The Neuro Response Team:
Improving the Rehabilitation
Experience
Lisa Cicchelli RN MN
Clinical Nurse Specialist
Pediatric Rehabilitation Services
Apr 14, 2015
About the Neuro Response Team
• Interdisciplinary team
• Works primarily with
children and youth who
have experienced a brain or
spinal cord injury (traumatic
or acquired injuries) and
their families
• Work with Life Needs Model
of Care
• Work with pt/family to use
solution-focused approach
Who do we serve?
Children and youth with:
• Acquired Brain Injuries
• Traumatic Brain Injuries
• Stroke
• Spinal Cord Injury/tumors
• Auto-immune diseases
Interdisciplinary Team
• A team may be defined as “a small number of
people with complementary skills who are
committed to a common purpose and
performance goals for which they hold
themselves accountable.”
• The common purpose should typically be to
provide effective, quality patient care.
(Katzenbach JR & Smith DK, 1994)
Interdisciplinary Team
• Trust and respect for shared expertise and
specific expertise
• Members know and appreciate contributions
of each discipline
• Negotiation of roles
• Effective mechanisms for conflict resolution
What does our team look like?
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Patient and Family
Clinical Nurse Specialist
Child Life
Nurses
Dietician
OT and PT
Psychology
School Services
Social Work
Speech pathologists
Physicians
Funding, Recreation therapy
“Johnny”
• 13 year old boy, Grade 8, from NS
• Car accident (injury to frontal lobe of brain,
orthopedic injuries)
• Previous history of ADHD (on medications)
and speech impediment (receiving speech
therapy at school)
• Likes sports, especially hockey and football
“Johnny”
• Lives with mom, dad and 2 siblings
• one sibling was also in accident, suffered a
mild concussion only
• Acute care – in ICU for 2 weeks
• Rehabilitation – 4 months
• Extended Drug Plan
Early Days…
• Well-rounded view of client
and caregiver
• Functional communication
• Prevention of pressure
sores
• Promote independence
(pt/family)
• Restoring of function
(bowel, bladder)
• Family support
Early Days…
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Cognition
Motor function
Sensory/Pain
Reflexes
Coping/Emotional needs
Diet
Relationships
Community resources
What is rehabilitation?
• Continuous process which begins early in recovery
• Maximization of health and function through health
restoration, maintenance and promotion
• Includes client and caregivers
Why a neuro rehabilitation team?
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Helps pt/family cope with injury
Educates pt/family
Works with pt to make best recovery possible
Goal setting
Why a neuro rehabilitation team?
• Links families with community services
• Prepares families for going home
• Works with schools to help them understand
the child’s needs
• Provides follow-up
• Contact point
Involving Families
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Weekly family/team rounds
Weekly schedule
Pt/family goal setting
Include family in therapies
Feedback survey
Discharge Planning…
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Community resources
Return to school
Return home
Follow-up
OT, SLP, PT
etc
Collaboration is Key…
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Brain Injury Association of NS
Nova Scotia school boards
NS Rehabilitation Centre
Canadian Paraplegic Society
Funding Sources
Home Health Care
Camps
Health Care Agencies and
Hospitals
• Family physicians
• Nova Scotia Hearing and
Speech Centres
“Johnny”
• 13 year old boy, Grade 8, from NS
• Car accident (injury to frontal lobe of brain,
orthopedic injuries)
• Previous history of ADHD (on medications)
and speech impediment (receiving speech
therapy at school)
• Likes sports, especially hockey and football
“Johnny”
• Lives with mom, dad and 2 siblings
• one sibling was also in accident, suffered a
mild concussion only
• Acute care – in ICU for 2 weeks
• Rehabilitation – 4 months
• Extended Drug Plan
Who Is Involved with Johnny?
Successes
• Unique within the walls of
IWK
• We offer a coordinated
approach to complex
situations
• We work with community
resources and schools
across the province to get
kids home/school
Challenges
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Resources
Complexity
Geography
Building capacity
Rehab in an acute
setting