Brain Injury Program Information

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WakeMed Rehab provides an integrated, comprehensive delivery of rehabilitation services directed toward a population of individuals who have suffered an acquired brain injury as a result of illness, injury or disease process. Various elements of the BIRS program are available through the Acute Neuro Care Unit, Rehabilitation Hospital and day treatment programs.\

Admission to the BIRS program benefits individuals in ways not otherwise possible by developing and restoring skills toward independence and decreasing the dependency effect on their families and communities.

Admission decision-making occurs within a team process by evaluating the patient's impairments, activity and participation limitations, determining rehab needs and potential for functional improvement. Additionally, a review of the program's ability to meet the patient's needs and recognize community resource alternatives and availability is assessed.

Appropriate placement of each person served is also addressed through the admission and discharge criteria for each component of care, the resources available, and resources previously used, ongoing assessment and the person's potential to benefit.

A physiatrist medically supervises WakeMed Rehabs BIRS program. Services are provided by highly qualified professional staff designated specifically for the brain injury rehabilitation program. Treatment space, bed assignment and equipment are also specifically identified for provision within the brain injury rehabilitation program.

The interdisciplinary teams for the brain injury program are comprised of consistently assigned staff from the following professional disciplines dependent on patient need:

  • Person Served
  • Neuropsychology
  • Family Members/Caregivers
  • Clinical Case Management
  • Rehabilitation Medicine
  • Therapeutic Recreation
  • Rehabilitation Nursing
  • Clinical Dietitian
  • Occupational Therapy
  • Speech-Language Pathology
  • Physical Therapy

If services not available within the WakeMed Rehab system are needed, referrals, contracts or consultations will be made to provide patients with appropriate services that may include, but are not limited to:

  • All medical, diagnostic and laboratory services offered at WakeMed
  • Pediatric services
  • Orthotics and Prosthetics
  • Department of Social Services
  • Social Security Administration
  • Community Support Agencies, Advocacy Groups, Support Groups
  • Optometry
  • Durable Medical Equipment
  • Vocational Rehabilitation
  • Audiology
  • Spiritual Care
  • Caregiver/Family services
  • Substance Abuse Counseling/Chemical Dependency Specialist
  • Rehab Engineering
  • Drivers Assessment and Education
  • Environmental modifications/Assistive Technology
  • Specialty consultants

Provision is made to include all consulting services and external case managers as members of the interdisciplinary team.

Upon admission to the BIRS Program, each individual receives a comprehensive assessment and evaluation by each team member initially involved in provision of his/her direct treatment. Appropriate assessments are provided based on the ages, cognitive levels, interests, concerns and cultural and developmental needs of the person served. Designated space, equipment, furniture, materials and private areas for family/peer visits are provided as appropriate.

The treatment team will meet for an initial team conference to develop a treatment plan based on realistic, achievable, functional goals and planned interventions necessary for goal achievement in a realistic time frame. Treatment planning includes a minimum standard of 3 hours of therapy per day in inpatient settings, Monday through Friday. In the inpatient settings weekend therapy is provided as recommended by the team and as part of the treatment plan.

The treatment plan is structured to include the patient/family's goals and discharge planning issues. An estimated length of stay and assessment of discharge needs are identified within the parameters of the long term goals. Through the case management process, the treatment plan is shared with the patient/family and, when appropriate, the individual's insurer to facilitate communication, reimbursement and a collaborative discharge plan.

Patient and family involvement in the brain injury program begins during the pre-admission and assessment phases and continues throughout the program. The Clinical Case Manager formally discusses the comprehensive treatment plan, progress and goals with the patient/family, at least weekly in inpatient settings and in Day Treatment settings within two weeks of admission and updated as needed.

Discipline specific goals are discussed during treatment sessions and include the family during specific family training sessions. Every effort is made to meet patient/family needs and goals through participation in the decision making process.

Goal conflicts are addressed primarily through the Case Management process or Family Conferences but may also be addressed during family training sessions or other family contacts. The BIRS program provides or arranges for the family/support system advocacy training, support services, education, family support, and peer/sibling support as appropriate.

Each patient's program includes Orientation, Assessment, Treatment, Discharge Planning and Follow Up. Evaluation, treatment, programming and patient/family education focus on the functional areas of:

  • Health/Medical Stability Bowel function, Bladder function, Skin integrity, Sleep/wake cycles, Medication management, Prevention of complications, contraindications
  • Nutrition/Diet Nutritional status, Nutritional intake, Assessment and
  • interpretation of lab values, Diet education
  • Psychosocial Support system, Education, Vocation, Patient/family understanding of illness, Patient/family coping/adjustment, Community and financial resources, Discharge planning.
  • Behavior Behavior management, social interaction, self-control
  • Mobility Bed mobility, Transfers, Gait, Wheelchair mobility, Environmental barrier management.
  • Self-care Feeding, Grooming, Bathing, Dressing, Toileting, Home management, Visual perception.
  • Communication Auditory comprehension, Verbal/nonverbal expression, Speech intelligibility, Reading, Writing, Hearing, Swallowing.
  • Cognition Orientation, Attention, Memory, Reasoning/problem solving, Visual/spatial.
  • Leisure Leisure skills, social skills, Leisure/recreation participation, Resource awareness, Adaptive leisure.
  • Environment Level of stimulation, safety, accommodations, compensatory aids.

Continued Care Planning occurs throughout the patient's admission and includes, as needed:

  1. Contact with the patient's primary or referring physician and/or hospital.
  2. Early identification of a realistic discharge destination.
  3. Assessment of accessibility and characteristics of the discharge environment and community.
  4. Identification of family/primary caregivers.
  5. Identification of and referral to community support resources, including but not limited to advocacy services, counseling/support resources for individual, family, parent, sibling, etc. and the BIANC).
  6. Referral for continued rehabilitation therapy on an outpatient or home care basis.
  7. Referral to medical specialists for follow-up after discharge.
  8. Education regarding prognosis, prevention and wellness.
  9. Referral to equipment, orthotic or prosthetic agencies.

Need for continued admission is decided upon by all team members during team and family conferences and is based on:

  1. Medical/physical problems which can best be treated within the rehabilitation hospitalization.
  2. Continued progress toward stated goals.
  3. Expected improvement in function and independence.

Discharge dates are planned or set when continued admission is no longer necessary, patient and family are adequately prepared and discharge destinations are finalized.

  1. Upon discharge, each patient and family receive a follow-up plan including the following, as needed:
  2. Follow up medical appointments with the primary physician and/or physiatrist and any other medical specialist determined by the discharging physiatrist.
  3. Telephone numbers for doctor's offices and other staff for questions or problems after discharge.
  4. List of medications, doses and directions for use.
  5. Therapy prescriptions.
  6. Recommendations for activity levels.
  7. Dietary instructions.
  8. Contacts with Home Health Care or Outpatient rehabilitation.
  9. Contacts with referred financial and vocational assistance agencies.
  10. Contacts with DME, orthotics or prosthetic agencies.
  11. Educational service contacts.
  12. Referral for psychosocial adjustment counseling (family counseling, individual counseling, parent support groups, sibling support groups).
  13. Substance abuse treatment referrals.
  14. Community support groups and/or advocacy groups (Specifically BIANC).


Brain Injury Patient Education Notebook:  Here you'll find detailed information on tramautic brain injuries, impact on living, BIRS treatment, the family's role, and much more pertaining to brain injury rehabilitation.