1 The following excerpt has been taken from the Christopher & Dana Reeve Foundation Paralysis Resource Center website. How_to_Pick_a_Rehab.htm Rehabilitation How do you choose the right rehab setting once you or your loved one is past the very early or acute phase of paralysis or disease? While the nearest facility may be the most convenient, and may offer many advantages in terms of support from family and friends, it may not offer the level of service needed in a complex injury or disease. Some questions to consider: Does the facility have experience with the particular diagnosis or condition? Usually the more patients a facility treats, the higher the expertise level of the staff. Is the place accredited that is, does it meet professional standards of care for your specific needs? Generally speaking, a facility with accredited expertise is preferable to a general rehabilitation program. For example, accreditation by the Rehabilitation Accreditation Commission (CARF) for spinal cord injury indicates that the facility meets a minimum standard level of care. Programs seek CARF accreditation when they feel their programs are exceptional. CARF promotes outcomes-driven, value-based services for people with disabilities due to disease or injury. CARF accreditation is important for both privately and publicly financed rehabilitation care. Another aspect of good rehab is the breadth and quality of the professional staff on hand. Among the professions you can expect to find on a rehabilitation team: Physiatrist A physiatrist (fizz-ee-at-trist, or more commonly pronounced fizz-eye-a-trist) is a doctor specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. They treat acute and chronic pain
2 and musculoskeletal disorders. They may see a person with back pain, an athlete who sprains an ankle or a typist who has carpal tunnel syndrome. Physiatrists coordinate the long-term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations and multiple sclerosis. A physiatrist must complete four years of graduate medical education and four years of postdoctoral residency training. Residency includes one year spent developing fundamental clinical skills and three years of training in the full scope of the specialty. Rehab Nurse Nurses with special training in rehabilitative and restorative principles work collaboratively with the rest of the rehabilitation team to solve problems and manage complex medical issues. Rehabilitation nurses are experts in bladder, bowel, nutrition, pain, skin integrity, breathing, self care, coordination of medical regimens and related issues. They provide ongoing patient and family education, set goals for maximal independence and establish plans of care to maintain optimal wellness. Rehabilitation nurses begin to work with individuals and their families soon after the onset of a disabling injury or chronic illness and they continue to provide support after return to home, work or school. According to the Association of Rehabilitation Nurses, "rehabilitation nursing" is a philosophy of care, not a work setting or phase of treatment. Rehabilitation nurses take a holistic approach to meeting patients' medical, vocational, educational, environmental and spiritual needs. Occupational Therapy An occupational therapist (OT) is skilled in helping individuals learn, or relearn, the dayto-day activities they need to achieve maximum independence. OTs offer treatment programs to help with bathing, dressing, preparing a meal, house cleaning, engaging in arts and crafts or gardening. They make recommendations and offer training in the use of adaptive equipment to replace lost function. OTs also evaluate home and job environments and make recommendations for adaptations. The occupational therapist also guides family members and caregivers in safe and effective methods of caring for people. Occupational therapy not only helps to restore basic physical skills, but also facilitates contact with the community outside of the hospital. Physical Therapy The physical therapists (PT) treat disabilities that result from motor and sensory impairments. Their aim is to help people increase strength and endurance, improve
3 coordination, reduce spasticity, maintain muscles in paralyzed limbs, protect skin from pressure sores and gain greater control over bladder and bowel function. PTs also teach paralyzed people techniques for using assistive devices such as wheelchairs, canes or braces. In addition to "hands-on" exercises and treatments, physical therapists also educate people to take care of themselves. PTs may also work with joints and assure their range of motion. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs and ice. Other therapists you should find on the rehab unit include: Recreation therapists help people discover the wide range of recreation options available in their community. Vocational therapists help people assess their job skills and to work with the state Vocational Rehab or other agencies to obtain equipment, training and placement. Many rehab facilities have seating and positioning experts to help people select the best wheelchair, cushion and positioning gear. Most facilities have rehab psychologists to assist people with the often-dramatic life changes that follow disease or trauma. Sex and family counseling are integral to most rehab programs, in order to help patients better understand sexual function, family planning, etc. Sources: American Occupational Therapy Association, American Physical Therapy Association, American Academy of Physical Medicine and Rehabilitation, Rehabilitation Accreditation Commission, Association of Rehabilitation Nurses Web Sites The American Academy of Physical Medicine and Rehabilitation The national medical society for more than 6,400 physicians who are specialists in the field of physical medicine and rehabilitation (physiatrists). Web site includes a physician directory by state. American Physical Therapy Association (APTA) The main membership organization for the PT profession, furthering the prevention, diagnosis and treatment of movement dysfunctions.
4 American Occupational Therapy Association (AOTA) Advances the field of occupational therapy through standard-setting, advocacy, education, and research. The American Congress of Rehabilitation Serves people with disabling conditions by promoting rehabilitation research and the transfer of technology. Association of Rehabilitation Nurses Promotes and accredits rehab nurses and promotes the philosophy of care of the nursing professional. Commission on Accreditation of Rehabilitation Facilities (CARF) CARF is an independent, not-for-profit accrediting body promoting quality, value, and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons receiving services. Founded in 1966 as the Commission on Accreditation of Rehabilitation Facilities, the accrediting body is now known as CARF. CARF establishes customer-focused standards to help providers measure and improve the quality, value, and outcomes of their services. At present, CARF has accredited more than 3,500 organizations in the United States, Canada, and Sweden in the areas of Adult Day Services, Assisted Living, Behavioral Health, Employment and Community Services, and Medical Rehabilitation. CARF develops and maintains practical and relevant standards of quality for such programs. RehabTeamSite / PoinTIS PoinTIS (Point of Care, Teambased Information System) is a web site that provides comprehensive information on spinal cord injury rehabilitation and traumatic brain injury rehabilitation for health care providers, patients and patients families. They are readily accessible at the point-of-care and along the entire continuum of patient care. PoinTIS provides access to a tutorial, handbooks and literature searches. Model Systems Knowledge Translation Center Lists the 14 model Spinal Cord Injury rehab centers in the U.S. National Rehabilitation Association (NRA) Not long after Congress passed the National Rehabilitation Act of 1920, the National Rehabilitation Association (NRA) began its commitment to persons with disabilities. As the oldest and strongest advocate for the rights of persons with disabilities, NRA's mission is to provide advocacy, awareness and career advancement for professionals in the fields of rehabilitation. Their members include rehab counselors, physical, speech and
5 occupational therapists, job trainers, consultants, independent living instructors and other professionals involved in the advocacy of programs and services for people with disabilities. Futures Unlimited Futures Unlimited is an outpatient physical therapy and rehabilitation service providing a broad range of physical and rehabilitation services, modalities and techniques. During the past few years, Futures Unlimited has been working with various problems related to the functions of the nervous system, using very basic techniques to allow the nervous system to correct itself. They have seen improvements in a number of different problems. The most notable improvements have been observed in the treatment of Cerebral Palsy (CP), Traumatic Brain Injuries (TBI), Spinal Cord Injuries (SCI) and Post Polio Syndrome (PPS). Their services are provided by licensed physical therapists according to the laws of the state in which the service is provided. Patients are treated only through proper medical referrals. All treatment methods, modes, techniques, modalities, equipment, facilities, personnel, etc. are within the purview of usual and accepted standards of physical therapy and physical therapy clinical practice. Northeast Center for Special Care (NCSC) The Northeast Center for Special care is a unique, state-of-art, inpatient, special care center designed to serve medically complex and multiply impaired needs such as: brain injury, neurological disease, spinal cord injury, neurobehavioral disorders, complex medical recovery and ventilator care/management. Committed to excellence and aware of the precious value of each person's life experience, Northeast Center for Special Care is focused on our neighbor and family outcomes. The neighbors, their family and our staff are empowered to overcome challenges and make choices together in a team therapy based on the faith that each has in the other's knowledge and experience. This special care rehabilitation center takes innovative approaches to evaluating and surmounting barriers to independence in order to enable our neighbors and their families to accomplish the complete rehabilitation, recovery and re-entry that is their goal, right and our duty. The Dynamics Walk Again Rehabilitation Unit The Dynamics Walk Again Rehabilitation Unit has taken the medical and ethical position that is important to understand the goals of each patient. If a patient can become more functional and/or ambulatory, the health care benefits can lessen the overall cost by several thousands of dollars and the quality of life enhanced. Benefits of ambulation of the spinal cord injured are multifold, including a decrease of bone fractures-osteoperosis, decubitus ulcer, thromobophebitis, pulmanary embolisms, urinary tract infections, and hospitalization is reduced. The positive side of all this is that patient self esteem is increased along with general health. The upright position promotes kidney and urethral drainage, improved respiration, upper body strength is increased, and all the benefits of aerobic exerise are realized. Located in California.
6 National Center on Physical Activity and Disability The mission of the National Center on Physical Activity and Disability (NCPAD) is to promote the substantial health benefits that can be gained from participating in regular physical activity. The slogan of NCPAD is Exercise is for EVERY body, and every person can gain some health benefit from being more physically active. This site provides information and resources that can enable people with disabilities to become as physically active as they choose to be. Project Walk Project Walk is internationally recognized as a pioneer in exercise-based recovery for people with spinal cord injuries; providing hope, improved quality of life and a chance for life beyond a wheelchair. Kennedy-Krieger Institute: Home and Community Rehabilitation An integral part of the Kennedy Krieger Institute continuum of rehabilitation care, the Home & Community program is an acute comprehensive rehabilitation program designed to address the complex issues that confront individuals with neurological injuries. The program assists patients and their family, on a temporary basis, toward continued longterm recovery. In the patient s home, school, or local community, a coordinated treatment team provides the following therapies: physical, occupational, speech and language, psychological and social work. Each interdisciplinary treatment team designs and implements a plan of care specific to the needs of individual patients and their families. The information contained in this message is presented for the purpose of educating and informing you about paralysis and its effects. Nothing contained in this message should be construed nor is intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified health care provider. Should you have any health care related questions, please call or see your physician or other qualified health care provider promptly. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program. You should never disregard medical advice or delay in seeking it because of something you have read in this message.
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