Four questions to ask a doctor about inpatient rehab

After a serious injury or massive medical event, such as a car accident, stroke, or traumatic brain injury, patients can be left feeling like a shell of their former self. They might be unable to speak, walk, or move their arms or legs. They might be unable to feed themselves, use the bathroom alone, or get into bed on their own.

This can lead to feelings of intense frustration, grief, and hopelessness, both on the part of patients and their families. For many patients, the hospital – specifically an inpatient rehabilitation program – is exactly where they should be.

In 2016, we helped 778 patients transition from inpatient rehab into outpatient care at home or at a care facility. With an average stay of less than two weeks, these severely injured or sick patients were able to regain more functional independence faster than they likely could have in an outpatient setting alone.

For a person who qualifies for inpatient rehabilitation, their participation in the program is very important. Let’s talk about who might need inpatient rehab and how it can affect the rest of their lives.

What is inpatient rehabilitation?

Inpatient rehab is a specialized therapy program in which a patient stays in our inpatient rehabilitation unit at UT Southwestern until he or she has achieved personalized physical and cognitive function goals. The goal is for these patients to regain the ability to perform basic self-care tasks – such as self-feeding, grooming, bathing, and dressing, mobilizing, communicating with others, and using the toilet on their own – so they can return home safely and continue rehab on an outpatient basis.

In order to qualify for inpatient rehab, a patient must need at least two of the three types of rehab we offer: speech, physical, or occupational. Qualified patients also must be able to physically and mentally participate in therapy three hours a day.

• Some of the conditions that often qualify for inpatient rehabilitation include:
• Cardiac events: severe heart attack, cardiomyopathy (heart muscle disease), LVAD placement
• Amputation of a limb
• Burn injury
• Severe sports injuries
• Spinal cord injury and post-surgical recovery
• Stroke
• Transplant recovery, including lung and heart
• Traumatic brain injury (TBI)

The median age for our inpatient rehabilitation patients is 64, though our patients range from young athletes to older adults. The intensive program can jumpstart recovery for patients who qualify and help them regain lost function and confidence as they heal. And the center you choose will deeply affect your long-term quality of life.

Inpatient Rehabilitation

UT Southwestern offers one of the nation's premier neurological hospital treatment centers. The mission of the Rehabilitation Program is to help patients achieve the highest level of independence, while providing attentive and personalized care using the most advanced therapies available.

Four questions to ask your doctor

Understandably, recovering at home sounds ideal if you become seriously ill or injured. But if you qualify for inpatient rehab, we strongly recommend you find a specialized center and participate.

Ultimately the decision is yours to make with your doctor. Before you decide for or against inpatient rehab, and before you choose a center, ask your doctor these four important questions:

1. What outcome can I reasonably expect if I go through inpatient rehab?

Three years ago, I was involved in a serious car accident. My doctor and therapists said I would never be able to run again. At the time, that was the hardest thing I’d ever had to hear. Looking back, I’m grateful the care team was honest with me. Today, I am happy that I can walk, thanks to rehabilitation and realistic goal-setting.

One of the first things we do in inpatient rehab is to sit down with you (and your family, if you choose) to discuss expectations and set reasonable goals and timeframes for recovery. We do this because we want you to be encouraged and acknowledge progress, no matter how small it might seem. Deciding that success is being able to walk a mile and go home in two weeks when you can’t take one step today is unreasonable. But walking down the hallway in two weeks might be reasonable, and it’s something to celebrate when it happens.

2. Does the center specialize in the kind of rehab I need?

Inpatient rehab is recommended for a wide range of conditions, and not every center is equally equipped to handle your condition. Techniques for treating a chronic hamstring injury are vastly different from helping a lung transplant recipient regain pulmonary function, for example. Don’t hesitate to ask questions about a center’s capabilities for your condition – the initial rehab period is critical to your recovery.

Our doctors, therapists, and nurses are specially trained and certified in specific types of rehabilitation. We have a stroke rehab team that specializes in specific therapies associated with stroke recovery. Dr. Kathleen Bell, Chair of Physical Medicine and Rehabilitation at UT Southwestern Medical Center, is a nationally recognized researcher of traumatic brain injury. She received the 2017 Frank H. Krusen, MD, Lifetime Achievement Award for advancing research and clinical care in the field. The award is the highest honor given by the American Academy of Physical Medicine and Rehabilitation.

All of our specialized rehab teams are supported by patient care coordinators, dietitians, and social workers who ensure every patient’s medical and emotional needs are met.

3. What medical support does the center provide on-site for my condition?

Often, people undergoing inpatient rehab are not only functionally impaired but also very sick. This is particularly true for transplant and stroke patients. If a medical emergency arises, it’s vital to know that care is readily available to come to you – transferring seriously ill patients to an emergency room or specialty center even a few miles away can be risky.

For example, I was working with a stroke rehab patient this spring who suddenly declined in cognitive function – I feared she was suffering another stroke. We immediately called in our stroke team which, within five minutes, was assessing the patient in her room.

We see very sick patients at UT Southwestern because we have streamlined access to specialty care support. Transplant doctors and cardiologists come to our unit daily to meet with patients, whereas nursing facilities or outpatient programs typically require the patient to travel to the doctor.

We also participate in research studies and clinical trials in which qualified patients might choose to enroll. This opens the door to different therapy options than what might be available at smaller or nonacademic medical centers.

4. What education opportunities are available?

Education is a major component of inpatient rehab. In order to recover, it’s important to understand exactly what happened to you and what has to happen for your body to heal. During your stay, we offer classes on your condition for you and your family.

We also will teach you how to do functional tasks at home, such as getting in and out of bed and getting dressed, and we’ll show your family how to help as well. One of worst things we see is when a patient goes home too quickly without this vital education. This slows down recovery and increases the risk of injury or incidents at home.

Many patients enter inpatient rehabilitation feeling shaken, insecure about their future, and unsure they will ever feel whole again. But our program gives them a chance to rediscover their identities, find joy again, and regain much of what their injury or illness stole from them.

It’s so inspiring to see patients go from wheelchair-bound to walking in a few weeks, or from being mute to saying “I love you” to their partners after suffering strokes. Miracles happen every day here, and my favorite part of every day is seeing our patients’ progress firsthand.