Dr. Rao’s Hospital TBI Network Continuum of Care

This page describes how patients are cared for throughout the Dr. Rao’s Hospital Traumatic Brain Injury (TBI) Network. We provide the best care possible, thanks to our team of highly trained professionals, and we coordinate the care across all specialties. It is also our objective to make the patient’s transitions and progress through the continuum of care as smooth as possible.

Emergency Medical System

Dr. Rao’s hospital is the state of the art facility for the neurotrauma and it is committed for the brain trauma and spinal cord trauma outcomes. The emergency department is one of the top class facility available in the Telugu states with capability of Level I facilities.

Emergency Department

Dr. Mohana Rao Patibandla or Other neurosurgeons will be in the hospital 24 x 7 and serves the trauma patients with utmost care.  The sphysician are responsible for initial assessment, airway interventions and stabilizing procedures.

Neurosurgical Care

Procedures for TBI patients include emergency craniotomies, intracranial pressure (ICP) monitoring, shunt placement, ventriculostomy, decompressive craniectomy, evacuation of intra- and extracranial hematomas, complex reconstruction of the skull and skull base, and treatment of cerebrospinal fluid (CSF) fistulae.

Intensive Care Units

Intensive care for TBI is structured in the following way at Dr. Rao’s Hospital. All adult patients with multiple injuries are admitted to the trauma ICU (ICU -1) under the care of the Neurosurgeon and trauma team. All patients are closely monitored by neurosurgeons who consult on their cases and is discussed in every day forum with evidence based treatment.

After being thoroughly assessed for other life-threatening injuries and cleared by the trauma service, patients with isolated head injuries are admitted to the Dr. Manisha Nukavarapu Neuro Intensive Care Unit (MNICU). Patients in the MNICU are either critically ill or have just come from complex brain or spine surgery.

Pediatric patients with TBI are also admitted to the ICU (MNICU). About one third of the trauma patients have significant brain injury. Care of pediatric patients with multiple injuries is collaborative. Professionals from the Critical Care, Pediatric Neurosurgery and Trauma services all contribute their insights to an ideal treatment plan.

All ICUs have 24-hour Anaesthesia physicians coverage. All units are covered 24 hours a day, seven days a week by respiratory therapy staff, laboratory staff for arterial blood gases and stat laboratory studies, and emergency staff for neuroimaging and X-rays. Rehabilitation therapies, including speech pathology, physical therapy and occupational therapy, begin while the patient is still in the ICU.

Patients who have been stabilized and no longer require the intense level of care provided in the ICU move to another bed in the “step-down” unit (ICU-3), where the level of care still exceeds that provided in a traditional inpatient setting.

Rehabilitation

At the acute level, Dr. Rao’s Hospital provides rehabilitation in a safe, structured, secure environment with a 24-hour Rehabilitation Companion assigned on admission. Immediate assessments and treatments initiated by psychiatry, rehabilitation nursing, neuropsychology, occupational therapy, physical therapy, and speech-language pathology are delivered. The team first assesses the patient within 48 hours of admission. Because the family is crucial to recovery, the initial team/family conference is held upon admission. One-on-one therapies offer the following elements every day:
· Gait training
· Respiratory care
· Spasticity management
· Positioning and orthotics
· Sensory stimulation
· Swallowing
· Communications
· Self-care
· Cognition
· Functional mobility
· Pharmacological intervention
· Reality counseling
· Support services with the family

As the patient progresses in the acute rehabilitation phase, we add other therapies.

Adult patients may receive additional therapy at our rehabilitation hospital, Dr. Rao’s Hospital. Children receive the full range of therapy at Rehabilitation Center.

Neuropsychology

Neuropsychology as a clinical specialty has evolved from being a consultative service to being more actively involved in multidisciplinary treatment teams, with faculty from several clinical departments.

The Neuropsychologists specialize in assessing brain-behavior relationships, and cognitive and behavioral strengths and weaknesses. Neuropsychological assessments are standardized, objective tests that quantify neurocognitive deficits and compare each patient’s performance to a general population of same-age peers. These evaluations also include a clinical interview conducted by a clinical neuropsychologist and an objective personality measure to identify psychological distress that might be contributing to the patient’s symptoms.

For a TBI patient, neuropsychology often is involved at the inpatient level. The work consists of brief patient assessments, family education, and developing behavior-management protocols. Patients may be seen by the neuropsychologist at the six-week follow-up visit, and also may be referred to neuropsychology later in recovery depending on patient needs and function.

Community Re-integration

The rehabilitation process does not end when the individual is discharged from the acute rehabilitation center. Rehabilitation continues through a wide range of outpatient, day services, and home care activities.