CRM: Life to Years

Pat Guasch and Devra Broan

Clifton Road in Decatur, Georgia, is a happening place of activity packed with medical staff, students and teachers, working professionals, visitors and patients. After all, Clifton is one of the main thoroughfares for Emory Healthcare and Emory University. It is to be expected that it would be a hub of daily activity and life. And, it also makes sense that, within this hustle and bustle, a place exists where an interdisciplinary team of medical professionals is hard at work trying to help its patients reenter this world and leave the social isolation that neurological damage, musculoskeletal problems, pain, amputations and chronic disease may cause. This place of reentry is called Emory Healthcare Center for Rehabilitation Medicine (CRM).

CRM serves individuals needing inpatient care, such as brain injury, stroke or general rehabilitation. It also provides outpatient care — care requiring two or more skilled therapies through an intensive track or a single therapy. Individual therapy services include dizziness and balance, driver rehabilitation, seating and mobility, intensive treatment for aphasia, assistive technology lab and aquatics.

“Our multidisciplinary team includes nurses, physical therapists, occupational therapists, speech therapists and therapeutic recreation specialists,” explains Pat Guasch, CRM’s nursing department director for inpatient services (pictured left). “As rehab nurses, we take a comprehensive approach to meeting our patients’ medical, educational, environmental and spiritual needs. On all shifts, we collaborate with other disciplines formally through team rounds and during bedside shift report, as well as informally, to help our patients. All of these activities are aimed at setting patient-centered goals. In rehab, we as a team focus on our patients’ abilities and strengths, not just their deficits."

Devra Brown, CRM’s manager of outpatient rehab services (pictured right), concurs. “Our patients need to think about the activities you take for granted when you are well,” she says. “How are they going to go shopping? Drive a golf cart? You have to consider the physical, medical, cognitive and psychological aspects of care. What if a patient likes to garden? How are they going to do that when they return to daily living? Our multidisciplinary team uses a collaborative approach to care, addressing endurance, mobility, fine motor skills, communication, problem solving, nutrition and medical needs.”

From the moment the team meets a new patient, discharge and return-to-community planning starts. In fact, from October 1, 2007, to September 30, 2008, CRM’s return-to-community rate was 82 percent, compared to the national average of 76.5 percent.

“We have to prepare our patients to be out on their own,” says Pat. “We are like coaches. We need to come to work with positive attitudes and spirit — all working together toward the same goal of helping our patients achieve their greatest potential and work toward productive, independent lives.”

Information Sharing

“Because Emory Healthcare is a teaching institution, we have access to innovative, evidence-based care,” says Devra. “We don’t just collaborate with our team, but we also partner with researchers and Emory University’s physical therapy program. An authentic sharing of information takes place here.”

Some of the current studies taking place at CRM examine constraint-induced therapy, where an unaffected hand is covered in a mitt to encourage use of the injured hand; the use of Botox in the wrists and hands of post-stroke patients combined with therapy; and AMES (assisted movement ehanced sensation) to get patients with limited movement at the wrist or ankle to gain greater motion. Patients also enjoy innovative therapeutic recreation, such as ceramics and playing Nintendo ® WiiTM.

A pass by CRM shows patients and the medical team not closing the door on life, but opening it wide. Patients and their caregivers move toward regaining access to life’s everyday and joyful moments. As Pat describes, “We don’t just give years to life; we give life to years.”