Meeting the Challenge of a Complex Injury: The Case of Congressman Steve Scalise
February 14, 2019
Collaborative Care That Puts Your Patient First
WASHINGTON, D.C. — In an instant with the crack of a bullet, the spin of a car, or the sudden burst of vessels in the brain, lives are irrevocably changed. For U.S. Congressman Steve Scalise, the innocence of a baseball game was shattered when a gunman aimed his weapon at the field where members of Congress were practicing for an annual game scheduled for the next evening.
His grave bullet wounds and his difficult journey through multiple surgeries and infection have been well documented. But like so many other patients with complex injuries, survival is just the first step in a recovery that may continue for months or years.
When the Congressman left his stay at MedStar Washington Hospital Center, he was immediately admitted to MedStar National Rehabilitation Hospital (MedStar NRH). His eight week stay at MedStar NRH demonstrates the critical importance of acute rehabilitation for patients who have suffered serious injury and who continue to have complex medical needs, as well.
For Congressman Scalise—and other patients with more complicated injury or illness—rehabilitation begins even before they enter the doors of MedStar NRH, explains John Aseff, MD, the physiatrist who cared for Rep. Scalise while in acute rehab.
“I visited the Congressman at the Hospital Center before he came to us. That’s an important element in creating continuity of care for our patients,” he says. “It’s good for patients and families to know what to expect during the next steps in the recovery process. When patients have multiple organ, nerve and blood vessel injury like the Congressman, we complete assessments before they are discharged from acute care to better understand their continued medical needs, as well as begin to map out their rehab.”
The shared electronic medical record systems among MedStar Health hospitals helps smooth transition of care from one facility to another, he adds. “We also have MedStar NRH physiatrists at our sister MedStar hospitals across the region to provide support and counsel,” Dr. Aseff explains.
Multidisciplinary Care Team
When the Congressman arrived at MedStar NRH, a team of rehabilitation experts had already been assigned to his care and provided an initial review of his immediate needs.
Every patient has a multidisciplinary care team that works collaboratively with one another, the patient and the family throughout hospitalization. Physiatrists, nurses, physical and occupational therapists, speech language pathologists, recreation therapists, neuropsychologists, case managers and dietitians work in concert to develop an individualized treatment plan to help ensure the best possible recovery.
The care team meets weekly to share updates on the patient’s progress—and to address problems that may impede recovery. “Family meetings are also held to provide the patient and loved ones with a more global picture of the present—and the future,” explains Social Worker Joan McKinon Reeves, LICSW, MedStar NRH director of case managers.
“From the very beginning of a patient’s hospitalization, we provide an evaluation and create open communication between us and the patient and family,” she adds. “With patients who have more complex injuries, it’s important to understand what kind of support system they have at home and even begin to look at what they may require when they are discharged.
“Acute rehab is about planning a patient’s future daily life. Our goal is to help patients return to their work, their life, and their passions after a life altering event, and help ensure that the progress they have made during inpatient rehab is sustained. Case managers act as a bridge to services in the community—to the best next steps in a patient’s rehabilitation.” McKinon Reeves says.
“Unlike some other facilities, an acute rehab facility like ours is equipped to provide a full-range of medical services, 24/7, especially for patients with more complicated issues,” says Nailah Campbell, BSN, RN, Nursing Manager. “We are trained to care for sicker patients and prepared for all kinds of special needs from patients requiring kidney dialysis or wound care to assistive devices.”
Rigorous Therapy, Six Days a Week
Working with patients who have an array of issues, care teams included therapists with special expertise working with patients suffering some type of neurological injury.
“Some patients need to relearn to walk,” says Meaghan Minzy, PT, DPT. “Our goal in physical therapy is to improve endurance, strengthen a patient’s upper body and help them use their legs.”
Amanda Summers, MS, OTR/L, ATP, says patients who present with physical weakness need to be mindful of overexertion. “Occupational therapy is focused on improving cardiovascular fitness and strengthening the upper body so that daily living tasks can once again be performed.”
For three hours-a-day, six-days-a-week, the Congressman pushed himself and his body, moving from wheelchair, to a walker and onto crutches. “In time, he went from walking 20 feet to 200,” says Minzy.
Progress like this is the result of a patient’s determination, the skill of rehab experts—plus the latest technology, such as FES, functional electrical stimulation to muscles, and the ZeroG® --the robotic body weight support system first developed at MedStar NRH.
Dr. Aseff visited Rep. Scalise twice a day and watched him during his therapy. “That’s typical for patients who have had critical trauma,” says Dr. Aseff. “It’s important to understanding their medical needs and to assess their progress.”
He also says most people are impatient about recovery—and Scalise was no exception.
“Too much therapy can be harmful—rest is important. Using energy efficiently and effectively is very important to recovery.”
Patients with very complex injuries face enormous challenges as they learn to “accept the injury and adjust to a new normal,” says Minzy. “For us, it never gets old to watch as patients improve and leave us able to move on with their lives.”
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About MedStar National Rehabilitation Network
The MedStar National Rehabilitation Network is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.
The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury. Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs. Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.
The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopaedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease, and sports and work-related injuries.
Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, DC and at more than 50 outpatient sites conveniently located throughout the region. MedStar National Rehabilitation Network is fully accredited by The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke.
For more on MedStar National Rehabilitation Network and to find a location near you, log on to MedStarNRH.org.
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