Long Term Phase
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As mentioned before, there are multiple options when it comes to a stay in a rehabilitation unit. Many hospitals have an in-patient unit and the natural flow is from the Neuro floor right in to the rehab unit. There are also some stand-alone rehabilitation centers that are not associated with your hospital. Some of these units have developed national reputations for their expertise.
The goal of these rehab units is to maximize the patient’s current abilities and to help them learn coping and compensation techniques for any deficits they may still have. Your insurance coverage will again come into play to determine what rehab options are available to you. What we have seen is that you only get so much in-patient rehab time so make sure you consult with your doctor so he or she can help you maximize the rehab opportunity.
Depending on where you live you may have a number of rehab units available to you. In our opinion, experience does matter. Each type of injury does have its own nuances and the more patients the facility treats with a similar injury to your own, the better.
Check to see what equipment the facility has. Having the latest equipment is not necessarily an indicator that the therapy will be better than any other place. But, in my mind it might indicate that the facility has a staff that is being aggressive and staying up with the latest industry techniques. Also, pay close attention to what equipment they use with your patient so you know what you will need to try to duplicate for your rehab set-up at home.
A couple of the rehab centers I have been in have areas where they have duplicated parts of the home environment to help patients re-learn some of the skills needed. One particular facility had an apartment set up with a bedroom, a kitchen, bathroom, and living room. Patients practiced cooking or just getting in and out of bed in an attempt to further prepare them for their transition home.
What To Expect
Each patient’s condition will vary but it is likely at this point that your loved one has not been active for weeks now. They come into the in-patient rehab center and they are expected to actively participate in therapy. The schedule will probably include all three disciplines, Speech, OT and PT, twice a day. Some facilities include recreational therapy which adds more therapeutic activity in a fun format with crafts and games.
It may take some time for them to ramp up their endurance. You can help by being there with them during therapy and helping to motivate them, even when they are tired. A key to continuing in rehab is the ability to make progress and meet the goals set. Again, you only get so many days, so, you want to help maximize every day and every therapy session.
Training The Family
Part of the goals for each therapist will probably include goals around training the family. Make sure you participate and feel comfortable with the tasks. The more you actually do hands-on the better. It is one of those things where it seems simple at the time but when you are home and trying to do something like a transfer by yourself, it is scary.
Expect To Be Surprised
For some patients, once they are up and actively participating in therapy they make rapid advances. Not to say that there may not still have deficits, but, considering where you were when they were in the ICU for instance, this is great.
If your patient has been more severely injured the advances will be smaller but you still may find yourself pleasantly surprised. As we have said before, the more severely injured the patient, the smaller the increments need to be as you measure improvements. Remember, it was not very long ago that you probably did not even know if they would survive.
Tips From One Family To Another
Attend The Therapy Sessions
We recommend going to as many of the therapy sessions as possible. You can help motivate your patient and learn the therapy techniques you will need to continue at home. The staff will let you know their particular visitation rules. We were always encouraged to participate as much as possible with our daughter.
Attend the Patient Reviews
Some rehab units have patient review meetings where the entire team, including the family, gets together and discusses each patient. They discuss how the patient is progressing towards their goals and any modifications to the plan. For you, these meetings are key as they will decide if the patient continues on in the rehab program. So, you definitely want to be there and participate.
Make Sure You Get Your Money's Worth
The therapy sessions in the hospital tend to be about forty-five minutes in length. While we had an overall good experience, the quality of the sessions can vary based on the particular therapist. Most therapists were ready and worked quickly from start to finish. A few were late and then took much of the time just preparing for the session. We were sometimes lucky to get ten minutes worth of exercise. Added into the mix are the logistics of the transporters getting the patients from session to session on time. So, the message is to stay on top of things and if you do not feel you are getting a full session, ask for more and, if necessary, speak with the doctor. Remember your rehab days are a scarce resource.
Challenge the rehab team to take an aggressive approach. Ask the doctor what are all the options available. What about gait training, standing frame, botox injections, or serial casting? We believe sometimes it comes down to individual therapists or doctors and their styles. Let the doctor know that while you want everything to be safe, you do want to be aggressive.
Consulting / Medical Equipment
Take advantage of the expertise of the physiatrist and the therapists to help plan the equipment you will need and help develop a plan of care after you leave rehab. The OT for example, can help explain what you need to do to make your home more accessible. They can recommend things like special silverware or plates for eating, or games to buy that will reinforce movements they want your loved one to practice. The PT can get your patient fitted with a wheelchair if necessary. The doctor will set the overall direction and will write the prescriptions for the specific items the therapists recommend.
Have Others Trained
Extend the training to others in your family who may be helping you when you go home. If you are learning how to do transfers, teach the others in your family how to do it as well. In fact, practice on each other. It will take away the anxiety that they will have in practicing on the patient. Have them attend some of the therapy sessions with you.
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