictions to participation in life situations to the extent possible
- Providing counseling to the individual and family and/or caregiver on alternative possibilities for life participation when necessary
- Preparing the individual, family and/or caregiver to make the transition to the next stage of the rehabilitation process
Cultural and religious needs are respected for each patient by the entire team. Accommodations to the patient’s schedule, dietary needs and requests, and the provision of appropriate equipment are provided to enhance the patient’s experience and support full participation in the rehabilitation program. All staff members participate in annual cultural diversity and sensitivity training.
In 2014, the Brain Injury/Neurological Program:
- Served 116 patients ranging in age from 18 to 92 years old, who suffered from a brain injury
- Discharged patients to the following environments:
- 54% of our patients with non-traumatic brain injuries and 53% of our patients with traumatic brain injuries returned home with home care, outpatient, or no further services because services were no longer needed.
- 27% of our patients with non-traumatic brain injuries and 33% of our patients went to a sub-acute facility to continue their inpatient rehabilitation
- 19% of our patients with non-traumatic brain injuries and 14% of our patients with traumatic brain injuries were transferred to an acute hospital
- 0% of our patients entered a long-term care facility
Within the scope of the Brain Injury Rehabilitation Program, patient evaluation and care planning are designed around traditional medical disablement models. These models assess three levels of dysfunction which stem from the patient’s admitting diagnosis (pathology).
Impairments: Weakening, damage, or deterioration of function within a specific component of the musculoskeletal system, especially as a result of injury or disease.
Examples: Decreases in strength, active range of motion, passive range of motion, cognition, balance, and/or activity tolerance along with increases in pain and/or edema
Activity Limitations: The inability to perform a specific task as a consequence of the aforementioned impairments.
Examples: Difficulty with ambulation, stair negotiation, dressing, grooming or self-care
Participation Restrictions: The cumulative effect of impairments and activity limitations on the ability of a person to participate in life roles.
Examples: Inability to perform duties as a parent, caregiver, employee or participant in social and leisure activities.
The Brain Injury program serves patient populations from adolescence through geriatric. Diagnoses of patients served include subarachnoid hemorrhage, subdural hematoma, epidural hematoma, diffuse axonal injury, skull fracture, cerebral contusion, intracerebral hemorrhage, anoxic encephalopathy, brain tumor, meningitis, encephalitis, brain abscess and stroke.
Beginning on the day of admission and continuing throughout the individual’s stay, the brain injury team works collaboratively to identify and address the needs of each patient. The interdisciplinary assessment of the brain-injured individuals is conducted by the medical and rehabilitation professionals on the individual’s team, including the physician, nurse, social worker/case manager, clinical neuropsychologist, occupational therapist, physical therapist, speech-language therapist, recreation therapist and dietician. Other professionals, such as the orthotist, become part of the team as warranted. These professionals share the information obtained from the assessment via verbal communication and chart documentation so that each team member can understand the brain-injured individual’s strengths, impairments, and limitations to activity, restrictions in participation, and the environmental and personal contextual factors that may influence treatment outcomes and plans for discharge.
Based on the results of the assessment, goals are determined with the individual and/or family/caregiver(s) and a treatment plan is implemented. Team consultation and collaboration occur throughout the treatment program. The individual’s progress is discussed formally once per week at a team meeting. Family members and/or caregiver(s) are encouraged to attend and participate in treatment sessions and patient care as appropriate. A series of educational lectures and discussions for families and other caregivers on various topics related to brain injury is conducted by team members once a week.
Within a safe, secure and structured environment, each individual receives intensive therapy five to six times a week for a minimum of three hours. Rehabilitation nursing is provided 24/7 and a physician is always available.
Candidates for admission include:
- Patients who have suffered a head trauma
- Patients who have had an aneurysm repair
- Patients who have had a subarachnoid hemorrhage
- Patients who have had anoxic encephalopathy
- Patients who have had benign tumor resection
- Patients should not require one-on-one observation, should be able to bear weight, should be medically stable and should be able to follow simple commands.
- Patients who are in a coma or vegetative state
- Patients who require ventilator support.
Patients are discharged from the Inpatient Brain Injury Program when any of the following occur:
- The patient demonstrates ambulation/mobility, self-care and cognitive skills that meet the patient’s needs and allow for a safe discharge to that patient’s next stage in the rehabilitation process
- The patient shows no functional improvement despite alteration of treatment modalities and techniques
- The patient is unable to participate in treatment because of medical, psychological or cognitive status
- The patient is discharged from the hospital for acute medical reasons.
The social worker/case manager assumes a leadership role in planning and preparing for the individual’s discharge from the inpatient program. This planning and preparation begins when the individual is admitted to the inpatient program, continues during the inpatient stay and culminates when the team determines that the individual is ready to move to the next step in the rehabilitation process. The social worker/case manager is also responsible for arranging for individual tutoring for adolescents when necessary to address the patient’s educational needs. A formal meeting with the family or caregiver(s) is scheduled when appropriate and communication with the family or caregiver(s) occurs throughout the duration of the individual’s stay at Burke.
Based on the individual’s functional, cognitive and behavioral status, family support, insurance and pre-morbid living situation, the brain injury team makes recommendations for the most appropriate and suitable discharge plan for the individual. This includes recommendations for equipment and continued services. A safe discharge is the main priority when considering possible options. Recommendations may include, but are not limited to:
- Home with home care services
- Home with outpatient services
- Sub acute rehabilitation services
- Long term care services
In order to ascertain the long-term outcome for the individual, Burke contracts with a company to conduct follow-up interviews via phone at one month and three month post-discharge.
Continuing Stay Criteria
Decisions to continue a patient’s stay are made by the medical director of the Brain Injury Program. Changes in a patient’s medical status at the time of the planned discharge may precipitate the need to lengthen the patient’s stay at Burke. If the discharge is deemed unsafe for any reason, the patient’s stay is extended until an appropriate and safe discharge plan can be organized and coordinated. Reasons and subsequent decision to extend a patient’s length of stay are communicated to the patient, family and/or caregiver(s).
The philosophy of the Brain Injury Program is that the program’s mission can best be accomplished by providing rehabilitative care through an interdisciplinary team approach. The team consists of the following:
Additional services available to meet the needs of each individual patient include:
- Medical consultations (Podiatry, Urology, Plastics, ENT, Dermatology, etc.)
- Pastoral Care
- Orthotic Services
- Laboratory Services
- Complimentary Therapy
- Brain injury support groups for patients and families
From admission through the discharge planning process, team members work collaboratively with each other, the individual with the brain injury and the family and/or caregiver(s) to ensure that the specific needs of each individual are addressed. Patient and family and/or caregiver involvement and participation is strongly encouraged throughout the entire rehabilitation process.
As the leader of the team, the physician is responsible for directing the medical care of the individual and monitoring the overall team process and outcome. The social worker/case manager ensures that information regarding available funding for the individual is documented and considered during the intake, assessment, and treatment planning so that the individual’s funds are used appropriately at this stage of the rehabilitation process and the lifelong needs of the individual are considered.
Information regarding sources of funding, such as the TBI waiver, charity care, etc., is provided as appropriate to assist the patient, family and/or caregiver(s). The interdisciplinary assessment of the brain-injured individuals is conducted by the medical and rehabilitation professionals on the individual’s team, including a physician, a nurse, a social worker/case manager, a clinical neuropsychologist, an occupational therapist, a physical therapist, a speech-language pathologist, and a dietitian. Other professionals, such as a therapeutic recreation specialist, become part of the team when warranted to identify and focus on a patient’s leisure and recreational needs. Rehabilitation nursing and access to a physician are available twenty-four hours a day, seven days a week. Physical, occupational and speech therapists provide therapy five to six times a week. The clinical neuropsychologist addresses mental health issues and chemical use/abuse/dependency issues. Other services, such as urology, are arranged on an as needed basis.
The Brain Injury Program is actively involved in performance improvement initiatives. As part of the hospital’s strategic plan, the goals of collecting and analyzing data on a continuous basis include:
- Improve operational efficiency in caring for brain injury patients
- Establish an optimal model for patient centered, cost effective, interdisciplinary rehabilitation care of the brain injured patient
- Develop a data collection system to document and provide information to monitor and evaluate the clinical effectiveness of the program
- Utilize outcome information to establish standardization of care and evaluation guidelines.
Outcomes that will be measured will address effectiveness, efficiency, access and satisfaction. They include:
- FIM gain by RIC
- Discharge disposition
- Achievement of FIM Scores for mobility and self care tasks
- FIM efficiency
- Compliance with the “Three Hour Rule”
- Percent of patients screened versus patients admitted
- Patient satisfaction
- Length of stay
Additional outcomes measured include:
The interdisciplinary team is lead by Dr. Justin Hill, MD, a neurologist who has experience caring for brain injured patients. As the leader of the team, Dr. Hill is responsible for directing the medical care of the individual and monitoring the overall team process and outcome. At Burke, a physician is available 24 hours a day, seven days a week. Medical consultations (Podiatry, Urology, Plastics, ENT, Dermatology, etc.) are available to address all patient needs while at Burke.
The Burke Rehabilitation Hospital has long recognized that coping with a neurological illness or injury is difficult for patients and families. Burke’s clinical neuropsychologist, Dr. Julieanne Shulman, Psy.D., a specialist in the evaluation and treatment of brain-behavior relationships, works with patients to monitor recovery progress and develop treatment goals and objectives for patients with behavioral and cognitive impairments such as personality changes, brought on by brain injury.
A formal neuropsychological progress evaluation is conducted each week to assess the patient’s psychological, behavioral, coping and adjustment status. Cognitive functioning is evaluated with widely used neuropsychological measures of attention, memory, visual-spatial skills, language abilities, and problem-solving skills. Intervention may consist of education about brain injury, its affects on cognition, learning strategies to effectively compensate, and individual and group exercises to rehearse and strengthen problem areas.
Occupational therapists assist patients in becoming as independent as possible with daily activities, including dressing, bathing, personal hygiene, feeding, getting around in the home and community, pursuing household, work related or leisure activities, and all other activities that occupy one’s day. Following a thorough and comprehensive evaluation, the occupational therapist design an individualized treatment program tailored to address each patient’s individual needs.
Occupational therapists are responsible for teaching patients the skills necessary for wheelchair mobility as well as determining the appropriate equipment for each patient (e.g. wheelchair, bathroom equipment, adaptive equipment, electronic equipment). In addition, occupational therapists evaluate visual skills, perception skills, and cognitive skills related to functional activities.The Occupational Therapy team assists patients and family members and/or caregivers in learning how to do familiar tasks in a new way, and help to make the transition to home and into the community as smooth as possible.
Physical therapists assist patients in becoming as functionally independent and maximize recovery following trauma or illness. Physical therapy may consist of muscle strengthening, endurance training, breathing retraining, improving flexibility, balance training, and functional mobility skills training. Functional mobility skills training includes getting in and out of bed, transferring to and from a wheelchair, mat, and bed, walking and going up and down stairs (as appropriate). Following a thorough and comprehensive evaluation, the physical therapists design an individualized treatment program tailored to address each patient’s individual needs.
Speech-language pathologists evaluate and treat adults with communication disorders, such as speech, language, voice and cognitive difficulties, and swallowing disorders. Each patient is evaluated by a speech-language pathologist. Following a thorough and comprehensive evaluation, the speech-language pathologist determines appropriate therapeutic interventions, and work with patients to help regain the ability to express and understand wants and needs at simple and complex levels. Speech-language pathologists help restore speech clarity and improve cognitive functioning, problem solving and memory as well as assisting patients with swallowing disorders to safely drink liquids and eat foods.
Rehabilitation nursing is a specialty of professional nursing and is available at Burke Rehabilitation Hospital 24 hours a day, seven days a week. Nurses at Burke function as care coordinators as they work with patients, family members and/or caregivers and as part of the rehabilitation team to solve problems and promote each patient’s maximum independence. The nursing team consists of a nurse manager, registered nurses, rehabilitation technicians, nursing assistants, and nursing attendants. Throughout a patient’s stay, the nursing team provides education to the patient, family and/or caregiver, administer medications and assist with personal care needs.
Social Work/Case Management
The social worker/case manager assumes a leadership role in planning and preparing for the individual’s discharge from the inpatient program. Social workers/case managers help patients and family members deal with social, financial, and emotional aspects of the patient’s condition. This planning and preparation begins when the individual is admitted to the inpatient program, continues during the inpatient stay and culminates when the team determines that the individual is ready to move to the next step in the rehabilitation process. The social worker/case manager is also responsible for arranging for individual tutoring for adolescents when necessary to address the patient’s educational needs. A formal meeting with the family or caregiver(s) is scheduled when appropriate and communication with the family or caregiver(s) occurs throughout the duration of the individual’s stay at Burke. In addition, social workers/case managers serve as hospital liaisons with the patient’s insurance case manager.
Recreation therapists use a wide range of interventions to help patients make improvements in the physical, cognitive, emotional, social, and leisure areas of their lives. They assist patients develop skills, knowledge and behaviors for daily living and community involvement. Recreation therapists work with the patient to incorporate specific interests into therapy to achieve optimal outcomes that transfer to real life situations. Research supports the concept that people with satisfying lifestyles will be happier and healthier.
Recreation therapy interventions for patients include individualized therapy sessions, humor therapy, relaxation therapy, and complementary therapy. Computers, games, crafts, adapted sports, and other activities are incorporated. Leisure education and leisure resources are offered, in addition to entertainment and social programs.
A registered dietitian visits patients in need of assistance in understanding their dietary modifications or other nutritional concerns in order to provide patients and family members with the knowledge and skills to make informed choices about healthful diets.
Education and Training:
In an effort to promote ongoing education and learning, an interdisciplinary inservice program is provided for the members of the Brain Injury Program. Each discipline is responsible for presenting a topic relevant to brain injury rehabilitation. Inservices are scheduled on a rotating basis once a month. Team members attend professional conferences, continuing education courses and seminars throughout the year to supplement what is learned and experienced in the clinic. Participation in research initiatives and presentations of poster/platform presentations at seminars and conferences is encouraged.
Team members are actively involved in community events, such as contributing to and participating in activities of the White Plains Chapter of the ThinkFirst Program, a nationally based spinal cord and brain injury prevention program. Certification training in Non-Violent Crisis Prevention Intervention (CPI) techniques is provided for team members to ensure consistency in handling behavioral issues. Annual re-certification training is required.
Patient and Family/Caregiver Education
Ongoing education of the individual with a brain injury and the family and/or caregiver is essential in order to maximize recovery from the physical, cognitive and psychological impairments caused by brain injury and effectively prepare the individual and family and/or caregiver for the transition to the next stage in the rehabilitation process.
Individuals with a brain injury will receive ongoing education from each discipline throughout his/her stay in order to maximize achievement of each individual’s goals. Family members and/or caregivers are encouraged to attend and participate in treatment sessions and patient care activities as appropriate. Providing education and training for the family and/or caregivers is an essential component of the patient’s rehabilitation stay and provides an opportunity to successfully transition the patient to the next phase of rehabilitation.
A series of educational lectures and discussions for families and other caregivers on various topics related to brain injury is provided by team members every Tuesday at 4 p.m.
Use of Technology
- RTI FES Bike
- Bioness H200 and L300+
- Zero G Lite
Hospital chaplains representing the Jewish, Catholic, and Protestant faiths are available to visit patients and families. Chaplains offer pastoral care and provide for various religious needs. Patients may arrange for visits from clergy from other religious traditions. Holiday services for various faiths are held. The chaplains respect each patient’s personal beliefs and individual ideas. The goal of the Pastoral Care Department is to help renew each patient’s sense of hope and offer a spiritual home away from home.
All appropriate information will be maintained in each patient’s Electronic Medical Record (EMR) for the duration of the patient’s stay. All other documents will be maintained in the patient’s medical chart. At discharge, these documents will be scanned to be included as part of the patient’s EMR.
Each discipline will be responsible for completing all appropriate documentation and abiding by timeframes established by the hospital. Discipline specific documentation requirements include:
- Pre-admission screening information
- Admission screens
- Initial evaluations
- Daily charting
- Discharge evaluations
- Equipment request/justification forms