Madonna Rehabilitation Hospitals

Brain Injury

Patient Stories

Brain Injury Rehabilitation

Medical teams led by physiatrists, or physicians who specialize in rehabilitation, determine a customized plan for each brain injury survivor, designed to maximize their independence and help them return to the things that matter most to them whenever possible. Additional medical professionals with specializations such as pulmonology, neurology, and neuropsychology may be consulted when appropriate.  

Madonna therapists work alongside physicians to help patients regain skills that may have been impaired by brain injury. Physical and occupational therapists utilize specially designed spaces to simulate life at home and in the community as well as provide variety and keep patients engaged. Family members are encouraged to participate in therapy whenever possible. Our language and cognition lab allows patients to work outside of formal speech therapy sessions.

Registered nurses with specialized training and experience in brain injuries are on staff at all times to care for patients. Madonna’s nursing model supports a 24/7 rehabilitation approach allowing patients additional opportunities to practice daily skills learned and supported by therapy throughout their rehabilitation stay, even outside of scheduled therapy sessions.

Madonna provides a comprehensive continuum of care for our brain injury patients, regardless of severity.

Madonna is unique in that we have two licensed hospitals located in Omaha and Lincoln. Our specialty hospitals (commonly known as LTAC, or long term acute care) are overseen by internal medicine hospitalists,  providing complex medical care for patients with a broad range of needs. Our approach to complex medical care enables patients to participate in rehabilitation from their first days at Madonna. The therapy process is customized to each brain injury patient based on their diagnosis and abilities, but the goal at this level is to help the patient tolerate increased activity while building up their endurance and strength to either return home or move to the rehabilitation hospital.

Our acute rehabilitation hospitals provide an intense program by providing of three or more hours of therapy per day. By focusing on community reintegration and getting patients ready to resume their life activities, the goal at the acute care level is to resume the highest level of independence possible. Having both levels of care on the same campus minimizes the need for transfer and provides continuity and enables collaboration among clinical teams.

Our Rehabilitation Day Program (RDP) may be appropriate at the next stage. Patients return to our campus 2-5 times per week for several daily hours of therapy, split among multiple disciplines of occupational, speech and physical therapy. RDP allows for community reintegration while still benefiting from a rigorous therapy schedule.

Outpatient therapy is offered through Madonna’s TherapyPlus clinics. Frequency of therapy is unique to each patient. Outpatient therapy can include one or more discipline and vary in frequency depending on patient needs.

Madonna staffs licensed respiratory care practitioners at all times. Our respiratory therapists are able to provide arterial blood gas (ABG) services. Pulmonologists can perform bronchoscopies on-site with help from the respiratory team. Madonna is recognized as a Center of Excellence for Vapotherm and the Passy-Muir valve, specialized technology utilized for patients with tracheostomy tubes.

An education series where patients, family and caregivers learn about the latest brain injury research, how to care for their bodies following an injury and how to be their own advocates in future care is provided for all brain injury patients.

Rehabilitation after brain injury is not just about regaining basic skills of self-care and mobility. The ability to resume one’s life role and reintegrate back into the community is an important component. Madonna integrates a variety of community re-entry, recreational, leisure and adaptive sports and recreation opportunities into the rehabilitation process. Therapy may include off-site visits to locations that may be challenging for brain injury patients. Patients may also work on specific goals related to returning to work, school or driving during their rehabilitation stay.

Madonna provides a full range of inpatient pharmacy services, including medication distribution, patient education and clinical/dosing services. 

Madonna is able to provide radiology services that include X-ray, CT scan, ultrasound, echocardiogram, venous doppler, arterial doppler, Holter monitor, sleep study and electroencephalogram (EEG).

Madonna's hospitals utilize in-house laboratory services to help diagnose and monitor patient conditions. Tests such as anticoagulation, hematology, chemistry, therapeutic drug level testing and urine analysis services with results often available the same day.

Neuropsychologists and rehabilitation counselors are an integral part of brain injury rehabilitation at Madonna. They provide a variety of services, including neuropsychological assessment, adjustment counseling,family therapy, behavioral management and psychoeducation. Our rehabilitation counselors also provide support, individually or in group settings, for family and caregivers affected by the patient’s brain injury.

Spiritual care is an important component of healing. Madonna is committed to meeting the needs of our patients, regardless of their individual beliefs. Chaplains and other spiritual care professionals consult with the care teams and visit patients to provide direct support when requested. Chapels are available on both campuses, as well as ample green spaces for contemplation and respite.

Madonna’s brain injury patients and their caregivers are provided with a self-care training program based upon principles of self-advocacy and self-direction. Patients are taught how to direct their care and what to do if emergencies arise. They are provided opportunities to practice these skills during their stay, ending with a two-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 caregiver will assist with personal care required during their stay. The patient will direct his or her care and independently follow a therapy schedule.

Madonna is the only hospital in the region to provide an extensive vision rehabilitation program delivered by specially trained experts who use state-of-the-art technology to help patients of all ages with visual impairments resulting from illness or injury to maximize their quality of life in home and community-related roles.

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Madonna's Continence Specialty Program helps patients who, because of an illness or serious injury, experience bowel and bladder dysfunction symptoms regain control and return to their life roles.

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Madonna has been a ThinkFirst Chapter since August 2010, creating injury prevention awareness in the community. We are committed to promoting safety and our clinicians offer expertise at thousands of community events each year to reduce the risk of serious injury. 

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Madonna is committed to the lifelong success and wellness of our patients. When appropriate, we offer services such as home modifications, assistive technology, orthotics, prosthetics and emotional support resources for patients during and after their preparation to return home. 

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The goal of Madonna’s Brain Injury Rehabilitation Program is to help the individuals we serve become as independent as possible after their injury.  Madonna strives to establish a partnership for life that the patient and their family can depend on throughout their recovery and beyond. Programming is highly individualized, dependent upon each individual’s needs, functional level and personal goals. Family members are encouraged to be actively involved in therapy and nursing care so they may reinforce learning new skills.

We serve survivors with traumatic or non-traumatic brain injuries including children ages 0-18 and adults of all ages. Madonna’s continuum of care serves patients with brain injury who may be emerging from coma (Rancho Level II or higher) to those who are actively participating in their rehabilitation, all the way through their last stages of rehabilitation focusing on return to home, community and work re-entry skills. Madonna Rehabilitation Hospital in Lincoln is one of the only hospitals in the region to be accredited by CARF, the Commission for the Accreditation of Rehabilitation Facilities, as a Brain Injury Rehabilitation Specialty Program for multiple levels of care, including  Acute Rehabilitation, intensive outpatient and traditional outpatient. Throughout Madonna’s continuum of care, the brain injury program specializes in recognizing, assessing and treating conditions related to brain injury and preventing complications related to brain injury. Our program also focuses on educating patient and families on prevention and reducing the risk of future brain injuries.

Madonna-Lincoln 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.  Madonna-Omaha is accredited by the Joint Commission and will undergo its first CARF accreditation visit in 2018.   

In fiscal year 2017, 60 percent of patients with brain injury admitted from the Midwest region, outside of the Lincoln or Omaha area. Madonna admits patient from multiple in-state and out-of-state trauma systems and acute care hospitals. We served 856 individuals with brain injury across the continuum of care over both Madonna campuses. Outpatients are referred to our services from a variety of physician specialties. A referral from a physician is required to access Madonna’s continuum of care.

Scope of services

Madonna’s Brain Injury Program is comprehensive, providing a wide array of services including physical, occupational, speech, respiratory, recreational and nutritional therapies, rehabilitation psychology, neuro-optometry, 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 caregivers for the persons served are provided with structured training and education on brain injury and providing care for their loved one. Education topics include: Deficits experienced post-brain injury, understanding the rehabilitation process, risks associated with brain injury, long term resources, aging with brain injury, relationships after brain injury and multiple others. Family and patient preferences are solicited and used as part of the rehabilitation process. Families and caregivers are involved in developing an appropriate discharge plan. They are provided resources to help access life-long care as needed. While most of our patients with brain injury are discharged to a community setting, patients who need additional time in a more structured, residential setting after discharge are also served.

Clinical Expertise:  Each patient’s care is directed by a physician who specializes in physical medicine and rehabilitation and/or a physician with specialization in internal medicine. A pediatrician is involved in the daily care of individuals 18 years or younger. 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 (CRRN). 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. Patients requiring specialized services and interventions such as cardiology, pulmonology, and orthopedics are referred and provided the appropriate medical and follow up services.

Rehabilitation:  Madonna’s dedicated team of professionals complete 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. On average, inpatients receive three hours of therapy each weekday on an acute rehabilitation level of care. Weekend therapy is provided on an as-needed basis. Madonna’s therapy staff is also trained in coma stimulation to assist in arousing patients in an altered state of consciousness. Madonna has a full staff of specially trained rehabilitation psychologists on site who are an integral part of the rehabilitation team. They participate in team meetings, lead behavioral intervention plans and provide counseling and support for both the patient and their family members. Madonna’s interdisciplinary team members have received nationally certified training in working with individuals with brain injury.

Days and Hours of Service:  Therapy services are provided Monday through Friday, 7 a.m. to 5 p.m. Patients receive on average, three hours of therapy per day, five days per week in acute rehabilitation and are seen on average, 2-3 times per week on an outpatient basis as appropriate. Saturday and Sunday therapies are provided on an as needed basis for inpatients.

Fees:  Cost of care is determined by diagnosis, level of care, acuity of care and length of stay. 

Madonna accepts patients with a wide variety of funding, including Medicare, Nebraska Medicaid, commercial insurances such as Blue Cross and Blue Shield, worker’s compensation, and will consider out-of-state Medicaid and non-funded patients on a case-by-case basis.

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Environment: Madonna’s environment is designed and specialized for the brain injury populations. 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 video monitoring as needed for patient safety. Adolescents and children 18 years or younger are admitted to Children’s Rehabilitation Unit. These children are provided rehabilitation in a dedicated, secure area designed specifically for children and adolescents.

Therapy can also be provided in a community setting. Therapists integrate functional activities in these areas to prepare patients for real-life activities in their home community.

Community Re-entry: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Participation in community activities is also an important part of the recovery process and is integrated into therapy sessions. Recreational therapy provides a variety of adaptive sports and recreational outings to help patients and families recognize that they can still participate in enjoyable activities. 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.

Preparation for Home:  Madonna's brain injury 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, often ending with a 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.

Home Assessment:  Another way to prepare the patient for a successful transition to home is by offering the opportunity for patients to return home for the day to practice skills in their home setting while evaluating the home for accessibility and any adaptations or modifications that may be required. For patients and families who live outside Lincoln and Omaha and the surrounding communities, a paper/pencil home assessment form is provided for the family member or caregiver to complete.

Long-Term Follow-Up: Madonna offers many ways to help individuals with brain injury and their family members continue to improve and maintain their functional gains, therefore maximizing their participation throughout the rest of their life.

It is important that individuals completing rehabilitation stay active and exercise safely. We promote success by teaching how and what to do in a community based fitness environment, featuring trained staff and specially adapted equipment.

After you experience a brain injury, you may be confronted with a wide range of challenges throughout your lifetime. Because these challenges and limitations may not be evident until later, focusing on maintaining health long-term, including preventing secondary complications, is an important part of lifelong care planning.

A representative from Madonna will contact you 6-12 months after discharge to see how you are doing and to gather outcome information.

Brain Injury Follow Up Clinic:  Survivors of Brain Injury can experience changes in function months and years post injury. Madonna provides a Brain Injury Follow Up Clinic for survivors of moderate to severe brain injury requiring a previous Inpatient Rehabilitation stay, either at Madonna or an external rehabilitation facility. This follow up clinic provides a comprehensive assessment of current function and changes in function and makes appropriate recommendations for continued care and rehabilitation.

Mild Traumatic Brain Injury Clinic:  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.

Cutting-Edge Technology and Research

We continually develop and acquire new technologies to enhance the lives of patients entrusting their care to us. Combining technical expertise with the experience of our clinical teams is critical to patients returning to work, school and community.