Rehabilitation After Debilitation. James Inzerillo MD Physiatrist

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1 Rehabilitation After Debilitation James Inzerillo MD Physiatrist

2 What Happens to Me If I m I m Not Able to Take Care of Myself?

3 Rehabilitation Options Self-Rehabilitation Outpatient Rehab At Home Rehab Sub-Acute Rehab Acute Rehabilitation

4 Self-Rehabilitation For Relatively Minor Injuries Broken Arm Mild Generalized Deconditioning

5 Outpatient Rehab For More Moderate Injuries Address Need for Professional Coaching Physical Therapy Occupational Therapy Speech Therapy Difficulties with Speech Difficulties with Communication Difficulties with Higher Cognitive Functions CardioPulmonary Rehab Driving Therapy

6 At Home Rehab Through Home Health Agency For Patients Too Debilitated to Travel Pts are considered Homebound But CAN go out to Doctor s s Office & To Church Pts Have Strong At-Home Support Includes Nursing Services PT OT ST Social Services Meals-on on-wheels

7 Sub-Acute Rehab Pts are Too Debilitated To Care for Themselves Pts Have Poor Cognitive Status Pts Have Special Medical Needs IV Antibiotics Intensive Wound Care Under Direct Care of NP; with MD Oversight Pts Have No/Poor Support Systems May or May Not Go Home afterward

8 Acute Rehabilitation Unit (ARU) Pts are Too Debilitated To Care for Themselves Pts need Medical Monitoring Have Active Medical Issues in Need of Treatment Under Daily MD Supervision Pts Have Potential to Return Home After a Short Stay May or May Not Have a Strong Support System

9 Who Decides The Type of Rehab I Get? Input comes from Many Sources The Patient (That s s YOU!!) Your Doctor Consults (Physiatrist; That s s ME!!) Therapists Who Have Worked with You The Plan Should Be Agreed Upon By Everyone Involved. And Don t t Forget the INSURANCE COMPANY

10 The Social Worker Your Advocate

11 Physical Therapy Strength & Endurance Conditioning Gait & Pre-Gait Training Exercises Balance Training Modalities for Further Focusing Strength Training Function & Meaningful Tasks Gait with Visual Challenges / Divided Attention Challenges

12 Self care Skills Occupational Therapy Adaptive Techniques Adaptive Equipment Transfer Training Bed; Tub Benches; Bedside Commodes Neuromuscular RE-education Safety / Cognitive Changes Caregiver Training & Education Home Safety Evaluations Driving Tests for Motorized Wheelchairs & Scooters

13 Speech Therapy Swallowing Improvement Speech Treatment Language Treatment Speaking; Understanding; Reading; Writing; Cognitive Function Memory; Thought Organization; Attention Tasks Environmental Function Check Writing; Medication Management; Community Re-entry entry

14 Cardiac Rehabilitation & Pulmonary Rehabilitation Done in OutPt Facility CardioPulmonary Exercise For Pts with: Recent Heart Attacks Heart Failure Recent Heart Surgeries COPD Other Chronic Lung Disease

15 Driving Rehabilitation Am I Physically Capable of Driving? Do I Need Adaptive Devices? Do I Need a Specialized Modification or Specialized Vehicle Am I Cognitively Able to Drive?

16 How much Function will I Regain? How Much Function Did you have to Begin With? How Long were You Debilitated? How Much Work Are You Willing To Do? How Much Pain are You Willing to Deal With? How Good Are Your Therapists, Nurses, & Caretakers? What Type of Rehabilitation Will I Get?

17 The Acute Rehab Unit The Cadillac Plan of Rehabilitation Factors that Improve Restoration of Function The FASTER therapy is INITIATED The MORE INTENSIVE the therapy The MORE EFFORT by the Patient The QUALITY of the Therapists & Staff Specialized in ARU Goals

18 Geneva General Hospital s Acute Rehabilitation Unit A Breed Apart

19 How Successful is the GGH ARU? In the top 1% of 800 ARUs Nationwide. 1 of Only 13 units Nationwide in the Top 10% 5 years in a row!!! 2010: Top 1 % 2009: Top 3 % 2008: Top 1 % 2007: Top 2 % 2006: Top 2 %

20 How Successful is the GGH ARU?

21 How Do We Stand? GGH Regional National FIM Score: (Functional Independence) Length of Stay (#days): Discharge to Home (%):

22 How Do We Stand? Patient Satisfaction Results Converted to percentage scale in July, 2010 July 100% October 97.5% August 100% November 100% September 100% December 100% 2011: January 100% February 100% March 100%

23 GGH ARU We Stand Tall!!!

24 What does our Prestigious Standing Mean?

25 On a Personal Note: GGH s ARU GETS YOU BACK TO YOUR LIFE SOONER AND STRONGER than any other route.

26 How much therapy will I get in the ARU? 3 Hours of Individualized Therapy Daily Physical Therapy Occupational Therapy Speech Therapy Nursing & Aides specially trained to carryover and add to Therapy techniques Social Work /Discharge Planning Holistic Approach Team Meetings Family Meetings

27 The Team we are Proud Of!

28 Garnsey Rehab Center Outpatient Rehab Shares Gym & Facilities with ARU

29 Physical Therapy

30 Occupational Therapy

31 Speech Therapy

32 Criteria for an ARU admission You can t t be Too Good & You can t t be Too Bad. Be able to undertake 3 hours of therapy daily Need at least 2 of 3 therapies (PT/OT/ST) Requires Medical Supervision of a Physician specializing in PM&R (Physiatrist)

33 That s s Me!!!

34 Criteria for an ARU admission Have Potential to Improve Function Be Motivated & Willing To Participate Have an Identified Discharge Plan

35 Key Obstacles to an ARU admission. Pt Not Willing to Participate Pt Unable to Tolerate schedule. Functionally Too Independent Insurance! Insurance! Insurance!

36 We hope Never to see you in our ARU But If You or Loved One Has A Stroke There is NO BETTER PLACE TO BE!!! ehab_cindy_v2_ema

37 Will the Therapy be too much for me? Training for the Olympics Pt s s are pushed to THEIR Limit (but Not beyond) Therapy is spread out throughout the day. Therapy emphasizes Function.

38 When Should My Rehabilitation Begin?

39 Match Game - Which Patient got Which Therapy? Ann 24 Years Old Cesarean Birth Anna 83 Years Old Open Heart Surgery Who had 10 Days of Bedrest? Who was up & Walking to the Commode 18 Hours After The Procedure?

40 When Is the BEST TIME to Start Rehab?? Voice Your Opinion (Show of Hands)??? Immediately?????? After a Brief Period of Recuperation?????? After Pt is Stabilized Medically??????When the Pt feels ready for rehab???

41 Oh My, I broke my hip; Does this mean I m I m going to die within a year? Does this mean I m I m spending the rest of my life in a Nursing Home?

42 Mr. Bob A Tale of Two Townies Fractured Hip; Surgically Repaired 88 Years Old 5 Day Stay in ARU before Returning Home Walking 1 Mile /Day within One Month of DC with Cane. Mr. Bill Fractured Hip; Surgically Repaired 79 Years Old 5 Day Stay in ARU before Asking for Transfer to SNF (2 Day Stay in SNF before Asking for Transfer Back to ARU) 5 Weeks in SNF before Returning Home; to Mostly Household Ambulation

43 Mr. Bob A Tale of Two Townies Was Walking 3 ½ Miles Every Day Prior to his Fracture Mr. Bill Was Little more than Household Ambulator Prior to his Fracture

44 Your Take-Away Message:

45 WHEN IS THE BEST TIME FOR REHABILITATION?

46 NOW IS THE BEST TIME FOR REHABILITATION!

47 In the Words of Red Skelton May God Bless!!!

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