InstituteNews Advanced Rehabilitation Summer 2023 Overcoming Stroke Obstacles with Occupational Therapy Hit Your Head? Don’t Ignore Signs of Concussion Are You Experiencing Dizziness? It Could Be Your Ear Christopher & Dana Reeve Foundation Grant Provided Sodium and Fat: The Dietary Roles Each Play Orlando Health Advanced Rehabilitation Institute new location opens October 2023
I am excited to join Orlando Health as the President of the Advanced Rehabilitation Institute on our journey of relocating the amazing program at Orlando Health Regional Medical Center to its new location (on the campus of Orlando Health – Health Central Hospital) as a specialized, free-standing rehabilitation hospital in the fall of 2023. The demand for inpatient rehabilitation continues to increase. In fact, the American Heart Association recommends inpatient rehabilitation for patients who have had a stroke. Why is that? Acute inpatient rehabilitation facilities (IRF) provide the highest level of intensity for rehabilitation and recovery following a neurologic or musculoskeletal injury or illness. What are some of the regulatory differences between an IRF and subacute rehabilitation at a nursing home? Relocating and becoming a free-standing hospital focused solely on rehabilitation is going to allow us to continue to grow to meet the needs of the community we serve. The Advanced Rehabilitation Institute is accredited by the Commission on Accreditation of Rehabilitation Facilities in Medical Rehabilitation as well as specialty accreditations in Stroke, Brain Injury and Spinal Cord Injury. Our program is committed to innovation and technology to implement best practices such as High Intensity Gait Training and robotics. Acute Inpatient Rehabilitation Facility Subacute rehabilitation at a skilled nursing facility (Nursing home) Close medical supervision by a physician with specialized training in rehabilitation An attending physician or advanced practitioner is only required to visit you once every 30 days 24-hour rehabilitation nursing Not required. A registered nurse (RN) is required to be in the building 8 hours per day. Requires a coordinated, multidisciplinary team approach Not required 3 hours of therapy, 5 days a week Not required Requires at least 2 disciplines (Physical, Occupational and/ or Speech Therapy) Not required Message From the President Focused on Rehabilitation Orlando Health Advanced Rehabilitation Institute new location opens Fall 2023 2
Our team consists of a multitude of specialists including, but not limited to, Certified Rehabilitation Registered Nurses (CRRN), Board Certified Clinical Specialists (Geriatric PT, Neurologic PT, Orthopedic PT), Neurodevelopmental Treatment Certifications (NDT) Certifications, Certified Brain Injury Specialists, Assistive Technology Professional (ATP), Seating and Mobility Specialist (SMS), Lee Silverman Voice Treatment (LSVT) LOUD/BIG Certifications, Certified Lymphedema Specialists, Certified Stroke Rehabilitation Specialist (CSRS), Vestibular Rehabilitation Certifications and Certificates in Home Modification. Our journey over the next several years includes additional growth and program development to ensure that world class rehabilitation services are available to you and delivered in a way that focuses on the goals of those that we serve. Our team is growing and will be growing more and we encourage health care providers in the community to come and be a part of something special! Annette Seabrook, MPT, MHA, FACHE President, Orlando Health Advanced Rehabilitation Institute Orlando Health Advanced Rehabilitation Institute new location opens Fall 2023 O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 3
Overcoming Stroke Obstacles with Occupational Therapy You might hear the term “occupational therapy” and assume it has something to do with helping people with physical issues that affect their ability to work. But it’s much broader than that. Think of “occupation” as anything that occupies your time that you find purposeful. This could be a mother caring for her children, a college student who needs to get back into the classroom or an older person who wants to attend church. For a stroke survivor, occupational therapy and exercise play key roles in returning to a life that’s as close as possible to what it was before the stroke. A stroke can create a wide range of complications, depending on its location in the brain. Among the most noticeable effects is one-sided weakness (hemiparesis). A stroke on the left side of the brain can result in weakness on the right side of the body and vice versa. This can affect your ability to dress or make meals. You may have trouble talking or understanding what other people are saying. You could have vision issues. Your brain may have trouble recognizing its own deficits – you may think you can walk across the room, even though one arm and leg aren’t working. Stroke Stacy McGinnis | Occupational Therapy 4
Holistic Approach A wide range of factors can affect your rehabilitation. Called the biopsychosocial model, therapists look at the biological impact of the stroke, but also the psychological (depression is a common symptom) and social implications. Your therapist is not just looking at the diagnosis, they are looking at you as a person, in light of that diagnosis. That analysis will help guide rehabilitation efforts as occupational therapists work with you to get as close as possible to your life before the stroke. Occupational therapy will seek first to restore as much function as possible. This could involve neuromuscular re-education to awaken affected muscles and get signals flowing from your brain. Therapists also work on adaptive techniques to boost your independence and reduce strain on your caregivers. When your arm and leg won’t move on their own, for example, there are techniques you can use to put on socks, shoes and a shirt without any help. Rehabilitation Exercises and Activities Therapy interventions could focus on a wide range of areas, depending on the therapist’s assessment. Among them: Passive range of motion: These efforts involve using external force to move a body part that isn’t moving on its own. For example, you might use your strong arm to move a paralyzed arm. The goal is to keep joints flexible and avoid contracture that could further restrict movement. Active assistive range of motion: These exercises target weak limbs that need assistance to achieve former levels of movement, with the goal of strengthening the limb. Active range of motion: For patients who still have full range of motion in a weak limb, these exercises attempt to build strength, flexibility and muscular endurance. Strengthening or resistance training: These exercises use gradual increases in resistance to develop stronger muscles. This can be done with bands, dumbbells, putty and exercise machines. Stretching: It’s not uncommon for muscles to become tight after a stroke. Regular flexibility exercises can help avoid joint contracture and muscle shortening. Yoga, Pilates and tai chi classes can be good options, though you need an instructor who understands your limitations, for safety purposes. Balance training: Patients often can experience decreased balance after stroke. One of the first areas of focus is core or trunk musculature, to help maintain balance while sitting. Gross and fine motor skills: These coordination exercises will help you with a wide range of movements, including walking, throwing, feeding yourself, getting dressed and writing. Eye exercises: Visual problems, including visual field loss and impaired eye movement, are common symptoms. In the Beginning One of the most important things for you to remember is that stroke recovery is a marathon. The early post-stroke period is more like a 100-yard dash, where you’re likely to make significant gains at a fairly quick pace. Continuing therapy will help you improve, but in the end, this is a lifelong journey. Your brain has an amazing quality called neuroplasticity. Basically, the brain is malleable and changeable. And that’s what your therapists will focus on throughout your rehab. Improvements and recovery can occur at any time. These changes can happen one day, one year or three years after the stroke. Never give up hope. O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 5
Hit Your Head? Don’t Ignore Signs of Concussion Traumatic Brain Injury Playing a high-impact sport like football or hockey isn’t the only way to get a concussion. And kids aren’t the only ones who hit their heads. If you’re older than 65, you also are at risk. Iordanca Daniela Anica, MD | Neuroscience Concussions are much more common than most people realize. Every year from recreational sports alone, between 1.6 million and 3.8 million Americans suffer a concussion. Add in falls and other household injuries, and the number is much higher. Making this diagnosis more complicated is that it’s often overlooked. Many who suffer a concussion either ignore the injury, dismissing it as a headache, or fail to consider how serious it might be. This can be dangerous because long-term effects can include disrupted memory, balance, sleep and mood. The biggest myth surrounding concussions is that they happen only on the football field or during any rough sport in which head-to-head collisions are common. While concussions are likely in those instances, they can also happen on the track field, basketball court or anyplace where physical activity is occurring. Something as simple as a collision with the basketball pole can cause a concussion. For this reason, high school and college kids active in sports are most likely to experience a concussion. 6
Older Adults at Risk, Too But adults over the age of 65 also are prone to concussions. As we age, our eyesight, hearing, balance and strength decline, making a fall much more likely. Whether falling in the shower, from a wheelchair or while stepping off a curb, you can suffer a head injury. In the moment, that injury may seem like nothing more than a bump on the head, but it could be far more serious. Keep Eye on Changes in Behavior In the absence of these immediate signs, a head injury may still warrant medical attention if there is any change in behavior in the days that follow. You may not realize these changes are happening, so it’s best to ask family, friends and coworkers to look for any of these signs: Difficulty making a decision. If you’re suffering from a concussion, you will likely have difficulty making both major and minor decisions. Even something as simple as choosing what you want for breakfast or dinner can become stressful. Difficulty making decisions can also look like increased impulsivity, as you may no longer be able to clearly weigh choices and consequences. Increased fatigue. This piggybacks on indecisiveness. Increased fatigue can look like excessive tiredness following a previously simple task or exercise, such as pushing the grocery cart and shopping. The number of decisions involved in this task, coupled with the physicality of the errand, can be overwhelming. Trouble focusing on work. Brain injuries affect your ability to focus on a task for a prolonged period. You can become easily distracted, struggling to finish projects. Difficulty focusing can also look like restlessness or an inability to sit down. These cognitive and behavioral signs can show up right after the injury or may grow increasingly apparent in the days that follow. If these signs are not improving or become worse over a few days to a week, it is likely time to see a primary care physician, who can refer you to a neurologist if necessary. Your neurologist will perform a medical evaluation and may suggest a CT or MRI scan to fully assess the extent and severity of the injury to determine next steps. If you’ve had any type of head injury, it’s worth monitoring. The most important symptoms to look for are that may require immediate attention are: • Severe headache • Loss of strength in any area of the body, especially one side of the body • Vomiting • Pupils dilated more than usual • Loss of consciousness • Loss of sensation in fingers and toes The signs immediately following impact that may indicate either a traumatic brain injury or a concussion, which also need immediate medical attention, include: • Slurred speech • Seizures • Irritability • Confusion • Memory loss or memory problems • Head pain • Nausea Signs that can also indicate a concussion include: • Difficulty sleeping • Dizziness • Fatigue O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 7
Christopher & Dana Reeve Foundation Provides Grant to Support Central Florida Residents Living with Paralysis Spinal Cord Injury As central Florida’s only Level One Trauma Center, Orlando Health Orlando Regional Medical Center (ORMC) sees an average of 79 patients per year that have been diagnosed with a spinal cord injury or disorder (SCI/D). Our team helps individuals with SCI/ D progress through the rehabilitation program, from acute care through inpatient and outpatient rehabilitation settings. The Orlando Health Advanced Rehabilitation Institute is the go-to program to care for these individuals, offering them education, wellness and support throughout their lives. 8
The Christopher & Dana Reeve Foundation was founded in 1982 and is dedicated to curing spinal cord injury by funding innovative research, and improving the quality of life for people living with paralysis through grants, information, and advocacy. A SCI/D can occur in many ways, such as from an injury, illness or disease that alters nerve function. These injuries can result in temporary or permanent changes to normal motor, sensory or autonomic function of the spinal cord, and can cause permanent and profound neurologic impairment and resulting mobility deficits. While individualized therapy helps to address independence at all levels of care for these patients, there is still limited access to resources that can help individuals living with SCI/D maintain a healthy lifestyle. To help provide these resources, the Christopher & Dana Reeve Foundation has recently provided Orlando Health with a $16,000 grant in support of individuals living with paralysis. Thanks to this grant, Orlando Health is able to provide community access to needed equipment, including a wheelchair accessible scale (pictured below) and a pressure mapping system, as well as offer a free seating clinic. The clinic is coordinated by skilled specialists in seating and positioning who provide recommendations to individuals on equipment and seating systems, along with strategies for effective pressure redistribution. Participation in the clinic is free, and is open to any individual living with paralysis in Central Florida. This assessment and education is a critical tool in maintaining the health and wellness of our community. Many individuals with SCI/D do not have an opportunity to receive an accurate measurement of their weight on a regular basis, nor can locate accessible scales that will accommodate the size of their wheelchair. The ability to monitor weight over time can help these individuals correlate the impacts of nutrition, physical activity and other medical conditions on their weight. As the largest organ in the body, the skin’s integrity and health is highly essential, especially in individuals with SCI/D. It is critically important that these individuals are aware of their positioning and areas of risk, in order to avoid the development of pressure related skin injuries. Having access to a pressure mapping system, when used as a combined diagnostic and educational tool, provides real-time feedback for the clinician and participant, and has a direct impact on an individual’s independence and well-being. “Our ultimate goal is to improve the quality of life and empower individuals to access personal health information, increase their knowledge about their specific conditions and modifiable risk factors, and improve overall health and wellness in the spinal cord injury community,” says Stacy McGinnis. “Through the spinal cord injury clinic, we aim to reach 300 individuals with spinal cord injuries and their families and caregivers annually, free of charge.” Thanks to the Christopher & Dana Reeve Foundation, Orlando Health has increased its ability to support individuals with SCI/D in Central Florida. This program has given these individuals the knowledge and equipment needed to meet their specific seating and mobility needs. O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 9
Are You Experiencing Dizziness? It Could Be Your Ear Every day we use our ears to hear, but these complex organs also help us maintain our balance. Deep within the inner ear is the vestibular system, which promotes our ability to stand steadily, stabilize eye position during head movement and move gracefully. When it’s not functioning properly, the vestibular system can cause dizziness, vertigo, visual disturbance and imbalance. This makes it difficult to perform even simple tasks and activities. Specialized therapy called vestibular rehabilitation can help relieve these symptoms and improve quality of life. How Did This Happen? Some causes of dizziness and vestibular impairment include: Rehabilitation Specialties | Vestibular These diagnoses may benefit from vestibular rehabilitation. Marissa Conrad, PT | Physical Therapist • Benign Paroxysmal Positional Vertigo (BPPV) • Head trauma (concussions or serious brain injuries) • Vestibular neuritis (inflammation of the vestibular nerve) • Stroke • Medications • Perilymph fistula • Meniere’s disease • Post-surgery 10
What Can I Expect on the First Day? On the first day of rehabilitation, patients undergo a physical therapy vestibular evaluation. This means recording the patient’s dizziness history, along with any balance impairment, falls and vertigo issues. The therapist looks at the patient’s eyes to see how they’re moving and evaluates how well they are able to move their head while trying to focus their gaze. The therapist takes the patient through different positions to see if their dizziness worsens. The therapist also assesses the patient’s gait and balance. Maintaining balance depends on three sensory systems: vision, somatosensation (the ability to know where one’s body is in space) and the vestibular system. These help identify problem areas so therapists can develop a personalized treatment plan. How Does this Therapy Work? The evidence supporting the effectiveness of vestibular rehabilitation is strong. It can promote recovery, expedite the recovery process, improve a person’s quality of life and increase their safety. Typically, vestibular rehabilitation focuses on balance and gait training, which activates the vestibular system. This therapy teaches someone how to strengthen their vestibular system through gaze stabilization. These techniques require a patient to look at an object and keep the object in focus while they lift their head up and down or turn it side to side. This helps train their vestibulo-ocular reflex, which is responsible for keeping an image stable while the head and body are in motion. In short, this therapy works to help improve the function of the vestibular system as well as desensitize feelings of dizziness through repeated exposure to provoking stimuli and positions. Once therapy is completed, patients are on their way to reclaiming the everyday activities they once enjoyed. If you are experiencing dizziness or think vestibular therapy may help you, please contact (407) 841-8911 to schedule your vestibular physical therapy evaluation. What’s Involved with Rehabilitation? The goal of vestibular rehabilitation is three-fold: To improve a patient’s balance and dynamic gait, increase their stability and safety and decrease their risk of falling. Vestibular therapists want to help patients return to school, sports or work. Therapy for vestibular disorders takes many forms. The type of exercise used depends upon the unique problems an individual demonstrates. Some are geared toward improving balance. Others help the brain improve your use of the vestibular system. Some exercises help improve visual clarity while moving. Many patients participate in balance training that requires head movements while their eyes are focused on a target. These exercises will likely bring on symptoms of dizziness, but that’s the goal. Over time, patients become desensitized to these feelings and will experience less dizziness. O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 11
Sodium and Fat: The Dietary Roles Each Play What does it mean to eat a “heart-healthy” diet? This isn’t an easy question to answer, particularly when you consider the vital roles played by sodium and fat. It might be tempting to simply eliminate both from your menu. But there’s a better way to eat healthy. To help you get there, let’s take a closer look at the dietary roles played by salt and fat, then use that information to build better meals. Health and Wellness Eshani Ewing, RD | Registered Dietitian 12
Too Much Sodium Our bodies need sodium for normal muscle and nerve functions, and to stay in balance. Eating too much of it, however, can wreak havoc on your health. Foods high in salt can cause you to retain excess water and make your organs work harder. This, in turn, increases your risk for high blood pressure (hypertension), which can lead to heart disease. So, how much salt should you eat? This may be difficult to hear, but the American Heart Association says anything more than 1,500 milligrams a day (about two-thirds of a teaspoon) is too much. The typical U.S. diet includes more than double that amount. One of the easiest ways to cut back is to avoid packaged, prepared and restaurant foods. But also know that some foods naturally contain sodium while others have added salt. Nutrition labels can help you identify foods lower in sodium. High-sodium foods to limit or avoid include: • Pizza • Sausage and bacon • Lunch meats • Hot dogs • Chips/packaged snacks • Condiments You also can cut your consumption by making fruits and vegetables a regular part of your meals, as they’re naturally low in salt and full of fiber. They also contain potassium, which can counter the effects of sodium and lower blood pressure. Another helpful tip is to rinse and drain canned vegetables to get rid of excess salt. Some Fats Are Healthier Than Others Fat is one of three key macronutrients we need. It provides energy, supports cell growth and helps us absorb certain vitamins. Key types of fat are: Saturated fats can be found in butter, lard and coconut and palm oils as well as animal products (meats, poultry and dairy). Trans fat can be identified as “hydrogenated or partially hydrogenated oils” in the ingredients list of many processed foods. Trans fat should be avoided as it can increase our risk for heart disease. In 2015, the Food and Drug Association (FDA) determined partially hydrogenated oils are no longer generally recognized as safe. Unsaturated fats are considered heart-healthy fats. There are two types: monounsaturated and polyunsaturated. Sources include salmon, sardines, walnuts, flaxseed, chia seeds, avocado, nuts and olive oil. Read Labels, Buy Fresh Unsaturated fats offer more heart-protective benefits than saturated fats, which can increase LDL (bad) cholesterol, according to studies. When that happens, the risk for heart disease and stroke also increases. On the other hand, unsaturated fats help increase HDL (healthy) cholesterol, lowering risk of heart disease. In general, the goal is to have 20 percent to 35 percent of your total daily calories come from healthy fats and fewer than 10 percent of calories come from saturated fats. So, read those nutrition labels to figure out which foods fit best in your heart-healthy diet. Strive for balance with whole grains, fruits, vegetables and lean-protein sources. Choose heart-healthy fats, such as olive oil and avocado. Cook at home and include more plant-based meals. And remember that you can cut back on the salt, without giving up flavor. Jazz up your dishes with things like rosemary, thyme, cinnamon and turmeric. You can be generous with those spices and herbs without worrying about the health problems that come with salt. O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 13
Team Member Spotlight Ringing in good news: RN (right now). Congratulations to both Reese Nibert and Zuri White as they have completed their course work to be pinned as registered nurses. Reese and Zuri have worked inpatient rehabilitation with us for 3 years as CNA and LPN respectively. These smiling faces are continuing their commitment to unmatched patient care through their compassion and ever growing clinical competencies. Zuri has already begun classes in pursuit of his next degree, but we were able to catch up with him on the unit and ask why he chose to continue on Rehab. His answer: “Rehabilitation is unlike any other place in our hospital system. The community that we’ve built on our unit we get to share with our patients as we are honored to help them shape the picture of their future health and wellness.” Patient Spotlight Sharon’s story: My name is Sharon. I had a stroke on Nov. 28, 2019. I have Aphasia. I am smart but my words don’t come out the way I want them to. I like to read. I have good days and bad days. I know that things are going to be OK in my life. I AM A SURVIVOR! You are not alone. There are support groups and they are all nice people. Wake up every day knowing that you are loved. Do everything your doctor says. Go to therapy. Make friends. Live life. This is your new life. Embrace it! 14
Five Locations CrossFit Iron Shamrock 12802 W. Colonial Dr. Winter Garden, FL 34787 Tiffany Ferlmann (309) 369-0904 SOCF Fitness 11687 S. Orange Blossom Trl. Orlando, FL 32837 Guillermo Reyes (407) 930-7724 South Orlando CrossFit 40 W. Illiana St. Orlando, FL 32806 Trevor Palmer (407) 203-6739 Steel Furnace CrossFit 4614 36th St., Suite 601 Orlando, FL 32811 Roy Cohen (407) 588-7809 Uncanny Fitness 1120 Solana Ave. Winter Park, FL 32789 Kuang Wei Huang (407) 620-0929 We have 5 locations including South Orlando, MetroWest, Winter Park, Winter Garden, and Downtown Orlando. Please communicate with Bob Melia or Erin Jones if you plan to participate to ensure we have a spot available for you. Then contact the gym at the number listed to set up a time to come in and meet the coaches and attend a class. To participate in the Adaptive CrossFit Program, the expectation is that: • You have medical clearance from your physician to participate in an adaptive exercise program (must have documentation of medical clearance) • If you are under the age of 18 years old, you have your guardian’s consent (must have signed consent from parent or guardian) • You will attend at least 2 classes per week. • You will start the program by attending class times at the discretion of your coach. You can join at other class times when cleared by the CrossFit coach. This will help with a more successful integration so that you and the coaches feel comfortable with the modifications and set-up. • Before you attend a class, you will look at the workout of the day. You will arrive early to discuss modifications or substitutions with the coaches early if needed. • If you require more than set-up assistance (supervision or assistance with exercises, transitions, maneuvering through the gym), the expectation is that you bring someone with you to assist. Adaptive CrossFit Wellness Program If you have any questions or would like to participate in our free program, please contact: Erin Jones (321) 843-5237 [email protected] Bob Melia (321) 843-2976 [email protected] We are happy to announce that Orlando Health’s Adaptive CrossFit Wellness Program will continue through 2023! With support from the Craig Nielsen Foundation and Orlando Health Foundation, we can continue to sponsor a limited number of memberships to those in the community living with a disability.
Community Outreach We Are a Neuro-Friendly Restaurant Demonstrating a commitment to the highest quality care, the Orlando Health Advanced Rehabilitation Institute has received accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) in stroke, spinal cord injury, traumatic brain injury and comprehensive inpatient rehabilitation programs. Working with Orlando Heath Advanced Rehabilitation Institute, we are proud to participate in the Neuro-Friendly Restaurant Initiative to assist our patrons with neurological impairments. The Neuro-Friendly Restaurant Initiative program is intended to promote healthy eating habits and further inclusion for those living with neurological condition. If you are in need, please ask a member of our team for more information or a neuro-friendly menu. OrlandoHealth.com/AdvancedRehabilitation Blood-sugar Friendly Heart Healthy Brain Wellness We have met the following program criteria: Staff training to better serve our guests Designated dining times with reduced stimulation and noise levels Specialized menus and meal options BGD 1164002 1/23 ©2023 Orlando Health, Inc. 1164002-OH Inst for Adv Rehab - Neuro Friendly Dining Poster-FINAL.indd 1 1/30/23 9:02 PM Community Initiatives 2022 Inaugural Rehabilitation Symposium, hosted by Orlando Health Rehabilitation Services On September 17, 2022, Orlando Health Rehabilitation Services hosted the Inaugural Rehabilitation Symposium. The goal of the symposium was to support clinical excellence to rehabilitation patients across the continuum of care through quality education and collaboration between disciplines and specialties within Orlando Health. The theme was “Technology, Research and Innovation,” and topics included rehabilitation of COVID-19 patients, assistive technology, outcome measures, locomotor training advances, rehabilitation in patients with cancer, a running program and pain management. The event kicked off with our keynote speakers, Robert and Unike Gonzalez, who shared their story as patient and family survivors that came through the Orlando Health rehabilitation program. Neuro-Friendly Restaurant Initiative The Neuro-Friendly Restaurant Initiative was developed to further community inclusion for those living with a neurological injury and to promote healthy eating habits to assist with the prevention and recovery of certain neurological injuries, such as strokes and traumatic brain injuries. Often, these individuals struggle with understanding their new diet restrictions and finding local restaurants and/or other local venues that provide an inclusive environment as it relates to their injuries. Each restaurant that participates in the program must meet certain criteria, which includes training staff in order to strengthen skills with working with individuals from these communities, pictorial menu books, assistive utensils (at some participating restaurants), modifications to food (at some participating restaurants), low traffic hours and meal options identified by the three following categories: heart healthy, blood-sugar friendly and brain wellness options. 16
Medical Alert Booklets Created an initiative to support our patients with neurological impairments as they discharged/entered back into community. We have worked with Orlando Health ORMC EMS liaison Melissa Smith and first responders in the following counties – Orange, Lake and Seminole – to educate them about this population. We also have created mandatory education for the above counties as it relates to working with individuals with neurological impairments and created individualized medical alert books and decals for their cars/houses to alert first responders. 2022 Institute Events 2022 Community Events We Supported Hi, my name is I have a medical condition related to: Stroke Traumatic Brain Injury Non-Traumatic Brain Injury Brain Tumor Neurological Impairment, such as Parkinson’s disease, MS, ALS Please review the information inside this booklet to learn how to best care for me in the case of an emergency. Medical Alert Booklet 821207 ORMC Rehabilitation ID Passport Book Final.indd 1 1/5/23 10:28 AM 5th Annual Stroke Reunion May 2022 6th Annual Spinal Cord Injury Reunion September 2022 Date Night Under the Stars June 2022 Halloween Spooktacular October 2022 Caregiver Care November 2022 MS Walk Outpatient Multiple Sclerosis Center Team participated with activating at a booth and providing event volunteers Head for the Cure Institute team walked with former patients/survivors to support brain tumor awareness Back to School Bash Institute team provided free school supplies to children within the community along with encouragement cards for their year (created by team members and patients) “Meet Orlando Health” Community Event at Lakeshore Community Center, Ocoee Family-friendly event allowed community members to learn more about Orlando Health; Orlando Health Community Relations hosted games, ice cream, music, raffles and more! Institute Team Members were present with a booth and giveaways, allowing us an opportunity to discuss what we do for our patients. Orlando Health at the Downtown Winter Garden Farmers Market Orlando Health partnered with Healthy West Orange to promote a healthy start to the new year through healthy living. The Institute team offered healthy eating and exercise tips for the new year and provided resources and education related to strokes, SCI and TBI with handouts and giveaways. Big Brothers Big Sisters of Central Florida Health Career Programs 2022 Hosted Littles Lunch and Learn events for children to learn about healthcare and rehabilitation. They explored different healthcare careers, learned about rehab technology, and discussed the importance of teamwork and resilience. O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 17
Orlando Health Advanced Rehabilitation Institute Discharged Back to the Community: 86.9% of our patients are discharged back to the community (national average is 82.2%) Institute Outcomes Inpatient Rehabilitation Program Data 45 40 35 30 25 21 15 10 5 0 SCORES Mobility Score* Changes for Incomplete Spinal Cord Injury (SCI) Mobility Score significantly greater changes in mobility than nat’l average OHARI NATIONAL OHARI NATIONAL 2018 Mobility 2022 Mobility 25.1 26.3 39.7 31.7 *Mobility Scores are based on the Inpatient Rehab Facility Patient Assessment Instrument (IRF-PAI) Quality Indicators scoring for Section GG Functional Abilities and Goals. Creating Change: Implementation of a High Intensity Gait Training (HIGT) Program in motor incomplete spinal cord injury. HIGT has been a large area for research in Physical Therapy. Our physical therapy clinical specialists attended conferences, completed training courses, and reviewed the most recent research on this intervention. They educated the rehabilitation team on HIGT, identified barriers to implementation, standardized practice with protocols and outcome measures, and reviewed their outcomes. This led to significant improvements in mobility outcomes for our patients. They found that patients with incomplete SCI improved in their scores for mobility, including walking household and community distances, as well as their ability to go up and down steps. Stroke 86.2% compared to 79.9% national average Traumatic Brain Injury 84.2% compared to 76.4% national average Traumatic Spinal Cord Injury 81.6% compared to 77.7% national average 21.6 OHARI 2022 Length of Stay (LOS) for Incomplete Spinal Cord Injury (SCI) 22 2022 National Average Orlando Health Advanced Rehabilitation Institute improved LOS to be shorter 18 than national average.
FY22 Data from Orlando Health Ambulatory Rehabilitation Programs 4 Active Research Projects** 86.9% of Patients Reintegrated into Their Community* 79% of SCI Patients Maintain Independence at Home During the Day* 500+ Persons Impacted by Community Programs** 92% of Patients Reported No Falls Post Discharge From Rehabilitation* Continuum of Care: Specialty Outpatient Rehabilitation Orlando Health is committed to ensuring care for our patients across the healthcare continuum. After discharge, the team will recommend outpatient services to support progress toward individual goals. Our CARF-accredited Outpatient Centers consist of multidisciplinary teams taking a collaborative approach by providing top notch, evidence-based, and individualized delivery of patient care. Outpatient Center Locations: Stroke, Brain Injury, and Spinal Cord Injury Orlando Health Advanced Rehabilitation Institute Outpatient Center 100 W. Gore St., Suite 104 | Orlando, FL 32806 (407) 841-8911 Neuromuscular and Movement Disorders Orlando Health Advanced Rehabilitation Institute Outpatient Center 32 W. Gore St. | Orlando, FL 32806 (407) 841-8911 Lymphedema Orlando Health Advanced Rehabilitation Institute Outpatient Center 125 W. Copeland St. | Orlando, FL 32806 located inside Orlando Health Aesthetic and Reconstructive Surgery Institute (321) 842-3700 Oncology/Lymphedema/Pelvic Health Orlando Health Advanced Rehabilitation Institute Outpatient Center 1222 S. Orange Ave. | Orlando, FL 32806 located inside Orlando Health Heart and Vascular Institute (407) 649-6888 O R L A N D O H E A LT H A DVA N C E D R E H A B I L I TAT I O N I N ST I T U T E N E WS | S U M M E R 2023 19
New Name, New Location Recognized by the Commission on Accreditation of Rehabilitation Facilities CARF International accreditation demonstrates a program’s quality, transparency and commitment to the satisfaction of those it serves. Our institute is committed to delivering high quality services and to maintaining a high level of quality standards for business practice. We are proud to have achieved CARF accreditation for our Brain Injury Program, Spinal Cord Injury Program, Stroke Program, and Comprehensive Inpatient Program. Opening Fall 2023 To learn more, visit OrlandoHealth.com/AdvancedRehabilitation As we continue to grow and enhance our services, we are also changing our name and our location. In the fall of 2023, we will move to our new state-of-the-art facility, newly named the Orlando Health Advanced Rehabilitation Institute. The new name highlights the advanced level of inpatient rehabilitation care, services and research we bring to the region. The Orlando Health Advanced Rehabilitation Institute will move to its new location as a 53-bed inpatient facility (with the capacity to expand rapidly to 100 beds) distinctively designed to provide high quality care for patients requiring medical and intensive rehabilitative services. Inpatient rehabilitation services will move to this newly renovated facility on the campus of Orlando Health – Health Central Hospital. This exciting move will enable Orlando Health to care for a growing population of rehabilitation patients from the trauma, neuroscience, cardiology, orthopedic and cancer programs. BGD 1535428 6/23 ©2023 Orlando Health, Inc.