EMERGENCY AND ACUTE MEDICAL SERVICES

Trauma Centers - In trauma centers, special emergency treatment is provided within the first hour after severe, life threatening injuries. Highly trained medical and surgical staff are available 24 hours a day to determine the severity of the brain injury and start treatment to prevent secondary brain injury.

Intensive Care Units (ICU) Intensive Care Units are hospital units that utilize highly sophisticated equipment and specially trained physicians and nurses to care for individuals who are in such serious condition that they must be continuously monitored. Following surgery, or if surgery is not needed, the individuals may be moved to the ICU which is designed to treat and closely monitor the individual around the clock to minimize any secondary problems.

Acute Medical Care - Acute medical care is the phase of managing health problems focused on the individual becoming medically stable, i.e. reaching a point in medical treatment where life-threatening injuries and disease have been brought under control.

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Acute Rehabilitation

Acute rehabilitation begins as soon as a persons emergent medical concerns are addressed and the capacity to profit from rehabilitation intervention exists. The typical length of stay is generally 1-3 months. Programs are designed to improve the functional ability of the individual through a coordinated program of medical care, evaluation and intensive rehabilitation services. Treatment is provided in a designated unit by an identifiable team of licensed rehabilitation professionals.

Acute Traumatic Brain Injury (TBI) Rehabilitation.
Rehabilitation services are provided on specialized TBI units certified by the State of New York. Traumatic brain injury is broadly defined on these units and includes survivors of:

• closed head injury
• open head injury
• stroke
• anoxia
• brain tumors
• other neurological problems

Admission guidelines to Acute TBI Units vary to a limited extent in areas such as whether or not the individual is in coma or requires a ventilator, but generally require that the person: is medically stable, has neurological or neurobehavioral deficits in such areas as: activities of daily living (ADLs), mobility, cognition, communication, psychological functioning, social relations, and vocational and leisure time activities, and shows the potential to participate and benefit from an active program of rehabilitation. Most Acute TBI Units in New York State are housed within hospital settings where rehabilitation and medical needs can be addressed simultaneously. Some are housed in skilled nursing facilities (SNFs) for individuals with TBI who require "extended care".

On Acute TBI Rehabilitation Units, treatment is medically supervised and coordinated by physiatrists (medically trained doctors specializing in rehabilitation), and provided by therapists with training and experience in head injury rehabilitation. Typically, a TBI rehabilitation team includes: the neuropsychologist, clinical psychologist, speech and language pathologist, occupational therapist, physical therapist, therapeutic recreational specialist, vocational rehabilitation counselor, prosthetic and orthotic specialist, rehabilitation nurse, social worker, and often, a case manager.

Neuropsychological evaluation is performed at this stage of rehabilitation to establish baseline cognitive status and to assist with defining realistic assessment and treatment goals.

These goals may include:

• to learn basic strategies to compensate for impaired cognitive skills
• to relearn ways to carry out activities of daily living
• to begin correcting speech and language problems
• to engage in active physical medicine rehabilitation
• to initiate training in physical restoration
• to begin vocational, educational, and vocational planning

Individuals in coma receive "coma stimulation," which is a multidisciplinary program of daily sensory stimulation including; tactile stimulation, auditory stimulation, olfactory stimulation, visual stimulation, and auditory/oral motor stimulation.

Work with families is often critical for successful outcome during the acute rehabilitation stage. Both counseling and educational services are available on Acute TBI Units to enable families to have clear expectations of the individual with TBI and begin preparing for the responsibilities of care giving.

Acute General Rehabilitation. Rehabilitation services are provided on a general rehabilitation unit within a hospital with staff trained in general rehabilitation. Neuropsychology ad cognitive therapy is not usually available in a general rehabilitation setting.