Madonna Rehabilitation Hospitals

Stroke

Patient Stories

Iowa man uses music and faith to heal
IOWA MAN USES MUSIC AND FAITH TO HEAL
October 04, 2018

Ted Gray of Council Bluffs, Iowa, used music therapy to recover from a stroke. His team at Madonna arranged for him to play the organ at one of Madonn...

Stroke Rehabilitation

Medical teams led by physiatrists, or physicians who specialize in rehabilitation, determine a customized plan for each stroke 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 stroke. 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 utilized in therapy whenever possible. Our language and cognition lab allows patients to work outside of formal speech therapy sessions.

Registered nurses with stroke rehabilitation training and experience 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 stroke 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 stroke 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.

We provide a daily education series to patients and families to equip them with the knowledge of brain structure as it relates to understanding stroke, recurrent stroke prevention, fall prevention, wellness, recreation and leisure, nutrition, emotional change following stroke and aging with a disability. We provide ongoing support for patients and families through our stroke support group, meeting monthly on both campuses.

Rehabilitation after stroke 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 stroke 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 stroke rehabilitation at Madonna. They provide a variety of services, including neuropsychological assessment, adjustment counseling, family therapy, memory testing, dementia evaluation, behavioral management and psychoeducation. Our rehabilitation counselors also provide support, individually or in group settings, for family and caregivers affected by the patient’s stroke.

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

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 stroke 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. Additionally, Madonna provides a two-week, daily stroke education class that covers a variety of stroke-related topics for all patients, family members and caregivers.

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 is committed to the lifelong success and wellness of our patients. When possible, 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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Madonna Rehabilitation Hospital offers comprehensive programming for individuals’ ages 0-100 with all types of strokes, from those still in the early stages of recovery following a very severe stroke to those who have had a mild stroke that doesn’t require inpatient care. Our program is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), as an inpatient and outpatient Stroke Specialty Program, hospital level, for adults and pediatric family centered care. Madonna’s multiple levels of inpatient care, as well as outpatient services, at both of our campus locations, ensures we are able to offer each stroke patient the right type of care at the right time. 

In fiscal year 2017, Madonna admitted 38 percent of patients from outside the Lincoln area to the Lincoln campus and 20 percent from outside the Omaha area to the Omaha campus. We admitted a total of 765 patients with stroke across inpatient and outpatient services at both hospital locations. 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 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 to attend therapy sessions whenever possible so they may reinforce new techniques being taught. Research shows a correlation between family involvement and the rate in which patients return 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 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 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. All Madonna nurses are specially trained in providing care for patients with stroke, and several Madonna nurses have specialty training as a Certified Rehabilitation Registered Nurse (CRRN).

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. 

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, medical acuity and length of stay. 

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

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 training, such as grocery shopping, cooking a meal, transferring in and out of a car or getting in and out of bed. 

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 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. 

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, frequently 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. 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. 

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 stroke 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 stroke 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.

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.