Neuro-Rehabilitation Services
Overview
Hoag Rehabilitation Services are available for inpatients and outpatients.
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. Under development is the Fudge Family Acute
Rehabilitation Center. This center will feature an 18-bed inpatient rehabilitation
facility located at Hoag Newport Beach. Opening is scheduled for the summer of 2018.
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 state- of-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 in 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 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 LSVT® Big
- 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
- 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-the- wheel evaluation
- Comprehensive Parkinson’s disease program including LSVT® Big
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-the-
wheel 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.
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
- Neuromuscular electrical stimulation for treatment of dysphagia
Swallowing is a complex function involving the mouth, throat and esophagus.
Hoag’s speech-language 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 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 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-on-one 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 motor skills, walking, arm and leg movement, and balance. This
class will meet on Thursdays for eight weeks. The classes are taught by
a licensed physical therapist and occupational therapist at
7:30 a.m. or 1:15 p.m.
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.
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. The Speech-Language
Pathology program is led by Sheila Gilmore, MS, CCC-SLP. The upcoming
Fudge Family Acute Rehabilitation Center will be led by Jill Biggane,
RN, BSN, CCM, CRRN and Brian Boone, PT, DPT.
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 with Parkinson’s
disease, receiving neurological rehabilitation:
- With physical therapy: 40% of clients experienced a functional mobility
improvement of one full level. 19% experienced a functional mobility improvement
of two levels. 2% experienced a functional mobility improvement of three
levels and 2% an improvement of five levels.
- With occupational therapy: 46% experienced a functional improvement of
one full level.
- With speech-language pathology: 36% experienced a voice improvement of
one full level and another 36% experienced a voice improvement of two levels.

https://www.cms.gov/Medicare/Billing/TherapyServices/Functional-Reporting.html



Patients with vestibular impairments are assessed using the Dizziness Handicap
Inventory (DHI). This self-reported measure evaluates how clients’
dizziness affects their daily functioning and quality of life. After a
course of physical therapy, on average, patients report a 61% improvement
on the DHI and thus a corresponding decrease in their handicap due to
dizziness.
To learn more, visit the
Neuro-Rehabilitation Services section or call 949-764-5645.