FORMER MARINE SHOWS FIGHTING SPIRIT IN THERAPYJune 01, 2023
During his six years in the Marine Corps, 27-year-old Francisco Barajas says he always wanted to be the best at everything. “I was always tryin...
Madonna Rehabilitation Hospitals is a national destination for brain injury rehabilitation. Our brain injury specialists move patients of all ages toward lifelong brain health and recovery, working with those who have sustained a concussion, diffuse axonal injury, hematoma, abusive head injury, skull fracture or other brain injury. Additionally, Madonna specializes in what is known as Disorders of Consciousness, categorized by a patient’s limited ability or inability to respond to their environment. Madonna’s interdisciplinary team creates individualized treatment plans as unique as each patient we serve to maximize outcomes.
Please click below to learn more about recent patient outcomes for our brain injury program, both inpatient and outpatient (OP) and in our Rehabilitation Day Program (RDP).
Madonna's brain injury program can help patients who have suffered any severity of brain injury.
A typical day for Madonna brain injury patients includes intensive therapy customized to each individual patient.
Our staff asks all the questions necessary to learn what is meaningful to each patient and integrate those things into their rehabilitation program.
The Madonna team involves families in patient therapy and caregiving whenever possible, including extensive education on how to care for their loved one after discharge.
A rehabilitation hospital like Madonna uses daily physician visits and intensive therapy to make sure patients are supported during their rehabilitation.
Madonna therapists utilize the latest in rehabilitation technology to produce outstanding results.
During his six years in the Marine Corps, 27-year-old Francisco Barajas says he always wanted to be the best at everything. “I was always tryin...
Between schoolwork, drama, band, choir, Ultimate Frisbee club and Boy Scouts, 16-year-old Matthew Schulte stays busy and knows the value of hard work....
From the basketball and volleyball courts to the track and softball field, 15-year-old Kinsley Provin is driven to succeed. But her biggest hurdle cam...
From critically injured to working on her short game, Blakeley Wooden’s recovery made great strides thanks to her no-quit attitude and the expertise...
After limited progress at home, Cooper Holloway and his family sought Madonna’s expertise in a last-ditch effort to recover from a complex concu...
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.
|24-hour Nursing Care|
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.
|Levels of Care|
Madonna provides a comprehensive continuum of care for our brain injury patients , regardless of severity.
Madonna is unique in that we offer two hospital levels of care on both our Omaha and Lincoln campuses. Our specialty hospitals (commonly known as LTACH, 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 acute rehabilitation level of care.
Our acute rehabilitation level of care delivers an intense program by providing 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.
|24-hour Respiratory Care|
Madonna staffs licensed respiratory care practitioners at all times. Our respiratory therapists are able to provide arterial blood gas (ABG) services, ventilator management and weaning as well as tracheostomy management and weaning. Madonna is recognized as a Center of Excellence for Vapotherm and the Passy-Muir valve, specialized technology utilized for patients with tracheostomy tubes.
|Patient and Family Education|
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.
|Mission Care Services|
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.
|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 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.
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.
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.
|Additional Programs and Services|
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.
|Scope of Services|
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 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 of any severity. 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 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 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 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 training, programming, patient and family education, advocacy and outcomes management.
Madonna admits patient from multiple in-state and out-of-state trauma systems and acute care hospitals. In Madonna’s 2019 fiscal year, we served 1500 individuals with brain injury across the continuum of care. 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 care 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. These specialized services are available throughout our continuum of care including Long Term Acute Care, Acute Rehabilitation, and Rehabilitation Day Programs. 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.
Fees of Service: Cost of care is determined by diagnosis, level of care, acuity of care and length of stay. For more information on fees of service please see: https://www.madonna.org/admissions
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.
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. 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 complete special competency and nationally certified 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, patients receive three hours of therapy on an acute rehabilitation level of care. Madonna’s therapy staff is also trained on coma stimulation to assist in arousing patients in a disordered 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.
Days and hours of Service: Monday-Fridays. Patients receive assigned hours of therapy appropriate for their level of care and function. Nursing and physician services provided within the scope of the brain injury program are provided 24 hours a day, seven days a week on an inpatient basis. Saturday and Sunday therapies provided on an as needed basis for inpatient therapies.
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 The Alexis Verzal 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.
Preparing for Home: Persons served 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.
Long Term Follow Up: 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.
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.
Dr. LaHolt graduated with a Doctor of Medicine degree from the University of Nebraska College of Medicine. After an internship in Family Medicine at the University of Nebraska Medical Center, he completed the physical medicine and rehabilitation residency program at the University of Missouri-Columbia and served as chief resident during his final year. He is board certified in the subspecialty of Brain Injury Medicine. He is also board certified by the American Board of Independent Medical Examiners.
“It isn’t any one person or discipline, it’s the entire team, working together, to assist our patients in the recovery process.”
Dr. Morgan LaHolt
A physical medicine and rehabilitation physician is available 24 hours per day and seven days a week. They manage all the health problems and complications as a result of the spinal cord injury and other medical conditions that may have existed before the injury. The physiatrist works in conjunction with the person’s hometown or family physician and other specialists, which may include an orthopedic surgeon, neurologist or internal medicine physician.
A pediatrician is involved in the daily care of individuals 18 years or younger.
The Neuropsychologist is trained to assess thinking skills including memory and problem solving and assists the person to understand spinal cord injury and implement compensation strategies. The neuropsychologist consults with the other clinicians on the treatment team if adjustment, behavioral changes or learning difficulties, are slowing progress in therapies. The neuropsychologist can work with the individual and family to help with emotional and adjustment issues which often accompany a spinal cord injury. The neuropsychologist is available to counsel with families, to support and encourage survivors and families and to enhance coping skills.
|Certified Rehabilitation Registered Nurse (CRRN)|
Certified Rehabilitation Registered Nurses are an integral part of any rehabilitation team. They have additional training and experience in rehabilitation diagnoses and their associated impairments, adaptive techniques for independent functioning, and potential complications. They develop and implement nursing care plans, provide patient family education, and supervise other direct care staff, such as nursing assistants.
A physical therapist (PT) assesses the person’s ability to move in and out of bed, a chair or car; the ability to walk or drive a wheelchair, as well as strength, balance and endurance. The therapist can provide a variety of activities to improve these areas. The PT also teaches family members and friends how to safely help the person out of the chair, into a car, to walk and go up and down stairs.
An occupational therapist (OT) assesses a person’s present abilities regarding activities of daily living, or ADL, with the goal of community re-integration. ADLs include skills such as dressing, bathing, toileting and eating, as well as homemaking and community skills. The OT works with arm and shoulder strengthening, vision changes and higher level thinking skills such as problems solving tasks, and job-related skills. The OT teaches the use of adaptive equipment to increase each person’s ability to complete ADLs with less assistance.
|Speech language pathologists|
The speech language pathologist focuses not only on the person’s speech or ability to talk clearly, but also on all aspects of communication such as talking, understanding what others say, reading, writing, taking turns in conversation, concentration and memory. They help patients who cannot talk find other ways of communicating. They also evaluate and treat difficulties the person may have with swallowing.
|Therapeutic recreation specialists|
To enhance leisure skills while at Madonna, individuals are offered therapeutic recreation after a referral from the treatment team. A recreation therapist discusses leisure lifestyle preferences prior to the injury with each person and family member to determine specific hobbies or interests. Leisure education sessions focus on relearning an activity or learning to modify a leisure activity by using equipment or different rules. The recreation therapist integrates the skills learned in other therapies for leisure activities. Community outings are available with the recreation therapist to practice skills needed to return back to the community.
Each person at Madonna has an assigned case manager who will lead the team in efforts to help recovery. The case manager communicates with representatives from the insurance company and keeps them informed of an individual’s progress plans. They will regularly visit with the person and his or her family members to see how the person and family feel the program is progressing and to help coordinate plans for discharge. This planning is to help assure a smooth transition from the rehabilitation setting to home or an alternative living setting.
The social worker assists the person and family with emotional and social concerns. He or she is available to assist the person, their family and friends to understand the effects of the injury and to learn how family and friends can adjust and be helpful in the recovery process. The social worker is able to assist survivors and their families to find support groups and communicate with other survivors of spinal cord injury and their families. At the time of admission, the social worker starts working on the discharge plan with family. The social worker will discuss community support services based on the team’s predictions of the person’s needs at that time.
|Spiritual care specialist|
The chapel is the center of Madonna, both literally and spiritually. It is open 24 hours a day for private meditation and prayer. The schedule of services is posted outside the chapel. Mission Services provides spiritual and religious support by offering daily Catholic Mass and regular Protestant services. A member of Mission Services visits regularly with every person to offer pastoral counseling. They also meet with individuals and their families on an on-call basis. Mission Services coordinates with the person's pastor when appropriate.
The Angel Dog program, an extension of Mission Services, combines traditional pet therapy with spiritual care. Trained handlers and their dogs can be referred to your family member for therapeutic visits.
The respiratory therapist (RT) provides specialized care for the individual with breathing and respiratory difficulties following spinal cord injury. The RT works with the team to wean the individual from a ventilator and/or tracheostomy. He or she also administers and monitors medications prescribed by the physician to improve a person's ability to cough, breath and resist infection.
|Certified driver rehabilitation specialist|
Through the Driver Retraining Program, an occupational therapist evaluates the person's driving skills and retrains him or her, if appropriate.
Licensed medical nutrition therapists staff the Nutrition Therapy Department. A nutritional assessment is completed for each person during the first part of his or her stay. A person's diet history and food preferences are obtained, either from the person or from a family member. The nutrition therapist routinely assesses the individual's weight and dietary intake and adjusts his or her diet according to each individual's needs. When a person has a special diet, the nutrition therapist instructs him or her and family members about how to maintain the specialized diet while in the hospital and at home.
For school-aged individuals, the education specialist is the liaison between the rehabilitation team and the school. He or she coordinates school meetings, training and assists school personnel to make the necessary modifications for a smooth transition back to the educational setting. The education specialist also works with college-aged individuals or those persons who wish to earn a general education degree (GED).
A certified prosthetist specializes in the fit and production of an artificial limb for those with amputations. They work collaboratively with the physician and other team members immediately after the amputation to prepare the patient’s limb for a prosthesis, and then after the wound is healed regarding the fit and proper use of the device. A certified orthotist specializes in the fit and production of a limb brace. They work collaboratively with the physician and other team members to insure proper fit and use of the brace.
View a list of awards and accreditations that demonstrate our commitment to providing the best quality of care for our patients.
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.
Contact our admissions team to learn how your loved one can begin their brain injury rehabilitation journey at Madonna.