Sub-Acute Rehabilitation

The Skilled Medical Rehabilitation Center at Florida Institute for Neurologic Rehabilitation, (SMRC) is designed to treat individuals 16 years of age and older with brain and neurologic injuries who are no longer in need of acute hospital care, but continue to be medically dependent.

Sub-Acute Program Overview

We are experienced in providing specialized rehabilitation services to adults and adolescents whose neurologic dysfunction is the result of:

  • Closed or penetrating head injury
  • Central nervous system disease
  • Cerebrovascular accidents (stroke)
  • Anoxic/hypoxic encephalopathy
  • Exposure to neurotoxin
  • Varied encephalopathies
  • Brain tumors
  • Metabolic disorders

The Skilled Medical Rehabilitation Center is able to provide skilled medical care including:

  • Sensory stimulation
  • Wound care
  • Infectious disease management
  • Ventilator weaning & management
  • IV/Infusion therapy
  • Continuous tube feeding
  • Tracheostomy care and decannulation
  • Fiberoptic endoscopic evaluation of swallowing
  • Total parenteral nutrition

An interdisciplinary team approach is utilized to provide the proper medical and rehabilitation services to increase the individual’s opportunities for recovery. The rehabilitation staff includes:

  • Neuropsychology
  • Internal medicine
  • Physical therapy
  • Speech/language pathology
  • Physiatry (physical medicine & rehabilitation)
  • Medical case management
  • Respiratory therapy
  • Occupational therapy
  • Recreational therapy
  • Rehabilitation nursing
  • Dietary services
  • Neurology

Sub-Acute Program Description

The Skilled Medical Rehabilitation Center (SMRC) is a modern, state of the art 25-bed facility located at Lakeside Neurologic. Skilled medical care is designed for patients who no longer need acute hospital care, but remain medically dependent. The SMRC has the expertise to provide aggressive interdisciplinary care with high intensity services to maximize rehabilitation potential with a goal of minimizing medical complications. The interdisciplinary treatment team meets regularly to discuss progress and needs for medically compromised brain and neurologically injured individuals and modifies the treatment plan accordingly to optimize functional progress. 

The medical staff consists of:

  • Neurology
  • Physiatry (physical medicine & rehabilitation)
  • Internal medicine
  • Orthopedic & pulmonology consultation services as needed

The clinical staff consists of:

  • Respiratory therapy
  • Physical therapy
  • Occupational therapy
  • Speech/language pathology
  • Rehabilitation nursing
  • Dietary services
  • Recreational therapy
  • Neuropsychological services

Additionally, coordinated medical case management is performed by Program Case Managers including assistance with family education and support.

The Skilled Medical Rehabilitation Center provides outcome-oriented, individualized care for patients with a wide range of complex medical needs.

Individuals who are in a comatose state, functioning at a Rancho Los Amigos Level of I or II, exhibit minimal responses to external stimulation and no purposeful movements, may also have been diagnosed as being in a persistent vegetative or a minimally conscious state. These individuals can benefit from such services as:

  • Multimodal sensory stimulation to encourage responses
  • Neurology services
  • Electroencephalogram to monitor brain activity
  • MRI and CT to track structural changes
  • Physical therapy to prevent or reduce contractures
  • Occupational therapy to increase upper body flexibility
  • Speech therapy services to provide oral motor stimulation
  • Respiratory services to monitor oxygen saturation and ventilator settings
  • Ventilator weaning
  • Tracheostomy care and decannulation
  • Tracheostomy care and decannulation
  • Emerging behavioral management issues
  • Coma intervention

Individuals who require ventilator support, have experienced a period of respiratory distress or arrest, and require mechanical assistance to protect their airway and to maintain appropriate oxygen saturation levels can benefit from our ventilator program. If the individual has been on the ventilator for an extended period of time, a tracheotomy will have been performed for more efficient suctioning and oxygen delivery. These individuals can benefit from such services as:

  • Respiratory therapy services
  • Respiratory therapy services
  • Suctioning
  • Ventilator weaning
  • Pulmonology consultation
  • Tracheostomy care and decannulation
  • Dysphagia management including an Endoscopic Swallowing Evaluation
  • Spasticity management including Botox injections

Individuals who have infectious processes causing fever, chest congestion, or septic processes will require careful monitoring of their medical condition. These issues are often found in individuals who have had extended hospital stays with multiple procedures. These individuals can benefit from such services as:

  • Infectious disease consultation
  • Continuous infusion intravenous medication
  • PICC or Central line management
  • Antibiotic management
  • Isolation room

Individuals who have brain injuries and neurologic damage often suffer from skin breakdown leading to wounds that require specialized management. Skin integrity management is a priority for all of our patients. SMRC utilizes a team approach to skin integrity management and wound healing, including physicians, nurses, physical and occupational therapists, respiratory therapists, and dieticians. These individuals can benefit from wound care services such as:

  • Specialized pressure relieving mattresses
  • Specialty support surfaces for beds and wheelchairs
  • Tissue debridement
  • Specialty dressings
  • Vacuum Assisted Closure, if necessary
  • Up and down schedule to reduce pressure on wounds

In order to provide patients with the best possible therapeutic and environmental stimulation, SMRC incorporates various pieces of specialty equipment, in addition to the typical therapeutic modalities. SMRC is experienced in recommending specialty patient-specific equipment. This includes but is not limited to:

  • Specialty beds: low beds, bariatric beds, wound care surfaces
  • Continuous passive motion machines
  • Mechanical lifts and shower chairs
  • Tilt table and Passive Standing Frames
  • Body Weight Support Gait Training Systems
  • Recliner chairs, high-back wheelchairs, tilt-in space wheelchairs

Endocrine and metabolic processes can be the cause of brain injury from hypoxic events, anoxic events, or toxins crossing the blood brain barrier. These processes must be adequately managed following a neurologic injury to help the individual recover fully and to reduce the likelihood of a future event. These individuals can benefit from services such as:

  • Endocrinology services
  • Oncology services
  • Peritoneal dialysis
  • Hemodialysis
  • Insulin management
  • Electrolyte management

The comprehensive treatment team at SMRC continually assesses the patient’s progress and needs implementing adjustments consistent with medical/functional status changes.  Upon achieving stable medical recovery, and when appropriate, there is an interdisciplinary treatment team evaluation for transfer into the State-Designated, CARF and JCAHO accredited brain injury neurorehabilitation program at Lakeside.

The Skilled Medical Rehabilitation Center has experience providing the services listed above, as well as other services that individuals suffering from a neurologic impairment may need. The SMRC provides rehabilitation and skilled medical services to individuals with brain injury and neurologic impairment; assisting them in achieving their highest level of functioning and progressing throughout the continuum of care, in order to participate in more intensive rehabilitation services.

Sub-Acute Admission Process

Survivors of traumatic brain injury and neurologic injury are referred to SMRC at Lakesude Neurologic on a national level. Individuals are qualified for admission individually on a clinical, medical and financial basis.

Family members and other concerned parties are encouraged to tour the program prior to admission in order to make informed placement decisions. SMRC assists in lessening the financial burden placed on family members by absorbing some of the costs associated with travel expenses, meals, and overnight accommodations.

The Admissions Department is available to assist all concerned parties with any questions. For assistance in making a referral, please call (800-697-5390) and ask to speak to a Referral Coordinator. During non-business hours, please ask the operator to transfer you to the on-call Referral Coordinator.

Sub-Acute Admission Criteria

  • Neurologic dysfunction
  • Traumatic Brain Injury
  • Neurologic Injury/Disorder
  • Central Nervous System Injury (as result of):
  • Closed or penetrating head injury
  • Central nervous system disease
  • Brain tumors
  • Cerebrovascular accidents
  • Exposure to neurotoxin
  • Metabolic disorders
  • Anoxic/hypoxic encephalopathy
  • Varied encephalopathies
  • Medically stable
  • Reasonably expected to benefit from rehabilitation
  • 16 years of age and above

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