Patient Care

Madonna Rehabilitation Hospital is accredited by CARF, the Commission on Accreditation of Rehabilitation Facilities, as an inpatient and outpatient Stroke Specialty Program, hospital level, for adults and pediatric family centered care. We offer comprehensive programming for individuals with all types of strokes, from those who are still in the early stages of recovery following a very severe stroke to those who have had a mild stroke which doesn't require inpatient care.

Unique Services:

Scope of Services: Madonna's goal is to help the people we serve become as independent as possible, while establishing a partnership for life that the patient and family can turn to when needed. Programming is highly individualized and dependent upon each person's needs. Family members are encouraged to be actively involved in the patient's care and attend therapy sessions whenever possible so they may reinforce new techniques being taught. Research shows the more involved the family is during rehabilitation, the higher the success rate is for returning home. Madonna's Stroke Program provides interventions in the following areas:

• Assessment and Treatment: Patients and families are taught prevention, how to recognize the signs/symptoms of stroke, and receive treatment for conditions related to stroke and its complications.
• Addressing Risk Factors: Risk for recurrent stroke is assessed and addressed. Patients and their families are taught about these risk factors.
• Functional independence: The overall goal of the program is to gain functional independence. This is accomplished with skilled rehabilitation interventions, training, and use of adaptive equipment and/or techniques.
• Coping Skills: Rehabilitation psychologists, other clinicians and peer volunteers assist patients and their family members/support system with learning techniques for coping and adapting to life with after stroke.
• Community Integration: The ability to resume one's life role and reintegrate back into the community is another goal of the Stroke Program at Madonna. Community integration skills are taught as part of therapy and activities relating to a patient's life roles simulated and practiced during the rehabilitation process.
• Services for Families: Stroke affects the whole family and involvement of spouses, children, and others in the patient's support system is a vital part of recovery. Madonna's Stroke Program encourages family members and caregivers to be involved in education, training, peer support, support groups and counseling.

Clinical Expertise: Each patient's care is directed by a physiatrist, a physician who specializes in physical medicine and rehabilitation and/or a physician with specialization in internal medicine. For individuals who are 18 years or younger, a pediatrician is involved in their care on a daily basis. Rehabilitation nurses are specially trained in providing care for patients with stroke.

Environment: Madonna's environment affords individuals with stroke many opportunities to interact and support one another, whether it is in the spacious gym area during therapy, sharing a meal in the congregate dining area, or participating in a leisure activity outside in one of many garden areas. Madonna is the only facility in the region to have a simulated community, called Independence Square, where patients may engage in real-life skills, such as grocery shopping, cooking a meal, transferring in and out of a car or getting in and out of bed.

Rehabilitation: Madonna has a dedicated team of professionals who have completed special competency training in the treatment of persons with stroke. Each individual's treatment team is made up of physical, occupational, speech, recreational and respiratory therapists, social worker, rehabilitation nurses and case manager, as well as staff from neuropsychology as appropriate. They work together with the patient and their family/caregiver to meet the unique physical, cognitive, social and emotional needs of the patient.

Treatment Equipment: Use of technology such as Body Weight Support Treadmill Training, Lokomat Robotic Gait Training, 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.

Community Re-Entry: Rehabilitation does not end when the patient gains basic skills of self-care and mobility. Participation in a variety of community re-entry and adaptive sports and recreational outing 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.

Assistive Technology: Madonna has a multitude of technology available that assists an individual with the opportunity to be more independent with tasks such as using the telephone, accessing the computer and controlling their environment. Examples include: voice activated phones, voice activated computer software, eye gaze software, environmental control systems using sip/puff or other switches.

Preparation for home: Madonna's stroke patients and their caregivers are provided with a self-care training program based upon principles of self-advocacy and self-direction. Patients, with or without their caregivers, are taught how to direct their care and what to do if emergencies arise. They are provided with opportunities to practice these skills during their stay, ending with a 2 night stay in Madonna's transitional living apartment. This apartment is located on the unit, with easy access to medical staff if needed, with the expectation that a family member or other caregiver will assist with the personal care required during their stay. The patient will direct his/her care and independently follow his/her therapy schedule. In addition, a 2-week daily stroke education class is provided for all patients and family members/caregivers on a variety of stroke related topics.

Vision Program: The ability to accurately perceive the environment is often affected following a stroke 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, in which all the disciplines apply integrated vision treatment strategies, specialized techniques, and equipment to improve visual processing.

Intense Aphasia: Madonna is one of the only providers in the region to offer an Intense Aphasia Service, for persons who have difficulty communicating after a stroke. This service involves 3-4 hours of speech therapy at least 4 days per week. The sessions include individual sessions, group sessions, and independent drill work using a computer program.

Long Term Success: Madonna offers many ways to help individuals with stroke and their family members continue to improve and maintain their functional gains, therefore maximizing their participation throughout the rest of their life. Some ways we do this are:

• Structured Independence Program: It is important for individuals completing their rehabilitation to stay active and exercise safely. Learning how and what to do in a community based fitness environment, with trained staff and specially adapted equipment available promotes success.

• Home Assessments: This service is offered on inpatient or outpatient basis. Identifying barriers in the home environment early on gives therapists an opportunity to address these issues through therapy or with recommendations for home modifications or adaptive equipment. Madonna staff encourage patients to complete a Portable Health Profile, which is a collection of vital health information aimed at minimizing the fragmentation of our healthcare system, improving communication between professionals and promoting a person's active role in their own healthcare.

• Long-term Follow Up: After you experience a stroke you may be confronted with a wide range of challenges throughout your lifetime. These challenges and limitations may not be evident today, but may occur in the future, a focus on maintaining health long-term, including prevention of secondary complications, is an important piece of lifelong care planning. A representative from Madonna will contact you at least annually following discharge to see how you are doing and to gather outcome information.

• Stroke Comprehensive Assessment: Madonna’s Comprehenive Clinic Assessment Coordinator will contact you by telephone between 6-12 months after discharge to see how you are doing and if you would like to be scheduled for a comprehensive assessment. The comprehensive assessment takes into consideration your unique, individual needs. Some of the areas that might be addressed during this assessment include: medical issues, swallowing, communication, adjustment issues, cognition, functional mobility, strength and balance, home management, nutrition, vision and work or school re-entry.

Continuum of Care:

Individuals with stroke can receive services in one or more of multiple levels of care, including:

• Long Term Acute Care Hospital - for those with moderate to severe impairments and/or medical needs

• Acute Rehabilitation - for those with moderate to severe impairment who are ready for intensive rehab and can tolerate at least three hours of therapy per day

• Rehabilitation Day Program - for those who can be at home or community setting in the evening but require an intense, coordinated program of multiple therapies with an emphasis on independent living and community re-entry during the day

• Outpatient Services - for those who need one or more therapy services or one of many specialty services such as Driver Rehabilitation, Vision Program or Stroke Comprehensive Assessment