VCU Physical Medicine and Rehabilitation

Traumatic Brain Injury

Our mission

To provide for those in our community who have served our nation.

Our goal

To maximize the quality of life of persons with brain injury through the use of rehabilitation services. We believe that quality of life is enhanced by improving functional independence, increasing participation in social activities, and preventing further injury. We aim to:

• Develop preventative, restorative and compensatory treatment plans based on each patient’s needs, preferences and strengths.
• Support the patient and family’s involvement in developing and implementing the treatment plan through education.
• Provide comprehensive and timely services so as to improve and/or stabilize medical condition and prevent further injury.
• Maximize/improve the patient’s level of function during activities of daily living.
• Maximize/improve the patient’s mobility.
• Maximize/improve the patient’s communication.
• Maximize/improve the patient’s leisure skills.
• Maximize/improve the patient’s cognitive and interpersonal skills.
• Identify and assist with modifications in the home and work environment that would foster independence.
• Facilitate return to professional interests and social roles through vocational exploration and referrals.

Program components

The Brain Injury Program offers:

• Acute inpatient brain injury rehabilitation.
• Comprehensive interdisciplinary evaluations.
• 24 hour coverage by physiatrist and nursing with rehabilitation experience.
• Outpatient assessments.
• Opportunities for research and participation in clinical trials.

Program description

Following admission, patients undergo a comprehensive interdisciplinary evaluation that leads to the development of an individualized treatment plan.

Patients and family members are actively involved in planning the rehabilitation process. This is accomplished through team meetings with participants and family members, education and training from case manager, therapists and medical staff, individual counseling, and support groups.

Specific program treatment is offered Monday through Friday (excluding holidays) from 8 a.m. to 4:30 p.m., with carry over activities conducted by covering therapists and nursing on week-ends and federal holidays.

In preparation for discharge, patients may participate in weekend therapeutic passes with their families or caregivers to determine level of assistance required to function in the community.

Program features

• CARF Accredited
• Case Management
• Dedicated, specialized treatment staff
• Individual and group therapeutic activities
• Cognitive Remediation
• Support Group
• Participant and family education
• Community Reintegration activities
• Driver training and evaluation
• Pool therapy
• Individualized Discharge Planning
• Outpatient Follow-up
• Brain Injury Association Interactive Resource Center

Clinical team

• Attending physician specialized in physiatry
• Resident physician
• Case manager/ Clinical nurse specialist
• Nursing with rehabilitation experience
• Neuropsychologist
• Kinesiotherapist
• Occupational therapist
• Physical therapist
• Speech language pathologist
• Therapeutic recreation specialist
• Vocational rehabilitation counselor
• Social Worker
• Dietitian

What we treat

We specialize in the evaluation and treatment of cognitive and behavioral effects of brain injury. Our program accepts individuals with acquired brain injury due to, but not limited to:

• Trauma (closed and penetrating injuries).
• Hypoxia and anoxia.
• Toxic-metabolic diseases.
• Cerebral infections.
• Neoplastic diseases.
• Vascular diseases.

Admission criteria

• 18 years of age or older.
• Medically stable.
• Off ventilator.
• Has potential to participate in 3 to 5 hours of rehabilitation programming with needs for multiple therapies.
• Does not require one-to-one staffing for medical or behavioral reasons.
• Eligible veteran or active duty military member.

Ethics

We believe that a critical facet of the rehabilitation process is to assist individuals and families affected by brain injury in exploring what constitutes quality of life for them, and to help them in attaining that quality of life.

Ethical problems that concern individual patients or hospital staff may be brought to the hospital Ethics Committee by patients/designee or by hospital staff. In these cases, the view of the committee will be communicated verbally to the appropriate parties.

All patients have the right to the same level of medical care regardless of their age, gender, cultural background, language spoken, sexual orientation, spiritual beliefs, socioeconomic status, or whether or not they have third party health insurance.

Strategic plan

The strategic plan of the Brain Injury Program is based on the Key Drivers of the Physical Medicine and Rehabilitation Service of the Veterans Hospital Administration:

• Assure VHA Rehabilitation Programs Meet Quality Standards of Care:
• Receive re-accreditation by CARF.
• Maintain excellent outcomes in the Brain Injury Program while improving efficiency of services.
• Obtain more complete data regarding patient satisfaction upon discharge.
• Improve access within our service delivery system.
• Assure Integration of Rehabilitation into the continuum of care:
• Explore need for a more extensive outpatient program.

Insure quality providers

• Increase participation in continuing education activities.
• Develop resident and fellowship training series.
• Enhance existing staffing and better utilize existing resources.

Program outcomes

• Average number of admissions annually 43
• Average age of persons admitted to the program 32
• Military status of admissions
  • active duty 70 percent
  • veteran 30 percent

Results are from persons discharged from January 2002 through December 2002.

Goal achievement

The following information shows the percentage of persons who achieved their goals for improving in the ability to perform daily activities such as dressing, bathing, mobility and communication.

Results are from persons discharged from January 2002 through December 2002

Where Our Patients Go When They Leave 2B-Rehab

Results are from persons discharged from January 2002 through December 2002
*Other includes Intermediate, Assisted Living, Transitional Living

Overall Satisfaction of Participants with the Rehabilitation Program

Results are from persons discharged from January 2002 through December 2002

Continuum of care

The Richmond VAMC Brain Injury Program is one of seven VHA or military sites that participate in the Defense and Veterans Brain Injury Center (DVBIC). This partnership between the Department of Defense and the Department of Veterans Affairs provides an integrated system that ensures that all military personnel and veterans with brain injury receive specialized evaluation, treatment and follow-up care.

As Lead Center for brain injury rehabilitation within the VHA, our Program serves as a referral center and cooperates with multiple other acute, sub-acute, and post acute facilities to ensure that persons eligible for care receive necessary services at the appropriate stage of their recovery.

The Case Manager, Social Worker and Vocational Counselor are primarily responsible for assisting individuals and their families with getting access to available resources, based on the recommendations of the interdisciplinary treatment team.