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Neurobehavioral Program

The Hook Rehabilitation Neurobehavioral Unit is an inpatient program designed for the individual with acquired brain injury who presents with behavioral and cognitive disorders that require specialized and intensive rehabilitation services and 24-hour supervision. The objectives of the neurobehavioral program are to enable patients to function independently with self-care, adapt to a less structured environment with respect to behavioral and cognitive stability and to decrease the need for 24-hour supervision. The behavioral programs are integrated into all therapeutic and rehabilitation services. The unit also provides 24-hour nursing care.

Neurobehavioral team

The unit is staffed with a physiatrist (a physician who specializes in physical medicine and rehabilitation) and a neuropsychologist; this allows for a combined approach using medication and behavioral treatment programs. In addition to a physiatrist and a neuropsychologist, the core team is also composed of rehabilitation nursing staff, a physical therapist, an occupational therapist, a speech-language pathologist, a recreational therapist and a social worker. The patient and his or her family are also considered an integral part of the team. Additionally, each patient will be assigned a primary therapist and a program coordinator.

Admission criteria

Admission of patients to the Neurobehavioral Unit is guided by the general admission criteria for patients with the diagnosis of brain injury with persisting cognitive and behavioral impairments that necessitate 24-hour care and supervision. The patient must also demonstrate the potential to benefit from specialized rehabilitation.

Individuals with the following primary diagnoses of acquired brain damage, and others, will be considered on a case-by-case basis:

• Traumatic brain injury
• Hypoxic, infectious and toxic encephalopathies
• Stroke
• Brain tumor

The rehabilitation team will assess the specific needs of each individual patient. Under certain circumstances, other diagnoses are appropriate for admission to the NeuroBehavioral Unit, as well. Stroke patients with agitation, severe confusion and/or disorientation may be considered.

Primary therapist

At the time of admission, each patient will be assigned a primary therapist. This individual is responsible for establishing a working relationship with the patient and family. He or she works with the treatment team to gather information regarding the patient and elicits support and suggestions from the team members while discussing generalization of strategies across disciplines. The primary therapist is responsible for staying informed regarding all aspects of the patient's treatment and informing key team members, as necessary, of new or ongoing issues impacting treatment. The primary therapist generates a weekly schedule for the patient reflecting the current need and the specific activities in the rehabilitation for that week.

Social worker

The social worker serves as the primary contact for the payor/insurance company. This individual communicates evaluation results, treatment progress and any changes to the treatment plan to the payor as it is requested. He or she works internally with the treatment team and primary therapist to provide updates to the family.

Family involvement

Family members play an important role in rehabilitation; they supply the treatment team with valuable information and help set goals. Communication between the family and treatment team is essential. Research has demonstrated that people with brain injury have better outcomes when their families and close significant others are involved in the rehabilitation program. Families have regular communication with the primary therapist and neuropsychologist to ensure information exchange. Families are asked to participate regularly in therapy during the patient's stay.

Evaluation and treament

Upon admission to the unit, all patients will complete a comprehensive evaluation process. This evaluation includes physical, occupational and speech therapy as well as physician, nursing, neuropsychological and behavioral assessments. A treatment plan, established and agreed upon by the treatment team, patient and family will be in place within seven days of admission. Patients will participate in individual and group therapy sessions on the unit, within the hospital and in the community, as appropriate to meet the individual's goals. The interdisciplinary team meets every two weeks to update goals, adjust treatment plans and notify the payor of progress. Families are updated on an ongoing basis and at a minimum of every two weeks.

Visitation

Visitation hours are from 4:30 p.m. to 9:00 p.m. weekdays and 1:00 p.m. to 9:00 p.m. on weekends, depending on scheduled activities. Additional visitation is encouraged during therapeutic hours for training, education and sharing information. This can be arranged through the primary therapist.

Therapeutic passes

There may be opportunities during the course of rehabilitation for the patient and family to spend time off the unit, either at home or in the community. Time outside the facility provides opportunities for patients and families to practice newly learned skills together and apply what is learned in therapy to home and community settings. Patients and families may also identify further needs and patient’s readiness to return home. Multiple factors need to be considered before a pass can be approved.