• CARF-accredited Specialty Brain Injury Unit
• Comprehensive multidisciplinary team approach

The MNRF inpatient brain injury rehabilitation program is designed for those persons who have experienced a significant traumatic brain injury (TBI) and are in need of specialized rehabilitation services. Changes in thinking skills and behavior during recovery from traumatic brain injury may present unique challenges for the patient, healthcare staff, and families or caregivers of the injured individual. The MNRF program was developed specifically to address these unique needs.

MNRF Inpatient Brain Injury Rehab

Admission Criteria

• Minimum Ranchos III – Emerging IV
• At least two therapy services and ability to tolerate three therapy hours
• The patient is medically stable and does not require a ventilator, continuous cardiac monitoring, airborne or droplet precautions.
• Sustained a traumatic brain injury
• At least sixteen years of age

Program Description

Patients in the brain injury rehabilitation program receive care on the same unit as other rehabilitation patients with a range of diagnoses and needs, but there are key aspects of the brain injury program that make it a unique and specialized program. The MNRF inpatient brain injury program implements specific interventions for safety, environmental control, treatment intervention, behavior management, and other aspects of the patient’s care based on the patients level of function, estimated by the Ranchos Los Amigos Scale of Cognitive Function. Each patient is assessed prior to entering the program and assigned a Ranchos score which provides an estimate of the patients current level of cognition and behavior. This Ranchos score guides development of the initial plan of care. This plan is modified and tailored to be a more individualized plan based on feedback from the clinical staff in daily team meetings.

There are a few key principles that our team sees as essential to providing the best care and support for our patients. Our program was developed with a focus on these components to provide the best possible care for patients and their caregivers: behavior and environmental management; family and patient education; staff expertise in TBI.

Behavior and Environmental Management

Persons recovering from brain injury often experience significant changes in thinking skills during the early stages of recovery and may be confused and disoriented. They may have difficulty paying attention to things, performing routine daily tasks, or remembering new information for more than a few minutes at a time. Their behavior may also be dramatically different from what families and caregivers are used to seeing in their loved one prior to the brain injury. It’s common for patients to be very restless, anger easily, and say or do things that in social situations may be seen as inappropriate. Making basic changes in the environment and in how we interact with these patients can go a long way in managing these behaviors so they are least disruptive for the patients and their care providers. Following are a few of the common tools and environmental adjustments used to keep TBI patients safe and better focused.

• All brain injury patients have private rooms. 
• Too much activity around a brain injury patient often enhances problems with confusion and disorientation. It may also trigger behavioral reactions such as restlessness and agitation. To minimize this, daily behavioral plans identify specific steps to minimize stimulation during the early stages of recovery. This may include guidelines concerning the number of visitors at one time, length of visits, use of the TV or telephone, or the amount or type of items in a patient's room.
• Specialized equipment is utilized to ensure patient safety.
• A Wanderguard bracelet is placed on each patient on admission. This sensor sends a signal for doors to automatically lock when a patient approaches, so they cannot accidentally wander from the unit.
• A Vail bed may be used for restless/agitated patients early in their recovery. This provides freedom of movement within the bed, but limits the patient's ability to get up without assistance or engage in other activities that may jeopardize their safety.
• Beds alarms can be utilized to notify a nurse if a patient attempts to get out of bed without supervision, when we know a patient requires supervision for safety.      
• A one-to-one observer may be needed if a patient requires constant observation or cueing to prevent a patient from pulling at tubes, lines or other medically necessary interventions.
• Behavior Management meetings are held each weekday. This allows the team to stay current in monitoring a patient’s changes and making any adjustments, however minor, to best meet the patient’s needs.  
• A structured daily scheduled is implemented alternating rest breaks with intense therapeutic activity to attain the best participation and benefit for the patient.

Structured Family/Patient Education and Support

• You will receive the “Family and Caregivers Guide” upon entry to the brain injury program. Your care coordinator will review this book with you. This binder contains information specific to the brain injury program. For example, it describes your treatment team, provides an explanation of the Ranchos Scale of Recovery, outlines environmental adjustments for the patient, and has a section for daily placement of the updated Behavior Management Plan for you to review.
• A TBI education book will also be provided. This binder contains extensive information regarding education for traumatic brain injury. We encourage you to review the sections of this guide that may be important to you or your loved one. We will schedule time for you to sit down with staff to review parts of this guide that apply to your loved one, and to answer specific questions of team members working in various disciplines (physical therapy, speech therapy, occupational therapy, nursing, social work and other team members).
• Care coordinator and social worker – You will have a care coordinator who can serve as your “point person” if you should have any questions about the program, treatment plan, and future options. The care coordinator and social worker will also encourage participation in education sessions with the team to acquire feedback specific to your loved one. Social work will also assist in connecting you with other helpful resources including future rehab/treatment options for the patient, placement options if needed, financial supports or connections with other community support agencies. 

Staff Expertise in Traumatic Brain Injury

• MNRF staff are passionate about the work that we do. We make it a core part of our training to stay current with the latest in brain injury intervention. MNRF inpatient and outpatient programs currently have over thirty staff who have passed a standardized national evaluation to become certified as brain injury Specialists.
• Staff takes pride in the program because it is their creation. Staff developed the program under the guidance of their rehab manager, and they continue to revise and shape the program to make it the best program possible. Customer surveys are reviewed routinely to see what is working well for patients and their caregivers, and to obtain customer input to continually grow and improve the quality of the program.