The goal of Madonna’s Brain Injury Rehabilitation Program is to help the people we serve become as independent as possible while establishing a partnership for life that the patient and their family can depend on. Programming is highly individualized, dependent upon each individual’s functional level and activity tolerance. Family members are encouraged to be actively involved in therapy and nursing care so they may reinforce learning new skills.
We serve individuals with traumatic or non-traumatic brain injuries of any severity. Patients who are just emerging from coma (Rancho Level II or higher) may be admitted to our LTACH level of care, while those who have already emerged from coma on ARU, and those with moderate to mild deficits, might be served in our outpatient program.
Madonna Rehabilitation Hospital is one of the only hospitals in the region to be accredited by CARF, the Rehabilitation Accreditation Commission, as a Brain Injury Rehabilitation Program for multiple levels of care, including LTACH, Acute Rehabilitation and Outpatient, multiple services. Madonna is one of only seven organizations in the U.S. which is accredited in both Brain Injury and Pediatric Specialty Programs. This means that Madonna meets higher standards relating to staff competency, programming, patient and family education, advocacy and outcomes management. During its most recent survey in April 2009, CARF surveyors reported the following regarding Madonna’s program:
“Madonna Rehabilitation maintains experienced and highly qualified personnel who are highly dedicated and demonstrate a commitment to the core values and mission of the organization.” For example, more than 50 direct-line inpatient and outpatient clinicians are Certified Brain Injury Specialists (CBIS) from the Brain Injury Association of America.
“The interdisciplinary treatment teams exhibit professionalism, enthusiasm and compassion while thoroughly addressing the physical, functional, cognitive, emotional, social and spiritual needs of the persons served and their family members.”
“The organization is commended for the integration of families and support systems into the brain injury continuum of care. Persons served, their families and support systems are partners throughout the rehabilitation process. Family engagement into the rehabilitation process enables carryover of the therapeutic techniques at all levels of care and return to community settings.”
Madonna’s Brain Injury Program is comprehensive, providing a wide array of services including physical, occupational, speech, respiratory, recreational and nutritional therapies, rehabilitation psychology, case management, social work services, spiritual services and orthotics/prosthetics as needed. In addition to these specialties, rehabilitation nursing and access to a physician with training in physical medicine and rehabilitation is available 24 hours per day, seven days per week on an inpatient basis.
Family members and other support system for the persons served are provided with structured training on how to interact with and care for their loved one. Their preferences are solicited and used as part of the rehabilitation process. And they are involved in developing an appropriate discharge plan. While most of our patients with brain injury are discharged to a community setting, patients who will need additional time in a more structured, residential setting after discharge are also served.
Madonna accepts patients with a wide variety of funding, including Medicare, Nebraska Medicaid and commercial insurances, and will consider out-of-state Medicaid and non-funded patients on a case-by-case basis.
Clinical Expertise: Each patient’s care is directed by a physician who specializes in physiatry and/or a physician with specialization in internal medicine. A pediatrician is involved in the daily care of individuals 18 years or younger. All Madonna nurses are specially trained in providing care for patients with brain injury, and several Madonna nurses have specialty training as a Certified Rehabilitation Registered Nurse. For very low-level patients, weaning them from a mechanical ventilator might be the first part of treatment. Madonna’s Pulmonary Program has an excellent track record for successful weaning.
Environment: Patients with a recent brain injury may go through an agitated and restless stage in their recovery. Madonna has the capacity to lock sections of the brain injury rehabilitation unit to provide better security for patients as they emerge from coma and go through this stage of recovery. Madonna also provides one-on-one supervision and care as needed. Adolescents and children 18 years or younger are admitted to The Alexis Verzal Children’s Rehabilitation Hospital. These children are provided rehabilitation in a dedicated, secure area designed specifically for children and adolescents.
During its most recent survey in April 2009, CARF surveyors praised Madonna for its therapeutic approach and environment, saying, “The organization is commended for its investment of significant resources to implement a simulated community environment utilizing therapeutic destinations throughout the inpatient and outpatient programs.”
Recent remodeling of the therapeutic space includes such items as a house with bedroom, kitchen, bath and laundry rooms, a retail store, automobile, riding lawn mower, pickup truck and workshop. Therapists integrate functional activities in these areas to prepare patients for real-life activities in their home community.
Rehabilitation: Madonna’s dedicated team of professionals have completed special competency training in treatment of persons with brain injury. The team, consisting of physical, occupational, speech, recreational and respiratory therapists, as well as neuropsychology, social worker, rehabilitation nurse and case manager, work together to meet the complex physical, cognitive, social and emotional needs of persons with brain injury.
Madonna is the only rehabilitation hospital in Lincoln that has a full staff of specially trained rehabilitation psychologists on site who are an integral part of the rehabilitation team, participating in team meetings, leading behavioral intervention plans and providing counseling and support for both the individual and their family members.
Treatment Equipment: Use of technology, such as the Lokomat, Bioness functional electrical stimulation, environmental control units, custom seating and mobility systems, and augmentative alternative communication are integrated into the treatment program throughout the continuum of care as appropriate for each individual's rehabilitation needs.
Vision: The ability to accurately perceive the environment is often affected following a brain injury and can result in difficulties with balance, walking, reading and attention. Madonna is the only rehabilitation provider in the region to offer a comprehensive vision program, led by Dr. Tanner Gates, Madonna’s Neuro Optometrist. All the disciplines apply integrated vision treatment strategies, specialized techniques and equipment to improve visual processing.
Community Re-Entry: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Participation in a variety of adaptive sports and recreational outings can be integrated into therapy or just for fun. Patients may also work on specific goals related to return to driving, school re-entry, or visit with a vocational rehabilitation counselor about work re-entry.
Mild Traumatic Brain Injury: Some individuals who have sustained brain injuries are not initially recognized or treated because they are mild. Often the need for treatment may not be identified until months after the incident, when academic, vocational, personal or family adjustment difficulties arise. Madonna is regionally known for its Mild Traumatic Brain Injury services — a comprehensive two-day assessment focusing on medical, physical, cognitive (thinking) and emotional aspects of mild traumatic brain injury. Patients may then receive treatment at Madonna based on the results of the assessment or treatment may be obtained in their local area if appropriate.
Follow-up Evaluation: Many individuals with brain injury require intermittent care throughout the rest of their lives. As a national expert in this area, Madonna offers an opportunity for persons who have previously received services to return for a re-evaluation to determine if there are any further needs. Individuals complete a telephone screen, then, based upon the information collected, may be scheduled for a comprehensive assessment, which is customized to their specific needs and includes a physiatrist as well as other clinicians who specialize in the assessment and treatment of persons with brain injury.
Sports Concussion: Madonna also offers a Sports Concussion Assessment for persons who have recently suffered a sports-related concussion and need assessment services for physical and cognitive changes and return-to-activities recommendations. Brain Injury Program Manager Lori Terryberry-Spohr, Ph.D., ABPP has completed research related to concussive injuries and leads educational efforts with local school coaches and parent groups.