The Neuro Response Team: Improving the Rehabilitation Experience Lisa Cicchelli RN MN Clinical Nurse Specialist Pediatric Rehabilitation Services Apr 14, 2015 About the Neuro Response Team • Interdisciplinary team • Works primarily with children and youth who have experienced a brain or spinal cord injury (traumatic or acquired injuries) and their families • Work with Life Needs Model of Care • Work with pt/family to use solution-focused approach Who do we serve? Children and youth with: • Acquired Brain Injuries • Traumatic Brain Injuries • Stroke • Spinal Cord Injury/tumors • Auto-immune diseases Interdisciplinary Team • A team may be defined as “a small number of people with complementary skills who are committed to a common purpose and performance goals for which they hold themselves accountable.” • The common purpose should typically be to provide effective, quality patient care. (Katzenbach JR & Smith DK, 1994) Interdisciplinary Team • Trust and respect for shared expertise and specific expertise • Members know and appreciate contributions of each discipline • Negotiation of roles • Effective mechanisms for conflict resolution What does our team look like? • • • • • • • • • • • • Patient and Family Clinical Nurse Specialist Child Life Nurses Dietician OT and PT Psychology School Services Social Work Speech pathologists Physicians Funding, Recreation therapy “Johnny” • 13 year old boy, Grade 8, from NS • Car accident (injury to frontal lobe of brain, orthopedic injuries) • Previous history of ADHD (on medications) and speech impediment (receiving speech therapy at school) • Likes sports, especially hockey and football “Johnny” • Lives with mom, dad and 2 siblings • one sibling was also in accident, suffered a mild concussion only • Acute care – in ICU for 2 weeks • Rehabilitation – 4 months • Extended Drug Plan Early Days… • Well-rounded view of client and caregiver • Functional communication • Prevention of pressure sores • Promote independence (pt/family) • Restoring of function (bowel, bladder) • Family support Early Days… • • • • • • • • Cognition Motor function Sensory/Pain Reflexes Coping/Emotional needs Diet Relationships Community resources What is rehabilitation? • Continuous process which begins early in recovery • Maximization of health and function through health restoration, maintenance and promotion • Includes client and caregivers Why a neuro rehabilitation team? • • • • Helps pt/family cope with injury Educates pt/family Works with pt to make best recovery possible Goal setting Why a neuro rehabilitation team? • Links families with community services • Prepares families for going home • Works with schools to help them understand the child’s needs • Provides follow-up • Contact point Involving Families • • • • • Weekly family/team rounds Weekly schedule Pt/family goal setting Include family in therapies Feedback survey Discharge Planning… • • • • • • Community resources Return to school Return home Follow-up OT, SLP, PT etc Collaboration is Key… Brain Injury Association of NS Nova Scotia school boards NS Rehabilitation Centre Canadian Paraplegic Society Funding Sources Home Health Care Camps Health Care Agencies and Hospitals • Family physicians • Nova Scotia Hearing and Speech Centres • • • • • • • • “Johnny” • 13 year old boy, Grade 8, from NS • Car accident (injury to frontal lobe of brain, orthopedic injuries) • Previous history of ADHD (on medications) and speech impediment (receiving speech therapy at school) • Likes sports, especially hockey and football “Johnny” • Lives with mom, dad and 2 siblings • one sibling was also in accident, suffered a mild concussion only • Acute care – in ICU for 2 weeks • Rehabilitation – 4 months • Extended Drug Plan Who Is Involved with Johnny? Successes • Unique within the walls of IWK • We offer a coordinated approach to complex situations • We work with community resources and schools across the province to get kids home/school Challenges • • • • • Resources Complexity Geography Building capacity Rehab in an acute setting