Transcription:
What is Inpatient Rehabilitation?

Melanie Cole (Host): Today’s topic is inpatient rehabilitation for patients disabled as a result of disease, disorder, or injury. My guest today is Dr. Margaret Anderson. She’s the medical director for the inpatient rehabilitation unit at Aspirus Wausau Hospital. Welcome to the show, Dr. Anderson. What is inpatient rehabilitation? People don’t always even know what that means.

Dr. Margaret Anderson, MD (Guest): Well, rehabilitation is – there’s different phases of it. So, when someone’s in the hospital, and they’re medically stable, but they’re not ready to go home because they can’t walk or whatever kind of difficulties. They have challenges. Then, they will come to our inpatient rehabilitation program which is really a separate hospital within Aspirus Wausau Hospital, where you get very intensive physical, occupational, speech therapy. It’s a coordinated team to get your rehabilitation so that you’re strong enough to go home and to train family if they need more help, and then, after they leave our inpatient rehab unit, then they may get outpatient therapies or sometimes they may get in-home therapies, depending on what their needs are.

Melanie: What types of care are involved in rehabilitation for these types of patients? Does it involve a coordination of many different care providers?

Dr. Anderson: That’s really the key to it because we all have to work as a team. So, our team consists of physical therapy, occupational therapy, speech therapy, a recreational therapist, a nutritionist, a rehabilitation nurse. We have a pastor. We have all different types of people that work together, and we huddle every morning and just touch base on how the patient’s night went, and then every week, we have updated meetings, more intensive evaluations to see how their progress are so we can set goals. What do they need to be able to do to go home? What are they having difficulty with? Are they having difficulty getting their pants on? Are they having difficulty going to the bathroom, and then how do we work together to solve those problems?

Melanie: What a great multidisciplinary way to approach it. So, tell us about some of the key elements of the program as far as getting them home and teaching them independent living.

Dr. Anderson: Well, I think that there’s a balance. So, some of it’s exercise to get people stronger, but also just teaching them how to be safe with their activity so they don’t fall. If they have had a stroke and maybe they have communication problems, we’ll try to teach them how they can communicate what they need to speak more clearly. They may have problems with their swallowing. So, we help teach them how to maybe modify their diet so they can safely swallow after a stroke. There’s just so many different things that we’ll teach them and then also teach their families so they know how to help that patient when they go home.

Melanie: So, speak a little bit more about helping the families because being a caregiver, especially if somebody has a traumatic injury like spinal cord injury or a brain injury, then sometimes, really a lot of that pressure is on the caregiver to help with those day to day needs. What do you do for the families?

Dr. Anderson: So, everybody’s individualized. Sometimes people don’t have the support that they need, and we really have to work at a different level to make them more independent, and I usually talk to the people and say that you’re a team, and it depends on what your goals are so that they feel confident as the team. I think practicing things makes them feel better for when they go home. So, we have a regular apartment with a regular bed, a regular tub, a shower, a kitchen. Some patients will spend overnight in our apartment and practice those things with their spouse or significant other so when they go home, they really know the skills that they need to be able to do.

We may do a home evaluation where the therapist goes to their home and sees how they really move around in their own bathroom in their own home. Our recreational therapists will help someone go into the community. So, sometimes it’s kind of – it’s fearful. They’re afraid to be seen outside in a wheelchair. That’s just, you know, awkward for them, and so, a recreational therapist can make sure that they have that comfort; how to use the public bathroom if you need to use a wheelchair accessible bathroom. What are all those things that we kind of take for granted? And you have to learn all those things new.

Melanie: Tell us about the rehab program at Aspirus and what does it look like to an outsider?

Dr. Anderson: Well, we really have a beautiful unit. It’s a 12-bed unit. It’s just dedicated for our patients. We have a dining room where patients go to and have their meals and regular gym where they can practice things and that area is actually a great opportunity for patients to support each other. They can see someone else’s struggles and someone else’s gains, and I think it always helps put things in perspective. They may have someone next to them may have a different kind of an injury, but they can see someone improving, and it’s always good to have that kind of a support in that environment.

Melanie: Tell us about quality measures, Dr. Anderson and additional certifications of your team. What do you do there?

Dr. Anderson: So, we have what we call a CARF, which is a certification for rehabilitation facilities across the country, and actually, it’s an international certification that we go through every three years, and we’ve always been accredited, and we’ve met the highest standards when we have all those surveys. It’s a very intensive program to meet those regulations, and then every year we’re also assessed and compared our outcomes to national data and rehabilitation units—like some 700 across the country, and we’ve always been in the top 90%. Some years in the top 2% of the country for our outcomes. We have very, very good support of our acute hospital physicians, and so they will see our patients on the unit. So, we don’t have the same degree of medical complications or admissions back to the acute hospital because we have such great support on our unit which is really a luxury and a very—it’s a big, strong part to our program.

Melanie: Tell us about Adaptive Adventures.

Dr. Anderson: Adaptive Adventures is a program that we’ve set up for outside of our unit, and it’s for anyone who wants to get back to doing higher-level activity. So, some of the things we do is adaptive curling. Wausau has the world’s best wheelchair accessible curling facility, and so we’ll do that. We have had the Olympic trials here every year. We do adaptive kayaking. We’ve done laser tag, cross country skiing, all different types of things to try to get people to be involved and to do recreational things despite having a disability. It could be from a spinal cord injury or a head injury or a stroke or an amputation. It doesn’t matter what kind of disability. We want people to be able to do fun things once they leave the hospital.

Melanie: So, you’ve mentioned people in your team. How do they work as team to solve some of the tougher problems that you might encounter?

Dr. Anderson: Well, you know, we discuss it, and we try to give each other support. Sometimes it’s patients that are depressed, and our neuropsychologist may meet with the patient and give the team advice and like this is the way that I might approach that person to help them achieve their goals and to try to make sure that we can personalize what a patient needs. Sometimes we’ll have a peer counselor come in. Someone who’s been through it all and kind of say, oh this is what I went through and now look at how much I’ve accomplished. So, we try to support each other as a team so we can give the most energy and the most personalized care to a patient.

Melanie: What’s the best part of the rehab program and what would you like to tell listeners about the Aspirus Inpatient Rehabilitation?

Dr. Anderson: You know, I think sometimes people think about rehabilitation as maybe being depressing because it’s people who’ve had fairly major traumatic events in their life, and the greatest thing about rehab is that people work together and obtain such great goals, things they could never, ever imagine that they could do. Instead of a disability, I always call it a different ability. It means that they just learn a new way of doing something. That doesn’t mean they’re going to stay home; they just learn a new way of driving their car or a new way of walking, and that’s a different ability and to see that progress is just amazing. It makes us not take for granted all the things that we do have.

Melanie: Thank you so much, Dr. Anderson, for being with us today. This is Aspirus Health Talk and for more information, please visit aspirus.org. That’s aspirus.org. I’m Melanie Cole; thanks so much for listening.