Madonna stands at the threshold of the future of rehabilitation. With donor, corporate and foundation support and through a carefully crafted plan for the future, Madonna can seize this opportunity to reinvent the rehabilitation experience. Three initiatives encompass the hospital's priorities as we move forward:
- Facility Enhancement
- Smart Hospital=Smart Rehabilitation
- Clinical Innovation for Patient Care
Facility Enhancement
Madonna is redefining the rehabilitation experience by building it into the world our patients, families, visitors and staff inhabit every day. We plan to create an environment that:
- reflects our core value of hospitality;
- engages those we serve and their families in a rehabilitation experience that delivers personalized, customized care; and
- prepares these individuals to return not only to their communities, but their life roles.
Proposed facility renovations will include both community and personal spaces:
Community Spaces:
Madonna's vision for the future is to redefine all of our community spaces by building opportunities to practice skills needed for returning to community, home and life roles throughout the hospital. Visually, the interior will have the effect of a town with streets, shops and park-like areas for socializing with visitors and other patients. All of these spaces will be therapeutic, offering patients safe spaces to practice skills in preparation for return to their home community.
Personal Spaces:
Madonna is keenly aware of the personal nature of injury and illness and the need for privacy and comfort. Patient rooms on all three of our levels will be redesigned to create private, relaxing and personally appealing spaces for patients. Additionally, we will provide state of the art upgrades to patient rooms to allow multimedia capability. Patients will be able to:
- access the Internet wirelessly,
- view video clips about their disability or a therapy exercise,
- communicate with friends and family outside the hospital and with staff, and
- have more entertainment options
Smart Hospital = Smart Rehabilitation
"Smart Hospital" technology, such as sophisticated nurse call systems, clinical documentation and electronic medical records were initially developed specifically for acute care hospitals. As the technology has advanced to allow the flexibility needed for a rehabilitation environment, Madonna plans to team man and machine to provide a life-changing experience for the patients we serve. This initiative includes:
Documenting Care in "Real-Time" - patients in rehabilitation are not confined to a room, which can make communication among the multiple clinicians on a patient's team challenging. An enhanced documentation system will capture elements of care while patient treatment is in progress from anywhere within the hospital. This documentation allows:
- Up-to-the-minute updates on patient status
- Enhanced communication and coordination between care givers and therapists
- Reduced cost of transcription services
- A large patient care database for care referrals
Patient Communication System Enhancements - Patient rooms will be updated with a sophisticated nurse call system which links the patient directly to the nurse, rather than the nurse's station. Nurses wear a voice activated communication device that allows direct contact with patients as well as with other treatment team members throughout the hospital.
Enhanced Physician Access to Information - To facilitate communication between Madonna and the more than 100 hospitals from which we receive patient referrals, a Picture Archival and Communication System (PACS) provides high-resolution digital x-ray images. PACS can be readily accessed from other hospitals and physician offices and homes.
Clinical Innovation for Patient Care:
In order to take rehabilitation to the next level, Madonna must continue to be innovative in bringing new clinical applications to the research lab, the bedside and the therapy gym. New clinical innovations support Madonna's Centers of Excellence, as well as program expertise in traumatic brain injury and spinal cord injury.
Driving Program - In order to fully prepare patients to take the wheel again, Madonna must upgrade its current driving program with a new, full-size modified van, an assessment driving simulation tool, and updated vision testing equipment that checks for acuity, color, depth perception, etc.. This new equipment will help measure patient readiness to drive and assist those with disabilities to use adapted vehicles.
Vision Program - Following a stroke, individuals may suffer from what is known as a "visual field cut." The brain is not able to interpret what the patient is seeing in certain areas of the field of vision. While even five years ago, therapy for a visual field cut meant working around the vision loss, today's therapy has the potential to retrain the brain to see the full visual field. Equipment upgrades will increase our therapists' ability to customize treatment for visual field losses, improving outcomes for a wider range of diagnoses.
Lokomat - Madonna currently has a Body Weight Support treadmill system on site to help clients regain their walking ability. The Lokomat is the next step with both clinical and research potential at Madonna. Originally designed for individuals with spinal cord injuries that prevent or limit gait, Lokomat incorporates "robotic arms" that help move a patient's legs on a treadmill, strengthening muscles needed for walking, and, in some cases, restoring function in these critical areas. This technology also affords a cost-savings as it requires fewer therapists than a conventional body support treadmill, and reduces strain on therapists as well.
Bioness - Patients who have incomplete spinal cord injuries or area recovering from a stroke or traumatic brain injury can benefit from electrical stimulation of the nerves in the arms and legs. The Bioness equipment is worn on the arm/hand or leg and can assist patients returning function to their extremities. Madonna currently has six Bioness units that are in constant use. Additional units are needed to get this critical technology to our patients on waiting lists.
Additional Needs
In addition to these initial priorities, Madonna has identified several other areas of need:
Virtual Reality - virtual reality equipment, gloves and goggles patients wear that allow them to navigate through a virtual, computerized environment, holds great potential for helping patients regain physical function in a safe, virtual environment.
Assistive Technology - Madonna's Center for Excellence in Communication is a leader in assistive technology research and clinical therapy. Research initiatives on the horizon include:
- A study with the potential to expand Madonna's aphasia, or speech loss due to a brain injury, program, allowing staff to better match technology for patients based on research outcomes.
- A study that could lead to the development of new memory aid strategies for individuals with severe memory impairments, such as Alzheimers (early stages), traumatic brain injury, advanced Parkinson's, advanced multiple sclerosis, and the like
- A study that will design a "smart room" for persons with severe physical impairments, allowing them greater control over their environment and a higher level of independence and evaluate patient outcomes in this environment.
- A study that will evaluate the effectiveness of providing service through Telehealth (videophone) technology to persons in remote or rural areas. This program has the potential not only to reach patients without immediate care options, but also to safe money and time by reducing travel while maintaining access to information.
- A study that could lead to the development of new memory aid strategies for individuals with severe memory impairments, such as Alzheimers (early stages), traumatic brain injury, advanced Parkinson's, advanced multiple sclerosis, and the like
Four-plex housing unit - This facility allows patient families to stay conveniently close during treatment.
Brain Mapping - This new field of research involves using a computer to map surface activity of the brain. Tracking this activity opens the possibility for training the brain, using biofeedback, to activate certain brain areas - allowing for greater recall, organization and mental efficiency. Software upgrades will allow mapping of deeper brain structures, important for the organization of working memory and the focusing of attention.
Movement Sciences Center - The Center for Excellence in Movement Sciences has several opportunities for research and its clinical application:
- Balance/Gait Equipment- this new equipment will allow staff to better diagnose balance and gait challenges in patients, and will offer opportunities for research in fall and fracture prevention.
- Metabolic Measurement- this equipment will allow staff to determine a patient's metabolic rate, or energy expenditure, providing information helpful to treatment and an important indicator in research.
- Research Chair Endowment- this area seeks funds to fully endow a research position within the center.
- Orthopedic Researcher- a researcher in this area will broaden the range of possibilities for research at Madonna to include the field of orthopedics, allowing access to a greater range of federal research funds and ultimately benefiting care for Madonna patients.
- Post-Doctoral Researcher- this position will help advance research at Madonna as well as link the hospital to other institutions.
Horticulture Therapy - the use of horticulture therapy can improve the functional skills in the physical, social, emotional, cognitive, and psychological domains of an individual. Through this program, Madonna patients Alzheimer's and long-term patients will be guided in gardening activities chosen for their therapeutic value. Currently, Madonna incorporates some horticulture therapy and seeks to expand this positive experience to as many patients as possible.
Swallowing Signals Lab - Madonna has long been a national leader in the research and treatment of swallowing disorders. By adding the swallowing signals lab to our existing equipment, we can improve our ability to assist patients with swallowing disorders by providing them with objective feedback during treatment sessions.
Adaptive Sports and Recreation - This program provides community adaptive sports and recreation workshops, open recreation times, and tournaments in a variety of sports and leisure activities to children and adults with disabilities. The programming allows individuals the opportunity to participate and compete in as varied activities as the rest of the community; to try new sports and recreation opportunities; and to explore new ways of doing previous activities. An active lifestyle prevents isolation as well as secondary complications of disabilities. Nearly 500 people participate each year.
Nebraska Concussion Study - This study has assessed, followed and managed 81 concussions sustained by high school athletes. In addition, the athletic trainers, coaches and physicians in the region have referred about 50 athletes to Madonna for further assessment and return to play guidelines. The goal of the expanded study is to be able to reduce the incidence of sports-related concussion through education and baseline testing, and to prevent the occurrence of second impact syndrome, a rare but potentially deadly outcome of repeat concussions.
Informatics - This research area will develop a revolutionary tool to support optimal therapy treatment planning by capturing, integrating and presenting all treatment-relevant information. Treatment records and information will be carefully selected, entered, and digitally organized to allow treatment teams to access and query the system about patient treatments not only in the immediacy of the moment, but the immediacy of the setting using hospital-specific information based on outcomes for patients in Madonna's specific treatment environment.
Education. - With the explosion of new technology and innovations in rehabilitative treatment, Madonna is looking to the future educational needs of our staff:
- Built into every piece of treatment equipment are funds to train staff on its optimal use. We are keenly aware of the nationwide nursing shortage and are responding by providing opportunities for nurses to continue their education while working.
- It is our belief that investing in our nurses by providing flexible options for nurses to progress from Licensed Practicing Nurse (LPN) to Registered Nurse (RN) to a Bachelor's program and rehabilitation nurse certification will encourage nurses to stay at Madonna, and attract new nurses to our facility. Along that continuum, nurses will also have access to a wide variety of certification options in treatment areas, allowing them to specialize according to their interests and needs.
- To continue to build the expertise in rehabilitation nursing we feel is critical to maintaining and improving the standard of care at Madonna and the rehabilitation community nationwide, we are creating the Institute for Rehabilitation Nursing. Through the institute, we will create a curriculum specific to the needs of rehabilitation hospitals and patients, creating a national model for the potential of rehabilitation nursing.
- Madonna's commitment to education reaches beyond the nursing staff. We believe that all employees benefit from a stimulating and engaged work environment. We will continue to encourage our staff to set and follow educational goals by providing on-site educational opportunities as well as tuition support for continuing education.
