Putting Recovery within Reach - Shands Rehab Hospital

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What happens when a patient leaves the hospital after a traumatic spinal cord or brain injury or debilitating disease? Well, typically, the patient goes through a rehabilitation program to try to restore body functions that may have been lost. Welcome to another Shands HealthCast, brought to you by Shands HealthCare. I'm your host, Garrett Hall, and here to tell us more about the Shands Rehab Hospital is Dr. Jim Atchison, UF professor of physical medicine and rehabilitation and Chief of the Division of Physical Medicine and Rehabilitation. Dr. Atchison its great to have you on the program today.

Thanks for having me here today and looking forward to the conversation.

GH: At the close of this HealthCast I'll let you know how you can get in touch with Dr. Atchison and his team if you'd like more information or to schedule an appointment.

Dr. Atchison, tell us how Shands Rehab Hospital fits into the spectrum of patient care?

ATCHISON: Shands Rehab Hospital is part of what we call the continuum of care when people are sick or have had injuries and helps them get through the recovery process. We kind of fit in after a patient has been in the acute hospital such as over at the main hospital at UF and they still are having trouble with their activities of daily living, things like dressing, bathing, grooming, even eating sometimes. They'll come here and our therapists will work with them to help develop those skills once again.

Also, if a patient is having walking difficulties or trouble getting up and starting to move again after some of their injuries we help them get started with those actitivites before they go home. In essence we look at the hospital as a transition from being a patient in acute care type hospital to becoming a person again and starting to do all the things they normally would do during their time living at home.

GH: What are the major differences between a rehab hospital and an acute, or what most of us would think of as a regular hospital?

ATCHISON: The rehab hospital is quite different than being in a regular hospital where they are trying to diagnose the problem or initially treat you after you have had some injuries. We are more of a transition to get people back up onto their feet, to get them home safely so they can start to resume their regular activities.

We spend a lot of time in therapy with doing basic things such as walking and starting to go to moving around and maybe it requires a walker or some kind of an assistive device. But certainly a patient would be more active at the rehab hospital than they would when they're in the main hospital. I think patients get here and they are surprised that maybe how much they can do when they are first recovering from their injuries and in essence we teach them some tricks of how to move around when they are going to protect one leg or one arm or they cant move certain parts of their body or they have to protect some area after surgery and there are certainly ways to do that safely that we have determined over the years and it makes it easier for them to get started with their daily lives at home again.

GH: Talk about the services you offer at the Shands Rehab Hospital.

ATCHISON: At the rehab hospital we function as a team. Team includes myself or another physiatrist who is working with specialized nurses that have skills and training in rehabilitation along with physical therapy, occupational therapy, speech therapy, clinical psychologist, rec therapists. We have case managers that work with most of our patients and as a team we kind of establish a treatment plan as to which parts of the team this patient would need the most and then emphasize those particular disciplines in order to help the person get started with their activities once again.

GH: Are there specialized programs at the rehab hospital?

ATCHISON: Yes there are. Classically in a rehab hospital there are specific programs for people who have experienced brain injuries, spinal cord injuries, strokes, other types of neurological disorders. On the other hand we have more of an orthopedic based team; we do special burn rehab; we have a team that does primarily orthopedic injuries either after elective joint surgery or multi-trauma problems.

But the teams are set up where they routinely work with a specific patient diagnosis so they have a little more expertise in those areas. And then we add other therapies as we need for that particular team to best monitor the kind of the medical status of that individual group.

GH: Give us an idea of the types of patients your teams treat most frequently.

ATCHISON: The stroke team and the orthopedic team would be the two highest volume groups. In our situation here about 1/3 of our patients fit into the stroke team and another third fit into the orthopedic team. The other diagnostic groups, fortunately, are much smaller. We have a much less number of people who have brain injuries, spinal cord injuries. We do see people here who have had non-traumatic injuries in those areas too like brain tumors or spine tumors or even spinal infections or things like that. But fortunately those injury types are much less frequent than the people who experience stroke.

GH: What are the ultimate goals of rehab? I know that rehab doesn't always restore someone to 100% functionality. So, what then?

ATCHISON: When a patient comes to rehab, certainly the first and foremost thing is they want to get home and we want to help them get home. Now in some cases if they have had a major injury, it may be that we are going to teach them the first steps of being able to get around and do things and then they have to go home and recover a little bit more before they would regain full function. Or in some cases we keep them for a longer period of time and then actually try to get them tuned up all the way to where they would be able to do those functions at home.

Some people unfortunately that we take care of aren't going to recover necessarily. So the alternative in rehab to actually making the person better is sometimes we are using equipment or other technology or things like that to assist them so they could do the activities even though their body hasn't recovered. If their body wasn't going to return to where it was before, can we use an adaptive piece of equipment that will allow them to get out and still do the things they want to do even though they would feel limited without them.

GH: How long might a patient expect to stay in the Shands Rehab Hospital?

ATCHISON: Certainly there is a difference in how long they stay based on the type of injury they had or the illness that they had. On the average when we take some of the orthopedic patients who have had a hip replacement or a knee replacement, the average is probably 5-7 maybe even up to 10 days at times. The person following stroke would probably be on the average of 17-21 days most of the time. Spinal cord injuries are 3-6 weeks. Brain injuries are extremely variable. Often times they might stay up to 6 weeks once again depending on the pattern of recovery.

Looking at the average we're also basing that on what it would normally take a person to get back to their baseline status and certainly the nature of the injury would be the determinate as to how long they are going to stay with us.

GH: The Shands Rehab Hospital is one of only 10 rehabilitation centers in the state designated by the Florida Brain and Spinal Cord Injury Program as a brain and spinal cord injury rehabilitation center. It also has been accredited by the Commission on Accreditation of Rehabilitation Facilities, or CARF for short, for comprehensive inpatient rehabilitation, brain injury and spinal cord injury. Thats a pretty high honor. Tell us more about what that means to patients and their families who come here for treatment.

ATCHISON: Well certainly we are very proud here at Shands Rehab hospital about the fact that we are the only CARF accredited in Florida brain and spinal cord injury accredited acute inpatient rehab hospital really in the whole north part of central Florida. These accreditations are important to us because they tell us we're doing a good job in the specialized areas of treatment that we do take care of.

There are certainly a lot of other levels of care that exist out there with people doing rehab in nursing homes and even home therapy at times. Those can be important places to do them but they certainly do not provide the level of expertise or the evel of intensity of care that we do. A patient comes to an acute rehab hospital like ours, we have to provide at least three hours of therapy a day. And a person should be able to benefit from that in order to be with us.

GH: Many other places would not provide those levels of treatment.

ATCHISON: We have specialized rehab nurses which often are certified to do things. They contribute to that rehab process differently. We are staffed differently for our nurses to do those things as opposed to, even in an acute hospital or certainly a nursing home as an example. So that the level in sophistication of rehab care here is something that is different than most other places would have certainly in this part of the state.

We are proud also to be part of that Florida Brain and Spinal Cord Injury Program. There are about 14 or so designated facilities throughout the state that have met that criteria. That's one of the things that we provide specialty care for such as people who have come off the trauma services and the other services when they went into the main hospital over at UF.

GH: Well, that brings us to the end of this conversation. Thanks so much Dr. Atchison. Any final words for our listeners?

ATCHISON: Thanks very much for having me today . I've enjoyed it. Hopefully people won't need our services too often but certainly for something that is happened to a friend or family member we can provide a level of service that may be of help to you.

If after listening to this HealthCast youd like to schedule a new patient appointment at Shands with Dr. Atchison or one of his colleagues, please call us toll free at 866-931-1185. A professional service representative will be happy to connect you with the appropriate appointment scheduler within our system. Please remember that this toll free number is only to schedule a new patient appointment. Thats all for now. This is Garrett Hall, take care.

Thank you for listening to Shands HealthCast. Shands HealthCare will continue to provide HealthCasts covering a wide variety of general health issues, if you would like to subscribe to Shands HealthCasts or would like more information on this or other topics. Please visit Shands.org/HealthCasts. Shands HealthCare is a private not for profit health care system affiliated with University of Florida. Shands includes 8 hospitals, an affiliated network of more than 80 UF primary and specialty clinical practices and a medical staff of more than 1500 UF faculty and community physicians. For more information about our hospital system visit Shands.org. There you'll find an illustrated medical health encyclopedia, care guides for specific conditions such as diabetes and high blood pressure, maps and directions, information about all Shands hospitals and services and links to other HealthCasts. UF and Shands the Science of Hope.