Brain Injury Assessment and Evaluation

therapist and woman meeting at tableAdmitting to Pate for rehabilitation starts with a brain injury assessment and clinical evaluation at the patient’s location.

The top question patients and families ask is, how long will rehab take?

It’s a great question. The answer depends on the type and severity of the brain injury. Some people stay with us for a few weeks, others a few months or longer.  Others come to us for day treatment while they live at home. It all depends on the individual situation. There are no hard and fast rules.

Whatever program your loved one enters, the process of rehabilitation at Pate has five phases.

 

Phase 1: Preliminary Assessment

 

The initial assessment for admission to Pate involves a meeting between the potential patient and/or family and one of our clinical liaisons who will make an appointment to meet for a clinical assessment. The liaison will typically review records beforehand to understand the complexities of the case but sometimes speed is of the essence and we get there before the records do.

The clinical liaison also meets with any appropriate professionals involved in the patient’s care. The purpose of these discussions is to better understand the patient’s needs, goals and expectations.

Our admissions coordinators are working during this initial evaluation to speak with your insurer and make sure you receive all the benefits of your coverage. Sometimes it can take a little time to receive approval, even up to a week, but don’t worry – we’re on it.

 

Phase 2: Admission and Intake Evaluations

 

If the patient decides on Pate, admission is planned for a specific date and a case manager is assigned who will help coordinate the admission and act as a single point of contact for the family throughout rehabilitation.

During the first week of treatment, we conduct in-depth evaluations including speech, occupational, cognitive ability, physical/motor skills, and a functional assessment. We may also do neuropsychological testing.

We use the standard assessment tools such as MPAI-4 and our own assessment system called PERPOS (Pate Environmentally Relevant Program Outcome System) that measures an individual’s tolerance for distraction and need for structure, important factors in rehabilitation that allow skills learned in rehabilitation to better transform back home.

As treatment advances, we track progress using PERPOS standards, and continuously mold and specialize the treatment plan for the best success in real world environments.

 

Phase 3: Program Design

 

After the initial evaluation, the patient’s custom treatment plan was created by a multi-disciplinary team of experts. The plan is based on neuropsychological knowledge and understanding of an injury’s effect on specific brain function. This relates not only to the physical dimensions of the injury but also is related to specific psychological processes and behaviors, including memory, thinking and judgment.

Plans are based on the reality of each person’s strengths, weaknesses, interests and personality.

Treatment plans will focus on three major areas:

• Physical
• Cognitive/Thinking
Emotional/Behavioral

*The first family conference is scheduled within the first 7-10 days of treatment. The plan is reviewed with all appropriate parties and input is considered.  Constant communication among members of the treatment team ensures accountability — while constant dialogue with the patient and family helps to keep everyone informed and in touch.

 

Phase 4: Rehabilitation and Continuing Improvement

 

The active rehab phase – and how long it lasts – will be determined by the patient’s individual medical situation. As rehab progresses, Pate professionals will be able to provide families with better insight into the patient’s expected outcome.  Many brain injuries involve deficits that are not immediately apparent and may emerge over time – such as difficulties with memory or other cognition, personality changes, etc. 

As our therapists learn more about each person they treat, and encourage them toward their highest independence level possible, you should see some dramatic improvements.

 

Phase 5: Discharge Planning

 

As the patient approaches the end of rehabilitation, discharge planning helps each patient prepare for the next phase of their life. During the treatment process, we’re constantly looking at what’s next — whether it’s a smooth transition into the workplace or a move home to live with family.

Planning for the future helps us develop a personalized course throughout the recovery process. Patients may meet with a vocational counselor about their career, school or volunteer goals. Therapists may help with workplace accommodations to enable return-to-work and they may visit the patient’s home to review it for potential dangers and provide advice on helpful changes. 

 


Evaluation During Treatment

 

In the first week of treatment, our clinical team assesses and evaluates each patient in depth to determine his or her individual needs.

Some areas evaluated are speech, self-care, physical/motor and cognitive abilities, as well as a functional assessment of daily life skills.

On an ongoing basis, our treatment teams monitor patients’ abilities, distraction tolerance, and need for structure. With biweekly meetings to assess progress, they frequently adjust treatment goals to better assist patients.

We also use a scale we designed to assist our treatment which was validated in the peer reviewed journal NeuroRehabilition. PERPOS is a measurement tool that focuses on the complex interactions of the environment and ability. We discovered that the level of distraction and structure in patient’s environments is very important in recovery.  So this tool measures:

  1. Amount of structure needed
  2. Distraction tolerated
  3. Overall functioning/deficit

 

Lower PERPOS scores represent a greater degree of impairment, while higher scores represent a lesser degree of impairment. These scores are determined during bi-weekly treatment team meetings, which include neuropsychologists, physical therapists, occupational therapists, speech language pathologists, case managers and other members of the clinical team.

   
High-level Structure, Low-level Distraction – Therapist directed activity provides patient with limited choices in a quiet environment with only the therapist and patient.Mid-level Structure, Mid-level Distraction – Therapist aided activity in an environment with more people around and more to see.Low-level Structure, High-level Distraction – Replication of real life situations such as grocery shopping that provides a highly distracted environment in which the patient may be structuring him/herself with little to no input from the therapist.

 

Importance of Environment

 

Pate Rehabilitation attempts to improve functional abilities in a way that maximizes the gains made at the treatment facility and transfers them to the patient’s home or work environments.

Maximum transfer of functional improvement to their environments occurs by treating patients’ functional impairments in settings that closely resemble the environment in which they plan to use their skills.

The level of distraction and amount of structure present in each patient’s environment are the core elements of our treatment approach. The PERPOS measures these elements, and this information informs therapists how well patients perform functional activities within different environments.

 

How We Use PERPOS Information

 

  • Forecasting effective length of stay
  • Therapists’ treatment planning
  • Justification of progress to payor
  • Patient insight development
  • Progress monitoring (data bi-weekly)

Our clinical teams monitor patients’ abilities, distraction tolerance, and need for structure on a biweekly basis and they frequently adjust treatment goals accordingly to better assist patients’ ability to return to their home and work environments.

 

 

 

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