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.

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
  • 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 clinic 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 and Language Pathology

Hoag speech and 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 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 and 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 Test 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. Each participant has completed their therapy. 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. 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 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 physical therapy:

  • 57% of clients experienced a functional mobility improvement of one full level.
  • 3% experienced a functional mobility improvement of 2 levels.
  • 3% experienced a functional mobility improvement of 4 levels.

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

Results are based on a two-week program of Complete Decongestive Therapy.