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Published on July 11, 2017

Acute Inpatient Rehab: Best Option for Comprehensive Stroke Care

David Padilla, COTA, helps a patient who
has had a stroke

David Padilla, COTA (right), helps a patient who
has had a stroke improve his upper extremity
motor skills to better develop his reaching and
grasping abilities.

When a patient experiences a stroke, a referral to the Acute Inpatient Rehabilitation Unit at North Kansas City Hospital can provide a level of comprehensive care that goes beyond that of a skilled nursing facility.

Improved Outcomes

The American Heart Association and the American Stroke Association recommend inpatient rehabilitation over skilled nursing for stroke rehabilitation. The AHA/ASA’s first-ever Guidelines for Adult Stroke Rehabilitation and Recovery, published in 2016, noted there is strong evidence that organized, interdisciplinary stroke care not only reduces mortality rates and the likelihood of institutional care and long-term disability, but also enhances functional recovery and increases independence in daily living activities.

According to the guidelines, when compared with skilled nursing, acute rehab results in:

  • Decreased hospital readmission rates
  • Faster recoveries
  • Improved long-term clinical outcomes
  • Reduced mortality rates

“Early stages of recovery post-stroke are crucial, and it is clearly evident that a team approach in a medically supervised acute rehab unit provides patients with their best chance for recovering to their fullest potential and results in better outcomes,” said Kala Danushkodi, MD, medical director of the NKCH Acute Inpatient Rehab Unit. “We have the expertise to detect and treat complex complications of stroke in a timely manner and avoid barriers to functional recovery. Every stroke patient should be treated in an acute rehab facility whenever possible.”

Coordinated Care

Acute Inpatient vs. skilled nursing tableThe Acute Inpatient Rehabilitation Unit has 48 private rooms, making it the largest hospital-based unit in the area. It is staffed by an interdisciplinary team dedicated to helping patients regain their health, strength and mobility so they can return to the highest functional levels possible. Two physiatrists; specially-trained rehabilitative care nurses; physical, occupational and speech therapists; case managers; social workers; dietitians; pharmacists and a psychologist comprise the team.

Dr. Danushkodi or her colleague Adam J. Schulte, MD, round on the unit each day. “We are able to catch complications of stroke, such as a DVT, neurogenic bowel or bladder, stroke-related pain, high blood pressure and diabetes. We closely monitor them so they don’t have setbacks,” explained Dr. Danushkodi, adding that she and Dr. Schulte consult with a range of specialists who are on-site at NKCH to provide patients with comprehensive and integrated care.

Unlike a skilled nursing facility, acute inpatient rehab provides patients with specialized 24/7 nursing care; low patient-to-nurse ratios; and three hours of intensive, individualized occupational, physical and speech therapy each day. Therapists tailor the treatment plan to individual patient goals and modify therapy schedules so family members can be included.

NKCH Surpasses National Stroke Outcome Averages“Family members are extremely satisfied with the care. They want their loved ones to come here because they know they are going to get the best treatment,” Dr. Danushkodi said.

That treatment involves the use of state-of-art equipment and programs for early mobilization to aid in achieving activities of daily living, including a partial-weight-bearing gait therapy device; aquatic therapy; vision testing to assess driving ability; a fully functional kitchen and laundry area; a simulated grocery shopping area; a spacious family-style dining room; pet therapy and weekly visits with a psychologist.

“We often see patients experience post-stroke depression, which is hard on patients and their families,” Dr. Danushkodi said. “The psychologist provides emotional support and coping skills.”

She and Dr. Schulte lead weekly interdisciplinary team meetings to:

  • Assess the patient’s progress toward rehabilitation goals
  • Consider possible resolutions to any problems that could impede the patient’s progress toward the goals
  • Reassess the validity of the rehabilitation goals previously established
  • Monitor and revise the treatment plan, as needed

Connected to Care

James Foster, MD

Kala Danushkodi, MD

Dr. Danushkodi earned her medical degree from Thanjavur Medical College. She completed her residency in internal medicine at Maryland General Hospital and a fellowship in physical and rehabilitation medicine at Northwestern Medicine Healthcare’s Marianjoy Rehabilitation Hospital.

Patients remain connected to care in several ways, starting with coordinated discharge planning to ensure the patient’s continuing care needs are met. This may include follow-up therapy and nursing services in an outpatient setting or the patient’s home. Prior to discharge, occupational and physical therapists may conduct a home evaluation with the patient and family members. They will make recommendations and provide education for home modifications, equipment needs and caring for the loved one.

Dr. Danushkodi also follows patients in her outpatient clinic, monitoring their progress and addressing chronic stroke-related problems to help them reach their fullest functional recovery.

Patients, caregivers and loved ones also can attend the unit’s stroke support group meetings. Led by a social worker, the group meets the third Tuesday of each month from 1:30-3 p.m. at North Kansas City Hospital.

“Taking care of these patients and being part of their recovery is a great honor and professionally rewarding,” Dr. Danushkodi said. “I interact, share experiences and emotionally connect with them and their families. It gives me great satisfaction to see them progress to recovery.”