The Neuro Response Team: Improving the Rehabilitation

Experience

Lisa Cicchelli RN MNClinical Nurse Specialist

Pediatric Rehabilitation ServicesApr 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