Spinal Cord Injury

Patients will be seen daily by a physiatrist, also known as a Physical Medicine and Rehabilitation (PM&R) physician, who specializes in the rehabilitative treatment and management of disease and injury affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. The primary focus is to restore function and promote overall health.

Registered nurses with rehabilitation training or experience are on staff at all times to care for patients.

Madonna provides a comprehensive continuum of care for our spinal cord 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 LTCH, 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 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, 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-family education is provided on a wide variety of topics, including emergency preparedness, management of a personal assistant, aging with disability, prevention of potential risks and complications from SCI, life-care planning, self-advocacy and community resources.

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, ultrasound, echocardiogram, venous doppler, arterial doppler, Holter monitor,  and electroencephalogram (EEG).

Madonna's in-house laboratory provides anticoagulation, hematology, chemistry, therapeutic drug level testing and urine analysis services with results available the same day in most cases.

Madonna has registered dietitians and licensed medical nutrition therapists who are part of the care team and ensure the patient's individualized nutrition plan is met

Neuropsychologists and rehabilitation counselors are an integral part of rehabilitation at Madonna.  They provide a variety of services, including neuropsychological assessment, adjustment counseling, pain management, family therapy, concussion or mild brain injury evaluation, memory testing, dementia evaluation, neurofeedback, biofeedback, behavioral management and psychoeducation

Assistive Technology Professional certified therapists provide seating and positioning evaluations for patients who use a wheelchair.

Our Spinal Cord Injury Program is comprehensive, providing medical interventions in the areas of autonomic dysreflexia, bladder and bowel function, circulation, swallowing and nutrition, infection, medication management, musculoskeletal and neurological effects, pain, respiration including ventilator and/or tracheostomy management, sexual function/fertility, skin integrity and spasticity management. Patients with a need for chemical use/abuse/dependency treatment are referred for treatment outside Madonna.

Life-long wellness training — including having a plan to stay active and to exercise safely — is also important for individuals completing their rehabilitation. Our trained staff promotes success by employing specially adapted equipment to teach patients how and what to do in a community based fitness environment. In addition, they explore new wellness opportunities that match a patient’s current fitness level.

Madonna is committed to meet all the needs of its patients--physical, spiritual and emotional. A spiritual care professional is a member of and consults with the care team. The chapel, the heart and soul of Madonna, is there to nurture faith and hope during times of crisis.

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. 

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. 

Rehabilitation after spinal cord 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 spinal cord injury patients. Patients may also work on specific goals related to returning to work, school or driving during their rehabilitation stay.

Madonna’s spinal cord 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’s Spinal Cord Injury Rehabilitation Program serves children 0-18 and adults of all ages with any level of complete or incomplete neurological impairments as a result of traumatic or non-traumatic spinal cord injury (SCI). An interdisciplinary team of clinicians address a multitude of functional areas, including activities of daily living (ADL), assistive technology, behavior management, cognition (thinking and reasoning skills), communication, community integration, driving, durable medical equipment, environmental modifications, leisure and recreation, mobility, orthotics and prosthetics, wheelchair seating systems and vocational rehabilitation.

Patient-family education is provided on a wide variety of topics both one-on-one and in a group classroom setting.  Education classes address emergency preparedness, management of personal care assistants, aging with disability, prevention of potential risks and secondary health complications from SCI, life-care planning, self-advocacy and community resources. This education is also available to the community and other professionals and provided through webinars, prevention education events, continuing education events and mentoring. 

The program is comprehensive, providing medical interventions and assessment in the areas of co-morbidities, neurological changes, abnormal tone, body composition, autonomic dysreflexia, bladder and bowel function, circulation, swallowing and nutrition, infection, medication management, musculoskeletal and neurological effects, pain, respiration including ventilator and/or tracheostomy management, sexual function/fertility, skin care and spasticity management. Patients with a need for chemical use/abuse/dependency treatment are referred for treatment outside Madonna.

Health promotion and life-long wellness training — including having a plan to stay active and to exercise safely — is also important for individuals completing their rehabilitation. Our trained staff promotes success by addressing women’s and men’s health issues and training in use of equipment to in a community-based fitness environment. In addition, they explore new wellness opportunities that match a patient’s current fitness level and develop a plan to move forward with them after discharge. 

Clinical Expertise: Each patient’s care is directed by a physician who specializes in physiatry and/or a physician who specializes in internal medicine. A pediatrician is involved in daily to care for individuals 18 years or younger. Other physician specialists, such as pulmonologists, also provide consultation services at Madonna.   Madonna nurses are specially trained to care for patients with spinal cord injury, and several of our nurses have specialty training as a Certified Rehabilitation Registered Nurse. The spinal cord team has a rehab counselor who facilitates the team approach to adjustment to the disability, behavior health, and peer support services. The psychology staff provides family and support system counseling both individual and in a support group setting and provides support in the area of sexual adjustment.  Case management is also a  key part of the program in preparing patients and families for transitions across the lifespan, resource management, and how the importance of lifelong follow up with key health care providers. 

Treatment Equipment: Madonna is one of the region’s only rehabilitation hospitals to offer treatment equipment such as the RT-300, body weight support treadmill, Lokomat and EKSO to help individuals with incomplete SCI regain motor strength and control. Equipment options are available to serve pediatric individuals as well as individuals who may need bariatric accommodations.  Our research capability and rehab engineering staff extends our scope into development of new equipment and technology patients with SCI can benefit from now and in the future as well. 

Madonna features a multitude of assistive technology that assists individuals with any level of injury the opportunity to be more independent while using the telephone, accessing the computer and environmental control units. Examples include: voice-activated phones; voice-activated computer software; eye-gaze software; and environmental control systems using sip/puff or other switches.

Wheelchair Seating and Positioning: Selecting a wheelchair and following up after getting a new wheelchair are important to the overall long-term success of an individual with spinal cord injury. Pressure ulcers are a common and very costly secondary complication in persons with SCI. An adequate seating system is one way to prevent this complication. Madonna features an electronic pressure-mapping system that visually indicates pressure points, allowing clinicians to design and provide an appropriate seating system.

Preparation for Home: Madonna patients with spinal cord injury are provided with a 24-hour, caregiver-training program based on principles of self-advocacy and self-direction. We teach individuals, with or without identified caregivers, how to direct their care and what to do if emergencies arise. We provide opportunities for training in safety in the environments in which they participate both at home and the community.  Independent and community integration are facilitated through use of our transitional apartment and regular community outings.  Recommendations for home modifications are also made in partnership between our home assessment specialists, the team and the patient and family.

Community Reintegration: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Madonna integrates a variety of  independent living skills into the program including adaptive sports and recreational outings into therapy, or just for fun. Patients may also visit with a vocational rehabilitation counselor about work re-entry, and may work on specific goals related to their return to driving or school.

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 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.

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.

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.

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.

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.