After a debilitating illness or injury, learning to walk or talk again can be a difficult and painful challenge that can take weeks, even months, to accomplish.
Milestones may be few and far between, but at Texoma Medical Center's Reba McEntire Center for Rehabilitation (Reba Rehab), each step is celebrated as a grand stride in the journey back to a normal life.
Listen as Katherine Ellis, MD, discusses why you might need rehab and what you can expect from your stay at Texoma Medical Center.
Selected Podcast
Inpatient Rehabilitation After a Hospital Stay
Featured Speaker:
Katherine Ellis, MD
Katherine Ellis, MD is a Physiatrist & Medical Director of TMC’s Reba McEntire Center for Rehabilitation. Transcription:
Inpatient Rehabilitation After a Hospital Stay
Melanie Cole (Host): After a debilitating illness or injury, learning to walk or talk again can be a difficult or painful challenge that can take weeks, even months to accomplish. My guest today, is Dr. Katherine Ellis. She’s a Physiatrist and the Medical Director of TMC’s Reba McEntire Center for Rehabilitation. Welcome to the show, Dr. Ellis. What is an inpatient rehab hospital? What’s involved in that?
Dr. Katherine Ellis (Guest): We are considered an acute care hospital and we take care of patients that need further, ongoing inpatient rehabilitation such as a stroke, or a hip fracture, spinal cord injuries, brain injuries. Those are just a few of the types of things that we treat.
Melanie: Why is inpatient rehab needed after a hospital stay? Why would someone need that? What types of injuries are you looking at that they would have to stay in the hospital for their rehab?
Dr. Ellis: There’s a variety of different types of patients that we take for inpatient rehab. For example, if somebody’s had a stroke and they’re still having ongoing weakness in either their arm or leg or both arms and legs, they need intensive therapy. We can offer more intensive therapy in an inpatient rehabilitation unit. If you are having home health services after you're discharged home after a knee replacement, then you may only get to see a physical therapist three times a week for about 45 minutes to an hour. In an inpatient rehabilitation unit, we offer therapy six out of seven days a week, and the patients can have three hours of therapy a day, total – and that’s with occupational therapy and physical therapists. Some of our patients -- like stroke patients, they need speech therapy, and that can add in another 45 minutes to an hour of therapy on a daily basis. Our goal is always to get a patient back to their home and former living situation.
Melanie: You mentioned physical therapy and speech therapy, what other kinds of therapies do you offer patients as inpatients?
Dr. Ellis: We also have occupational therapists. Occupational therapists work on the arms and the hands and along with cognitive therapy too, and they work on such activities as getting dressed, taking a bath, going to the bathroom, eating, groom activities, things like that.
Melanie: What’s it like, Dr. Ellis, for a patient – you mentioned that there are up to three hours a day, six days a week – what is the intensity like for a patient? I know it depends on the patient and how much they can tolerate, but how do you determine that intensity that they’re going to need?
Dr. Ellis: We see what their current levels of assistance are – how much physical assistance that they’re taking at the present time after whatever event brought them to the hospital. It sounds like it’s very intensive therapy for three hours a day, but out therapists break up their treatment sessions into 45 minutes segments. Some of their therapeutic activities would include things like cooking, doing laundry, getting dressed, taking a shower, and that counts during therapy minutes. They’re not down in the gym for three hours at a time doing heavy, intensive activities. A lot of our patients are pretty debilitated when they come to us, so some of our patients we do schedule rest breaks in between therapy sessions to where they can lay down and rest in between therapy sessions if they aren’t ready to sit up all day and do activities.
The therapists also allow the patients to have rest breaks if they need it while they are working with them. Sometimes they have a sitting rest break, or sometimes it’s a standing rest break. We try to individualize their treatment to what their current functional level is and how good their endurance is and what kind of rehab problem they have -- if they’re paralyzed or a hip fracture or something like that. Our intensity of therapy varies from person to person, but we try to work around to determine what would be the best option for the patient.
Melanie: And what are some other special services that are available at the Reba Rehab? Neurodevelopmental treatment, swallowing protocols, any of these kinds of things? Speak about some of the other services.
Dr. Ellis: We do have a speech therapist. She works with a lot of our neurological patients, but she works on people who are having swallowing problems, which is called dysphagia. A lot of the stroke patients will have dysphagia after a stroke, so she works on strengthening the muscles of their head and neck to try and help treat patients for that. Sometimes she’ll do something called E-Stim where she puts little electrodes over the patients’ head and neck muscles and stimulates the muscles to contract to hopefully strengthen the swallowing muscles so the patient can get back to a regular diet.
We also have aquatic therapy for our patients, which is a really good therapy option for those patients that – say we have somebody with a pelvic fracture that did not have surgery, but they’re still having severe pain, but they can’t get up and walk because the pain is so severe. We have a wheelchair that we can put the patient in and then go down a wheelchair ramp into the pool. That way the physical therapists and occupational therapists can do physical therapy in the pool. The water unweights the body so that they don’t have as much pain when they’re doing the activity. They will gradually get to the point where they can walk across the pool. Once they can do that with improved pain that usually translates to being able to get back to walking on land.
When we do our aquatic or pool therapy, we always have a therapist in the pool with them, and they are not doing swimming activities. People always worry about that. They’re not swimming, and they’re not ever left alone in the pool. The therapist is in there guiding their exercises. That’s been a very effective treatment option for us.
Melanie: And what about the socio – mental and emotional aspects of a traumatic injury? If they’re at an in-hospital rehab, do you have people that work with them? Speak about some of the social workers and case managers. And also, if they are working with them on some of these emotional issues are they also working with the families on when you get that person home and some of those issues that might be present?
Dr. Ellis: We don’t have a psychologist that works at our inpatient rehabilitation unit, but we do have a psychiatrist that’s available to help us with any type of medication management or psychotherapy. We do – unless our patients are totally independent by the time they go home, we do a lot of caregiver training, and the therapists show the family members how to take care of that patient when they go home. They do it a lot with our patients that still – a lot of our stroke or brain injury patients will have some confusion, and they may not be safe enough to leave alone, so the therapist will show the family members how to take care of that patient at home. We do have a monthly Stroke Support group that’s offered at Reba Rehab on a monthly basis, so that’s been very helpful too. We also have a Parkinson’s Support Group as well.
Melanie: Wrap it up for us, Dr. Ellis, and tell us about your rehabilitation team at the Reba Rehab.
Dr. Ellis: We have the physician, and we have a case manager. She helps with all the discharge planning, coordinating services with the family, ordering special equipment, things like that. And also, she sets up when our patient is discharged, are they going to go home with home health or do they need outpatient therapy services?
We have physical therapy. A lot of them have special neurological training in stroke rehab. They help with things like general strengthening, endurance, learning to walk again, getting in and out of bed, on and off a chair, things like that – and also range of motion of the leg. And then we have occupational therapy that works with the upper extremity or the arm. They do work on daily care activities such as getting dressed, grooming activities like combing your hair, brushing your teeth, self-feeding, bathing, and toileting. Those are the activities that the physical therapist – I’m sorry, the occupational therapist work with too. They also do range of motion and strengthening of the upper extremities.
As I said, all of our therapists, we do encourage the family members to watch the therapy sessions so they can see the progress that the patient is making and also for educating the family on what their current levels are or if a therapist has safety concerns with a patient, things like that. We also have a speech therapist, and she can work with patients that after a stroke they may be slurring their words – the medical term for that is dysarthria. There may be patients that can’t talk at all because of the location of where they had a stroke, so she works with trying to develop their language skills again or communication skills. And as we talked about, she also works on the swallowing disorders – the medical word for that is dysphagia.
Melanie: How can someone access this type of service and how do you – what do you tell them about choosing a rehab hospital?
Dr. Ellis: The way that the patient can access this type of service – usually, we get our referrals for people that are currently in the hospital. If the patient or their family speak with a social worker or a case manager, they make the referral to us. Once that happens, we have our rehab nurse evaluator go see the patient, explain what they do, and see if the patient meets our inpatient criteria. Medicare and insurance companies have a lot of medical requirements for somebody to be admitted to the inpatient rehabilitation hospital, so we have to consider that as well to make sure that they’re appropriate for inpatient rehab.
Melanie: And in just the last few minutes, Dr. Ellis, what would you like to tell patients and their families about what to expect from an inpatient rehab hospital and why they should come to Texoma Medical Center for their care?
Dr. Ellis: We have, I think, excellent nurses and therapists at Reba’s Rehab. I’ve worked here for nearly 20 years, and a lot of our therapists have worked here a long time, too. We have a great team of very caring nurses and therapists and I think we’re all proud of the job we do and we just want to help people get back to being able to go home and get to how they were previously, before they had a stroke, or a hip fracture, or their knee replacement, things like that. We do have therapies available six out of seven days a week, and we do try to individualize the patients’ therapies to what that patient and family members need. We try to get the patient to the highest functional level to where they can be independent as much as possible with their current disability.
Melanie: Thank you, Dr. Ellis, for being with us today. You’re listening to TMC Health Talk with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.
Inpatient Rehabilitation After a Hospital Stay
Melanie Cole (Host): After a debilitating illness or injury, learning to walk or talk again can be a difficult or painful challenge that can take weeks, even months to accomplish. My guest today, is Dr. Katherine Ellis. She’s a Physiatrist and the Medical Director of TMC’s Reba McEntire Center for Rehabilitation. Welcome to the show, Dr. Ellis. What is an inpatient rehab hospital? What’s involved in that?
Dr. Katherine Ellis (Guest): We are considered an acute care hospital and we take care of patients that need further, ongoing inpatient rehabilitation such as a stroke, or a hip fracture, spinal cord injuries, brain injuries. Those are just a few of the types of things that we treat.
Melanie: Why is inpatient rehab needed after a hospital stay? Why would someone need that? What types of injuries are you looking at that they would have to stay in the hospital for their rehab?
Dr. Ellis: There’s a variety of different types of patients that we take for inpatient rehab. For example, if somebody’s had a stroke and they’re still having ongoing weakness in either their arm or leg or both arms and legs, they need intensive therapy. We can offer more intensive therapy in an inpatient rehabilitation unit. If you are having home health services after you're discharged home after a knee replacement, then you may only get to see a physical therapist three times a week for about 45 minutes to an hour. In an inpatient rehabilitation unit, we offer therapy six out of seven days a week, and the patients can have three hours of therapy a day, total – and that’s with occupational therapy and physical therapists. Some of our patients -- like stroke patients, they need speech therapy, and that can add in another 45 minutes to an hour of therapy on a daily basis. Our goal is always to get a patient back to their home and former living situation.
Melanie: You mentioned physical therapy and speech therapy, what other kinds of therapies do you offer patients as inpatients?
Dr. Ellis: We also have occupational therapists. Occupational therapists work on the arms and the hands and along with cognitive therapy too, and they work on such activities as getting dressed, taking a bath, going to the bathroom, eating, groom activities, things like that.
Melanie: What’s it like, Dr. Ellis, for a patient – you mentioned that there are up to three hours a day, six days a week – what is the intensity like for a patient? I know it depends on the patient and how much they can tolerate, but how do you determine that intensity that they’re going to need?
Dr. Ellis: We see what their current levels of assistance are – how much physical assistance that they’re taking at the present time after whatever event brought them to the hospital. It sounds like it’s very intensive therapy for three hours a day, but out therapists break up their treatment sessions into 45 minutes segments. Some of their therapeutic activities would include things like cooking, doing laundry, getting dressed, taking a shower, and that counts during therapy minutes. They’re not down in the gym for three hours at a time doing heavy, intensive activities. A lot of our patients are pretty debilitated when they come to us, so some of our patients we do schedule rest breaks in between therapy sessions to where they can lay down and rest in between therapy sessions if they aren’t ready to sit up all day and do activities.
The therapists also allow the patients to have rest breaks if they need it while they are working with them. Sometimes they have a sitting rest break, or sometimes it’s a standing rest break. We try to individualize their treatment to what their current functional level is and how good their endurance is and what kind of rehab problem they have -- if they’re paralyzed or a hip fracture or something like that. Our intensity of therapy varies from person to person, but we try to work around to determine what would be the best option for the patient.
Melanie: And what are some other special services that are available at the Reba Rehab? Neurodevelopmental treatment, swallowing protocols, any of these kinds of things? Speak about some of the other services.
Dr. Ellis: We do have a speech therapist. She works with a lot of our neurological patients, but she works on people who are having swallowing problems, which is called dysphagia. A lot of the stroke patients will have dysphagia after a stroke, so she works on strengthening the muscles of their head and neck to try and help treat patients for that. Sometimes she’ll do something called E-Stim where she puts little electrodes over the patients’ head and neck muscles and stimulates the muscles to contract to hopefully strengthen the swallowing muscles so the patient can get back to a regular diet.
We also have aquatic therapy for our patients, which is a really good therapy option for those patients that – say we have somebody with a pelvic fracture that did not have surgery, but they’re still having severe pain, but they can’t get up and walk because the pain is so severe. We have a wheelchair that we can put the patient in and then go down a wheelchair ramp into the pool. That way the physical therapists and occupational therapists can do physical therapy in the pool. The water unweights the body so that they don’t have as much pain when they’re doing the activity. They will gradually get to the point where they can walk across the pool. Once they can do that with improved pain that usually translates to being able to get back to walking on land.
When we do our aquatic or pool therapy, we always have a therapist in the pool with them, and they are not doing swimming activities. People always worry about that. They’re not swimming, and they’re not ever left alone in the pool. The therapist is in there guiding their exercises. That’s been a very effective treatment option for us.
Melanie: And what about the socio – mental and emotional aspects of a traumatic injury? If they’re at an in-hospital rehab, do you have people that work with them? Speak about some of the social workers and case managers. And also, if they are working with them on some of these emotional issues are they also working with the families on when you get that person home and some of those issues that might be present?
Dr. Ellis: We don’t have a psychologist that works at our inpatient rehabilitation unit, but we do have a psychiatrist that’s available to help us with any type of medication management or psychotherapy. We do – unless our patients are totally independent by the time they go home, we do a lot of caregiver training, and the therapists show the family members how to take care of that patient when they go home. They do it a lot with our patients that still – a lot of our stroke or brain injury patients will have some confusion, and they may not be safe enough to leave alone, so the therapist will show the family members how to take care of that patient at home. We do have a monthly Stroke Support group that’s offered at Reba Rehab on a monthly basis, so that’s been very helpful too. We also have a Parkinson’s Support Group as well.
Melanie: Wrap it up for us, Dr. Ellis, and tell us about your rehabilitation team at the Reba Rehab.
Dr. Ellis: We have the physician, and we have a case manager. She helps with all the discharge planning, coordinating services with the family, ordering special equipment, things like that. And also, she sets up when our patient is discharged, are they going to go home with home health or do they need outpatient therapy services?
We have physical therapy. A lot of them have special neurological training in stroke rehab. They help with things like general strengthening, endurance, learning to walk again, getting in and out of bed, on and off a chair, things like that – and also range of motion of the leg. And then we have occupational therapy that works with the upper extremity or the arm. They do work on daily care activities such as getting dressed, grooming activities like combing your hair, brushing your teeth, self-feeding, bathing, and toileting. Those are the activities that the physical therapist – I’m sorry, the occupational therapist work with too. They also do range of motion and strengthening of the upper extremities.
As I said, all of our therapists, we do encourage the family members to watch the therapy sessions so they can see the progress that the patient is making and also for educating the family on what their current levels are or if a therapist has safety concerns with a patient, things like that. We also have a speech therapist, and she can work with patients that after a stroke they may be slurring their words – the medical term for that is dysarthria. There may be patients that can’t talk at all because of the location of where they had a stroke, so she works with trying to develop their language skills again or communication skills. And as we talked about, she also works on the swallowing disorders – the medical word for that is dysphagia.
Melanie: How can someone access this type of service and how do you – what do you tell them about choosing a rehab hospital?
Dr. Ellis: The way that the patient can access this type of service – usually, we get our referrals for people that are currently in the hospital. If the patient or their family speak with a social worker or a case manager, they make the referral to us. Once that happens, we have our rehab nurse evaluator go see the patient, explain what they do, and see if the patient meets our inpatient criteria. Medicare and insurance companies have a lot of medical requirements for somebody to be admitted to the inpatient rehabilitation hospital, so we have to consider that as well to make sure that they’re appropriate for inpatient rehab.
Melanie: And in just the last few minutes, Dr. Ellis, what would you like to tell patients and their families about what to expect from an inpatient rehab hospital and why they should come to Texoma Medical Center for their care?
Dr. Ellis: We have, I think, excellent nurses and therapists at Reba’s Rehab. I’ve worked here for nearly 20 years, and a lot of our therapists have worked here a long time, too. We have a great team of very caring nurses and therapists and I think we’re all proud of the job we do and we just want to help people get back to being able to go home and get to how they were previously, before they had a stroke, or a hip fracture, or their knee replacement, things like that. We do have therapies available six out of seven days a week, and we do try to individualize the patients’ therapies to what that patient and family members need. We try to get the patient to the highest functional level to where they can be independent as much as possible with their current disability.
Melanie: Thank you, Dr. Ellis, for being with us today. You’re listening to TMC Health Talk with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.