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Charles Robert Wilson had a stroke last year that affected the left side of his body. It was his second stroke and this time he required acute inpatient care. When it was time to graduate to an outpatient setting, he was grateful to learn about Baptist Rehabilitation-Germantown’s new Next Step program, a comprehensive, multidisciplinary outpatient rehabilitation curriculum for those who require more than one type of outpatient therapy.

The Next Step uses a team approach of physical, occupational, speech and recreational therapy, along with educational and support services for the management of ongoing medical and community-based needs. For patients who have had a stroke, brain injury or other neurological impairment, Next Step acts as bridge between inpatient rehabilitation and traditional outpatient rehabilitation. The integrated therapy is for two to three hours daily, three to five days per week and includes tasks that coincide not only with reintegration and less dependence, but with the goals that are personally important to the patient.

“It’s not just what the therapist wants them to do but it’s really what is important to the patient and what they want to be able to do by the end of the program,” explained physiatrist Dr. Sunita Jain, medical director of Baptist Rehabilitation-Germantown. “You’re addressing all of their functional needs rather than a specific impairment that they might have.”

“It’s important to not be dependent,” Wilson said. “No nursing home!”

The intensive program originally began as a brain injury program in Boston and other cities to allow patients who needed multiple therapies access to work toward rehabilitating multiple functions in one location with a key therapist, rather than in fragments. For Baptist to include the program, there had to be adequate space and a team of dedicated therapists who offer the appropriate services. Jain worked over the past year to organize the program for its January launch.

Next Step is for patients ages 13 and older. Patients are screened for eligibility and must meet basic requirements which include the need for multidisciplinary therapy, the ability to meet the functional needs of the program, medical stability, and the ability to participate in their own care. While all therapy regimens are individualized, the average length of attendance is four to five weeks. Patients generally fall into two categories, those who have come directly from acute inpatient care, and those who go directly to outpatient therapy, for instance, a mild stroke patient who has enough functional stability to forego inpatient care. In addition, patients must show a willingness to participate through punctuality and active involvement. If necessary, patients can be picked up for therapy.

For Wilson, it was the opportunity he needed to gain back some independence. As a former cafeteria manager for the Memphis City Schools, one of his personal goals is being able to cook. While he is still in a wheelchair and has limited use of his left arm, he has made notable progress. He’s able to use a walker for short periods, can open canned goods and fold laundry. But above all, he was concerned about having interaction with intelligent adults, he said, instead of sitting around the house. And the workouts are worth the pain.

“They really put me through the paces,” said Wilson. “I enjoy everyday. In fact, when I miss a day, I’m very upset.”

Another aspect to the Next Step program is regular outings, such as trips to a petting zoo, bowling alley or a grocery store, which are based on patients’ individual interests. These events are designed to help patients realize what they are capable of doing and where they need help. The outings allow patients to apply the strategies of planning, organization, coordination, endurance and money management to ultimately gain confidence in their abilities.

“Our aim is to reintegrate them into the community so we do the outings in a controlled environment where we’re not overwhelming them with so many things to deal with all at once,” Jain said. “We show them strategies and techniques that they can use once they’re in a restaurant or a grocery store; and really help them work through the barriers they might face in the community.”

The new program currently has five enrolled patients and clinicians want the medical community to know, “there are many types of patients that will benefit from this type of program,” said Jain. “Not all of them have to go through an inpatient rehabilitation setting to be eligible.”



April 2008

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