Stroke Rehabilitation Program Description
The Burke Rehabilitation Hospital’s Stroke Rehabilitation Program is dedicated to providing the most effective, patient-centered, state of the art rehabilitative care to individuals who have sustained a stroke. The Stroke Program provides comprehensive services that prevent secondary complications, minimize impairment, reduce activity limitations, and maximize the participation and quality of life for persons who have sustained a stroke. Interdisciplinary rehabilitation, provided by a trained and experienced team, maximizes recovery from the physical, visual, cognitive and psychological impairments caused by stroke. The multidisciplinary team works collaboratively with the individual and the family and/or caregiver, providing patient centered care and using evidence-based practices, to help every patient achieve his/her full potential.
Scope of Services
The Stroke Rehabilitation Program provides comprehensive services and medical management, anchored by interdisciplinary professionals who involve patients and families in all phases of rehabilitative care. These stroke specialists assess each person’s abilities and help each patient develop realistic short- and long-term goals, applying the latest research and technology methods. The program provides ongoing access to information about available services and resources that improve the quality of life of the patient.
The rehabilitation team consists of the patient, his or her family and/or caregivers, and medical, nursing and other rehabilitation personnel who, by virtue of their education and experience, are trained to work with individuals who have sustained a stroke. The medical and rehabilitation professionals on the team are responsible for assessing the individual’s medical, behavioral and rehabilitation needs, establishing individualized goals in consultation with the individual and/or family/caregiver, designing and implementing a treatment program, assessing its outcome, communicating with the team and preparing the individual and family for the next phase in the rehabilitation process.
Burke’s rehabilitative program:
- Maximizes recovery from the physical, cognitive, and psychological impairments caused by stroke.
- 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 and family/caregiver to make the transition to the next stage of the rehabilitative process.
- Provides interdisciplinary rehabilitation that emphasizes communication, collaboration and cooperation
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 Stroke Program:
- Served 449 patients ranging in age from 37 to 96 years old, who suffered from a stroke.
- Discharged patients to the following environments:
- 51% of our patients returned home with home care, outpatient, or no further services because services were no longer needed.
- 37% of our patients went to a sub-acute facility to continue their inpatient rehabilitation.
- 12% were transferred to an acute hospital
- 0% entered a long-term care facility
Within the scope of the Stroke 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 cardiopulmonary and/or musculoskeletal system resulting from injury or disease.
Examples: decrease in exercise tolerance, decrease in balance, limitations in pulmonary hygiene, decreased cardiac output, decreased ventilator capacity, decrease in strength, decrease in active and/or passive ROM.
Activity Limitations: The inability to perform a specific task (i.e. dressing or stair climbing) 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.
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. Nurse Screeners may accept patients from referring acute care facilities. The patient screens may be done in person or from faxed material and staff phone interviews. A rehabilitation nurse may also perform a detailed evaluation at the referring institution. A reasonable medical and functional profile must be provided and appropriate sections of the medical record from the acute care hospital are included. Recommendations are then made to the appropriate member of the medical staff who renders a final decision with regard to admission.
Patients may be candidates for the Stroke Program if they present with the following:
- Primary diagnosis of stroke, subarachnoid hemorrhage, intracerebral hemorrhage, subdural hematoma and resection of meningioma
- Prior to onset of diagnosis, patient was independent in ambulation and activities of daily living
- Onset of stroke is within 6 weeks of screening
- Patient is not receiving Haldol, Mellaril or any anti-psychotic medication. Anti-depressant therapy is accepted. Patient is not a suicidal risk
- Patient should be medically stable, out of ICU and off telemetry. Will accept patients with feeding tubes, IV antibiotics and oxygen
- Patients who have had removal of benign/malignant brain tumors, who are currently not undergoing chemotherapy or radiation therapy
- Patients who have residual weakness, incoordination, spasticity, dysphagia, dysarthria, sensory loss or perceptual problems
- Comatose patients are not accepted
- Patient does not have an infectious disease
- Patient demonstrates ability to interact with nursing staff and therapists
If any one or combination of criteria is not met, the patient may still be considered for admission to Burke, at the discretion of the physician.
Patients are discharged from the Stroke Rehabilitation 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 has achieved maximal levels of functional improvement for the acute rehabilitation level of care
- 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 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 and acts as the primary liaison between the team and the patient and family. Based on the individual’s functional status for self care, mobility, and other daily life skills, family/caregiver support, medical needs, pre-morbid living situation and level of function, and available heath insurance, the team, in collaboration with the patient and family, makes recommendations for the most appropriate and suitable discharge plan for the patient. At the team or family’s request, a meeting with the team and patient/family is scheduled to discuss available discharge options. The patient’s and family’s preferences are of primary concern and the team will make recommendations for a safe discharge when options for continued care and rehabilitation are considered.
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
- Hospice services
The Stroke Rehabilitation Program focuses on building a caring and compassionate relationship with each patient and his or her family members and/or caregivers. Rehabilitative care is provided through the integration of services from an interdisciplinary team.
The rehabilitation program’s interdisciplinary team consists of:
Additional services are available on site to meet the needs of each individual. These include:
- Medical consultations
- Pastoral care
- Orthotic services
- Laboratory services
Additional medical needs are met, either on site, through consultative services with various specialists, or at a local hospital for any specialized services.
From admission through the discharge planning process, all team members work collaboratively to ensure that the specific needs of each individual are addressed. Based on assessment results, 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. Family and/or caregiver involvement and participation is strongly encouraged throughout the entire rehabilitation process.
The Rehab Program
Patients in the stroke program will receive a minimum of 3 hours of therapy a day, 5 days per week, generally Monday through Friday, and a sixth day of therapy, generally Saturday, for 1-2 hours. Patients’ therapy schedules are customized to meet individual needs, facilitate goal achievement and expected discharge environment and to meet patient and family preferences and needs. The therapy complement often changes during the patient’s rehab stay to continuously meet these changing and ongoing needs. Therapy gyms and a dining room are located on the same floor with the nursing unit and patient rooms, which insures a milieu environment most conducive to carryover of rehab goals, and facilitating carryover with all members of the treatment team, patients and families.
The Stroke Rehabilitation Program continuously looks for ways to improve performance. The Stroke Rehabilitation Program is actively involved in performance improvement initiatives which:
- Improve operational efficiency in caring for patients who have sustained a stroke;
- Establish an optimal model for patient centered, cost effective, interdisciplinary rehabilitation care of the patient who has sustained a stroke;
- Utilizing data 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.
In accordance with Burke’s overall strategic plan to improve effectiveness, efficiency, access and satisfaction, data is collected and analyzed on a continuous basis. The following core outcome measures are tracked, measured and analyzed:
- Maximizing functional gain and recovery by looking at FIM gain
- Optimizing discharge to the community by tracking discharge disposition
- Maximizing functional outcomes for self care by comparing admission and discharge FIM scores
- Length of stay
- Maximizing functional improvement within the LOS (FIM efficiency)
- Compliance with the “3 hour rule”
- Minimizing time from referral to authorization of admission
- Maximizing inpatient admissions to the program
- Patient satisfaction with their stay at Burke Rehabilitation Hospital
- Patients reporting that they have met their therapy goals
- Patients likely to recommend Burke Rehabilitation Hospital
In order to ascertain long-term outcomes for the individual, follow up information is collected post-discharge via phone interviews. Information is collected, collated, and analyzed for potential program updates to facilitate outcome durability.
Through partnerships with the Burke Medical Research Institute, many opportunities exist for patients to participate in cutting-edge clinical rehabilitation research trials. Past and current projects focus on enhancing the rehabilitation process through the use of specific treatments and/or drugs, which can optimize rehabilitation and the recovery process. Past and current projects have included:
- The Influence of Motor Control Instruction and Taping on Center of Pressureand Scapulothoracic Kinematics During Reaching in Individuals with Hemiparesis
- Comparison of Physical Therapy Interventions for Individuals with Lateropulsion Following Stroke
- Effect of Electrical Stimulation to Neck Muscles on Unilateral Neglect Following Stroke
- Use of a Wakefulness-Promoting Agent(Armodafinil ) Combined with Neuro-Rehabilitation to Improve Neurological Recovery and to Reduce Disability in Patients Who Suffered A Stroke
- Iris Trial: Insulin Resistance Intervention After Stroke or TIA
- Stroke Biomarkers
- Quantification of Visual Neglect Through Thresholding: The Absolute and Relative Differences in Visual Fields
- Aphasia, Depression and Functional Outcomes in Stroke Patients
- Robotics Research
- Promoting Stroke Recovery with Theophylline: A Pilot Study
- SIRROWS: Stroke Inpatient Rehabilitation Reinforcement of Walking Speed
- Transcranial Magnetic Stimulation Trial for Patients with Lateropulsion
- Reduced Impedance Torque Activator (RITA)
- Visual Restoration Therapy
- SIRRACT: Stroke Inpatient Rehabilitation Reinforcement of ACTivity
- Epigenetic Predictors of Stroke Recovery
Education is offered both to patients/families/caregivers, as well as to staff.
Patient and Family/Caregiver
Education is provided throughout the rehabilitation process during all treatment sessions, as well as though a weekly, evening, Stroke Education Program. These are multidisciplinary sessions, with a comprehensive learning agenda, that is available for all patients and their families/caregivers within the program.
Patients’ families and caregivers are encouraged to make arrangements to observe therapies in order to be aware of their loved one’s progress. Often, additionally, the team will initiate not only observation of treatment, but active participation in training, so that families/caregivers are educated regarding safe and effective techniques to assist their loved ones. 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.
Much education focuses on the fact that, for many patients, their conditions are life-changing and lifelong. Coping, resources, and the need for lifelong follow up to deal with changing needs are provided.
In-house education via in-services provided by Burke staff, research staff, as well as outside speakers, including vendors, is provided to team members. Staff are encouraged to attend continuing education seminars and workshops that address current trends in the treatment of spinal cord injury and neurological conditions. Opportunities are available for education for advanced degrees and clinical specialty certifications. Staff are encouraged to contribute to and participate in community projects and organizations. Participation in research initiatives and presentations of poster/platform presentations at seminars and conferences is encouraged.
The program’s goal is to provide evidence-based, state of the art treatment. All staff education initiatives and opportunities support this goal.
Documentation is completed using Burke’s electronic medical record (EMR). Each discipline is responsible for completing required documentation, according to hospital wide policies and procedures. All appropriate information will be maintained in each patient’s 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.
Documentation that is included in the EMR includes:
- Pre-admission screenings
- Admission screens
- Initial evaluations
- Daily notes
- Weekly progress notes/reevaluations
- Discharge summaries
- FIM initial and discharge scores
- Team conference reports
- Equipment requests/justification forms
The goal of Burke's Stroke Rehabilitation Program is to help patients achieve the highest level of independence possible while recovering from the physical, visual, cognitive and psychological impairments caused by stroke. Burke’s expert team uses evidence-based practices and comprehensive services to prevent secondary complications, minimize impairment, and reduces activity limitations while helping each individual achieve his/her full potential.
Burke’s individualized programs, including one-to-one therapy, use of state of the art technologies, and evidence based treatments, provide training and education to improve independence and quality of life for patients and families/caregivers.