Patient Care

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 attend therapy sessions whenever possible so they may reinforce new techniques being taught. Research shows the more involved the family is during rehabilitation, the higher success rate for returning 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 with after stroke.

Community Integration The ability to resume one's life role and participate in the community to the extent desired 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 so involvement of spouses, children, and others in the patient's support system is a vital part of recovery. Madonna's Stroke Program does this through involvement in education/training as well as peer support, involvement in support groups, and other counseling.

Madonna Rehabilitation Hospital is accredited by CARF, the Rehabilitation Accreditation Commission as an inpatient and outpatient Stroke Specialty Program, hospital level, for adults and pediatric family centered care. We offer comprehensive programming for individuals with all types of stroke, from those who are still in the early stages of recovery following a very severe stroke to those who have had a mild stroke which doesn't require inpatient care. Individuals with stroke can receive services in one or more of multiple levels of care, including:

• Long Term Acute Care Hospital - for those with moderate to severe impairments and/or medical needs
  
• Acute Rehabilitation- for those with moderate to severe impairment who are ready for intensive rehab and can tolerate at least three hours of therapy per day
  
• Rehab. Day Program- for those who can be at 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 or one of many specialty services such as Driver Rehabilitation, Vision Program, or Stroke Clinic
  

Key components of Madonna's Stroke Program include:

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 practice real life tasks such as grocery shopping, banking, climbing up and down from a tractor, or going to a movie theater. A teaching kitchen with a variety of adaptive equipment is available for patients to learn how to prepare simple meals in preparation for returning home.

Medical care: Each patient's care is directed by a physician who specializes in physiatry
(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. Other specialty physicians, such as pulmonary or internal medicine, are available as needed.

Rehabilitation nursing staff are specially trained in providing care for patients with stroke. Several nurses have specialty training as a Certified Rehabilitation Registered Nurse. Patients served on LTACH or ARU recieve care from nurses with rehabiltation training and/or experience 24 hours per day, seven days per week.

Rehabilitation: Madonna has a dedicated team of professionals who have completed special training in treatment of persons with stroke. Each individual's treatment team is made up of physical, occupational, speech, recreational, and respiratory therapists, social worker, rehabilitation nurse, and case manager as well as staff from neuropsychology as appropriate. They work together with the patient and their family/caretaker to meet the unique physical, cognitive, social and emotional needs of the patient. Patients on LTACH receive 2 hours and patients on ARU receive 3 hours of PT,OT and/or ST per weekday with supplemental care on the weekends. Patients served on SAR receive 1 hour of PT,OT,ST per weekday. Outpatients who receive multiple services, such as in the Rehabilitation Day Program receive PT,OT,ST up to 3 hours per day, 5 days per week. Traditional or single service outpatient therapy is generally for 1-2 hours, 3 days per week.

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

Specialty Staff: Madonna is the only rehabilitation hospital in Lincoln that has a full staff of specially trained rehabilitation and neuropsychologists 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 patient and their family members. Madonna has 4 physical therapists and 4 Occupational Therapists who are NDT (neuro-developmental treatment approach) trained, which means they have completed extensive training and testing regarding treatment of patients with neurological injuries and illnesses such as brain injury and stroke. This team of professionals is lead by a physiatrist and a physician specializing in physical medicine and rehabilitation who has expertise and experience in the area of stroke rehabilitation.

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.

Technology: Madonna has a multitude of technology available to help individuals to be more independent with tasks, such as using the telephone, accessing the computer and controlling their environment. Examples include: voice activated phones, voice activated computer software, eye gaze software, environmental control systems using sip/puff or other switches.

High-Tech Treatment: Madonna is one of the only rehabilitation hospitals in the region to offer high tech treatment equipment, such as the body weight support treadmill, Bioness functional electric stimulation braces that help individuals improve hand or leg function.

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, ending in a 2-3 night stay in Madonna's transitional 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 series of daily education classes is provided for all patients and family/friends on a variety of stroke related topics.

Vision Program: The ability to accurately perceive the environment is often affected following a stroke 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.

Intensive Aphasia: Madonna is one of the only providers in the region to offer an Intense Aphasia Service, for persons who have difficulty communicating. This service involves 3-4 hours of speech therapy at least 4 days per week. The sessions include individual sessions, group sessions, and independent drill work using a computer program.

Long term Success: 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. Some ways we do this are:

• Structured Independence Program: It is important for individuals completing their rehabilitation to stay active and exercise safely. Learning how and what to do in a community based fitness environment, with trained staff and specially adapted equipment available promotes success.
  
  
• Home Assessments: This service is offered on inpatient or outpatient basis. Identifying barriers in the home environment early on gives therapists an opportunity to address these issues through therapy or with recommendations for architectural changes or adaptive equipment. Often very inexpensive changes can result in a person’s ability to remain in their own home.
  
  
• Portable Health Profile: Madonna staff help patients complete a personal Portable Health Profile, which is a collection of vital health information aimed at minimizing the fragmentation of our healthcare system, improving communication between professionals and promoting a person's active role in their own care.
  
  
• Stroke Clinic: A multidisciplinary Stroke Clinic is held at Madonna weekly, where a person may be seen by a physiatrist Dr. Zeng as well as physical, occupational and speech therapists as appropriate.