Question:

My minor child is being discharged from the hospital to in-patient rehabilitation. What should I expect?

Answer:

 Rehabilitation can start at an in-patient rehabilitation setting, then continue at home. It is important you continue to advocate for your loved one as they transition from one setting to another. Keep continuous communication with the rehabilitation team, social services, nurses, doctors, as well as educational specialists and teachers.

If neuro-cognitive deficits are identified, consultation with a neuropsychologist may identify strategies to utilize the child’s strengths to facilitate their ability to learn and perform in the school environment. They may make suggestions to assist the child in learning, including seat placement in the classroom and identifying areas where the child may benefit from one-to-one assistance. Education strategies such as “chunking” the material, giving lectures notes, presenting the material in a novel way, or utilizing different methods to assess mastery of the material, also may be provided.

The educational specialist, who typically has some experience in special education, works with the members of the therapy team, along with the patient’s family and school, to identify and plan for any accommodations and support services a child may need to assure a smooth re-entry in the school setting after their inpatient rehabilitation. They assist the school and team with making an individualized educational plan (IEP) for re-entry to school.

An IEP takes into consideration the medical condition and its effect on brain functioning, and the need for accommodations based on neuropsychological testing and the clinical examination. Accommodations can be made to assist the child in the school environment, which will allow them to reach their maximal potential. Depending on the child’s needs, they may qualify for physical, occupational, or speech therapies in the school setting, which will be specified in the IEP. As clinically appropriate, the educational specialist will assist the child with schoolwork while they are admitted for inpatient rehabilitation.

In pediatric patients, the length of stay in a rehabilitation facility can vary considerably depending on the severity of deficits and medical complications. In the recent study,  the length of stay for pediatric patients varied from two to six weeks. Five out of six patients required ongoing cognitive and speech therapy after inpatient rehabilitation.

Of note, there are no studies available describing the rehabilitation course of adults. 

References: Anti-N-methyl-D-aspartate Receptor Encephalitis: Diagnostic and Treatment Information for the Physiatrist, Winter 2013 Edition of UPMC Ground Rounds by: Angela Garcia, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine
Amy Houtrow, MD, PhD, MPH Associate Professor, Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh School of Medicine