Rehabilitation for patients with neurological deficits may feel they’ve signed up for the Boston Marathon. It’s a run for recovery: Challenging physical conditioning. Difficult dexterity and balance programs. Repetitive speech and language practice. Recreational activities to stimulate the brain and the body.

Typically, patients are recovering from strokes, traumatic brain injury, surgery to remove brain or lumbar tumors, or other debilitating neurological diseases.

Depending on severity, patients have a limited inpatient time frame to re-build life skills, and are urged to make the most of every minute. Patients must be able to spend three hours in therapy every day for the 2-3 week inpatient stay. Each patient has his/her room, and a schedule that starts early.

All patients are initially evaluated by medical director Ravi Lakkaraju, M.D. A team conference of all nursing and therapy disciplines distills a comprehensive treatment regimen, designed to achieve the patient’s and family’s goals for rehabilitation. Nurses and therapists know each patient’s goals, and take every opportunity to reinforce skills the patient’s need to overcome limitations.

Inpatient Rehab has a fully equipped apartment that some patients, nearing discharge, use to practice skills they’ve been learning.

Each day starts with re-learning day- to-day living activities -- getting out of bed, using the commode, taking a shower or bath, and getting dressed. Nurses monitor each patient’s vital signs, noting any physical, mental, or language deficits that have changed. Nurses play a key role in evaluating patient reactions to stimulation, medications, and ambulation. "They are the 24/7 caregivers that know the needs and personalities of each patient," says Kimberly Ligney, BSN, Inpatient Rehab Nursing Manager.

One ‘marathon’ trainer is Jacqueline Irvine, PT. The interdisciplinary team meeting sets a baseline for each patient’s various therapeutic goals. Like all therapists, Jacqueline does her own patient evaluations, specifically evaluating functional and cognitive (understanding) abilities.

"I want to see where we need to start: Can the patient get out of bed? What level of mobility, coordination and flexibility does the patient have? Does the patient understand what I am asking them to do, when I ask them to move a certain way physically?

"Often, we begin with my moving a leg, for example, for the patient. From there, we use verbal and touch prompts to remind the patient how to move the leg. The body has an amazing ability to compensate for physical deficits. Regaining muscle strength is something a patient must work on, not just during therapy, but throughout the day.

"Sometimes electrical stimulation can help to stimulate nerve impulses to make new connections. Patients may be excited about regaining a particular function, but we put safety over independence while they are in our care.

"Family support is very important, so they can understand what to expect in function and mobility for the short-term, and after the patient leaves inpatient rehab. That first year after a neuro injury is the window for regaining the greatest degree of independence and mobility. Family and friends can make a huge difference in encouraging patients to continue with therapy.

"We encourage patients to work toward physical stability and balance. Progress comes gradually, and with constant repetition. Their dedication determines how life will be for them – their physical independence and emotional self-esteem."

Occupational therapist Sandra Lauria works with neurological patients with varying degrees of losses, depending on where the injury occurred and its severity.

"In Occupational Therapy, we evaluate the strengths and weaknesses the patient has, and how these affect their activities of daily living. We may need to re-educate and improve muscle control for bathing, dressing and cooking activities. At times, the patient may need to use equipment for tasks, and learn new ways to do something that they have always done. If a patient has weakness in one hand and is unable to button their shirt, we may use a buttonhook or teach them to do it one-handed.

"When a patient has some sensory loss or vision problem, we educate the patient and their family on how this may affect their participation in some activities such as cooking, driving or money management. The patient may need to find new ways to perform these tasks that are personally and financially safe.

"At times, we may need to go to a patient’s home to observe the patient moving around their own house or apartment. We have the patient get in and out of their bed, on and off the toilet, in and out of the tub, walk around or use a wheelchair in their own home. One of the biggest obstacles in returning home may be how they will get inside. We may recommend a ramp or other changes to accommodate the patient in their home.

In Occupational Therapy, we want to help the patient (with the help of family and friends) return to living as independently as possible, engaging in tasks and activities they once performed and enjoyed".

Most stroke and brain injury patients are certain to encounter speech pathologist Mary Grant. "One of the first things we check for is dysphasia, or a swallowing disorder. They may have weakness with the lips and tongue, and it can be difficult to transfer food from the front to the back of their throat. Damage to the cranial nerves may have compromised coordination and strength, so they cannot swallow safely.

"This may require diet modification and helping them re-learn how to swallow food. Individuals with swallowing disorders are re-introduced to food by taking very small bites of food, small sips of liquids, and with laryngeal exercises and oral strengthening, to name a few.

"Patients whose language and understanding skills have been affected may need to learn to read and speak all over again. By using their strengths we can develop a program specific to their needs."

If there’s one therapist patients want to see, it’s the recreational therapist Annmarie Sitkewicz. "I want patients to recapture skills, so activities are fun and stimulating. So, I want to find out what they enjoy doing in their spare time, and how they interact with others.

"We engage patients in favorite activities.. It might be chess or backgammon, or Scrabble. Individuals can re-learn almost any recreational skill, from knitting and jigsaw puzzles, to woodworking and golf. The key is adapting activities within the limitations they have.

"We may focus on strength building, coordination, word and speech recognition, or problem-solving. I like to see patients leave with three activities they enjoy and will practice after discharge.

"We organize weekly outings, so they can practice social skills and be comfortable out in the community. We work on skills they will use during the outing beforehand, which includes a restaurant meal. The whole team emphasizes the importance of ‘giving back’.

"Maybe it’s getting re-involved in church or other volunteer activities. It could be joining an activity club that meets on a regular basis. What we stress is not to stay at home, but to learn how to get out and about where you live. Do as much as you can for yourself, and ask for help as needed.

"We tell patients that everything they do is about improving their quality of life. The late Christopher Reeve, paralyzed from the neck down, never gave up. The word that describes him and our patients is ‘courage.’ We suggest they take some of their courage and ‘pass it on’."

The plan for discharge starts the day the patient arrives. "We observe their emotional adjustment and support system," says social worker Karen Pabalis. "Most patients are here a short time, so we closely monitor their progress and work with family on what adaptations will allow the patient to go home. It usually involves some continuing outpatient rehabilitation, so they may need help with mobility and transportation.

"We may do a home visit to see if adaptations are required for the patient’s safety. We encourage caregivers to let their loved ones do as much as they can on their own. This gives the patient permission to practice skills they’ve learned, and become as independent as possible."

For more information about neuro-lumbar inpatient rehabilitation, call (989) 667-6600.