1. The Neuro Response Team: Improving the Rehabilitation Experience Lisa Cicchelli RN MN Clinical Nurse Specialist Pediatric Rehabilitation Services Apr 14, 2015

2. 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

3. Who do we serve? Children and youth with: Acquired Brain Injuries Traumatic Brain Injuries Stroke Spinal Cord Injury/tumors Auto-immune diseases

4. 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)

5. 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

6. 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

7. “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

8. “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

9. 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

10. Early Days… Cognition Motor function Sensory/Pain Reflexes Coping/Emotional needs Diet Relationships Community resources

11. 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

12. Why a neuro rehabilitation team? Helps pt/family cope with injury Educates pt/family Works with pt to make best recovery possible Goal setting

13. 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

14. Involving Families Weekly family/team rounds Weekly schedule Pt/family goal setting Include family in therapies Feedback survey

15. Discharge Planning… Community resources Return to school Return home Follow-up OT, SLP, PT etc

16. 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

17. “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

18. “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

19. Who Is Involved with Johnny?

20. 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

21. Challenges Resources Complexity Geography Building capacity Rehab in an acute setting