Quality, technology and a multidisciplinary staff of experienced physicians, mid-level providers and therapists position Helen Hayes Hospital as a regional leader in acute, sub-acute and outpatient physical rehabilitation.
Rehabilitation plays an important role in improving function and quality of life following lengthy hospitalizations, complex surgical procedures, strokes, amputations or serious injuries such as traumatic brain or spinal cord injury. Helen Hayes Hospital’s breadth of inpatient and outpatient programs enables patients — from comatose individuals to those in need of intensive inpatient and outpatient therapy — to reach their full potential and re-adapt to community living.
Enhancing Outcomes, Managing Costs
In the current era of health care, Medicare reimbursement rates are shifting toward a value-based payment model, with payments linked to care quality and patient outcomes. One area of particular scrutiny for reimbursement dollars is post-acute rehabilitation, which accounts for roughly 15 percent of Medicare spending, according to Marjorie King, MD, FACC, MAACVPR, Chief Medical Officer at Helen Hayes Hospital and Assistant Clinical Professor of Medicine at Columbia University.
Glenn M. Seliger, MD, Director of Traumatic Brain Injury Rehabilitation Services at Helen Hayes Hospital and Assistant Professor of Clinical Neurology at Columbia University, prepares for team rounds with Marjorie L. King, MD, FACC, MAACVPR, Chief Medical Officer at Helen Hayes Hospital and Assistant Clinical Professor of Medicine at Columbia University.
Matthew Castelluccio, Coordinator of Adapted Sports and Peer Mentoring Services, demonstrates to Dr. King one of the hand cycles used by the Hospital’s Adaptive Sports and Recreation participants.
Mary Guarracini, MD, Director, Rehabilitation Medicine; Director, Amputee and SubAcute Rehabilitation Service; Assistant Professor of Clinical Rehabilitation Medicine, Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians & Surgeons, confers with physical therapists during a patient’s therapy session using the TheraStride, a body-weight-support treadmill system that promotes neuro recovery. The Hospital is one of the only facilities in the metropolitan region with this equipment.
“Ironically, the basic principles being used to drive healthcare reform are the same ones I witnessed when I came to work here 30 years ago — putting the patient’s goals first and using a team approach to achieve meaningful health outcomes,” Dr. King says.
Helen Hayes Hospital routinely tracks quality metrics, including the Hospital’s transfer rate to acute-care facilities. The Hospital is equipped with an in-house laboratory, pharmacy and on-site X-ray imaging and can manage medical concerns, including intravenous antibiotic administration and ventilator management. This enables patients to receive the medical care they need while continuing their course of rehabilitation treatment. While patients may be transferred back to the acute-care setting if they become acutely ill or need a surgical procedure, for example, transfers are minimized.
“Our transfer rate to acute-care facilities has consistently hovered around 10 percent since 2010,” Dr. King says.
Helen Hayes Hospital also participates in several databases, including eRehabData, IT HealthTrack and Press Ganey, to track and compare patient outcomes with those of other facilities on a national and regional level. Both patient satisfaction and a range of functional outcomes are monitored through these programs. Helen Hayes Hospital compares very favorably with its peers, regionally and nationwide.
“Historically, our patients make outstanding functional gains from the time of admission to discharge, with over 94 percent living in their communities 90 days post-discharge,” says Mary Guarracini, MD, Director, Rehabilitation Medicine; Director, Amputee and SubAcute Rehabilitation Service; and Assistant Professor of Clinical Rehabilitation Medicine, Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians & Surgeons.
The Neurorecovery Program
While Helen Hayes Hospital offers programs for a variety of diagnoses, it specializes in rehabilitation for patients who have a neurological disorder or who have experienced a stroke or a traumatic brain or spinal cord injury.
The Traumatic Brain Injury (TBI) Rehabilitation Program at Helen Hayes Hospital is one of the most extensive programs in the nation, featuring a 48-bed, restraint-free unit. Board-certified neurologists and physiatrists, rehabilitation nurses, behavioral health specialists, physical and occupational therapists who have achieved certification by the Brain Injury Association of America, nurse practitioners, and speech and respiratory therapists work collaboratively as a dedicated TBI team.
The first step to rehabilitation following a TBI is often the Neurorecovery Program, which is designed for comatose patients. These patients may remain immobile and comatose for an extended period of time and are at greater risk of severe complications, including muscle contracture, pressure ulcers, heterotopic ossification and bronchiecstasis. The goal of the program is two-fold: to help the patient emerge from coma and to prevent the secondary complications.
“During this time, we use a multitude of strategies to improve the likelihood that patients will emerge from coma,” explains Glenn Seliger, MD, Director of Traumatic Brain Injury Rehabilitation Services at Helen Hayes Hospital and Assistant Professor of Clinical Neurology at Columbia University. “Medications to stimulate the brain, therapies designed to elicit a stimulus response, such as touch, sound and aromatherapy, as well as range-of-motion exercises at the bedside, are all employed.”
Dr. Seliger confers on a patient’s progress with Vivian Breslin, RN, MS, MSN, NP.
From left, Tammy Goedken, DPT, ATP, rehab technologist, discusses with Debra Zeitlin, MASLP, CCC, ATP, Director of the Center for Rehabilitation Technology, how neurologically impaired patients can benefit from use of a robotic arm.
Splinting and serial casting, tracheostomy care and suctioning, and nutritional interventions also play a key role.
“Neurological recovery bears similarities to neurological development,” Dr. Seliger says. “A 1940s study on neurological development found that infants who were given basic nutrition but who weren’t held failed to thrive, which was termed ‘hospitalism.’ This serves as the theory behind our Neurorecovery Program. We provide patients an enriched environment that includes therapeutic nursing, recreation and stimulation to enhance neurologic recovery.”
Patients are typically in the Neurorecovery Program 30 to 60 days, depending on the level of progress achieved. Once patients emerge from coma and are able to respond to simple instructions, they progress to acute inpatient rehabilitation.
From Acute Inpatient Care to Transitional Rehabilitation
Acute inpatient rehabilitation encompasses up to six weeks of nursing, daily physical, occupational, speech, recreational and neuropsychological therapy, and pharmacologic management for issues such as focus and mood.
Physical and occupational therapists working with inpatients participating in the TBI Rehabilitation Program, as well as with patients who are completing outpatient therapy, may use a variety of technologically advanced therapeutic equipment, including the Armeo, functional electrical stimulation, treadmill training, SaeboFlex and Bertec Balance Advantage. These modalities, along with vibration therapy, may also be part of the customized rehabilitative plan following a stroke or spinal cord injury. Speech-language pathologists may also use videofluoroscopy swallowing tests and flexible fiberoptic endoscopic examination of swallowing to assess whether or not patients are experiencing aspiration and to determine what types of speech therapy and/or dietary modifications may be beneficial. Complementary medicine services, including massage, meditation, acupuncture, aquatics and yoga, have been well-received by the patient population and have proved to be an excellent adjunct to traditional therapies.
As patients approach the end of their inpatient rehab stay, a team of social workers and case managers works closely with the family to arrange for any needed home or follow-up care. Many TBI patients benefit from the Hospital’s unique Transitional Rehabilitation Program, which is often covered by a Medicaid TBI waiver.
Adapting to Community Living
The Transitional Rehabilitation Program helps patients regain the skills they need to function at home and in the community. Under supervision, patients may practice performing activities of daily living and/or take trips to grocery stores and other locations outside the Hospital to hone necessary life skills.
Krista Hludzinski, OTR/L, ATRI, senior occupational therapist, works with a patient in the Hospital’s warm-water pool. In the therapeutic pool, patients are often able to control body movements in ways that are not possible “on land.”
Dr. Guarracini and Zeitlin review the use of eye gaze technology. The Center for Rehabilitation Technology is a national leader in the innovative and interdisciplinary application of technology to assist people with physical disabilities to increase their independence. Staff are specialists in a range of assistive technologies and excel in working with clients who may have multiple and/or severe disabilities.
An Adaptive Driving Program is available on an outpatient basis for people who may need assistance behind the wheel, which includes individuals who have experienced a stroke, TBI or spinal cord injury or have other neurological or orthopedic concerns. As part of the program, occupational therapists assess patients’ ability to drive safely and help them master the use of adaptive equipment.
“Most of our patients make substantial gains over time,” Dr. Seliger says. “A significant percentage is able to return home or is discharged to a sub-acute program designated for head injury. If need be, we also follow and care for our patients for the rest of their lives.”
The Center for Rehabilitation Technology
The Hospital’s unique Center for Rehabilitation Technology offers services for patients with a range of disorders, from multiple sclerosis and amyotrophic lateral sclerosis to spinal cord and brain injury, all aimed at enabling the patient to be as independent as possible at home, work or school. Assistive technology specialists provide evaluation, training, custom design and fabrication for everything from seating and wheeled mobility to augmentative/alternative communication and computer access. A model Smart Apartment showcases over 35 items that patients can view and experiment with to see if they would be helpful in allowing them to live autonomously in their own homes.
“The technology in the Smart Apartment can be controlled by voice, eye tracking, touch and integrated wheelchair controls, enabling people to turn on the lights, for example, and perform other mechanical functions inside their home using brainwaves,” Dr. King says. “In addition, adaptations to commercially available equipment, including appliances, toilets, showers and lifts, are highlighted so patients can see what types of modifications they may need or want to make in their homes before discharge.”
Through a partnership with the Center for Adaptive Neurotechnologies at the Wadsworth Center, the Helen Hayes Hospital Center for Rehabilitation Technology has been utilizing brain-computer interface (BCI) technology to allow patients with specific disabilities to translate their thoughts into communication and actions. BCI technology uses brainwaves detected through an electroencephalogram (EEG), which are then processed by a computer or electronic device. Patients with TBI don’t typically require adaptive equipment featuring BCI technology, according to Dr. Seliger. However, the technology may be beneficial for patients who have sustained a spinal cord injury or have neurodegenerative conditions that may result in paralysis, such as amyotrophic lateral sclerosis.
An Entire Spectrum of Outpatient Services
Care doesn’t end once patients are discharged from an acute or sub-acute rehabilitation program. The Helen Hayes Hospital Outpatient Neurological Rehabilitation Center offers ongoing physical, speech, occupational and aquatic therapy, as well as designated programs for specific diagnoses.
The Outpatient Parkinson’s Disease Program, for example, utilizes evidence-based rehabilitative protocols, including LSVT LOUD and LSVT BIG, to enhance speech and mobility. Patients with multiple sclerosis or those who have had a stroke or sustained a spinal cord injury may choose to participate in the Center’s new Life ReBooted or “neuro boot camp,” a self-pay program designed for patients who elect to pursue further recovery.
“The latest scientific evidence demonstrates that even years post-injury, further functional restoration is possible,” Dr. Guarracini says. “We now know that through neuroplasticity, the brain can compensate for injury and build new connections.”
Support groups are also held at Helen Hayes Hospital for patients and families who have been affected by stroke, a traumatic brain or spinal cord injury, amputation, Parkinson’s disease, or osteoporosis.
“Helen Hayes Hospital is a hidden gem in this region. The Hospital features a multidisciplinary medical staff, an excellent therapy and nursing staff, and advanced technology, as well as a culture devoted to patient-centered, quality care. We’re here to serve the patients of referring physicians in the community.”
— Marjorie King, MD, FACC, MAACVPR, Chief Medical Officer at Helen Hayes Hospital and Assistant Clinical Professor of Medicine at Columbia University
The Traumatic Brain Injury Rehabilitation Team, including Colleen Dudek, LMSW, and Linda Egenes, RN, case managers; Dr. Seliger; Jacqueline Velez, PT, Program Manager; and ToniAnn Rubin, RN, Nurse Manager, work collaboratively to help every TBI patient achieve his or her rehab goals.
In addition to the host of outpatient therapy services, patients with cardiopulmonary, orthopedic or neurological disorders can participate in the Helen Hayes Hospital Wellness Center, a gym that features adaptive equipment and offers supervised exercise. Individuals with disabilities may also participate in Helen Hayes Hospital’s Adaptive Sports and Recreation Program, which offers adaptive gardening, kayaking, sailing, softball, rock climbing, golf and other activities.
“The opportunity to stay active really improves psychological well-being,” Dr. King says. “From yoga and meditation to sports, our recreational therapy department offers the full continuum of wellness activities.”
For more information about the rehabilitative services available at Helen Hayes Hospital, visit helenhayeshospital.org.