Scope of Services
Burke’s Spinal Cord Injury/Neurological Rehabilitation Program:
- Maximizes recovery from the physical, cognitive, and psychological impairments caused by spinal cord injury
- Providing the highest quality, patient focused rehabilitation
- Provides rehabilitation through an interdisciplinary approach that emphasizes communication, collaboration and cooperation
- Focuses on the individual’s capabilities and use of compensatory strategies and devices to lessen activity limitations
- Removes or lessens restrictions to participation in life roles and situations to the extent possible, and counsels and educates individuals and families on alternative possibilities for life participation when necessary
- Prepares the individual with a spinal cord injury, family and/or caregiver to make the transition to the next stage of the rehabilitative process.
Burke’s intensive and comprehensive program focuses on maximizing each person’s ability to function, through personalized care and individually designed therapy programs. Preventing complications, improving self confidence, and optimizing adaptation and education, helps patients achieve the highest level of independence possible.
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 Spinal Cord Injury/Neurological Program:
- Served 55 patients with non-traumatic spinal cord injuries and 37 patients with traumatic spinal cord injuries ranging in age from 17 to 93 years old
- Discharged patients to the following environments:
- 53% of our patients with non-traumatic spinal cord injuries and 42% of our patients with traumatic spinal cord injuries returned home with home care, outpatient, or no further services because services were no longer needed
- 25% of our patients with non-traumatic spinal cord injuries and 35% of our patients with traumatic spinal cord injuries went to a sub-acute facility to continue their inpatient rehabilitation
- 22% of our patients with non-traumatic spinal cord injuries and 22% of our patients with traumatic spinal cord injuries were transferred to an acute hospital.
- 0% of our patients entered a long-term care facility
Within the scope of the Spinal Cord Injury/Neurological 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.
Diagnoses of patients served include traumatic spinal cord injury, aneurysm dissection with spinal cord infarction, transverse myelitis of any etiology, spinal tumors, etc. Beginning on the day of admission and continuing throughout the individual’s stay, the spinal cord injury team works collaboratively to identify and address the needs of each patient. The interdisciplinary assessment 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 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. The goal of the intensive rehabilitation program at Burke is to help each patient return to as active and productive a life as possible despite physical disability. 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 spinal cord injury is conducted by team members throughout the 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 and access to a physician are available twenty-four hours a day, seven days a week.
Every potential patient who may benefit from our care is discussed with the screening staff, physician, and/or program director. The rehabilitation potential for every patient is evaluated prior to admission.
Referrals to Burke are usually made by physicians, social workers, discharge planners or case managers. A reasonable medical and functional profile must be provided and appropriate sections of the medical record from the acute care process are included. A rehabilitation nurse may also perform a detailed evaluation at the referring institution. Recommendations are then made to the appropriate member of the medical staff who renders a final decision with regard to admission.
Diagnoses for admission include, but are not limited to: traumatic spinal cord injury, aneurysm dissection with spinal cord infarction, transverse myelitis of any etiology, spinal tumors, as well as disease of the peripheral nervous system.
Additionally, the following is a brief, but not inclusive, list of admission criteria:
- Prior to admission, the patient was independent in ambulation and activities of daily living
- The onset of spinal cord injury is within four weeks. Admission to Burke to commence once the patient is medically stable and can begin an aggressive therapy regimen. Patients should be transferred from the acute care neurotrauma services of regional or area hospitals as soon as ICU support is not longer needed, and he/she is not at risk for transport.
- The patient is not in danger to him/herself or other patients on the unit
- Patients with pulmonary complication and other neurological illness are accepted if viable candidate
- Any patient with tetraplegia will be admitted except those who require continuous respiratory support or custodial care
- Patients with paraplegia are admitted
- There is clinical documentation of spinal stability and/or the use of halo traction or esthetics, to enable the patient to participate in an aggressive therapy program
- If any one or combination of criteria is not met, the patient may still be considered for admission to Burke, but the program physician must review the screen
Patients are discharged from the inpatient rehabilitation program when any of the following occur:
- The patient has achieved maximal levels of functional improvement, or has gained the ability to direct his or her own care
- The patient shows no functional improvement despite alteration of treatment techniques
- The patient is discharged to an acute care hospital for medical reasons
- The patient is unable to participate in treatment due to medical, psychological, or cognitive reasons
The discharge planning process begins when the patient is first admitted to the program. The social worker/case manager leads the planning process, coordinating information from all members of the interdisciplinary team. Based on the individual’s functional status, family support, pre-morbid living situation and level of function and available health insurance, the team makes recommendations for the most appropriate and suitable discharge plan for the patient. At the team or family’s request, a formal meeting with the team and patient/family is scheduled to discuss appropriate options. A safe discharge is a primary consideration when options are considered.
Recommendations for discharge may include:
- Home with home care services
- Home with outpatient services
- Sub acute rehabilitation services
- Long term care services
The philosophy of the Spinal Cord 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:
- Individual with spinal cord injury
- Individual’s family and/or caregiver(s)
- Rehabilitation Nursing
- Speech and Language Therapy
- Occupational Therapy
- Physical Therapy
- Recreation Therapy
- Social Work/Case Management
- Respiratory Therapy
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
- Peer support
From admission through the discharge planning process, team members work collaboratively with each other, the individual with the spinal cord injury or neurological condition 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.
Based on the results of the initial assessment, goals are determined with the individual and/or family, and a treatment plan is implemented. The individual’s progress is discussed formally once per week at team conference/medical rounds. Team consultation and collaboration occur throughout the treatment program. In addition to speaking directly with members of the team regarding the patient’s medical condition, progress, functional status, participation in therapy, achievement of established goals, family members and/or caregivers are strongly encouraged to attend and participate in treatment sessions and patient care as appropriate.
As the leader of the interdisciplinary team, Dr. Huang 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 program also offers:
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 the injury or difficulty with adjustment to the disability.
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 therapist 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. Patients are evaluated by a speech-language pathologist when it is recommended by the team. Following a thorough and comprehensive evaluation, the speech-language pathologist determines appropriate therapeutic interventions, and work with patients to help regain communication skills 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.
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.
Use of Technology
- RTI FES Bike
- Bioness H200 and L300+
- Zero G Lite
The Spinal Cord 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 patients with spinal cord/neurological injury
- Establish an optimal model for patient centered, cost effective, interdisciplinary rehabilitation care of the individual with a spinal cord injury/neurological injury
- 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:
Patient and Family/Caregiver:
Ongoing education of the individual with a spinal cord injury or neurological condition and the family and/or caregiver is essential in order to maximize recovery from the physical, cognitive and psychological impairments caused by the condition and effectively prepare the individual and family and/or caregiver for the transition to the next stage in the rehabilitation process.
Individuals with a spinal cord injury or neurological condition will receive ongoing education from each discipline throughout his/her stay in order to maximize achievement of each individual’s goals. Much education focuses on the fact that, for many patients, their injuries and resulting conditions are life-changing and lifelong. Coping, resources, and the need for lifelong follow up to deal with changing needs are provided.
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 monthly support group is held at Burke for people with spinal cord injuries.
In house education via in-services provided by Burke staff, research staff, as well as outside speakers, including vendors, is provided to team members. Team members attend professional conferences, continuing education courses and seminars throughout the year. Clinical learning workshops that address current trends in the treatment of spinal cord injury and neurological conditions are provided regularly. Opportunities are available for education for advanced degrees and clinical specialty certifications.The program’s goal is to provide evidence-based, state of the art treatment. All staff education initiatives and opportunities will attempt to support this goal. 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.
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 time frames 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