News from CARF

CARF…THE REHABILITATION ACCREDITATION COMMISSION

Applying Standards to Persons Served with Limb Loss, Brain Injury, and Spinal Cord Injury

Terrence Carolan, MSPT

Medical rehabilitation programs often serve a patient population with many different types of diagnoses. In many cases, programs work with a large percentage of patients from certain populations (ie, stroke). Ensuring that the program meets the needs of these frequently served populations is somewhat easier because of the volumes of patients served. When programs serve patient populations that make up a relatively small percentage of their total volume, it can be more challenging to ensure both the competency of staff and the needed depth of the program itself. CARF has identified 3 populations that programs must focus on even if they serve only 1 person with these diagnoses: persons with limb loss, brain injury, and/or spinal cord injury. These standards in CARF section 2.D help to ensure that the program is able to meet the unique needs of these populations when these diagnoses may not be focal points of the program’s service delivery.

For limb loss any medical rehabilitation program should be sure to focus on several aspects of the care of these individuals. Using limb loss–specific competencies will ensure that staff maintain the appropriate skill sets required to work with these individuals. Have you ever found yourself in a situation where you’ve been taught a skill, several months have passed, and then you’re asked to demonstrate that skill? Your confidence in performing that skill may have faded as time passed, and you may need a refresher on how to best demonstrate that skill. This is the intent behind developing competencies for specific populations. Education is also crucial to the successful improvement and discharge of any patient. For persons with limb loss, this education should include a broad swath of content including use of the prosthesis and environmental modification (eg, when the patient’s residence needs to modified). Providing peer support is also key to patients’ successful movement through the program, and other support that should be considered includes psychological services, sexual counseling, specialty consultants, substance use counseling and treatment, and smoking cessation.

When working with patients with brain injury, the program will need to address the impact of behavior, cognition, communication, and medical and sensory deficits on physical, psychological, social, and vocational function as well as education and family dynamics and participation. The program also should assess future risks to the patient and also be aware that the patient’s family and support system may have been profoundly impacted by the brain injury and the family may also need support.

Finally, when the program includes any patients with spinal cord injury (SCI), it is important for the program to clearly define its scope of service for persons with SCI including information on the etiology, completeness, and levels of SCI as well as what comorbidities are included in that scope. Does the program accept patients using ventilators? Is the program prepared to work with patients with any level or completeness of SCI? Once this is all defined, it is important that the program shares this information with the public. This will allow prospective patients, payers, and others to understand if the program is the right setting for the patient. Because of the unique needs of persons with SCI, the program will need to either provide or

Terrence Carolan,

MSPT, is the Managing Director of Medical Rehabilitation in Tucson, Arizona. He is part of the medical rehabilitation team responsible for the training of CARF surveyors and for the development and revision of CARF standards.

Medical rehabilitation programs often serve a patient population with many different types of diagnoses. CARF has identified 3 populations that programs must focus on even if they serve only 1 person with these diagnoses: persons with limb loss, brain injury, and/or spinal cord injury.

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