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Rehabilitation Institute of Chicago: LIFE Center

Inpatient Rehabilitation Care: Description of Rehabilitation Roles

Reviewed February 2014
Author: Kristine C. Cichowski , MS
Rehabilitation Institute of Chicago
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Author: Lynn Danford , MS, LD
Education Program Manager
Rehabilitation Institute of Chicago LIFE Center
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Inpatient rehabilitation is provided by a multidiscipline treatment team which is directed by a Physiatrist (rehabilitation doctor). The rehabilitation team is composed of a variety of specialists depending upon a person’s individual needs and goals. The team works with patients and significant others to identify goals, discuss progress, and create an individual treatment plan focused on restoring and maximizing ability.

Therapy programs occur Monday through Saturday and some holidays. Patients receive a schedule each day that shows the time, location and type of therapy. It is typical to start with three hours per day including individual and group sessions. Attendance is required for all sessions.

Family and significant others play an important part of care and recovery. In addition to being a major motivator, family involvement ensures skills learned in therapy are continued in daily routines and healthy lifestyles are maintained after discharge. There are many aspects of care that need to be learned before discharge. Patient schedules will also include patient and family education sessions in order to help family members in developing care knowledge, skill and adjustment. Active and consistent participation of family is a vital component of rehabilitation success.

Each week the Physiatrist and team members meet and discuss patient treatment programs in a Team Conference. Based upon progress and needs, the team develops a plan to support patients and families in preparing for discharge. Team discussion includes: health status, goals, progress, weekly therapy, patient and family education needs and discharge plan.

Members of a Rehabilitation Team are selected based on specific needs and may include:

Physiatrists (Rehabilitation Physicians)
Doctors in the rehabilitation field who receive advanced training and certification in physical medicine and rehabilitation. “Physiatrists are experts on how nerves, muscles, bones and the brain work together. They look at the whole person, not just one symptom or condition.” 1 Inpatient Physiatrists manage medical care and oversee progress in therapy. In teaching hospitals, patients may also be seen by a resident physician – a medical doctor in training to specialize in physical medicine and rehabilitation or neurology. After discharge, the rehabilitation physician continues to provide and direct outpatient rehabilitation care. Patients should also maintain an internal medicine or family practice doctor for other, general medical needs.

Nurses
Rehabilitation nurses are very involved in teaching both patient and family about care needs and routines and have a variety of responsibilities:
• monitor and oversee daily care;
• teach and help patients and families practice care routines;
• administer medication and teach patients and families about scheduled use and possible side effects;
• collaborate with other team members regarding rehabilitation goals and needs for community reentry.
Note: At many facilities, a nursing assistant also provides for dressing, hygiene needs and assistance with feeding.

Care Manager
The Care Manager coordinates discharge plans and communicates with insurance or other payers about benefits. The Care Manager shares this information with the rehabilitation team to develop a plan that maximizes the rehabilitation stay. The care manager may have a background in either social work or nursing.

Social Worker
The social worker works with both patient and family in identifying care and transition needs to ensure a smooth discharge:
• evaluating support system and home needs;
• helping access community resources such as financial entitlements, home care and transportation;
• providing information about other types of care;
• counseling about adjustment issues related to disability.

Occupational Therapist (OT)
The OT checks current abilities and develops a treatment plan for meeting goals in Activities of Daily Living (ADLs) including:
• self–care, such as dressing and bathing;
• leisure, such as hobbies;
• work–related tasks;
• problem solving to accomplish any of the above;
• fine-motor skill development and strengthening, such as hand and arm exercises;
• if necessary, identify alternate ways with or without equipment to accomplish daily tasks.

Physical Therapist (PT)
The PT checks current physical abilities and develops a treatment program for meeting goals in:
• mobility needed for activities of everyday life such as exercising muscles and joints, moving in bed, using a wheelchair, transferring (for example, from the wheelchair to the car) and walking with or without equipment;
• performing mobility skills and exercises;
• selecting and ordering any equipment for discharge.

Speech Therapist/Speech–Language Pathologist
The speech–language pathologist works on communication skills including:
• listening, understanding and remembering what is heard in a conversation;
• thinking quickly and putting thoughts into words;
• sounding out words and explaining ideas;
• reading, understanding and remembering what is read;
• writing and putting thoughts into writing;
• if necessary, chewing and swallowing food since this involves the mouth and the throat.

Neuropsychologist
The neuropsychologist tests for thinking abilities and provides help with:
• understanding the links between brain injury, brain functioning and behavior;
• attention, memory, problem–solving skills, language skills and other areas of thinking;
• vocational recommendations;
• adjusting and coping with changes from a brain injury.

Psychologist
The rehabilitation psychologist meets with patients, family and significant others to help with adjustment to hospitalization and disability. The psychologist collaborates with the rehabilitation team to support psychological and interpersonal functioning.

Therapeutic Recreational Specialist
The therapeutic recreation specialist helps patients and families in applying skills learned in rehabilitation to activities that support their personal growth and active community participation:
• developing self-confidence and comfort in social situations both at home and in the community;
• experiencing individual and group activities to practice skills and develop strategies to nurture friendships and social support networks. Examples: athletics, travel, music, art, and hobbies as well as trips to restaurants, theaters and sporting events.
• finding new ways to pursue old interests through adaptations;
• identifying new areas of interest;

Vocational Rehabilitation Specialist
The vocational specialist assists with concerns and needs for returning to school or work:
• meeting with and educating employer or school staff regarding needs for reasonable accommodations;
• identifying educational or employment opportunities of interest;
• developing strategies for work or school reentry.

Chaplain
When a life–changing event occurs, spiritual needs may become heightened and yet they may be difficult to express. The chaplain can help with spiritual support during a hospital stay.

Clinical Dietitian
The clinical dietitian evaluates nutritional needs based on physicians' orders and medical condition. This can include:
• help with special diets as prescribed;
• general information on maintaining a healthy diet.

Prosthetist/Orthotist
Prosthetists and orthotists provide care for anyone requiring an artificial limb (prosthesis) or device to support or control part of the body (orthosis).
• Prosthetists design and provide limb replacements.
• Orthotists provide splints, braces and special footwear.

Respiratory Therapist (RT)
The RT helps with any breathing difficulties with may limit participation in other treatment activities.
• measure needs for supplemental oxygen and fit proper equipment;
• use treatments to help with coughing and keeping lungs clear;
• administer medications to open airways;
• work with necessary equipment.


References:
1American Association of Physical Rehabilitation & Medicine

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