Patient Care

Our Philosophy: Madonna's goal is to help the people we serve become as independent as possible while establishing a partnership for life that the person served and their family can turn to when needed. Programming is highly individualized, dependent upon each individual's functional level and activity tolerance. Family members are encouraged to be actively involved in therapy and nursing care so they may reinforce learning new skills.

Madonna's Brain Injury Rehabilitation Program serves individuals with traumatic or non-traumatic brain injuries of any severity. Patients who are just emerging from coma (Rancho Level II or higher) may be admitted to our LTACH level of care, those who have already emerged from coma on ARU, and those with moderate to mild deficits might be served in our outpatient program.

Madonna Rehabilitation Hospital is accredited by CARF, the Rehabilitation Accreditation Commission, as a Brain Injury Rehabilitation Program for multiple levels of care including long term acute care hospital (LTACH), acute rehabiltation (AR), transitional care and comprehensive outpatient (rehabilitation day hospital). Madonna is one of only 8 organizations in the US who are accredited in both Brain Injury and Pediatric Specialty Programs. This means that Madonna meets higher standards relating to staff competency, programming, patient -family edcuation, advocacy and outcomes management. During its most recent survey in April 2009, CARF surveyors reported the following regarding Madonna's program:

"Madonna Rehabilitation maintains experienced and highly qualified peresonnel who are highly dedicated and demonstrate a commitment to the core values and mission of the organization." For example, 24 direct line inpatient and outpatient clinicians are Certified Brain Injury Specialists (CBIS) from the AACBIS.

"The interdisciplinary treatment teams exhibit professionlism, enthusiasm, and compassion while thoroughly addressing the physical, functional, cognitive, emotional, social and spiritual needs of the persons served and their family members."

"The organization is commended for the integration of families and support systems into the brain injury continuum of care. Persons served, their families, and support systems are partners throughout the rehabilitation process. Family engagement into the rehabilitation process enables carryover of the therapeutic techniques at all levels of care and return to community settings."

Individuals with brain injury can receive services in a variety of areas including the following:

• Long Term Acute Care Hospital - for those with moderate to severe injuries or illnesses with lots of medical needs)
  
• Acute Rehabilitation- for those with moderate to severe injuries or illnesses who are ready for intensive rehab and can tolerate at least three hours of therapy per day
  
• Rehabilitation Day Program - for those who can be a home or community setting in the evening but require an intense, coordinated program of multiple therapies with an emphasis on independent living and community re-entry during the day
  
• Outpatient Services- for those who need one or more therapy services but not the intensity or coordination typically provided in RDP
  

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, case management, social work services, spiritual services, and orthotics/prosthetics as needed. In addition to these specialities, 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 other support system for the persons served are provided with structured training on how to interact with and care for their loved one, their preferences are solicited and used as part of the rehabilitation process, and they are involved in developing an appropriate discharge plan. While most of our patients with brain injury are discharged to a community setting, patients who will need additional time in a more structured residential setting after discharge are also served.

Madonna accepts patients with a wide variety of funding, including Medicare, Nebraska Medicaid, commercial insurances, and will consider out of state Medicaid and non-funded patients on a case by case basis.

Key components of Madonna's Brain Injury Program include:

Environment - 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 care if necessary. Adolescents and children 18 years or younger are admitted to a special, closed Adolescent and Childrens Unit which is decorated in an age-appropriate manner. These children are provided rehabilitation in special age-specific treatment spaces, such as the pediatric gym and Therapeutic Learning Center, a 2-room school house.

During its most recent survey in April 2009, CARF surveyors praised Madonna for its therapeutic approach and environment, saying: "The organization is commended for its investment of significant resources to implement a simulated community environment utilizing therapeutic destinations throughout the inpatient and outpatient programs." Recent remodeling of the therapeutic space includes such items as a house with bedroom, kitchen, bath and laundry rooms, a retail store, automobile, tractor, and pickup truck and workshop. Therapists integrate functional activities in these areas in preparation for real life activities in their home community.

Medical care - Each patient's care is directed by a physician who specializes in physiatry 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 brain injury and several Madonna nurses have specialty training as a Certified Rehabilitation Registered Nurse. For patients who are very low level, the first part of their treatment might be to wean them from a mechanical ventilator. Madonna's Pulmonary Program has an excellent track record for successful weaning.

Rehabilitation - Madonna has a dedicated team of professionals who have completed special competency training in treatment of persons with brain injury. The team, which is made up 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. Madonna is the only rehabilitation hospital in Lincoln that has a full staff of specially trained rehabilitation psychologists on-site who are an integral part of the rehabilitation team, participating in team meetings, leading behavioral intervention plans, and providing counseling and support for both the individual and their family members. Use of technology, such as the Body Weight Support Treadmill, Bioness functional electrical stimulation, environmental control units, custom seating and mobility systems, and augmentative alternative communication are integrated into the treatment program throughout the continuum of care.

Community Re-Entry: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Participation in a variety of 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.

Unique Services

• The ability to accurately perceive the environment is often affected following a brain injury and can result in difficulties with balance, walking, reading, and attention. Madonna is the only rehabilitation provider in the region to offer a comprehensive vision program, in which all the disciplines apply integrated vision treatment strategies, specialized techniques, and equipment to improve visual processing
  
• Many 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 2-day assessment and treatment focusing on medical, physical, cognitive (thinking) and emotional aspects of mild traumatic brain injury.
  
• Madonna also offers a Sports Concussion Assessment for persons who have recently suffered a sports-related concussion and need assessment services for physical and cognitive changes and return to activities recommendations. Program Manager Lori Terryberry-Spohr, Ph.D. has completed research related to concussion injuries and leads educational efforts with local school coaches and parent groups.
  
• Many individuals with brain injury require intermittent care throughout the rest of their lives. As the regional 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. Twice per month a multidisciplinary Brain Injury Clinic is held at Madonna, where a person may be seen by physiatrist Dr. Eric Hartman, as well as a team of therapists.