Appendix III


Inpatient Rehabilitation

Most patients with a new spinal cord injury will need inpatient rehabilitation to gain independence and learn new ways to do things. After talking with your doctors, your social worker will discuss options for different centers with you and your family.

It is best if you can help to make the final decision on which rehabilitation center is right for you.
Family members can tour several rehabilitation centers to ask questions (as outlined below), get a
feel for the center, and whether or not it may be a good fit for you. If your family is unable to tour
the center(s) themselves, they may want to ask a friend or other family member to go for them,
and report back. The social worker assisting you with discharge planning also has videotapes about
many centers. Upon request, the social worker can arrange to have video equipment set up in your
hospital room to allow you to view the centers.


Items to Consider When Selecting a Rehabilitation Center:

Rehabilitation Center’s Experience with Spinal Cord Injuries:

❏ How many patients with spinal cord injuries have they treated in the last year?
❏ What is the average number of rehabilitation patients at any one time?
❏ Average number of spinal cord injury patients at any one time?
❏ What is the average length of stay?
❏ What kind of treatment outcomes can the rehabilitation center provide for spinal cord injury patients?


Staffing Considerations:

❏ How many years of experience do the key staff persons have?
❏ What is the patient-to-nurse ratio? Patient-to-therapist ratio?
❏ Are the following team members full-time staff or consultants?

  • Physical Therapist
  • Occupational Therapist
  • Physiatrist (A physician who specializes in rehabilitation and physical medicine who will be overseeing the entire rehabilitation hospitalization). Is he or she Board-Certified in Spinal Cord Injury Medicine?

 


Therapy Considerations:

❏ How often do Physical Therapy and Occupational Therapy see patients (twice a day or once a day, or on weekends?)
❏ Who does evaluations and makes recommendations if the patient needs a specialized wheelchair or equipment?
❏ What does the vocational (return to work) program consist of at their center?


Emergency Situations:

❏ Is there a physician available on site twenty-four hours a day to deal with emergency
situations (ie. breathing problems, infections, falls)?
❏ Are patients referred to a nearby hospital for medical emergencies?

Environmental Considerations:
❏ Is there enough physical space for therapy?
❏ Is the center clean?
❏ Is there an overall positive atmosphere?
❏ Are the staff attentive and positive towards those they are working with?
❏ Is there a daily schedule posted noting the time and place each patient should be throughout
the day?
❏ After touring several centers, what is your overall feeling? Sometimes instincts are as valuable
as concrete facts.


Family Involvement:

❏ How far is a given rehabilitation center from your home?
❏ If the distance is great, limiting visits from friends and family, how will that affect the progress of your loved one in rehabilitation?
❏ How often are family meetings scheduled?

  • Routinely scheduled at specific intervals?
  • When progress is made?
  • When no progress is made?
  • Emergency changes?

 

❏ What are the policies on home visits?
❏ Are there any educational or support groups for family members within the center?


Discharge Planning:

❏ At what point will the patient be recommended for discharge?
❏ How does the center help the patient and family plan for discharge?
❏ Is there post-discharge follow-up?
❏ Will they help you to obtain equipment (such as wheelchairs, etc.) for post- discharge?
❏ Do they provide home evaluations to give accessibility recommendations?

Financial Aspects of Rehabilitation:
❏ Does your insurance company have certain providers that are "in-network", where the rehabilitation stay would be covered better?
❏ Once you are at a chosen center, who is responsible to communicate with the financial/ insurance provider? How often?
❏ How long will the insurance last (both in months and dollar amounts)?
❏ What additional costs may there be?


Publication of this educational booklet is made possible in part by the generous support of the following sponsors:

  • Metronic
  • Stryker
  • DePuy Spine
  • Fraternal Order of Eagles