Neuro-Rehabilitation Services
Hoag Rehabilitation Services are available for patients across the full
continuum of care, from the acute hospitalization to the inpatient rehabilitation
facility to the outpatient setting. The rehabilitation team of specialists
is here to support patient needs at each step of their journey. Our goal
is to help return our patients to their highest level of functioning and
optimize outcomes by integrating skilled treatment techniques with patient
and caregiver education. This program is offered at both Hoag Newport
Beach and Hoag Irvine. The Fudge Family Acute Rehabilitation Center is
now open as well.
The rehabilitation team includes physical therapists, occupational therapists
and speech-language pathologists. The therapists have advanced certification
or training in neurology, orthopedics, vestibular rehabilitation, geriatrics,
lymphedema, pelvic floor, hand rehabilitation, voice and swallowing.
Rehabilitation Services at Hoag provides high-quality care by utilizing
evidence-based practice and stateof-the-art equipment and technology.
The highly skilled staff collaborates with the physician to develop an
individualized plan of care.
Comprehensive rehabilitation services play an important role in assisting
patients with neurological disorders and achieving their highest level
of function.
Physical Therapy
Hoag physical therapists are specifically trained to improve movement,
restore function and/or relieve pain for the following disorders:
- Neurological disorders such as stroke, traumatic brain injury and brain tumor
- Parkinson’s disease and other movement disorders
- Multiple sclerosis
- Balance and vestibular disorders including vertigo and dizziness
- Other degenerative neurological diseases
- Neuropathy
- Spinal disorders
- General weakness
- Orthopedic injuries
- Headaches
- Gait instability
- Facial weakness
- Lymphedema
Individual patient needs may include:
- Comprehensive balance and vestibular testing and fall prevention treatment
- Functional mobility and transfer training
- Gait training
- Exercises for strength and flexibility
- Neuromuscular re-education
- Cardiovascular conditioning
- Joint and soft tissue mobilization
- Modalities for swelling and muscle re-education
- Patient, family and caregiver education
- Wheelchair evaluation
- Comprehensive Parkinson’s disease program including PWR! Principles
- Neuromuscular electrical stimulation gait training with Walkaide®
Occupational Therapy
Hoag occupational therapists support individuals who are experiencing performance
deficits in daily life skills as a result of injury or disease such as:
- Stroke
- Traumatic brain injury
- Brain tumor
- Parkinson’s disease and other movement disorders
- Multiple sclerosis and other degenerative neurological diseases
- Fracture, dislocation and subluxation of fingers, hand, wrist and elbow
- Tendon and ligamentous injuries of the wrist and hand
- Upper extremity peripheral neuropathy
- Cumulative trauma disorder/repetitive strain injury
- Cancer
Individual patient needs may include:
- Upper extremity exercises to improve strength and dexterity
- Provision of orthotics and splinting
- Edema management
- Computerized strengthening equipment
- Training in self-care and activities of daily living
- Instruction in use of adaptive equipment
- Provision of suggestions for environmental modifications and fall prevention
strategies
- Cognitive training – attention, memory, concept formation, time management,
problem solving and thinking skills
- Perceptual training – ability to interpret sensory information received
from the environment
- Visual processing therapy – visual eye control, reading, reduced
vision due to double or blurred vision and visual field deficits
- Neurodevelopmental treatment
- Vocational simulation
- Patient, family and caregiver education
- Driving assessment and training – the assessment consists of a clinical
evaluation and a behind-thewheel evaluation
- Comprehensive Parkinson’s disease program including PWR! Principles

The goal of Hoag Hospital’s Driving Rehabilitation Program is to
promote independence and ensure safety while using a vehicle. This program
can help maintain a client’s independence, teach compensation strategies
for physical, cognitive and visual limitations and ensure safety on the
road. The assessment consists of a clinical evaluation and a behind-thewheel
evaluation. The clinical evaluation includes assessment of vision, reaction
time, cognition, perception, memory, concentration, attention, judgment,
processing, physical function and the need for adaptive equipment. The
behind-the-wheel evaluation assesses the driver’s skills under normal
driving conditions. Adaptive equipment may be added to the vehicle and
used if needed. Recommendations will be made for any needed car modifications.
The assessment is provided by an occupational therapist and driving instructor
who are certified driver rehabilitation specialists.
Specialized neonatal occupational therapists also provide care in our Neonatal
Intensive Care Unit at Hoag Hospital Newport Beach. Critically ill newborns
and infants are seen for developmental progression, feeding, positioning,
massage and parent/family education.
Speech-Language Pathology
Hoag speech-language pathologists specialize in assessment and treatment
of the following:
- Communication and cognitive problems after a stroke or brain injury
- Parkinson’s disease and other movement disorders
- Aphasia – loss of the ability to express or understand spoken or
written language
- Dysarthria – disturbance in the strength or coordination of the muscles
of the speech mechanism
- Apraxia – difficulty sequencing movements or actions related to speech
- Voice disorders such as vocal nodules, paralyzed vocal cords and muscle
tension dysphonia
- Dysphagia – swallowing difficulties. Interventions include diagnostic
procedures: modified barium swallow studies and fiberoptic endoscopic
evaluation of swallowing. Treatment may include exercise, neuromuscular
stimulation and biofeedback.
- Communication and swallowing problems after surgical procedures and/or
radiation therapy
Individual patient needs may include:
- Identification of appropriate diet that specifies the thickness and consistency
of food and liquids that can be safely swallowed
- Provision of recommendations for optimal swallowing safety
- Development strategies including postural changes and other maneuvers to
enhance swallowing
- Instruction in appropriate oral hygiene
- Exercises for strengthening and improving coordination of the swallowing mechanism
- Neuromuscular electrical stimulation
- Perceptual clinical assessment of the vocal mechanism
- Identify factors contributing to voice problems
- Education on environmental irritants, vocal use, adequate hydration, avoidance
of phonotraumatic behaviors and control of health issues – reflux,
allergies and asthma
- Establishing a phonation pattern that does not cause damage – addresses
pitch, loudness, intonation, phonation, breathing and resonance
- Vocal function exercises to achieve optimal stamina, strength and coordination
of breath support, phonation and resonance
- Acoustic and objective analysis
- Family and caregiver training
- Comprehensive Parkinson’s disease program including LSVT® Loud
and SpeakOut!®
- Neuromuscular electrical stimulation for treatment of dysphagia
Swallowing is a complex function involving the mouth, throat and esophagus.
Hoag’s speechlanguage pathologists provide a comprehensive approach
to evaluation and treatment of swallowing disorders caused by stroke,
and other neurologic disorders, cervical spine disease, head and neck
cancer, laryngectomy and weakness of or damage to the muscles and nerves
used for swallowing. Initial assessment may include a modified barium
swallow study, which is a videofluoroscopic X-ray assessment of the swallowing
mechanism or fiberoptic endoscopic evaluation of swallowing (FEES). These
exams enable the clinicians to identify the disorder and help guide NEURO-REHABILITATION
SERVICES 57 the appropriate treatment program. The goal of the program
is to keep patients eating by mouth or to return them to eating by mouth
whenever possible.
Aftercare and Group Classes
These classes are offered to Hoag Rehabilitation Services patients at the
Hoag Health Center Newport Beach. Each participant has already successfully
completed their individualized, one-onone rehabilitation. It enables the
patients to continue activities in a supervised group setting while at Hoag.
Independent Gym Exercise Class
This class continues the exercise program that was prescribed by their
therapist in a supervised setting utilizing the Hoag Rehab gym and equipment.
Participant must be able to walk unassisted and be independent. The class
will meet twice each week (Tuesdays and Thursdays) for eight weeks.
Assisted Gym Exercise Class
This class will enable the patient to continue the exercise program that
was prescribed by their therapist in a supervised setting. This class
provides closer supervision and is available for patients that require
some physical assistance. If assistance is required, the participant must
attend with a caregiver. The class is held twice each week (Tuesdays and
Thursdays) for eight weeks, starting at 12:30 p.m.
Balance Mobility Exercise Class
This class focuses on balance and mobility. It will build on the principles
introduced in previous physical therapy. This is for participants who
may require some physical assistance and closer supervision. The class
is taught by a licensed therapist. This class is held twice each week
(Tuesdays and Thursdays) for eight weeks.
Forced Use Exercise Class
This is a group class for people with Parkinson’s disease focusing
on exercise principles using equipment including the stationary bike,
treadmill and elliptical trainer. This class includes high-intensity exercise
during which participants will be working with a goal of 60-80% heart
rate max. The classes are taught by a licensed therapist at 7:45 a.m.
or 12:30 p.m. This class will meet three times each week (Monday, Wednesday
and Friday) for eight weeks.
“Power Over Parkinson’s” Exercise Class
This is a group exercise class for people with Parkinson’s disease
utilizing large amplitude movements (PWR! Principles). Participants will
improve their overall movement and coordination, walking, arm and leg
movement, and balance. The morning class will meet at 7:30 am on Tuesdays
and Thursdays for eight weeks. The afternoon classes will meet at 1:15
pm on Thursdays for eight weeks. The classes are taught by a licensed
physical therapist and occupational therapist.
Communication Recovery Group
This once per week small group meeting is for those who have experienced
speech and language impairment because of a stroke. The group is facilitated
by one of our speech-language pathologists with a goal of enabling practice
and improvement of communicative abilities. This includes spoken and written
expression as well as listening and reading comprehension. The group meets
on Fridays from 1:15 to 2:30 p.m. There is also a corresponding caregiver
support group that meets concurrently with a licensed social worker.
Clinic Information
The outpatient rehabilitation offices operate Monday through Friday from
7 a.m. to 6 p.m. The Newport Beach office is located at 520 Superior Avenue,
Suite 100, and can be reached at 949-764-5645. The Irvine office is located
at 16300 Sand Canyon Avenue, Suite 100, and can be reached at 949-557-0630.
State-ofthe-art equipment and facilities support recovery with compassionate
and dedicated Hoag staff.
Team
The Rehabilitation Services program at Hoag is led by Mark Glavinic, PT,
DPT, NCS, doctor of physical therapy and board-certified neurologic clinical
specialist. The inpatient program is led by Samantha Day, PT, DPT, and
the outpatient program is led by Gene Peterson, PT and Amy M. Salinas,
OTR/L. The Speech-Language Pathology program is led by Sheila Gilmore,
MS, CCC-SLP. The Fudge Family Acute Rehabilitation Center is led by Dr.
Keyvan Esmaeili, MD, Brian Boone, PT, DPT and Belinda StewartBurger, MSN,
RN, CCRN, CNRN, SCRN (interim nurse manager).
The clinical team includes board-certified clinical specialists in neurology,
orthopedics, and geriatrics. Also included are certifications in lymphedema
care, vestibular rehabilitation, hand therapy, and wound care, clinical
expertise in use of fiberoptic endoscopic evaluation of swallowing (FEES),
and clinical specialization in critical care management of the adult and neonate.
Outcomes
Based on Medicare’s functional severity modifier scale, the following
outcomes were more specifically achieved in clients receiving neurological
rehabilitation:
Based on Medicare’s functional severity modifier scale, the following
outcomes were more specifically achieved in clients receiving neurological
rehabilitation:
- With physical therapy: Patients referred for vestibular rehabilitation
experienced a 22% functional improvement in only 5 visits. Patients seen
with Parkinson’s disease experienced a 27% improvement in gait speed
over the course of their therapy.
- With occupational therapy: Patients with hand dysfunction experienced over
28% improvement in functional abilities with treatment.
- With speech-language pathology: 36% experienced a voice improvement of
one full level and another 36% experienced a voice improvement of two levels.
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To learn more, visit the
Neuro-Rehabilitation Services section or call 949-764-5645.