In-Patient

Comprehensive Inpatient Program

DESCRIPTION

Provides an individualized, intensive comprehensive, aggressive physical, behavioral and avocational/vocational rehabilitation.
Designed for persons with acute or chronic intractable pain whose level of function, productivity and life style is moderately to severely impaired.
Designed for persons who require observation and treatment in a hospital setting.
Designed for persons who have met the criteria for this program on completion of the Comprehensive Multidisciplinary Evaluation.
Provides safe, therapeutic environment with constant supervision for physically impaired, not totally independent, depressed, anxious or otherwise disturbed, drug/alcohol dependent patients.
Designed for persons who may or may not have underlying or associated complex medical problems which require observation and/or treatment.

GOALS / OBJECTIVES

To physically recondition and restore the patient to the optimal level of function to include full range of motion, acceptable strength requirements, decreased pain level and functional tolerances.
To prepare for transfer to the comprehensive outpatient program or discharge home.
To physically recondition and restore patients who require close nursing and medical inpatient supervision, during the entire program, to optimal level of function with minimal to no pain, with minimal to no limitations and minimal to no disability on discharge to home.
To reduce or eliminate the use of addictive pain medications and educate the patient to use alternative methods to alleviate pain.
To assure that the patient is able to self administer any medication needed at the time of transfer or discharge to maintain health.
To educate patients to manage pain episodes that may arise so they may be totally able to self administer any modalities or exercises required so they may be discharged and be totally independent.
To educate the patient to maintain his/her optimal weight to avoid exacerbation of pain due to excessive loading of the spine and hips.
To reduce or eliminate the need for assistive devices such as braces, corsets, canes, crutches, walkers, wheelchairs, stimulators, etc., which serve to perpetuate deconditioning and are counter productive in the alleviation of pain.
To achieve body realignment to reduce or eliminate poor posture and maladaptive gait which contributes to intractable pain and perpetuates the cycle.
To provide stress management, relaxation, psychological support and family counseling so that patient may be able to function appropriately in the outpatient setting or after return to his/her own environment.
To effect positive behavioral change so that patient will be independent of the health care system and be in control of his/her situation.
To educate patient to substitute inappropriate behavior and responses with appropriate behavior to reduce pain producing stress.
To teach patient to understand self and be totally responsible for actions and rehabilitation.
To enable the patient to perceive self as a well person.
To develop constructive coping strategies to reduce stress.
To fully understand biofeedback and relaxation techniques and the relationship between muscle tension, anxiety and pain in order to reduce stress and prevent reinjury.
To alleviate and teach control of anxiety, depression, fear, anger and interpersonal problems so the individual may function in an emotionally healthy manner thereby maintaining physical and mental gains made.
To dispel disability oriented attitude in patient and family and educate the patient's family to support wellness behavior and attitude.
To enable the patient to relate to family and others appropriately.
To educate the patient's family concerning the patient's problem, abilities, and their role in his/her rehabilitative process so that they may offer positive reinforcement and to foster open communication within the family structure.
To function at a high level, and enjoy optimal wellness through training to instinctively use good body mechanics, pacing, energy saving techniques, as well as exercise and modalities.
To teach patient to maintain rehabilitation gains and prevent reinjury without reliance on health care professionals, medication and assistive devices.
To enable the patient to participate in leisure activities, including active sports, in a safe and planned manner so that the patient may prevent injury or reinjury and enjoy a complete well rounded, and satisfying life style.
To teach the patient to overcome obstacles which may interfere with return to productive lifestyle.
To educate the patient to avoid situations that would contribute to a recurrence of the chronic pain cycle through knowledge of ergonomics and how to make practical adjustments to the home and workplace setting.
To restore and enable the patient to return to gainful employment with minimal to no limitations or modification in the workplace (heavy labor not precluded).
To increase patient's confidence in the ability to do their job in a safe manner.

ADMISSION CRITERIA

(Admission to the comprehensive inpatient program is determined prior to and following the multidisciplinary evaluation based on any or all of the following criteria)

Physician, self referral or other.
Completion of multidisciplinary comprehensive evaluation.
Moderate to severe acute or chronic pain not readily managed on an outpatient basis.
Injury or diagnosis which can be appropriately managed in the Center.
Intractable and reoccurring pain which requires assistance with activities of daily living.
Neurological deficits that require close monitoring including acute radiculopathy - possible herniated disc.
Subject to falls due to maladaptive gait, weakness, dizziness and unsteadiness.
Moderate to severe depression.
Moderate to severe anxiety.
Drug dependency requiring detoxification.
Alcohol abuse.
Moderate to severe complex associated medical problems that require monitoring and medical care.
Utilization of wheelchair, walker or other appliances.
Related bladder and bowel problems requiring intervention and rehabilitation.
Mental status that would prevent the independence required in an outpatient setting.
History of surgeries for chronic pain and pain related problems.
Moderate to severe functional limitations requiring assistance, monitoring and/or medical intervention.
Unable to self medicate.
Unable to physically tolerate commuting to and from the Center.
Failure of outpatient treatment management to alleviate the pain problem.
Requires I.V. medications and treatment.
Suicidal ideation related to pain.
Willing to follow prescribed treatment plans.
Willing to follow unit and Center policies.
Willing to participate in an intensive comprehensive full day of treatment and activities.
Ability to learn techniques and concepts of self-care.
Medical clearance prior to admission or during the first hospital week.
Admitting diagnosis with rehabilitation potential for successful outcome in 2-5 weeks.
Cancer patients with intractable pain in remission from active disease who are too debilitated to be managed in an outpatient setting but have good potential for rehabilitation and pain management.
Home bound.

DISCHARGE CRITERIA

(Patients are discharged from the comprehensive inpatient program based on any or all of the following criteria)

Successfully rehabilitated.
Achieved optimal function without pain.
Associated medical problems no longer require intensity of hospital care.
No longer in need of inpatient observation and treatment for physical and/or behavioral problem.
Able to self medicate.
Able to commute and be treated in an outpatient setting.
No longer requires comprehensive full time rehabilitation.
Non-compliant, uncooperative, with no improvement after discussion with the Medical Director or RCPC Physician and Psychologist.
Violation of unit and Center policies and procedures.
Behavioral crisis requiring specialized management.
Associated medical problems which continue to interfere with patient's ability to fully participate in the rehabilitation program
Unable to learn techniques and concepts necessary for self care.
Inability to fully participate in the intensive comprehensive treatment program after 1 week of hospitalization.
Medical emergency requiring transfer to acute medical unit.
Cancer patients whose disease becomes active and requires medical management for that problem or prevents full program participation.
Diminution/alleviation of acute neurological deficits.
Ability to ambulate alone and safely.
Related bowel and bladder problems resolved.
Failure to make progress and meet daily treatment goals of the rehabilitation program.
Disruptive behavior which interferes with the community setting or threatens the safety of patients or staff.
No longer willing to participate in the intensive full day rehabilitation.

SERVICES

Overall supervision by Medical Director.
24 hour supervision by Doctor of Physical Medicine (Physiatrist).
On call supervision by Team Psychiatrist.
Daily medical visits by Medical Director and RCPC physicians.
Rehabilitation Team daily rounds.
Physical Therapy.
Occupational Therapy.
Movement Therapy.
Muscle Re-education.
Motor Dysfunction Evaluation / Treatment.
Vocational Counseling - Rehabilitation, Placement.
Job Analysis, Job Simulation, and Work Fitness.
Primary Counselor (Doctoral level Psychologists) - 24 hour availability.
Individual Counseling.
Group Counseling.
Family - Individual and Group Counseling.
Stress Management.
Biofeedback and Relaxation Techniques.
Coping Strategies.
Educational Lectures (all disciplines).
Functional Capacity Assessment, tolerance building, work tolerances (Ergonomics).
Rehabilitation Engineering / Ergonomics.
Ergonomic Job Analysis.
Functional Electric Stimulation.
Nursing Interventions - including detoxification monitoring and 24 hour observation.
Case Management.
Detoxification.
Crisis Intervention.
Multidisciplinary Patient Progress Conferences.
Multidisciplinary Medical Director rounds.
Multidisciplinary Report.
Transfer or Discharge Planning and Coordination.
Patient Relations Services.
Home program.

STRUCTURE

Comprehensive Inpatient Program with full-day of scheduled treatment and/or activities. Patient activity assignments to be carried out with supervision on evenings or Sunday.
Estimated Length of Program: on the average 2 weeks with transfer to comprehensive outpatient program or home depending on progress. Length of program varies depends upon medical, behavioral, and financial determinations.

TYPES OF CONDITIONS TREATED

1. Musculo-skeletal diseases

Myofascial pain syndrome (fibrositis, fibromyalgia)
Cumulative or repetitive trauma (Carpal Tunnel Syndrome)
Cervical pain (strain, whiplash)
Temporomandibular joint disease (TMJ)
Back pain (sprain, strain)
Herniated disc and radiculopathy
Degenerative disease of the spine (stenosis, osteoarthritis, acquired spondylolisthesis, degenerative arthritis - other)
Post-surgical rehabilitation
Geriatric rehabilitation
Chronic fatigue syndrome
Osteoporosis
Atrophy - disuse, non-use
Maladaptive gait
Knee, shoulder, elbow pain and limited range of motion
Sports injuries
Peripheral nerve injuries
Head pain
Other neuromuscular problems
Regional complex pain disorders or reflex sympathetic dystrophy (RSD)

2. Other Conditions

Problems not controlled with traditional medical approaches, in which pain has become chronic and Intractable or interferes with function or quality of life.

Headache
Abdominal
Pelvic
Cancer
Neurological

3. Psychiatric Sequel Related to Pain

Anxiety
Depression
Drug dependence due to pain (detoxification)
Alcohol abuse
Personality disorder
Suicidal ideation related to pain