Here’s how TRAIL works for Michigan rehab facility

Rehab team makes most of re-entry program

The Therapeutic Rehabilitation Approach to Independent Living (TRAIL) has become an integral part of the inpatient program at Grand Blanc, MI-based Genesys Regional Medical Center’s rehab facility.

The rehab facility uses various features of the hospital’s campus as part of the community re-entry program for inpatient rehab patients.

"It definitely increases patients’ self confidence and self-perception, especially with stroke patients," says Stacie Bommersbach, RN, MBA, program director for neurosciences and rehab.

"Simple tasks of going to the grocery store are not so simple anymore for these patients. The TRAIL program provides them with a true environment while they’re still in the hospital," Bommersbach says, "so it doesn’t seem as scary to them once they get out in the community."

The fact that patients are still within the hospital grounds while they’re practicing their community re-entry is an added bonus to their need for security, Bommersbach adds.

"It relieves their fears to know they’re still in the hospital and someone to help them isn’t far away, and it increases their learning," she says. "We’re able to show them a different technique or different way of doing something that they wouldn’t have thought of if they were home by themselves."

Bommersbach offers this example of how it works in the case of a stroke patient in his 40s:

Physical therapy: The stroke patient and his family are faced with the reality that their lives will change dramatically, particularly if the patient had been the primary breadwinner.

The physical therapist (PT) will work with the patient on basic problem-solving tasks by giving the patient a task to withdraw money from his bank account at the ATM in the atrium. A family member will accompany the patient during this exercise. This will involve the patient having to learn his bank account password, then walk to the ATM and physically make the transaction. Next, the PT will have the patient take the money to the cafeteria to buy a cup of coffee.

"The physical therapist will always be with the patient and will evaluate the patient’s cognitive level to see if the patient can remember the pass code, deal with multiple tasks, and follow directions," Bommersbach says.

The physical therapist also will set up a problem-solving scenario in which the patient will be given a prescription that is either real or fictitious to the pharmacy.

OTs supervise meal preparation

Occupational therapy: Using the transitional living apartment, the occupational therapist (OT) will assess the patient’s ability to cook a meal, beginning with taking items safely in and out of the refrigerator. The meal would be something simple like macaroni and cheese, and the OT will observe the patient to see if the patient remembers to turn on the stove to boil the water and then to turn it off when the noodles are finished.

For some patients, these meal preparation lessons may take place in the rehab facility’s therapy gym where the patient can prepare a meal, under close supervision, for an entire family.

The OT also will observe the patient transferring in and out of the transitional apartment’s bed, which is a regular bed such as what the patient will have at home.

"If the patient has one side that is weak, simple tasks of getting from the wheelchair to the bed or from the bed to the wheelchair can be practiced," Bommersbach says.

Likewise, the OT will monitor how the patient uses the apartment’s bathroom, observing how the patient is able to transfer to and from the toilet, brush teeth, and attend to other basic activities of daily living (ADL), she says.

"It depends on how severe the stroke is," Bommersbach says.

If the stroke was less severe, then the OT will assess the patient’s ability to return to work and ADLs. If the stroke was more severe, the OT will work with the patient and family in the transitional apartment, making certain the family members will be able to manage the patient on their own.

"We also evaluate whether the patient can be left alone for six or eight hours a day while family members work," Bommersbach says. "That’s when we use the transitional apartment to see whether the patient can go to the bathroom alone safely or cook a meal without assistance."

Also, if the patient is left alone, can she get out of the house safely in the event of an emergency, or can she dial 911 for help?

"Those are the things we look at," Bommersbach says. "We try to do everything we can to keep patients as independent as possible."

So sometimes the rehab team will have a patient stay in the transitional apartment for the entire day, with therapists walking in and out, monitoring him or her.

Family consultation: When family members are presented with information about how the patient did during these community re-entry exercises, they often will develop more realistic expectations of what will happen when the patient returns home.

"Sometimes families will realize that they are out of their realm, that it’s too much and they can’t manage it because the patient can’t be left alone," Bommersbach says.

Therapists might have witnessed how the patient left the refrigerator door open or left the stove on, or perhaps the patient had become confused and began to walk aimlessly down the hallway, Bommersbach explains.

Also, the community re-entry exercises will give staff and family members a good idea of how continent the patient is under normal living circumstances and whether the patient truly can maneuver and transfer from and to the wheelchair.

The rehab staff and family members meet in weekly conferences during the patient’s stay, and there is one last session before the patient is discharged.

"It’s a conversation that starts out by the physiatrist saying, This is what we notice is going on,’" Bommersbach says. "Then the physiatrist will give recommendations to the family and we say that we’ll work with them in any way we can and help them meet the patient’s needs, but ultimately the family is responsible."

So if it’s the staff’s observation that the patient does not do well when left alone for long periods of time, the physiatrist will say that the home would not be a safe environment for the patient if he or she were left alone. The physiatrist would offer various alternatives, such as adult day care.

If family members resist advice, the staff would provide specific details of what they observed during the community re-entry exercises.

Need More Information?

  • Stacie Bommersbach, RN, MBA, Program Director for Neurosciences and Rehab, Genesys Regional Medical Center, One Genesys Parkway, Grand Blanc, MI 48439. Telephone: (810) 606-5974.