Brooks Expo Hall Digital Toolkit 1/25

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SAWGRASS MARRIOTT GOLF RESORT AND SPA

JANUARY 24, 2025

Acute Rehab at HCA Florida Memorial Hospital

The Road to Recovery for HCA Florida Memorial Hospital Patients

Did you know that Brooks Rehabilitation provides rehabilitation services to acute hospital patients of HCA Florida Memorial Hospital?

Brooks Rehabilitation is HCA Florida Memorial’s acute rehabilitation team! With more than 350 years of combined experience among the team — and under the guidance of a manager and director — the Brooks rehabilitation team at HCA Florida Memorial is highly trained to care for all patients throughout the hospital.

Examples of the rehabilitation care we provide:

• Cardiac patients such as: open heart surgery/ coronary artery bypass graft (CABG) and valve replacements, pacemaker, aneurysm repair

• Thoracic surgeries

• Extracorporeal membrane oxygenation (ECMO)

• Neonatal intensive care unit (NICU)

• Major trauma, including brain and spinal cord and orthopedic injuries

• Joint replacement (total hip, knee and shoulder)

• Behavioral health

• Septic patients

Interested or have questions?

• Amputation patients

• Bariatric patients

• Stroke patients

• Vascular patients

• Medical patients (diabetic patients, wound)

• Pulmonary patients (mechanically ventilated or tracheostomy patients)

• Nephrology patients

• Surgical patients

• Oncology patients

• Swallow evaluations, modified barium swallow (MBS) exam and Fiberoptic endoscopic evaluation of swallowing (FEES) exams

PHYSICAL THERAPISTS

PHYSICAL THERAPY ASSISTANTS

OCCUPATIONAL THERAPISTS

OCCUPATIONAL THERAPY ASSISTANTS

SPEECH LANGUAGE PATHOLOGISTS

REHABILITATION TECHNICIANS

Contact Emily Hamilton, Director of Rehabilitation, Brooks Rehabilitation at HCA Florida Memorial Hospital Emily.Hamilton@brooksrehab.org, (904) 702-6892.

Adaptive Sports & Recreation and Pediatric Recreation

Please

Revised 8/27/24

Pediatric Recreation

Activities and events are available throughout North Florida and are FREE for all participants.

The Brooks Pediatric Recreation Program provides youth with disabilities meaningful and accessible recreation opportunities that offer social connection, family empowerment and community integration to enhance quality of life.

We serve youth (birth – 17-years-old) and offer both sport and recreation programs year-round through weekly classes, monthly activities and family-friendly special events.

Spring

Plant Pals

Aquabilties Young Athletes Program (YAP)

Brooks BullSharks wheelchair basketball

Brooks IceBreakers sled hockey

Summer Aquabilities Young Athletes Program (YAP)

Fall Plant Pals

Dance

Young Athletes Program (YAP)

Brooks BullSharks summer league

Brooks IceBreakers sled hockey

Brooks BullSharks wheelchair basketball

Brooks IceBreakers sled hockey

Winter Cooking Young Athletes Program (YAP)

Pediatric Recreation Annual Calendar Volunteer

Brooks BullSharks wheelchair basketball

Brooks IceBreakers sled hockey

Bowling

Little Ones Music

Peds Play Day

Kayaking

Challenge Mile

Little Putters

Horsin’ Around

Bowling

Little Ones Music

Surf

Kayaking

Family Field Day

Bowling

Little Ones Music

Peds Play Day

Jump Back to School

Family Fishing Day

Horsin’ Around

Bowling

Little Ones Music

Peds Play Day

Brooks On Ice

Kayaking

Hole in Fun

Medtronic – Nelson Building 6703 Southpoint Drive N Jacksonville, FL 32216

Brooks is currently accepting applications for children with limited mobility.

The build will be held in the morning followed by a car rally from 1–3 p.m.

To Nominate a Child, fill out an application at brooksrehab.org/gobabygo

FOR QUESTIONS PLEASE CONTACT: GoBabyGo@brooksrehab.org (904) 345-7501 www.BrooksRehab.org/GoBabyGo

Aging Services

SKILLED NURSING

5-Star Quality of Care from a Name You Trust

At Brooks Rehabilitation, we provide world-class rehabilitation solutions to advance the health and well-being of our communities. Our skilled nursing facilities offer 5-star quality care awarded from the Centers for Medicare and Medicaid Services (CMS) with all private rooms. Both facilities are also rated “High Performing” for short-term rehabilitation by US News and World Report.

When a patient is admitted to one of our skilled nursing facilities, they can expect to receive an individualized, rehabilitation focused plan of care to help them achieve their highest level of recovery.

OUR TEAM

Our medical care is overseen by physiatrists, doctors who specialize in physical medicine and rehabilitation. The team may also include:

• Internal medicine physicians/nurse practitioners on-site

• Nurses (RN, LPN, CNA) with specialized training in rehabilitation

• Physical, occupational and speech therapists as needed

• Case manager on-site to assist with discharge back to the community

• Registered dietitian/nutritionist

• Recreation activities manager

• Psychology services

• Access to a network of specialists available as needed, including podiatry, dentistry and optometry

OUR SERVICES

Our skilled nursing facilities offer a wide range of essential clinical services, including but not limited to:

• Post medical-surgical assessment and management

• Wound care services provided by Certified Wound Care specialists, including negative pressure wound therapy

• Intravenous (IV) hydration and antibiotic therapy

• Medication management

• Balance and fall prevention

• Blood sugar monitoring and treatment

• Gastrostomy (GT) feeding

• Oxygen and nebulizer treatments

• Foley and suprapubic catheter management

• Drain management

• Enteral nutrition

• Bladder and bowel training programs

• Patient and family education

• Assistance with activities of daily living

Since your medical team has decided that your healthcare needs have improved enough that you no longer need a hospital level of care, you can expect to see less nursing staff members in a skilled nursing facility as your care needs have decreased. Our nursing staffing levels are above the state and federally mandated minimum standards to ensure the highest level of resident care delivery and safety.

Your Next Step in Recovery is the Brooks System of Care

Discharge planning begins from the moment of admission to University or Bartram Crossing. Our comprehensive team works with patients and families to ensure a smooth transition home.

After skilled nursing care, you’ll have access to everything the Brooks system has to offer:

• Home health and private duty services

• More than 50 outpatient therapy clinics

• Assisted living and memory care facilities

• Research

• Free community programs.

We provide care in the right setting for your individual needs, resulting in the best outcomes.

P: (904) 528-3000 F: (904) 456-8771

P: (904) 345-8100 F: (904) 456-8771

Respite Care is available at Bartram Lakes Assisted Living and the Green House, based on availability. Respite stays are a great option for seniors who are discharging from a hospital or rehab center but need a little extra care. It’s also useful for caregivers who have a senior living with them and are planning a trip. Our guests enjoy a fully furnished apartment or bedroom, private bath, plus three meals per day and assistance with medication oversight and activities of daily living. We accept respite stays for one week – two months. Brooks will partner with providers to offer these guests therapy as needed.

Brooks Rehabilitation invites you to redefine Assisted Living at Bartram Lakes. We provide care and services centered on enhancing our residents’ lives and wellbeing. Bartram Lakes is a community where seniors can live fully, where physical abilities are treated with dignity and assistance is available and delivered respectfully.

• Beautiful studio, one and two bedroom apartments

• Meals and snacks, made from scratch and featuring local ingredients

• Wellness program includes fitness center, chair exercises & walking paths

• Priority access to Bartram Crossing for short term rehabilitation or long term care

• 24 hour nursing and Extended Congregate Care (ECC) licensure offers ability for residents to Age in Place

• Social opportunities include musical performances, restaurant & shopping outings, art classes, sporting programs plus games

THE GREEN HOUSE® RESIDENCES at Bartram Park

Brooks Rehabilitation has built a place where individuals with dementia can feel safe, nurtured and lead a meaningful life. Brooks Green House Residences are real homes with round the clock caregivers who provide meals, daily care and most importantly personal engagement for Elders living with dementia. Our Elders enjoy their beautiful surroundings and the caring relationships they build with each other and their caregivers. The result is a warm, loving home filled with laughter and compassion – where meaningful life continues.

A Real Home

• Cozy Hearth

• Family Dining Table

• Secure Outdoor Garden

• Private Bedrooms & Baths

Meaningful Engagement

• Personal Interaction

• Elder Centered Living

• Elder Participation

Specialized Care

• 24 Hour Care and Nursing

• Independence Promoted

• Age in Place Philosophy

PRICING

Shabazim and nurses provide care 24 hours a day, seven days a week based on individualized care plans addressing specific needs of each Elder including medication management and assistance with activities of daily living.

Meals are prepared fresh from scratch in each Green House®, tailored to individual needs and preferences of each Elder under the oversight of a registered dietitian.

Care teams are trained in Best Life™ certification focused on providing personalized meaning to each daily interaction and encounter

An additional $400 per month will be charged for any of the following medical services:

Complex medication management (oxygen, insulin or nebulizer)

Direct assistance with eating

Assistance with catheter, ostomy or feeding tube

Two-person transfer

Individual care plans are based on medical assessment. One-time community fee: $2,000; Second person fee: $3,500

GH FLOOR PLANS

Aphasia Center

AphasiaCenter

WhatisAphasia?

Wearededicatedto helpingpeoplewithAphasia achievethehighestlevelof recoveryandparticipationinlife.

In

a time crunch...

Communication Tips for Healthcare Providers

Supporting communication exchanges with gestures and words can increase understanding. Try using the following gestures as you talk with your patient.

Point to your mouth

Point to your left brain

"I know talking is challenging for you."

"It's tough because you know it in your brain and can't get it out."

Gesture towards the hallway

"But there are a lot of other patients."

Point to the person

"What you have to say is important. I need help, so I need to talk to (the communcation partner)."

"I hope that's alright with you."

Gesture ok

Communicating with People with Aphasia

Aphasia

Is an acquired communication disorder that affects language. Aphasia does not affect intelligence.

Aphasia

Can occur after a stroke or brain injury. People with aphasia know what they want to say but may have difficulty getting the words out. To talk to someone who has aphasia, you just need to communicate differently.

Tips for Communications

?

Ask 1 question at a time.

Pen and paper helps. Write down key words.

Hear him or her out. Do not rush them.

brooksrehab.org/aphasia • (904) 345-6780 • aphasia@brooksrehab.org

Allow enough time to respond.

Slow down. Speak clearly.

Incorporate drawings, pictures and gestures

Ask. Wait. Listen!

Aphasia Center

Making Aphasia Friendly Materials

can affect reading and comprehension of written and visual materials. Try these tips to help support a person with aphasia.

• Font

o Use large font size (size 16 or larger)

o Sans Serif fonts are best (i.e., Arial, Tahoma, Verdana)

Aphasia is a loss of language, not intellect. (Arial, 16 point)

Aphasia is a loss of language, not intellect. (Monotype Cursiva , 16 point)

o Do not use block capitals. The shape of the word is lost.

o Keep at least 1.5 spacing between lines (as shown by the spacing in this document)

• Conveying key points

o Bold key words. Be careful not to over use because it feels like shouting.

o Write in lower case letters.

o Bullet points are helpful

o Use text boxes to highlight important information.

o Use numbers instead of words

1, 5, 67

o Use real pictures

o Keep background colors plain

• General Tips

one, five, sixty-seven

o Ensure words and sentences are short, clear, and simple

o Have clear headings to signpost information

o Keep reading level at 5th – 6th grade level

brooksrehab org/aphasia (904) 345-6780

aphasia@brooksrehab org

Aphasia Center Programs

Helping people join in life’s conversation

Aphasia is a language disorder caused by a stroke or brain injury that does not affect someone’s intelligence. The Brooks Rehabilitation Aphasia Center bridges the gap between medical rehabilitation and community reintegration. We provide comprehensive support to those affected by aphasia and their families. Our center offers two programs for people with aphasia. We offer a community aphasia program and an intensive comprehensive six-week program. We offer all families communication support, outings, aphasia groups on line, family training and support groups.

The community program provides a matrix of coordinated group activities. These language-based groups are designed to help with re-engagement in life and communication. Our groups help reduce the barriers to communication while teaching new strategies and techniques to improve reading, writing, understanding, and expression. Members are given choices for group participation, which includes a variety of interests such as book and movie clubs, journaling, TV series, travel, music, and technology groups.

Highly trained speech-language pathologists and other specialists facilitate all groups from 9:00 am to 2:00 pm. Members are allowed to participate in this program for as long as they may wish to continue. Rates are determined on a sliding fee scale and range from $10-40 per day. A member can attend our program and receive outpatient therapy at the same time.

is an

intensive therapy program designed to help maximize communication potential and improve life participation. ICAPs are multifaceted and take into consideration the many aspects of communication needs faced by persons with aphasia and their families, including reading, writing, speaking, and understanding. Our program runs Monday through Friday, averaging over 25 hours per week for 6 weeks. It encompasses focus on reengagement in life through individualized evidence based 1:1 therapy, outings, family training, and interactive language and social groups. This program is specialized for the person with aphasia and their family. Potential candidates for the ICAP must be able to participate in 5-6 hours of daily intensive speech and interact in a group setting.

brooksrehab.org/aphasia (904) 345-6780

aphasia@brooksrehab.org

Intensive Comprehensive Aphasia Program (ICAP)

individualized,

Community Program

Intensive Comprehensive Aphasia Program (ICAP)

Aphasia Center Programs

Community Involvement

Both programs support community involvement and facilitate outings such as museums and lunch outings. We offer a free adaptive sports program after hours including events such as golfing, bowling, and surfing. We also offer 5 free Zoom groups a week including language and social groups, music therapy, and mental health and well-being groups.

Satellite Locations

We have two satellite conversation groups based in Daytona, Florida and Orange Park, Florida. These weekly conversation groups focus on various topics and social activities focusing on improving communication skills, confidence, and friendship.

Criteria for Participation

The criteria for participation in both programs include primary diagnosis of aphasia, must be able to toilet and feed independently. Detailed information can be provided for either program by contacting us.

brooksrehab.org/aphasia (904) 345-6780

aphasia@brooksrehab.org

ResearchArticle

Two-YearLongitudinalEvaluationofCommunity

AphasiaCenterParticipationonLinguistic, FunctionalCommunication,andQualityof

LifeMeasuresAcrossPeopleWitha RangeofAphasiaPresentations

LisaA.Edmondsa andJodiMorganb,c

a DepartmentofBiobehavioralSciences,TeachersCollege,ColumbiaUniversity,NewYork,NY b BrooksRehabilitationAphasiaCenter, Jacksonville,FL c DepartmentofCommunicationSciencesandDisorders,JacksonvilleUniversity,FL

ARTICLEINFO

ArticleHistory:

ReceivedSeptember27,2021

RevisionreceivedJanuary17,2022

AcceptedAugust2,2022

Editor-in-Chief:MelissaCollinsDuff

Editor:WilliamS.Evans

https://doi.org/10.1044/2022_AJSLP-21-00308

ABSTRACT

Purpose: Thepurposeofthisstudywastoevaluatepotentialchangesona hierarchyoflanguagetasksandmeasuresoffunctionalcommunicationand qualityoflifeinagroupofpeoplewithaphasia(PWA)whoattendedacommunityaphasiacenterfor2years.Asecondarypurposewastodeterminewhether therewereanypredictorsofchange.

Method: Twenty-sevenPWAwhoattendedBrooksRehabilitationAphasiaCenter(BRAC)wereevaluatedonanaphasiabattery,confrontationnaming,and structureddiscourseinadditiontocompletingself-reportedmeasuresoffunctionalcommunicationandqualityoflifeatthreetimepoints:beforeattending BRACandafter1(N =27)and2(N =20)yearsofBRACparticipation.TwentysixcommunicationpartnerswhocommunicatedregularlywiththePWAcompletedaquestionnaireabouttheirfunctionalcommunicationatthesametime points.Amixedlinearmodelwasconductedforalldependentvariablesto determinechangeovertime.Tau-bcorrelationswereconductedbetween demographicandaphasia-relatedvariablesanddifferencescoresforoutcome measuresthatexhibitedsignificantimprovements.

Results: At1-yeartesting,significantimprovementswereobservedontheaphasia battery,objectandactionnaming,andallself-andcommunicationpartner–reported measures.At2-yeartesting,allimprovementsweremaintainedexceptfortheselfreportedmeasureoffunctionalcommunication.Structureddiscourseshowed increasesinaveragenumberofwords,percentageofmeaningfulwordsandutterances,andefficiencyofmeaningfulwordproductionafter2years.Nosignificantcorrelationswereobservedbetweenpredictorvariablesanddifferencescores.

Conclusions: Participationinaphasiacenterscanresultinsignificantchanges inlanguage,functionalcommunication,andqualityoflifeinpeoplewithchronic aphasia.ThesefindingssupporttheimportanceofaphasiacentersinthecontinuumofcareforPWA.

SupplementalMaterial: https://doi.org/10.23641/asha.21313689

CorrespondencetoLisaA.Edmonds:lisa.edmonds@tc.columbia.edu. PublisherNote: ThisarticleispartoftheSpecialIssue:SelectPapersFrom the50thClinicalAphasiologyConference. Disclosure: LisaA.Edmonds isaresearchconsultantforBrooksRehabilitationAphasiaCenter (BRAC),forwhichshereceivesfinancialcompensation.JodiMorganis theDirectorofBRACandapaidemployeeofBrooksRehabilitation.

“Ahighlysupportiveenvironmentcanlessenthe consequencesofaphasiaonone’slife,whateverthelanguageimpairment” (Chapeyetal.,2000).Aphasiaisan acquiredlanguageimpairmentcausedbydamageinthe language-dominanthemisphere,mostoftenduetostroke, thataffectscomprehensionandproductionofspokenand writtenlanguagewiththepreservationofintellect.The

AmericanJournalofSpeech-LanguagePathology • 1–17 • Copyright©2022TheAuthors ThisworkislicensedunderaCreativeCommonsAttribution-NonCommercial-NoDerivatives4.0InternationalLicense. 1 Downloaded from: https://pubs.asha.org 134.6.212.101 on 10/19/2022, Terms of Use: https://pubs.asha.org/pubs/rights_and_permissions

communicationdifficultiesresultingfromaphasiacannegativelyaffectaperson’ssocial/friendnetworks(Vickers, 2010),interpersonalrelationships,returntowork(Dalemans etal.,2010),communityinvolvement(Cruiceetal.,2006), identityandsenseofself(Strong&Shadden,2020),selfesteem(Shadden&Agan,2004;Shadden&Koski,2007), andoverallparticipationinlife(Chapeyetal.,2000). Reducedmeaningfulengagementisassociatedwithdepression(Cruiceetal.,2003;Whiteetal.,2014),loneliness, socialisolation,andotherpsychosocialconsequences (Cruiceetal.,2003).Aphasiaalsoaffectsthepersonwith aphasia’sfamily/supportsystemaswellascommunication withinthefamily(Howeetal.,2012).

Mostspeech-languageservicesaretypicallyavailable withinthefirst2–3monthspostonsetofaphasia,withfew servicesavailableafter1year(Simmons-Mackie,2018). Thislimitedaccessoccursdespitethechronicityofaphasia (Flowersetal.,2016),evidencethatpeoplewithchronic aphasiacancontinuetoimprovelongafteronset(Allen etal.,2012;Moss&Nicholas,2006),andthedesirefor long-termspeech-languageservicesbypeoplewithaphasia (PWA)andtheirfamilies.Aprimaryreasonforinsufficientaccesstoservicesisareductionofthird-partypayers toreimbursetreatment(Elman,1998).Anadditionalfactoraffectingservicesforaphasiaisthatspeech-language offeringsprovidedwithintraditional/medicalsettingsoften differfromtheprioritiesandgoalsofPWAandtheirfamilies(Brownetal.,2012;Leachetal.,2010;Threats,2007; Worralletal.,2011).Theseprioritiesincludepersonalized, collaborative,andfunctionaltreatmentgoalsaimed towardincreasedindependence,socialinteraction(Worrall etal.,2011),andlifeparticipation(Cruiceetal.,2006). PWAalsoreportwantingtherapytooccurwithinapositiveenvironment(Brownetal.,2012).

Aphasiacentersareaserviceoptionthatcanmeetthe needforlong-termspeech-languageservicesthatarealso consistentwiththeprioritiesofPWAandtheirfamilies.The group/social-basedapproachofaphasiacentersaimstopositivelyimpactcommunicativeparticipation,socialengagement,andqualityoflife.Thesupportiveenvironmentalso lessenstheeffectsoflinguisticimpairments.However,many aphasiacentersarecommunitybasedanddependonselfpay,donations,grants,and/orfundraising(SimmonsMackie&Holland,2011).Asaresult,manycentershave limitedresourcesforresearchtoevaluatehow,andtowhat extent,aphasiacenterparticipationmightaffectthelanguage,communication,andqualityoflifeofthePWAwho attend.Researchevidenceiscriticalasanimpetusforinsurancecompaniestoconsiderreimbursementforaphasiacenterparticipation.Researchfindingsmayalsosupport increasedfundingoptionsforaphasiacenters.

Thus,thisstudyaimstoaddresstheneedformore researchonthepotentialbenefitsofaphasiacenters.Previousstudiesprimarilyevaluatedpsychosocial/qualityof

lifeoutcomesinPWAwhoattendedaphasiacenters (Armouretal.,2019;Hoenetal.,1997;McCalletal., 2014;vanderGaagetal.,2005),withlessevaluationof functionalcommunication(McCalletal.,2014;vander Gaagetal.,2005)orlanguage(McCalletal.,2014).Additionally,moststudiesevaluatedatimelineof6monthsor less(Armouretal.,2019;Hoenetal.,1997;vanderGaag etal.,2005),whichmaynotreflecttheeffectsoflong-term aphasiacenterparticipation.Thus,thepurposeofthislongitudinalstudyistoevaluatetheeffectofaphasiacenter participationinacohortofPWAacrossthreedomainsof outcomemeasures:language,functionalcommunication, andqualityoflife.Togaininsightintopossiblechanges overtime,outcomeswereevaluatedovera2-yearperiod. Toprovidecontextforthisstudy,thefollowingsections providebackgroundonmodelsofaphasiamanagement, aphasiacenters,andrelevantresearchfindings,followedby thestudy’sspecificresearchquestions.

ModelsofAphasiaManagement

Withinthetraditional/medicalmodelofhealthcare, aphasiaislargelyassessedandtreatedwithafocuson impairmentandremediation.However,theemphasison impairmentlimitstheabilitytoprovideanindividualized andlong-termresponsetoaphasia,includingthesocial, participation,psychosocial,andidentityneedsofPWA andtheirsupportsystems(Kaganetal.,2008;Leach etal.,2010).Inresponsetotheneedforamoreholistic approach,asocial/person-centeredapproachofhealth carewasintroducedinthe1970s,wherethepersonwith aphasiawaspositionedasacollaborativememberoftheir healthcareteamandwherehealthcareissueswereviewed asaninteractionofpersonal,physical,environmental,and socialfactors(Elman,2016).

In2001,theWorldHealthOrganization’s(WHO’s) InternationalClassificationofFunctioning,Disabilityand Health(WHO,2001)providedamodelthatintegrated medicalandsocialmodelsbyconsideringtheinteractions betweenhealthconditions,bodyfunctions(e.g.,language) andstructures(e.g.,vocalfolds),activities,andparticipation(e.g.,engaginginsocialconversationorvolunteer activities).Aroundthesametime,theLifeParticipation ApproachtoAphasia(LPAA)wasintroducedasa frameworkforguidingservicesforthoseaffectedbyaphasia(Chapeyetal.,2000).LPAAisaphilosophywitha coresetofvaluesconsistentwithsocialand/orpragmatic approachestoaphasiaandafocusonincreasingparticipationandre-engagementinlifeactivities.Importantly, LPAAempowersthoseaffectedbyaphasiatobemore activelyinvolvedinchoosinghowtoparticipateintheir recoveryprocess,includingcollaborationontheselection anddesignofinterventionsorotheractivities.Thecore LPAAvaluesthatserveasguidestoassessment, 2 AmericanJournalofSpeech-LanguagePathology •

intervention,andresearchareasfollows:(a)Theexplicit goalisenhancementoflifeparticipation,(b)everyone affectedbyaphasiaisentitledtoservice,(c)success measuresshouldincludedocumentedlifeenhancement changes,(d)bothpersonalandenvironmentalfactorsare interventiontargets,and(e)emphasisisonavailabilityof servicesasneededatallstagesofaphasia(Chapeyetal., 2000).

In2008,auser-friendlyadaptationofWHO’sInternationalClassificationofFunctioning,Disabilityand Healthmodel,consistentwithLPAAprinciples,was developedforaphasia.TheLivingwithAphasia:FrameworkforOutcomeMeasurement(A-FROM;Kagan etal.,2008)modelputsthepersonlivingwithaphasiaat thecenterofthemodel,withthefollowingintersecting domainscontributingtolifewithaphasia:participationin lifesituations;personalidentity(anotableaddition),attitudes,andfeelings;languageandrelatedimpairments; andcommunicationandlanguageenvironment.While LPAAprinciplescanbeappliedwithinanysetting,aphasiacentersprovidemuch-neededlong-term,patientcentered,andcommunity-basedservicesforpersonwith aphasiaandtheirfamilymembers.

AphasiaCenters

ThefirstaphasiacenterwasfoundedbyPatArato in1979inToronto,andsincethen,aphasiacentershave becomeanimportantandgrowingservicedeliveryoption outsidetraditionalhealthcareforPWA(seeElman,2016, foracomprehensivediscussionofaphasiacenters).As definedbySimmons-MackieandHolland(2011), “aphasia centersprovideprogrammingdesignedexclusivelyfor PWA,and,insomecases,fortheirfamilymembers.These dedicatedaphasiaprogramsaredistinctfromstrokerehabilitationorgeneralrehabilitationprograms,andtypically offerservicessuchasconversationgroups,leisureactivities,orsimilarparticipationorientedactivities” (p.204). Mostcentersincludeparticipation-orientedgroupactivitiesandmultimodalityconversationgroups(SimmonsMackie&Holland,2011),therebyprovidingopportunities forauthenticconversationandsocialrelationships,which canpotentiallyfacilitatelinguistic,communicative,participation,andsocialandpsychosocialbenefits.

Currently,aphasiacentersmeetmanyneedsofPWA andtheirfamilies/supportsystems(Simmons-Mackie& Holland,2011).Thereisalsogrowingevidenceaboutthe potentialbenefitsofhobby-based,skill-based,andrecreationalgroupsaswellaschoirs,bookclubs,andcomputer programs(e.g.,Elman&Hoover,2013;Tamplinetal., 2013).Additionally,participant-focusedgroupsthatprioritizetheexchangeofinformationinnaturalisticcontexts withaphasia-friendlysupportshaveprovedbeneficial acrossavarietyofareas.Areasofimprovementinclude

increasedinitiationofconversationandexchangeofinformation(Elman&Bernstein-Ellis,1999a),socialparticipationandsenseofsocialconnectedness(Vickers,2010), qualityoflife(vanderGaagetal.,2005),andsocialparticipationinconversationwhentrainedpartnersareavailable (Kagan,1998;Kaganetal.,2001;andseeSimmonsMackieetal.,2010,2016).Additionally,PWAhave reportedthefollowingbenefitsafterparticipatingingroup communicationtreatment:enjoymentofbeingwithothers, beingsupportedbyothers,beingabletohelpothers,enjoyingseeingothersimprove,makingfriends,feelingmore confident,enjoyingconversations,andimprovementon talkingandreading/writing(Elman&Bernstein-Ellis, 1999b).Furthermore,Lanyonetal.’s(2013)reviewconcludedthatthegrouptherapyliteraturesupportsthesuppositionthatcommunityandoutpatientgroupparticipation canimprovespecificlinguisticprocesses,withsomeevidenceofimprovementinfunctionalcommunicationwith groupparticipation.

AphasiaCenterResearch

Whilethereisagrowingliteraturethatsupportsthe positiveeffectsofgroupinteractionsandgroupactivities, fewstudieshaveevaluatedthepotentialbenefitsofoverall involvementinaphasiacenters(Armouretal.,2019; Hoenetal.,1997;McCalletal.,2014;vanderGaag etal.,2005),whichconstitutemorediverseanddynamic activitiesandinteractionsthanmightoccurwithinsingulargrouptherapysessions.Allstudiesthathaveevaluated aphasiacenterparticipationhavereportedimprovementin qualityoflifeand/orpsychosocialoutcomes(Armour etal.,2019;Hoenetal.,1997;McCalletal.,2014; vanderGaagetal.,2005).Twostudiesevaluatedand reportedchangesinfunctionalcommunication(McCall etal.,2014;vanderGaagetal.,2005),andtheonestudy thatevaluatedlanguagedidnotshowchangesinaphasia severity(McCalletal.,2014).SeeTable1fordetails acrossstudies.

Theresultsfrompreviousstudiesthatinvestigated aphasiacenteroutcomesarepromising,especiallywith respecttoqualityoflife/psychosocialmeasuresand reports.Thepurposeofthisstudyistoevaluateawider rangeofoutcomesinagroupofPWAwhoattendeda community-basedaphasiacenter.Tounderstandthe potentialeffectofparticipationintheaphasiacenterover time,participantswereevaluatedatmultipletimepoints. Thespecificresearchquestionsareasfollows:After1and 2yearsofaphasiacenterparticipation,

(1)arechangesobservedinaphasiaseverity,naming ofnounsandverbs,functionalcommunication,andqualityoflife?

(2)areimprovementsobservedinspokendiscourse ability? Edmonds&Morgan:Two-YearEvaluationofCommunityAphasiaCenter

Table1. Summariesoffourstudiesevaluatingoutcomesofaphasiacenterparticipation.

Study N

(years)

Aphasiaprofile details

Group composition details Involvement inotherSLP services

Hoenetal.(1997)35 Mdn =61–65, range:31–90 12/23 Mdn =4years, range:1–20 N/A N/A Yes

Armouretal.(2019)41 M =65.2, range:33–84 19/223months–37years, 41%<1year postonset

vanderGaag etal.(2005) 38 M =58, range:31–81 12/26 M =33months, range:11–81

Fluentandnonfluent, rangeofseverities Yes

Aphasiaseverity skewedtoward mild-to-moderate

30White, 1Chinese, 5Black, 2Asian No

McCalletal.(2014)11–23N/A N/AN/A N/A N/A

Note.N =numberofparticipants;SLP=speech-languagepathology;QoL=qualityoflife;N/A=Informationnotavailable;DNT=didnot test;CETI=CommunicativeEffectivenessIndex;PWA=peoplewithaphasia;pts=participants;QCL=QualityofCommunicationLife Scale;WAB-R=WesternAphasiaBattery–Revised.

(3)dodemographicandaphasia-relatedvariablespredictthedegreeofchangeacrossoutcomemeasures?

Method

Thislongitudinalstudyevaluatedlanguage,communication,andqualityoflifemeasuresacrossacohortof PWAwhoattendedBrooksRehabilitationAphasiaCenter (BRAC)after1and2yearsofattendance.Thestudywas approvedbytheInstitutionalReviewBoardatTeachers College,ColumbiaUniversity.

BRACPhilosophyandProgramming

BRACisacommunityaphasiaprogramfundedby BrooksRehabilitationHospitalthatopenedinJacksonville, Florida,inMarch2016toprovidecommunityspaceand servicesforthevariedneedsofPWAandtheirfamilies/ supportsystems.BRACembracestheLPAAandfosters acomplexcommunicativeenvironment,whichpromotes diversecommunicativeandsocialinteractionsthatare criticaltoimprovinglong-termoutcomesforindividuals withaphasia(andotheracquiredbraininjuries;Hengst

4 AmericanJournalofSpeech-LanguagePathology • 1–17

etal.,2019).Assuch,BRACencouragescommunitybasedgroupinteraction,whichengagesnaturalisticconversationalskills,anarrayofcommunicativepartners, dynamicinteraction,support,interactionwithothers withaphasia,andpositivityrelatedtolivingsuccessfully withaphasia(Lanyonetal.,2018).Interactionandconversationopportunitiesoccurthroughouttheday,from thecheck-inprocess,tomorningcoffeechat,tolunch withanaphasia-friendlymenu,andwithinallgroup interactions.

Topromoteautonomy,BRACmemberschoosethe groupsandactivitiestheywanttoparticipatein,with threedifferentchoiceseveryhour.Groupoptionschange fromdaytodayandincludejournaling,travel,advocacy group,technologyandapps,bookandmovieclub,shark tank,musictherapy,currentevents,andBRACNews. Eachgroupconsistsoftwotosevenmembers,one speech-languagepathologist(SLP),and/oronetotwo trainedgraduatestudentsorvolunteers.Allgroupshave multimodalitysupportsandaphasia-friendlymaterials, includingscheduleboards,writtenmaterialandinstructions,andlunchmenus.Thesemodificationssupport readingcomprehensionforandareoftenpreferredby PWA(Brennanetal.,2005;Knollman-Porteretal.,

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Table1. (Continued).

Study

Hoenetal. (1997)

6monthsRyff’s(1989)Psychological Well-beingScale

Significantchangeonall well-beingdomainsexcept positiverelationswithothers Armouretal. (2019) 11weeksStrokeandAphasia QualityofLife Measure(SAQoL-39: Hilarietal.,2003)

vanderGaag etal.(2005)

McCalletal. (2014)

6monthsEuroQoL(EQ-5D: EuroQolGroup, 1990)andSAQoL-39 (Hilarietal.,2003) CETIgivento PWAand communication partners

1yearASHAQCLScale (Pauletal.,2004; N =23);Burden ofStrokeScale (Doyleetal.,2004; N =11); Communication ConfidenceRating ScaleforAphasia (Babbittetal.,2011; N =11)

Communication Activitiesof DailyLiving-2 (CADL-2: Holland,1999; N =23)

2015).Membersalsodevelopandleadgroups,giveBRAC facilitytours,coordinateevents,andareactiveinaphasia advocacygroupsandcommittees.Memberscanalsoparticipateinbimonthlyoutingstomuseums,restaurants,andfree adaptivesportsprogramssponsoredbyBrooksRehabilitation.SeeSupplementalMaterialS1fordetailsaboutadministrationofgroups.

Additionally,eachfamilyofBRACmembersreceives educationandinformationaboutaphasia,including3–4hr ofSupportedConversationforAdultswithAphasia(SCA) training(Kagan,1998).Familiescanreturnforadditional training,asneeded.Volunteers,SLPs,mentalhealthcounselors,andotherswhoattendthecenteralsoreceiveSCA training.SCAisacommunicationmethodthatusestechniquestoencourageconversationwhenworkingwithsomeonewithaphasiathroughwrittenandspokenkeywords, bodylanguage,andgestures(Kagan,1998).

Participants

Twotypesofparticipantswereincludedinthis study:BRACmemberswithaphasiawhoattendedthe centerandcommunicationpartnerswithoutaphasia(e.g., spouses)whoratedthefunctionalcommunicationofthe BRACmembers.

WesternAphasia Battery–Revised (Kertesz,2006)

Significantchangesonthe SAQoL-39foralldomains (andoverall)

SignificantchangeinEQ-5D andCETI,nochangeon SAQoL-39. Qualitative: Majorityofptsreported increasedself-confidence, independence, communication,anddesire formoreinsocial encounters.

SignificantchangeonCADL-2 (meanchange=7.57)and theASHAQCL(mean change=0.4),withno changesontheWAB-R (meandifference=0.29)

BRACMembers

Therequirementsforenrollinginthestudywere attendanceatBRACandanaphasiadiagnosis.Initially, 47BRACmemberssignedaconsentformagreeingfor theirassessmentmaterialsto bereviewedforresearch(all BRACmembersaretestedaspartofstandardBRAC procedures).However,20oftheconsentedmemberswere notincludedinthestudybecauseofmedicalcomplications(e.g.,seizures),pursuanceofindividualspeechtherapy,optingoutoftesting,ormoving/travelbeforethe firsttestingperiod(1year).Thus,27memberswere retainedinthestudyafter1year.Ofthese,25were monolingualEnglishspeakers,andtwowereproficient bilingualspeakers,forwhomKoreanandSpanishwere firstlanguages(althougha lltestingwasconductedin English).AtYear2,20participantsremainedinthe study,assevenwereexcludedduetomedicalissues,pursuanceofindividualspeech-languageservices,ormoving. SeeTable2fordemographicdetails.

Withrespecttocost,BRAChasaslidingscaleof $10–$40perday,withnoonerefusedforlackoffunds. Thedailyfeeforeachparticipantwasusedasanindicator ofsocioeconomicstatus,withfamilyincomeevaluatedin relationtopercentageofpovertyline($10/day: ≤ 300%, $20:301%–400%,$30,401%–500%,$40:>501%;e.g.,a

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Table2. Demographics,aphasiainformation,anddaysofattendanceofBrooksRehabilitationAphasiaCenter(BRAC)members.

Note.n/a=notapplicable;WNL=withinnormallimits. N =27forCohort1; N =20forCohort2, whichisasubsetofCohort1.

familyoftwocouldearnupto$52,260/year[300%above povertylineof$17,420])fora$10/dayrate.

ParticipantComposition

The27BRACmembersinthisstudywererelatively diverseinagewithabalanceofmenandwomen.While therewasracialandethnicdiversityinthegroup(70% White,22%Black,3.7%Hispanic,and3.7%Asian),the groupskewedtowardmoreWhitememberswhencompared withJacksonville,FL,demographics(58.2%White,31% Black,10%Hispanic,and4.8%Asian;populationestimatesfor July2019,census.gov;UnitedStatesCensusBureau,n.d.).The socioeconomicstatusindicatorsuggestedahighrepresentationoflowersocioeconomicstatus(with63%ofmembers qualifyingforthelowestcostperday).Theeducationof participantsrangedfromhighschoolto21yearsofeducationwithameanof2yearsofcollege.Aphasiadiagnoses

wererelativelyequalacrossfluentandnonfluenttypes, althoughseverityofaphasiaskewedtowardmoderateand severe,withmorethan75%oftheWesternAphasiaBattery–Revised(WAB-R)AphasiaQuotient(AQ)scoresat51or lower.Averageattendancewas7.4dayspermonth,or roughly2daysperweek,at5hrperday.

CommunicationPartnerParticipants

Twenty-sixcommunicationpartners(15significant others,fiveparents,threesiblings,andthreeadultchildren) whoregularlycommunicatedwiththePWAinthisstudy signedaconsentformtoparticipateaswell.Thecommunicationpartnerscompletedaquestionnairethatprovides insightintohowPWAmanagefunctionalcommunication scenarios.Twenty-sixcommunicationpartnerscompleted thequestionnaireatinitialand1-yeartesting.Twenty-three wereavailableatthe2-yeartestingperiod.

Test,Questionnaire,andDiscourse Administration,Scoring,andReliability

Thefollowingtests,whichservedasoutcomemeasures,wereadministeredbyBRACSLPs,whowere trainedonthetestingprotocolbythesecondauthor.Consistencyinadministrationmethodswasassuredbygroup reviewofassessmentvideosevery1–2weeks.Testingwas conductedinaquietroomandwasvideo-andaudiotapedfortranscription,scoring,andreliability.Published guidelineswereadheredtofortestsandquestionnaires unlessotherwiseindicatedbelow.

AphasiaseveritywasmeasuredwiththeAQfrom theWAB-R(Kertesz,2006).ScoringreliabilitywasconductedontheWAB-Rspontaneousspeechsampledueto thepotentialforvariabilityinscoringgiventhetest’smultidimensionalscoringhierarchy.Toachievethis,thefirst authorviewedtheWAB-Rpicturedescriptionvideofor eachparticipantwithaphasiawithoutknowledgeoftheoriginalscore(i.e.,blinded)andscoredtheresponse.Afterscoring,theoriginalclinician’sscoreswererevealed.Ifthefirst author’sscorematchedtheBRACSLPscore,thenthat scorewasretained.Inthecaseofdisagreementbetween raters,asecondresearchSLPwith20yearsofaphasiaexperiencewhowasfullyblindedtothestudyreviewedand scoredthespeechsample.In69.44%ofthecases,twooutof thetwoscoresmatched.In29.17%ofcases,twoofthree scoresmatched.Inonlyonecase(1.39%),therewasno agreement(thescoreswere4,5,and6);inthiscase,themiddlescoreof “5” wasusedasthefinalscore.

AnObjectandActionNamingBattery(Druks& Masterson,2000)wasusedtomeasureconfrontationnamingabilitiesofobjectsandactions.Thecompletetestbatterycontains161objectsand100actions.Tomitigatethe length/burdenoftesting,20objectand20actionitems wereadministered.Itemswereselectedbymatchingobject andactionitemsonpsycholinguisticvariables.Specifically, thepsycholinguisticinformationfromthetestmanualwas matchedacrossgrammaticalclassforageofacquisition, syllablelength,visualcomplexity,andimageability.No cueingwasprovided,andthefinalresponsewasscored, allowingfor1-phonemeerror(e.g.,addition/substitution; e.g., “feaver” for “feather”; “rying” for “crying”).Blinded scoringreliabilityfornaming(100%ofresponses)was 99.1%.

TheAphasiaCommunicationOutcomeMeasure (ACOM)isapatient-reportedmeasureofcommunicative functioningwithquestionsrelatedtoproductionandcomprehensionofcommon,everydaybehaviors,tasks,activities,andlifesituationsusingspoken,written,and/ornonverbalmodalities.Thequestionnairewasdevelopedwith PWAandtheirfamiliesandhasstrongpsychometricpropertieswithasingle,interpretablescore(Hulaetal.,2015). Thestaticshortversion,whichcontains12items(Hula&

Doyle,2021),wasadministeredviacomputerwithspoken andwritteninstructionsprovidedbytheSLP.

TheAssessmentforLivingwithAphasia(ALA; Kaganetal.,2011)isaclinician-administeredquestionnairewithstrongpsychometrics(Simmons-Mackieetal., 2014)thatevaluatesaphasia-relatedqualityoflife.The38 self-ratedquestionsaccompaniedbyaphasia-friendlypicturesarebasedonthefivedomainsoftheWHO’sInternationalClassificationofFunctioning,Disabilityand Health:aphasia(e.g., Howdoyourateyourwriting?),participation(e.g., Doyougetouttowhereyouwanttogo?), environment(Doyougetcommunicationhelpathome?), personal(e.g., Areyouinchargeofyourlife?),andmoving onwithlife(visualrepresentationofaphasiaasawall). Formostquestions,participantsrateonascaleof0(no problem)to5(abigproblem)inhalf-pointincrements.

TheCommunicativeEffectivenessIndex(CETI)isa questionnairedevelopedforcommunicationpartnerswho spendsufficienttimewiththePWAtomakeaccuratejudgmentsofcommunication(Lomasetal.,1989).The16scenariosrepresentedonthequestionnaireweredevelopedin collaborationwithPWAacrossfourcategories:BasicNeed, HealthThreat,LifeSkill,andSocialNeed.Thecommunicationpartnerratesalonga10-cmvisualanalogscalehow thepersonwithaphasiaisabletoparticipateineachscenario.Thescaleanchorsare notatallable and asableas beforethestroke.Inthisstudy,communicationpartners werenotshowntheirpreviousratings,aswasdoneduring thequestionnaire’sdevelopment,toreducepossiblefeelings ofobligationtoprovidehigherratingsovertime.

DiscourseAdministration,Scoring,andReliability

Fivestimulusitemswereusedtoelicitspokendiscoursefromparticipants.Theseitemsincludedtwopicture descriptions,onesequentialstory,onepersonal,andone proceduralprompt,which,together,correspondtostimulussetBfromBrookshireandNicholas(1994).Alldiscourseproductionwasvideo-andaudio-recordedinorder toensuresuitablevisualandaudioqualityforanalysis.The videoswereviewedfortranscriptionusingSystematic AnalysisofLanguageTranscripts(SALT)software(Miller &Iglesias,2012).UtteranceswerebrokenintoT-units,ora mainclausewithitssubordinateclauses.Pauses ≥ 2sand mazes,definedasanyfilledpause(e.g., “uh,”“um”),false starts(e.g.,k*k*),oruncompletedwords(dir*dir*),were alsotranscribed.

Transcriptswerecodedfornumberofwords(W)and correctinformationunits(CIUs),aword-levelmeasureof informativeness(thewordisrelevantandmeaningfultothe context),fromwhichpercentCIUs(%CIU)andCIUsper minute(CIUs/min)werecalculated(seeNicholas& Brookshire,1993).Eachutterancewasalsocodedforthe presenceorabsenceofabasicsentencestructure(subject, verb,andobject[SVO],ifrequired),afterwhicheachword

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oftheSVOwasevaluatedforrelevance/accuracy(REL). Eachutterancewasthencodedforcompleteutterance (CU)status.ACUcontainsacompleteSVOforwhichthe wordsinthatSVOareallrelevant(REL).

Theexamplesbelowillustratecodingfordifferent attemptsatexpressingtheideaof “Theboyisflying akite” fromtheWAB-Rpicture.

The[W][CIU]boy[W][CIU]flying[W][CIU]kite[W] [CIU][SVO+][REL+][CU+].

Boy[W][CIU]making[W]thing[W][SVO+][REL ] [CU ].

Well[W]there[W]time[W]of[W]days[W][SVO ] [REL ][CU ].

The[W][CIU]boy[W][CIU]and[W]kite[W][CIU] [SVO ][REL+][CU ].

Thediscoursemeasuresevaluatedwereaveragenumberofwordsproduced,%CIU,CIUs/min,percentutteranceswithanSVO(%SVO),percentrelevantutterances (%REL),andpercentCUs(%CU)andmeanlengthof utterance(MLU),providedbySALTsoftware.Transcriptionreliabilityon100%ofsampleswas>95%forwords, utterancebreaks,andpauses.Codingreliabilityfor66%of transcriptsacrossparticipantswas>80%forallvariables.

DataAnalysis

ForResearchQuestions1and2,alinearmixed modelwasplanned(SPSSStatistics26)foralldependent variables,withtestingperiodastherepeatedandfixedvariableandparticipantinterceptastherandomeffect.This modelwaschosentoallowforevaluatingrepeatedmeasureswithinparticipantswhilealsoadjustingformissing datawithinandacrossmeasures(West,2009).Missingdata resultedfromsometasksnotbeingcompleted(e.g.,discourseinmoreseverepresentationsofaphasia,CETIsnot beingcompletedbycommunicationpartners).Thepercentageofmissingdataacrossmeasureswas16.3%,19.1%,and 18.3%forinitial,1-year,and2-yeartesting,respectively. Uponvisualinspectionofthemeansandstandarddeviations,itwasclearthattherewasnochangein%SVOor MLU;therefore,toreducethenumberofmodels,astatisticalanalysiswasnotconductedonthosevariables.Forthe remainingvariables,Bonferroniposthocstatisticswere conductedformaineffectdifferences(e.g.,naming)within eachmodelacrossthreetestperiods(initialto1year,1–2years,initialto2years).

Similartotheotherresearchstudiesevaluatingaphasiacenteroutcomes(seeTable1),thisstudydidnothavea

controlgrouportask,andthus,anyimprovementsonthe linearmixedmodelscannotbeconsideredascausal,but rathersuggestiveoftheeffectsofBRACattendance.Thus, inadditiontothemodelresults,wereferenceexistingbenchmarksforsignificantchangefromarecentmeta-analysisof treatmentstudies(Gilmoreetal.,2019)fortheCETI(10.37 points[confidenceinterval(CI):6.08–14.66, p< .001])and WAB-R(5.03points[CI:3.95–6.10, p <.001]).

Publishedbenchmarksintheformofminimaldetectablechangearealsoavailable(Leaman&Edmonds,2021) formostofthediscoursemeasuresinthisstudy.Minimal detectablechangeisametricthatmakestest–retestreliability clinicallymeaningfulbycalculatingtheamountofchange reliabilitydemonstratingposttreatmentchange(Boyle,2014; Stratford,2004).Thus,thefollowingchangescores,reflective ofminimaldetectablechangebenchmarks,wereusedin additiontothestatisticalresultstoaiddiscourseinterpretation:%CIU=5.1;%REL=9.3;%SVO=5.2;%CU=4.6. Theseminimaldetectablechangeparameterswerecalculated fromastructureddiscourse(narrative)taskwithagroupof 20PWAandareconservativeforthisstudyconsideringthat thePWAinLeamanandEdmonds(2021)exhibitedless severeaphasia(meanWAB-RAQ=81.81).

Assumptionsofnormalityweremetforalltestand questionnaireoutcomesexceptCIUs/minand%CU.However, afteraLog10 transformation,bothvariablesmetassumptions ofnormality,andthelinearmixedmodelswererunonthe transformeddata.Giventhelargenumberofstatisticalcomparisonsandexploratorynatureofthiswork,a p valueof.01 wasestablishedasthethresholdofsignificanceforallmodels.

Toevaluatepotentialpredictorsofimprovement, Kendall’stau-bcorrelationswereconductedbetween1-year differencescores(1-yearscore initialscore)ontheWAB-R AQ,namingitems,ACOM,ALA,andCETI.Two-year differencescoreswerenotevaluatedonthesemeasures, becausetheywerenotsignificantlydifferentfromthoseof Year1.Two-yeardifferencescores(2-yearscore initial score)wereconductedonlyon%CIUs.Thevariables enteredaspotentialpredictorsofchangeforallcorrelations wereinitialaphasiaseverity(WAB-RAQ)andALAqualityoflifescores,age,yearsofeducation,socioeconomic statusasmeasuredbythedollaramountBRACmembers paidperday,timepostonset,anddaysofattendancein Year1or2.A p valueof.01wasusedtoaccountformultiplecomparisons.

Results

ChangesinAphasiaSeverity,Naming,and FunctionalCommunication

Theresultsoflinearmixedmodelsshowedsignificant improvementinaphasiaseverity(WAB-R:Kertesz,2006),

confrontationnaming,self-reportoffunctionalcommunication(ACOM:Hulaetal.,2015),qualityoflife(ALA: Kaganetal.,2011),andratingsoffunctionalcommunicationbycommunicationpartnerreport(CETI:Lomasetal., 1989)afterYear1withmaintenanceofimprovementat Year2forallmeasuresexcepttheACOM.Furthermore, theAQ(WAB-R)andCETIscoresexceededthemetaanalysisbenchmarksfromGilmoreetal.(2019).See Table3forstatisticalresultsandSupplementalMaterialS2 fordetailsofthelinearmixedmodels.

ChangesinDiscourse

Theresultsofthelinearmixedmodelsshowedno improvementonanydiscoursemeasureafterYear1.However,atYear2,thefollowingmeasuresshowedsignificant improvementoverbaseline:averagenumberofwordsproduced,%CIU,and%REL,whichrepresentword-and utterance-levelmeasuresofrelevance/accuracy.CIUs/min,a measureofefficiency,improvedaswell.Asdiscussed above,statisticswerenotconductedforSVOstructureor MLU,becausetheirmeansclearlyshowednochange.

Evaluationofthediscoursemeasureswithminimal detectablechangefromLeamanandEdmonds(2021) supportedtheinsignifican tfindingsofthelinearmixed modelresultsatYear1,withnovariablesurpassingthe minimaldetectablechangethresholds.However,similar tothemodelresults,theYear2%CIUdifferenceof 9.71exceededthepublishedminimaldetectablechange of5.1,andthe%RELdifference(8.64)wasclosetothe minimaldetectablechangeof9.3.EventhoughtheYear2 %CUdifferencescoreof5.13exceededtheminimal detectablechangeof4.6,themodelresultswerenotsignificant,andthus,CUswerenotconsideredtohave changed.

CorrelationsBetweenPotentialPredictor VariablesandChangeScores

Nosignificantcorrelations(ps<.01)wereobserved betweenchangescores(e.g.,betweeninitialtestingand 1year)andanypotentialpredictorvariables(e.g.,initial aphasiaseverity[WAB-RAQ]).

Discussion

ChangesinAphasiaSeverity,NounandVerb Naming,FunctionalCommunication,and QualityofLife

Multipletestsandquestionnairesservedasoutcome measurestodeterminewhether,andwhen,improvement tolanguage,functionalcommunication,andqualityoflife

mightoccurafter1and2yearsofvoluntaryaphasiacenterparticipationinacohortofcommunity-dwellingPWA. Theresultsshowedimprovementsacrossallmeasuresat Year1,andimprovementsweremaintainedatYear2for allmeasuresexcepttheACOM(Hulaetal.,2015),which evaluatedself-reportedfunctionalcommunication.These improvementssuggestthatmeaningfulimprovementscan occurforPWAwithinacollaborative,person-centered,and community-basedenvironment,whichprovideslong-term servicesconsistentwithprioritiesofPWAandtheirfamilies (Brownetal.,2012;Threats,2007;Worralletal.,2011).

Specifically,BRACmembershadtheautonomyto choosethefrequencywithwhichtheyattendedthecenter andthegroupsandactivitiesinwhichtheywantedtoparticipate.Thegroupsfocusedonmeaningful,peer-based engagementthatfacilitatedfriendships,peersupport,confidence,andpositivity.Someparticipantsalsoengagedin leadershipbypitching,creating,andleadingtheirown groups,therebyallowingthemtosharetheirinterests, knowledge,andskills.

TheACOM(Hulaetal.,2015)wastheonlymeasurethatdidnotremainsignificantatYear2.Areviewof thedatarevealedthatsomeparticipantsratedtheirfunctionalcommunicationhigheratYear1andmaintainedor increasedthatratingatYear2.Otherparticipantsshowed increasesatYear1,butthenloweredtheirratingsatYear 2.Bycomparison,theself-ratingsontheALAgenerally increasedacrossparticipantsovertime.Whilespeculative, itisconceivablethat,atYear1,participantsexpressed increasedabilityontheACOM,becausetheyperceived improvementinfunctionalcommunication(whichaligns withtheincreaseinotherlanguageoutcomes).Then,at Year2,assomemembersbegannegotiatingmorechallengingcommunicativeenvironments,theyadjustedtheir ACOMscoreswithinthosecontexts.

ChangesinSpokenDiscourseAbility

TheNicholasandBrookshire(1993)spokendiscourseprotocolwasusedtoevaluatepotentialimprovementinspokenmonologuesacrossavarietyofdiscourse types(e.g.,picturedescription,personalinformation).This protocolwaschosenduetoitswideclinicaluseasadiscourseoutcomemeasure(Bryantetal.,2016),strongpsychometricproperties(Pritchardetal.,2017),andecologicalvalidityasanindexofinformativeness(Webster& Morris,2019).

Thespokendiscourseresultsrevealedincreasedoutputasmeasuredbynumberofwords.Withinthatcontext, theabilitytoconveymeaningfulwords(%CIU)andutterances(%REL)relevanttothetopicsalsoincreased.Furthermore,theincreaseinefficiencywithwhichmeaningful wordswereproduced(CIUs/min)suggestsincreasedease ofproduction.However,theabilitytoproduceabasic

Table3. ResultsforalloutcomemeasuresforYears1and2testingforallBrooksRehabilitationAphasiaCentermembers.

Mixedmodel

Outcomemeasure

19.78(21.2)23.04(22.8)24.91(25.2)3.26ns0.00ns1.87ns0.285ns2

Note. Boldedvaluesarestatisticallysignificantwitha p valueof<.01.WAB-RAQ=WesternAphasiaBattery –RevisedAphasiaQuotient;OANBitems=20objectsand20actions fromAnObjectandActionNamingBattery;ACOM=AphasiaCommunicationOutcomeMeasure;ALA=AssessmentforLivingwithAphasia;CETI=Communicativ eEffectiveness Index;%CIU=percentageofcorrectinformationunits;%REL=percentageofrelevantwordsinthesubject –verb –object(SVO)portionofanutterance;CIU=correctinformation unit;CIUs/min=correctinformationunitsperminute;%SVO=percentageofutterancescontaininganSVO(ifrequired);N/A=notapplicable,because statisticswerenotconducted;MLU=meanlengthofutterance;%CU=percentageofutteranceswithanSVOsentenceframethatcontainsrelevantwords;ns=notstatisticallys ignificant. a Differencebetweentwomeansacrosstwotimeperiods(e.g.,1yearmean –initialmean).

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sentenceframe(SVO)didnotimprove.Thesefindingsare consistentwithBRAC’semphasisoncommunicatingone’s ideas(i.e.,meaning)ratherthanfocusingonsyntaxand form.

Theobserveddiscourseimprovementisencouraging andsuggestiveofgeneralization,sincethemonologicdiscoursewasproducedexclusivelyinthespokenmodality, whichisoutsideofthesupportiveandmultimodality groupcommunicativecontextstypicalatBRAC.While mechanismofimprovementisoutsidethescopeofthis study,itisconceivablethatthespokendiscourseimprovementswererelatedtoneuroplasticity,whichreferstoneuralchangesresultingfromchangesinbehavioral,sensory, and/orcognitiveexperiences(Kleim&Jones,2008).With respecttoaphasia,thesechangessupporttherelearningof linguisticprocesses(Crossonetal.,2019)throughrepetition(e.g.,Raymeretal.,2008).

Inthisstudy,use-dependentneuroplasticity(Crosson etal.,2019)mayhaveresultedfromthehighdosage/number ofhoursofenrichedcommunicativeinteractions(Hengst etal.,2019)over2yearsofBRACparticipation.Thesecommunicativeopportunitiesallowedparticipantstorepeatedly engageinfunctionalexchanges(e.g.,orderinglunch),socialization(e.g.,morningcoffeetime),andgroupinteractions acrossawiderangeoftopicsandpartners.Withinthese interactions,whereconveyanceofmeaningwasprimary, participantscouldhaveimprovedinspokenwordretrieval andotherlanguagefunctions(aswasobservedwith increasedWAB-Randnamingscores),whichmayhavecontributedtotheirincreasedefficiencyandabilitytoproduce meaningfulwordsandutterancesinspokendiscourse.It mayhavetaken2yearsforspokenoutputtoimprove, becausecommunicationatBRACishighlysupportedand multimodality,althoughmoreresearchisneededtoaddress suchquestions.

DemographicandAphasia-Related PredictorsofBRACParticipationOutcomes

Finally,correlationswereperformedbetweenchange scoresandparticipants’ age,yearsofeducation,daysof attendance,socioeconomicstatus,timepostonset,initial aphasiaseverity(WAB-RAQ),orqualityoflife(ALA) scores(seeTable4).Thepreliminaryfindingssuggestthat noneoftheparticipantvariableswererelatedtodegreeof improvement.Similarly,vanderGaagetal.(2005)did notfinddemographicoraphasiaseverity–relatedmeasures tobemodifyingfactorsofoutcomes.

Themostsurprisingresultfromthisinquirywasthat daysofattendancewerenotsignificantlycorrelatedto improvementinanyvariable.Afterevaluatingthedataand reflectingonparticipationpatterns,tworelatedreasonsare positedforthislackofrelationship.First,involvementat BRACresultedinincreasedparticipationwithinthe

greatercommunity,whichisaprimarygoalofBRACand theLPAA.Thisincreaseinparticipationmayhavecontributedtoflattenedordecreasedattendance.Thus,attendance didnotcorrespondinglyincreasewithtestscoresandselfreportedmeasures.Second,thepotentialbenefitsofthe interactions,relationships,andsupportfromBRACattendancearepotentiallymoreimportanttooutcomesthan numberofdaysinattendance(i.e.,qualityvs.quantity).

IndirectSupportofImprovement

Aspreviouslymentioned,theresultsofthisstudy cannotbeinterpretedascausalgiventhatthisstudy,like theotheraphasiacenterstudies(Armouretal.,2019; Hoenetal.,1997;McCalletal.,2014;vanderGaag etal.,2005),didnotincludeacontrolgrouportask. However,someaspectsofthestudyprovideadditional andindirectsupportoftheobservedimprovement.

First,theBRACmembersinthisstudydidnot receiveadditionalspeech-languageservicesduringtheir timeinthestudy,removingthatasapotentialconfound. ThisdiffersfromHoenetal.(1997)andArmouretal. (2019),whereparticipantswerereportedtohavereceived additionalservices.McCalletal.(2014)didnotstate whetherparticipantsengagedinadditionalservices.Furthermore,25/27oftheparticipantsinthisstudywere >6monthspoststroke,therebyreducingtheinfluenceof spontaneousrecovery.

Second,thequalityoflifeincreasesobservedonthe ALA(Kaganetal.,2011)areconsistentnotonlywiththe aphasiacenterliterature(Armouretal.,2019;Hoenetal., 1997;McCalletal.,2014;vanderGaagetal.,2005)but alsowiththefindingsfromcontrolledstudiesthathave evaluatedtheeffectsofconversationgroups(e.g.,Elman &Bernstein-Ellis,1999a,1999b).Additionally,thereports ofimprovedfunctionalcommunicationareconsistentwith previousaphasiacenterfindings(McCalletal.,2014;vander Gaagetal.,2005).

Third,inadditiontostatisticalimprovement,the meandifferencescoresfortestanddiscoursemeasures exceededpublishedbenchmarks.TheWAB-R(Kertesz, 2006)andCETI(Lomasetal.,1989)changesat1and 2yearssurpassedbenchmarksforbothmeasures(Gilmore etal.,2019).Increasesinthepercentageofmeaningful wordsindiscourse(%CIU)surpassedpublishedminimal detectablechangescores (Leaman&Edmonds,2021). Theimprovementofmeaningfulutterances(%REL) nearlymetthepublishedminimaldetectablechange threshold,whichissuggestiveofchange,giventhe greaterdegreeofaphasiaseverityoftheparticipantsin thisstudyascomparedtothereferencegroup(Leaman &Edmonds,2021).

Afollow-upsecondaryanalysisofcliniciandocumentsprovidesadditionalindirectsupportofimprovement.

Edmonds&Morgan:Two-YearEvaluationofCommunityAphasiaCenter 11

Table4. Correlationfindingsevaluatingpotentialrelationshipsbetweendifferencescoresandvariousdemographicandaphasia-relatedvariables. Variable

Note. WAB-RAQ=WesternAphasiaBattery –RevisedAphasiaQuotient;ACOM=AphasiaCommunicationOutcome Measure;ALA=AssessmentforLivingwithAphasia;CETI=CommunicativeEffectivenessIndex;OANB=20objectsand20actionsfromAnObj ectandActionNamingBattery;%CIU=percentageofcorrectinformationun its. p <.01. 12 AmericanJournalofSpeech-LanguagePathology • 1–17 Downloaded from: https://pubs.asha.org 134.6.212.101 on 10/19/2022, Terms of Use: https://pubs.asha.org/pubs/rights_and_permiss ions

Year1correlations

(1)1-yearWAB-RAQdifference1.000.367.36

(2)1-yearACOMdifference

(3)1-yearALAdifference

(4)1-yearCETIdifference

(5)1-yearOANBdifference

(6)Yearspostonset

(9)InitialWAB-RAQ

Year2correlations (6)Yearspostonset

(7)Age

(8)Yearsofeducation

(9)InitialWAB-RAQ

(10)InitialALA

(11)Dailypayrate

(12)Daysofattendance

(13)2-year%CIUdifference

AspartofBRAC’sstandardprotocol,cliniciansrecorded observationsorreportsofmilestones(e.g.,resumingtravel), increasedparticipation(returntochurch),and/orincreased competencies(nowabletoorderfoodwithicons)forall BRACmembers.Thefirstauthor(whodoesnotworkat BRACorwiththemembers)reviewedtheclinicians’ notes andfoundreferencetoincreasedparticipationformore thanhalfofthemembersacrossthefollowingdomains:(a) travel(e.g.,abletotravelalonesincestartingatBRAC), (b)re-obtainingdriver’slicenses(e.g.,agrassrootsdriver’s licensegroupwasstartedinresponsetomemberrequests), (c)advocacy(forselfandaphasia;e.g.,workingwithStarbuckstodevelopanaphasia-friendlymenu),(d)leadership (e.g.,memberspitchedandstartedtheirowngroups),(e) increasedcommunicationandsocialization(e.g.,engagementincommunityactivities),and(f)increasedextracurricularactivities(e.g.,adaptivesports,familyevents,going outtoeat).Whilethisevaluationofparticipation,milestones,andcompetencieswasinformal,thegeneralcategoriesofincreasedparticipationareconsistentwithother studiesthatconductedinterviewswithpeoplewhohadparticipatedincommunity-basedaphasiagroups(Lanyon etal.,2018)andanaphasiacenter(vanderGaagetal., 2005)andaresuggestiveofmeaningfulchangesinlifeparticipationandfunctionalcommunication.

ClinicalConsiderations

Ofteninclinicalresearch,weaimtoidentifycritical componentsofatreatmentoranapproach,whichisalso importantinLPAA-relatedservices(Elman,2016).What makesaphasiacenterssouniqueandimportantandhardto distillistheintegrityofthewholeofwhattheyofferto PWAandothersaffectedbyaphasia.Inotherwords,an aphasiacenterismorethanitssumofcomponentparts orhowthosepartsrelatetoindividualoutcomes.Anaphasiacenterisproject-basedgroups(Behnetal.,2019);conversationgroups(Simmons-Mackieetal.,2007);developmentoffriendships(Brownetal.,2013);andbeingwithand supportingotherPWA,tellingstories,bigandsmall,about one’slife,includingillness/strokenarratives(Armstrong& Ulatowska,2007;Strong&Shadden,2020).Itisaboutconversationpartnertraining(Kagan,1998)andsupported communication.Itisthecasualandorganicconversations andconfidencesthatoccurinthehallway,duringcoffee time,andduringoutings.Itisaboutthepeople,therelationships,andeachindividualbeinganintegralpartofthe largerwhole.Itisthetimeandspaceandplacetobecome empoweredandtoempowerandtoreimagineidentitywith respecttolivingsuccessfullywithaphasia(Brownetal., 2012;Hoenetal.,1997;Strong&Shadden,2020).Andall ofthisis,admittedly,difficulttodescribe,measure,or deconstruct,becauseitismultidimensionalandlayeredand notlinearbynatureand,consistentwiththeA-FROM

model,requiresmultidirectionalthinkingandquestions (Kaganetal.,2008).

Theimprovementsinthisstudyoccurredwithout traditionalorindividualized therapy;however,itisimportanttonotethatmemberswereexposedtoandshowndifferentwaystocommunicate(e.g.,gestures,writing,drawing),whichtheycouldtrywithinavarietyofgroupsettingswithdifferentpeople.Astheseskillsdeveloped, memberscouldpotentiallyusethemoutsidethecenter, thusgeneralizingtheirfunctionalcommunicationabilities (Elman&Bernstein-Ellis,1999a).AnothercriticalcomponenttocommunicationandinterpersonalrelationshipsoutsidethecenterisfamilyeducationandSCAtraining (Kagan,1998),asanaphasiacenterisuniquelypoisedfor gaininginsightonfamilyneedsanddynamicsovertimeand providingindividualizedsupportandresources.

Themoreobjectivemeasuresinthestudy,the WAB-Randconfrontationnaming,maynotdirectlysuggestimprovementtofunctionalcommunication.However, improvedscoresonthesetests,inadditiontoanincreased abilitytoproducemeaningfulwordsandutterancesin structureddiscourse,suggestanincreasedabilityoflexical retrieval.Thesefindings,combinedwiththeresultsfrom thefunctionalcommunicationandqualityoflifemeasures,aswellasthesecondaryanalysisfindingsof increasedparticipation,supportthepotentialofsynergistic,integratedchangesinoverallcommunicationand engagementinlife.

Manyoftheparticipantsinthisstudypresentedwith moderate-to-severeandsevereaphasia,includingglobal aphasia.TheircontinuedparticipationatBRACfor1–2yearsaswellastheimprovementtheyexhibitedsignal thataphasiacenterscansupportcommunication,inclusion, andsocialinteractioninpeoplewithmoresevereaphasia, whichispromisinggiventheneedtoreduceisolationand promoteparticipationandsocializationforthosewithmore pronouncedaphasia(Lanyonetal.,2018).

Limitations

Animportantlimitationofthisstudyisthepotentialforsamplingbias,whichcouldaffectthegeneralizabilityoffindings.Thisisbecauseparticipationinthe studywasvoluntary,datawereonlyanalyzedfromparticipantswhoremainedinBRACforatleast1year,and someparticipantswerelosttofollow-up.Aprimaryconsiderationiswhethertherewassomethingspecificabout the27participantswhocontinuedatBRACforatleast 1year.Forexample,theymayhavehadbetterhealth, enjoyedgroupactivitiesmorethanothers,ornoticed greaterpersonalbenefitsthanmemberswhodecidedto leavethecenter.

Toevaluatethis,the20BRACmemberswhoconsentedtoparticipateinthestudy,butwhowerenotincluded, Edmonds&Morgan:Two-YearEvaluationofCommunityAphasiaCenter 13

servedasacomparisongroup.Fourteenofthesemembers notonlyattendedBRACforatleast1yearbutalsoengaged inindividualspeech-languagetherapy,whichdisqualified themfromthestudy.TheremainingsixmembersleftBRAC beforeayearduetomedicalortransportationissuesand moving.Asmallergroupof16BRACmemberschosenot toparticipateinthestudy,citingmedicalissuesastheprimaryreason.Onlyfourofthesemembersattendedfor 1year.Oftheremaining12,eightleftformedicalreasons.

Thus,almost3timesasmanyBRACmembers chosetoparticipateinthestudy(47)ascomparedwith thosewhodidnot(16).Ofthosewhoconsentedtothe study,41/47participatedforatleast1year.Thesmaller groupof16citedmedicalissuesastheprimaryreasonfor notenrolling.Thesedatasuggestthatthecurrentfindings arereasonablygeneralizabletoPWAwhohavesufficient healthtoattendanaphasiacenterfor1yearandwhovoluntarilychoosetodoso.

FutureDirections

Futurestudieswouldbestrengthenedwithresearch designsthatincludeacontrolgroup,adelayedgroup, and/oracontroltask.Additionally,whilethequalitativeinformationinthisstudyaddedimportantandcomplementary informationtothequalitativefindings,futurestudies shouldaprioriconsidermixedmethodstobetterunderstandnotonlyquantitativeoutcomesbutalsotheperspectivesofPWAandtheirfamilies.

Futurestudiesshouldalsoevaluatediscoursemore representativeofthecommunicationatBRACandwithin dailycommunicativeenvironments.Suchdiscourseshould involvemultiplespeakersandmultimodalitycommunicationwithinfunctionalactivitiesacrossmultiplediscourse genres.

Finally,studyparticipantsshouldbemorerepresentativeacrossmultiplespectra,includinglinguistically diversepopulations,membersoftheLGBTQIA+community,immigrantgroups,andmore.Toaccomplishthis, moreoutreachintothesecommunitiesisneeded.

Conclusions

Aphasiacentersprovideacriticalcomponenttothe continuumofcareforPWA(Elman,2016).Thecurrent findingsreplicateandextendpreviousresearchtoshow thatPWAwithdiversepresentationsofaphasiacan improveonlanguage,functionalcommunication,and qualityoflifemeasuresinconcertwithreportedand observedincreasesinlifeparticipation,socialization,and independence.Theauthorshopethatthecurrentfindings helptofilltheneedforevidencetosupportthird-party paymentforaphasiacenters,inspiremoreaphasiacenter

14 AmericanJournalofSpeech-LanguagePathology • 1–17

research,andmotivatemorefundingandopeningof aphasiacenterstohelpaddressinsufficientavailabilityof communicationintervention/servicesforPWA.

DataAvailabilityStatement

Thedatasetsgeneratedduringthisstudyarenot publiclyavailableduetoalackofinstitutionalreview boardapproval.However,theymaybeavailablefromthe correspondingauthoruponreasonablerequest.

Acknowledgments

TheauthorswouldliketoacknowledgealltheBrooks RehabilitationAphasiaCenter(BRAC)membersandtheir familieswhoparticipatedinthisstudyaswellasthefollowingpeopleatBRAC:LaurenBush,KaylaCollard,JoEllen Gilbert,ErinNikitas,andFloSingletary.Theywouldalso liketoacknowledgethefollowingresearchassistantsinthe AphasiaRehabilitation&BilingualismResearchLabat TeachersCollege,ColumbiaUniversity,fortheirhelpwith datamanagementandanalysis:CelesteDiLauro,Veronica Fletcher,BethAnnIngrassia,MarionLeaman,Chelsea Rabinowitz,DaniellaSassieni,KatyaVillarreal-Cavazos, andMercedesZettlemoyer.

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vanderGaag,A.,Smith,L.,Davis,S.,Moss,B.,Cornelius,V., Laing,S.,&Mowles,C. (2005).Therapyandsupportservices forpeoplewithlong-termstrokeandaphasiaandtheirrelatives:Asix-monthfollow-upstudy. ClinicalRehabilitation, 19(4),372–380.https://doi.org/10.1191/0269215505cr785oa Vickers,C.P. (2010).Socialnetworksaftertheonsetofaphasia: Theimpactofaphasiagroupattendance. Aphasiology, 24(6–8),902–913.https://doi.org/10.1080/02687030903438532 Webster,J.,&Morris,J. (2019).Communicativeinformativeness inaphasia:Investigatingtherelationshipbetweenlinguisticand perceptualmeasures. AmericanJournalofSpeech-Language Pathology,28(3),1115–1126.https://doi.org/10.1044/2019_ AJSLP-18-0256

West,B.T. (2009).Analyzinglongitudinaldatawiththelinearmixed modelsprocedureinSPSS. Evaluation&theHealthProfessions, 32(3),207–228.https://doi.org/10.1177/0163278709338554

White,J.H.,Attia,J.,Sturm,J.,Carter,G.,&Magin,P. (2014). Predictorsofdepressionandanxietyincommunitydwelling strokesurvivors:Acohortstudy. DisabilityandRehabilitation, 36(23),1975–1982.https://doi.org/10.3109/09638288.2014.884172 WorldHealthOrganization. (2001). InternationalClassificationof Functioning,DisabilityandHealth Worrall,L.,Sherratt,S.,Rogers,P.,Howe,T.,Hersh,D., Ferguson,A.,&Davidson,B. (2011).Whatpeoplewith aphasiawant:TheirgoalsaccordingtotheICF. Aphasiology, 25(3),309–322.https://doi.org/10.1080/02687038.2010.508530

Edmonds&Morgan:Two-YearEvaluationofCommunityAphasiaCenter 17 Downloaded from: https://pubs.asha.org 134.6.212.101 on 10/19/2022, Terms of Use: https://pubs.asha.org/pubs/rights_and_permissions

Brooks Clubhouse

Clubhouse members can also enjoy other non-vocational activities each day, structured to foster engagement, creativity and communication. Activities can include arts and crafts, performing arts, exercise and gardening.

Clubhouse

The Clubhouse is a community health program that provides for the long-term recovery needs of individuals who have su ered an acquired brain injury. The day-program bridges the gap between medical rehabilitation, vocational training and community reintegration.

It is currently the only Brain Injury Clubhouse in Florida and one of only 17 in the world.

There are three main work units at the Clubhouse that are designed to provide hands-on training and practice in preparation for job placement or volunteer work. They include:

Business Unit

Food and Kitchen Unit

Facility and Grounds Maintenance

Criteria for Membership

• Age 16 or older

• Acquired neurological injury (brain injury)

• Independent daily self-care activities or accompaniment by a companion

• Behavior does not pose a risk of injury to self or others

• Membership is voluntary and does not require a physician referral

Clubhouse

Mission

The Brooks Clubhouse exists to advance the continuum of care for adults living with a brain injury. The mission of the Clubhouse is to enhance cognitive, physical and emotional recovery and to improve quality of life and vocational outcome for individuals with a brain injury.

The Brooks Clubhouse is a community-based day program operated by professional staff in conjunction with program members and volunteers. The program follows a work-ordered day which parallels typical working days and hours, Monday to Friday, 9 a.m. – 3 p.m. The Clubhouse engages members and staff, working side by side, in the daily operations of the Clubhouse. It focuses on improving functional abilities, developing work skills, enhancing strengths and talents, and achievement of individual goals. Brooks Clubhouse follows the guidelines established by the International Brain Injury Clubhouse Alliance (IBICA).

There are two available tracks of participation - a Community Inclusion Track and a Vocational Track. If the goal of participation is to enhance rehabilitation outcome, life skill abilities and general quality of life, the Clubhouse will provide opportunities for socialization, life skill training, and meaningful, productive involvement with activities in a safe and caring environment. However, if the goal is employment, the Clubhouse will provide all of the above, as well as facilitate employment opportunities through pre-vocational training, volunteer work and supported employment.

Who is Eligible: Membership is available to any adult, age 16 or older, who would benefit from activities to enhance social, physical, cognitive and vocational outcome following an acquired brain injury. This includes individuals with a diagnosis of traumatic brain injury, stroke, anoxia or other acquired central nervous system dysfunction.

Daily Structure: The Clubhouse is organized into work units, which have hired staff and members working together to provide a full and productive work day. The work is designed to help facilitate increased work skills, confidence, self-worth and purpose. Sample work groups may include, but are not limited to the following

4Business Unit: Responsible for management of all clerical and business functions including reception, telephone, file maintenance, intake operations, record keeping, generation of the newsletter and other general office duties as needed. Also responsible for usage and upkeep of Clubhouse business work unit computers and oversight of computer skills enhancement training classes.

4Food and Kitchen Unit: Responsible for meeting the daily nutritional needs of the Clubhouse staff and members. This work group plans, shops, prepares and serves the daily lunch for the Clubhouse.

4Facility and Grounds Maintenance: Responsible for overall cleaning, maintenance and repair of indoor facility and outdoor groundsat the Clubhouse. Also, responsible for production of selected products that are made at the Clubhouse, e.g., hand-constructed projects and crafts such as bird feeders, tile mosaic tables, plant gardens, pottery, etc.

In addition to the above listed work units, individuals have the opportunity to gain skills in computer usage in the computer lab and opportunities for academic skill remediation and GED preparation. Health and wellness activities include yoga, attending the YMCA fitness program, aquatics, music therapy, creative dance, meditation/mindfulness and Zumba. There are also many opportunities for a variety of other social and recreational activities.

For additional information, to make a referral or inquire about eligibility, contact:

Kathy Martin, M.Ed. | Manager of Brooks Clubhouse 2700 University Blvd. West | (904) 674-6400 katherine.martin@brooksrehab.org

Brooks Foundation

WHEEL CLUB

JOIN TODAY

Help our patients on their journey of recovery and independence. Your support can make all the difference. Join today and be a part of their success!

$2,000,006 RAISED IN 2023

$2,772,506 IN CHARITY CARE

1,263 HOSPITAL DAYS

10,514 INSTRUCTIONAL HOURS

$10,796,632 TOTAL GIVEN BACK TO THE COMMUNITY

2,297 COMMUNITY PROGRAM PARTICIPANTS SERVED

31 ACTIVE RESEARCH STUDIES

5,906 OUTPATIENT VISITS

232 ACTIVE PARTICIPANTS IN RESEARCH STUDIES

Cancer Rehabilitation

Breast Cancer Prehab Program

If you are diagnosed with breast cancer and have not started cancer treatments yet, physical and occupational therapy can still play an important role early in your journey. Prehabilitation can have positive effects on physical and psychological outcomes as well as increase potential treatment options. Our prehab program is usually one to two sessions unless deficits are found, at which time further treatment will be recommended.

Evaluation Services

• Assessment of baseline functional measures as well as baseline shoulder range of motion and strength

• Identify impairments that may affect your recovery and devise a plan of care to address those impairments prior to treatment

• Create an individualized exercise program to address overall cardiovascular strength and endurance

• Education on early signs of lymphedema, risk factors and prevention

• Education for dealing with cancer and related fatigue

Educational Services

• Cancer related fatigue

• Lymphedema early signs and prevention

Breast Cancer Post-op Program

If you are diagnosed with breast cancer and are currently undergoing or have completed cancer treatment, physical and occupational rehabilitation can relieve pain, restore function and improve quality of life.

Evaluation Services

• Pain in the neck, shoulder, upper back, shoulder blades, arm and trunk

• Range of motion restrictions, muscular weakness and decreased core strength

• Soft tissue and scar restrictions caused by surgery, radiation or postural difficulty

• Cording or Axillary Web syndrome

• Lymphedema - will be referred for lymphedema treatment if patient is experiencing abnormal post-op edema/lymphedema

• Sensory deficits in the affected extremity

• Difficulties with daily living activities and/or recreational activities performed prior to surgery

• An individualized exercise program to address deficits

Educational Services

• Prehab program information if patient has not previously attended the program

Our prehab and post-op programs, as well as other treatments, are available at Brooks locations in Jacksonville, Orange Park, Amelia and St. Augustine. Your physician can send your order to our Central Intake Unit to ensure you are sent to the most convenient location.

Phone: (904) 345-7277

Fax: (904) 345-7280

Treatment is covered by insurance and Medicare.

BrooksRehab.org

#WeAreBrooks

Reference: Silver, Julie K., and Jennifer Baima. “Cancer Prehabilitation.” American Journal of Physical Medicine & Rehabilitation, vol. 92, no. 8, 8 Aug. 2013, pp. 715–727., doi:10.1097/phm.0b013e31829b4afe.

Breast Cancer Prehab Program

If you are diagnosed with breast cancer and have not started cancer treatments yet, physical and occupational therapy can still play an important role early in your journey. Prehabilitation can have positive effects on physical and psychological outcomes as well as increase potential treatment options. Our prehab program is usually one to two sessions unless deficits are found, at which time further treatment will be recommended.

EVALUATION SERVICES

• Assessment of baseline functional measures as well as baseline shoulder range of motion and strength

• Identify impairments that may affect your recovery and devise a plan of care to address those impairments prior to treatment

• Create an individualized exercise program to address overall cardiovascular strength and endurance

• Education on early signs of lymphedema, risk factors and prevention

• Education for dealing with cancer and related fatigue

EDUCATIONAL SERVICES

• Cancer related fatigue

• Lymphedema early signs and prevention

Breast Cancer Post-op Program

If you are diagnosed with breast cancer and are currently undergoing or have completed cancer treatment, physical and occupational rehabilitation can relieve pain, restore function and improve quality of life.

EVALUATION SERVICES

• Pain in the neck, shoulder, upper back, shoulder blades, arm and trunk

• Range of motion restrictions, muscular weakness and decreased core strength

• Soft tissue and scar restrictions caused by surgery, radiation or postural difficulty

• Cording or Axillary Web syndrome

• Lymphedema – will be referred for lymphedema treatment if patient is experiencing abnormal post-op edema/lymphedema

• Sensory deficits in the affected extremity

• Difficulties with daily living activities and/or recreational activities performed prior to surgery

• An individualized exercise program to address deficits

EDUCATIONAL SERVICES

• Prehab program information if patient has not previously attended the program

Our prehab and post-op programs, as well as other treatments, are available at Brooks locations in Jacksonville, Orange Park, Amelia Island and St. Augustine. Your physician can send your order to our Central Intake Unit to ensure you are sent to the most convenient location.

Reference: Silver, Julie K., and Jennifer Baima. “Cancer Prehabilitation.”

CANCER PROGRAM

Inpatient Rehabilitation Hospital

Home Health

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Outpatient

The

Pre-habilitation Program

(services

Assessment

Lymphedema

Development

An

Education

During and After Cancer

Oncology Program

The Brooks Rehabilitation Oncology Program takes a multidisciplinary approach to address specific needs and interests of cancer patients and survivors. Brooks clinicians are trained to meet the unique needs of cancer patients in various stages of treatment. Our goal is to help patients return to their highest level of recovery and to mitigate the effects of cancer treatments before they become debilitating.

If you are experiencing any of the following, talk to your physician today about a referral for rehabilitation services:

• Fatigue

• Decreased range of motion

• Pain

• Peripheral neuropathy

• Decreased balance/falls

• Decreased bone density

• Swallowing difficulties related to cancer treatments

• Pelvic floor dysfunctions such as urinary incontinence, painful sex and erectile dysfunction

We also offer a prehabilitation program. These services are initiated before oncology interventions and typically consist of 1-2 sessions which include:

• Assessment of baseline functional measures, range of motion and strength

• Development of an individual plan to address any impairments that may affect your recovery while receiving cancer treatments

• An individualized exercise program to address overall cardiovascular strength and endurance

• Education on early signs of lymphedema, risk factors and prevention

• Education for identifying and addressing cancer and related fatigue

Let our experienced clinicians develop an individualized treatment plan to take your fight to the next level.

For further information please email Brooks.Oncology@brooksrehab.org or contact our Central Intake Unit at (888) 323-8005 or (904) 345-7277.

Oncology Program

Brooks Rehabilitation outpatient team of physical, occupational and speech therapists will complete a thorough evaluation and work with you to design an individualized treatment plan to address your functional limitations. There is strong evidence that a conservative, multidisciplinary approach is beneficial for managing the effects of chemo and radiation. This supports preservation and restoration of function.

Physical Therapy addresses challenges relating to pain, nerve damage, deconditioning, cancer related fatigue, range of motion limitations, soft tissue restrictions, posture, decreased muscle endurance, bowel or bladder incontinence, pelvic floor weakness or pain.

Occupational Therapy addresses your ability to resume meaningful self care, home work and leisure activities. This may include splints, orthotics, pressure garments and intervention.

Speech Therapy addresses your concerns related to swallowing, speech and voice. This may include clinical swallow evaluation, education for the management of acute and chronic side effects of chemo-radiation, providing training for compensatory and rehabilitative dysphagia treatment and education for results of swallowing assessment (FEES/MBSS).

For more information please call our central intake unit at (904) 345-7277 or send a fax to (904) 345-7280

Clinical Integration and Research

Clinical Integration and Research

Creating a community of researchers, clinical professionals and patients transforming rehabilitation through innovations in science, technology and care.

Brooks Clinical Integration and Research is committed to advancing rehabilitation science, technology and care through research and developing the most effective therapies for our patients. Our clinical research programs are focused on patient populations who have experienced neurological injuries such as stroke, brain injury, or spinal cord injury and individuals who are battling musculoskeletal pain and other disabling conditions.

We partner with leading experts in academia, clinical care and the industry to offer individuals the opportunity to participate in innovative research studies that focus on solving real-world problems that patients and healthcare professionals experience in rehabilitation. Our skilled team is driven by a mission to generate new evidence and integrate the latest research discoveries into clinical practice.

OUR AREAS OF FOCUS

health, mobility, walking recovery, speech, breathing and swallowing function following neurologic injury

cutting-edge technologies and interventions to improve quality of care

delivery of care for musculoskeletal pain and disabling conditions

Brooks Rehabilitation is committed to advancing science, technology and care through

and d developing the most effective therapies for our p patients

Brooks

CENTER FOR INNOVATION

About Brooks Rehabilitation

For over five decades, Brooks Rehabilitation has been at the forefront of physical rehabilitation care. The nonprofit, based in Florida, is recognized as a premier rehabilitation system and ranks among the top 20 nationally according to U.S. News & World Report. Brooks currently operates three inpatient hospitals in Florida and is set to expand its reach through a collaboration with Mayo Clinic by opening a new facility on Mayo’s Arizona campus in 2026. The organization’s commitment to advancing rehabilitation science is evident in its focus on innovative research, education and cutting-edge technology. Offering a comprehensive system of care, Brooks provides inpatient and outpatient services, skilled nursing, assisted living, and memory care and impacts lives beyond the clinical setting through community programs designed to enhance the quality of life for individuals with physical disabilities.

The Brooks Center for Innovation: Expertise through Experience, Research and Collaboration

Effective and efficient use of rehabilitation and assistive technologies is an integral part of providing exceptional care at Brooks Rehabilitation. The Center for Innovation was created to help identify the most efficient and effective ways to deliver rehabilitation to maximize a patient’s functional potential. We gain expertise through experience of providing patient care, clinical research, collaboration with rehabilitation partners and industry.

One of the goals is to help integrate rehabilitative and assistive technologies into clinical practice by determining clinical efficacy, cost efficiency and overall ease of integrating the technology. The Center’s activities help our Brooks system of care, as well as providing consultation to help other rehabilitation centers in the country to deliver the best care.

Brooks Rehabilitation Center for Innovation Partnership Services

The Brooks Innovation Center prides itself in its ability to leverage expert clinicians in rehabilitation. At right is a fee schedule for services available for the Brooks Rehabilitation Center for Innovation.

Consultation with Center Director

More than 60,000 patients receive care through Brooks Rehabilitation annually.

• As part of the Brooks Rehabilitation Innovation Center, we partner with rehabilitation technology companies to provide clinical consultation and expertise for product development, product placement and to help determine cost utilization.

• These activities may include consultation with expert clinicians to clinical research trials for feasibility studies, FDA approval and clinical efficacy.

• We have the advantage of being able to conduct most trials in a very efficient manner due to our large patient volumes mentioned above.

We look forward to collaborating with you.

Below is pricing for partnership opportunities.

The Brooks Rehabilitation Innovation Center Team

Mark Bowden, PhD, PT – Vice President of Clinical Integration & Research

Kenneth Ngo, MD – Medical Director

Bob McIver, PT, DPT, NCS – Program Director

Gina Brunetti, PT, DPT, NCS – Research Scientist

Hannah Grimes – Clinical Research Coordinator

Heather Dangman – NeuroRecovery Center Coordinator

Consultation with Medical Director/Physiatrist

$250/hr

$350/hr

Consultation with Center Director and Medical Director $500/hr

Consultation with a Brooks Rehabilitation Expert Therapist $200/hr

Assistance with Food and Drug Administration (FDA) approval $10,000

Non-Endorsement Marketing assistance

Clinical Trials: • Feasibility Trials • Efficacy Trials

• Pragmatic/Comparative Efficacy Trial

$500/hr

$900/hr

Rates are negotiable, depending on needs.

CONTACT:

innovation@brooksrehab.org (904) 345-6812

Brooksrehab.org/innovation

Welcome to the Center for Outcomes, Analytics & Research

LETTER OF WELCOME FROM THE DIRECTOR

Central to our mission is the concept of a learning health system (LHS), which continuously collects, analyzes and applies knowledge from clinical practice to improve healthcare delivery and patient outcomes.

The Brooks Center for Outcomes, Analytics & Research (COAR) is dedicated to advancing evidence-based and data-driven methods to support improved rehabilitation care and outcomes. We do this by improving clinical effectiveness in rehabilitation research through fostering collaboration between clinical, research and data teams.

COAR is a branch of the Clinical Integration & Research (CI&R) division at Brooks Rehabilitation. CI&R’s main goal is to bring Brooks research, data and education centers together to ensure a learning hospital environment and culture.

I am excited to introduce our Center for Outcomes, Analytics and Research (COAR) and to share our commitment to improving patient care. Our mission is to advance evidence-based and data-driven methods to support improved rehabilitation care and outcomes. By studying rehabilitation outcomes, we aim to identify best practices, reduce care variability and provide the highest quality of care, as well as promote health equity through rehabilitation research.

Central to our mission is the concept of a learning health system (LHS), which continuously collects, analyzes and applies knowledge from clinical practice to improve healthcare delivery and patient outcomes.

Here’s how COAR contributes to this approach:

1. Data Analytics: We analyze large-scale health data and utilize advanced analytical tools to uncover insights that drive evidencebased practice.

2. Research: We conduct rigorous studies and develop innovative methods to address healthcare challenges and generate new clinical knowledge.

3. Quality Improvement: We collaborate with healthcare providers on projects that reduce care variability, enhance patient safety, and improve health outcomes.

4. Patient-Centered Care: We prioritize understanding patient needs to tailor care accordingly.

Thank you for your interest in COAR. We look forward to collaborating to improve rehabilitation care through continuous learning and innovation.

Sincerely,

Mindi R. Manes

Mindi R. Manes, PhD

MEET THE COAR TEAM

Mindi Manes, PhD Director, Center for Outcomes, Analytics & Research

Heather Kendall, MSN, RN, LSSBB, CPHQ Director of System Clinical Quality & Patient Safety

Chloe Bailey, MHA, BHA Research Coordinator

Parag Shah, MD, MBA, FACHE Medical Program Director

UNDERSTANDING LEARNING HEALTH SYSTEMS

A Learning Health System (LHS) is a dynamic system that continuously collects, analyzes and applies knowledge from clinical practice to improve healthcare delivery and patient outcomes.

According to the Agency for Healthcare Research and Quality (AHRQ), Learning Health Systems:

• Gather and analyze data from patient care experiences and internal metrics to improve overall care.

• Continually assess outcomes, while refining processes and training, to develop a cycle for learning and improvement.

• Provide care teams with actionable data and tools.

• Are important for health system transformation.

Source: Agency for Healthcare Research and Quality. (2019). About Learning Health Systems. Retrieved from: https://www.ahrq.gov/learning-health-systems/about.html

COLLABORATING WITH COAR

Mark Bowden, PT, PhD Vice President, Clinical Integration & Research

Jason Beneciuk, PT, DPT, PhD, MPH Clinical Research Scientist, Brooks – UF PHHP Research Collaboration

COAR is proud to work with both internal and external collaborators. We welcome project submissions from Brooks staff, researchers, clinicians, administrators and more.

If you are interested in collaborating with COAR, here are a few ways to decide if your project is the right fit.

• Is this a project that you want support in using data-driven methods to improve care and outcomes?

• Is this project “more than a report”?

• Will this project generate evidence that will inform our clinical/ operational practice?

If you answered yes to these questions, then your project may be right for COAR. If you are still unsure, check out project examples on the next page.

What Does Collaboration Look Like?

In order to ensure a successful partnership with COAR, here are the expectations for both parties to help you better understand the scope of work that will be provided.

Investigator Expectations of COAR

» Review and scope project requests and direct them to the appropriate team.

» Clearly communicate project priority, timelines and potential dependencies.

» Work closely with IT and data teams to meet data needs.

» Collaborate with COAR investigators and experts to ensure project quality and value.

» Provide guidance on survey development and statistical methods.

» Provide clean, valid data with detailed dictionary and sources.

» Provide useful and accurate data analyses.

» Provide support for dissemination, esp. related to statistical methods and results.

» Develop sustained partnerships with Brooks.

COAR Expectations of Investigator

» Partner with COAR to define project objectives, timelines and project scope.

» Provide relevant project documentation such as research protocol, grant application, IRB application, etc.

» Include COAR and System Quality team before initiation of QI projects, when possible.

» Review project outcomes with key shareholders and provide modification needs in a reasonable time period.

» Be an active participant in data validation and analyses, where necessary.

» Include COAR as investigator(s) on dissemination materials.

» Provide materials to COAR for review before presentation or publication of findings.

» If seeking grant funding, COAR should be part of the investigative team and included in the budget.

EXAMPLE COAR PROJECTS

• Data pull for a research study or grant proposal

• Survey design and development

• Statistical/predictive analytics focused on patient outcomes

• Identification of populations for targeted care/interventions

• Implementation, tracking and/or evaluation of a new or existing:

» Quality improvement process

» Program initiative

» Care models

» Clinical intervention

» Technology

COAR Project Designation Flow Chart

Internal Auditing

Eval optimal functioning or specific programs of org

Designed to bring immediate improvement to single setting

Interventions adjusted based on a quality goal

Compare program/process/system to an established set of standards Quality Assurance or Quality Improvement

KEY DEFINITIONS

Quality Improvement Projects

Answer a research question/test a hypothesis

Establish new clinical practice standard/intervention or contribute to generalizable knowledge

Fixed protocol and interventions that are not revised as data is collected

Involves key project roles of researchers with no ongoing commitment to improvement of the local care situation

Randomization or other systematic process to assign groups

Interacts/intervenes with living individuals and/or utilizes PHI data or bio-specimens beyond patient care info

Poses more than minimal/additional risk to patients beyond possible privacy/confidentiality concerns

Data for grant submission

If prospective study or randomization

The Center for Disease Control and Prevention defines quality improvement as “…a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, and outcomes... of quality in services or processes...”

Riley, W. J., Moran, J. W., Corso, L. C., Beitsch, L. M., Bialek, R., & Cofsky, A. (2010). Defining quality improvement in public health. Journal of Public Health Management and Practice, 16(1), 5-7.

Human Subjects Research

According to US Health and Human Services, human subjects research is “any research or clinical investigation that involves human subjects ... where the investigator obtains: (1) data through intervention or interaction with the individual; or (2) identifiable private information.”

US Department of Health and Human Services. (2017). Subpart A of 45 CFR Part 46: Basic HHS Policy for Protection of Human Subjects. Washington, DC. Retrieved from https:// research.virginia.edu/sites/vpr/files/202303/45CFR46.pdf

READY TO SUBMIT?

Please submit all projects to the “New Project Application” by clicking the button below or scanning the QR code.

SUBMIT A PROJECT

Submit Your Project

Your project request will be submitted to Clinical Integration & Research. The application below is the official communication of your intent to conduct a project with CI&R.

CI&R accepts all project requests to determine project efficacy and routes to the correct division.

PROJECT SUBMISSION PROCESS

STEP 1: Project submission form

STEP 2: Clinical Integration & Research Division Review

STEP 3: COAR or Brooks Clinical Research

Based on project needs, applications will be appropriately directed to the Brooks Rehabilitation Clinical Research Center (BRCRC) and/or the Center for Outcomes Analytics & Research (COAR) teams for further review.

A project application should be submitted at the earliest point possible once you determine an interest in conducting a project with CI&R/COAR.

Information Needed to Complete the Form

At a minimum, the following information is required:

1. A working title for the project.

2. The name and email address for the project contact person.

3. A brief description of the purpose and plan for the project.

Additional information requested based on the nature of the project application submission:

1. General information about funding source (if applicable).

2. Information about grant application deadlines and funding periods (if applicable).

3. Information about anticipated needs from Brooks Rehabilitation.

Please submit all projects to the “New Project Application” by CLICKING HERE or scan the QR code.

Contact COAR

If you have further questions about submitting a project, please reach out at (904) 345-7719 or COAR@BrooksRehab.org.

Speech Therapy Clinical Fellowship

Each year, our Speech Therapy Clinical Fellowship accepts master’s level graduates who are seeking mentorship through Brooks Rehabilitation to complete their mandatory postgraduate Clinical Fellowship Year (CFY) with criteria set by the American Speech and Language Hearing Association (ASHA).

The Speech Therapy Clinical Fellowship with Brooks Rehabilitation fosters completion of mentorship requirements of ASHA in addition to providing an elevated clinical fellowship experience. Our SLPs will not only be able to meet requirements for their governing body to receive final licensure, but will receive increased mentorship hours beyond what the minimal requirement is, didactic learning hours, professional engagement to present lectures and the opportunity to rotate or shadow clinical work in different clinical settings across the Brooks’ System of Care

Program Highlights:

One-on-one mentoring

Paid observation and shadow days throughout the Brooks System of Care

Full-time benefits with Brooks Rehabilitation

Funding of ASHA certification and membership upon completion of the fellowship year

2 0 2 4 C O N T I N U I N G E D U C A T I O N

C O U R S E C A T A L O G

2023/2024 Brooks IHL Residents and Fellows-In-Training Basic Management of Urinary

Integrating Trigger Point Dry Needling into the Management of Common Musculoskeletal Conditions - Part 1

Assessments and Interventions in the Neonatal Intensive Care Unit (NICU)

Therapeutic Exercise Dosing for Patients with Neuromusculoskeletal Impairments

Mary

Jessica Magee, PT, DPT, WCS

Sandra Brown, PhD, OTR/L, BCP, BCBA, CAS

Amy Jo Rohe, MSOT, OTR/L, CSRS Geoff Willard, PT, DPT, NCS, CSRS

Stephanie

Jamie Dyson, PT, DPT

Briana Elson, MS, OTR/L, BCPR, CBIS

Geoff Willard, PT, DPT, NCS,

Walter Weiss, PT, MPT, NCS, KEMG

Debra Gray, PT, DPT, DHS, MEd

R. Bertie Gatlin, PT, DScPT

Jason Beneciuk, PT, DPT, PhD, MPH Joel Bialosky, PT, PhD, OCS, FAAOMPT

Anita Davis, PT, DPT, DAAPM, ATRIC

Stephanie Bush, PT, DPT, WCS,

3599 University Blvd S Jacksonville, FL 32216

Rehabilitation Transition to Practice Nursing Program:

About Brooks Rehabilitation

For more than 50 years, Brooks Rehabilitation, headquartered in Jacksonville, Fla., has been a comprehensive source for physical rehabilitation services.

Our nurses COLLABORATE with physicians, therapists and clinicians and have an important voice in advocating for patients.

Nurses are CRITICAL TEAM MEMBERS with a high level of responsibility for the SAFETY and QUALITY of CARE for patients.

Nurses have access to CUTTING-EDGE TECHNOLOGY and EQUIPMENT to provide care and enhance skill training and competency including a state-of-the-art high-fidelity SIM LAB.

As the leader in rehabilitation, Brooks is NATIONALLY RECOGNIZED for QUALITY and SATISFACTION. Our innovative system of care provides world-class care and solutions

Program Highlights:

Dedicated time for experiential learning, high-fidelity simulation and interactive seminars

Structured, evidence-based clinical orientation in a specialty with experienced Registered Nurses Shared experience with all our Residency and Fellowship Programs

Opportunities to collaborate and build lifelong relationships with other professionals Shadow experiences with specialty experts throughout the Brooks Rehabilitation System

Admission Requirements:

Applicants to the Brooks Nurse Residency Program must: Graduate from an accredited nursing program. Current and unencumbered licensure in the state of Florida or Compact.

Meet all employment eligibility requirements within Brooks Rehabilitation.

Have less than 12 months of professional, clinical nursing experience.

Celebrating Success:

Upon completion of the program, residents and their families attend a celebratory reception that highlights their achievement as they continue to serve as professionals who contribute to patient and family-centered care in our communities and beyond.

Benefits:

New graduate nurses who participate in the residency program gain additional skills and confidence to ensure their success. Additionally, Brooks provides tuition reimbursement for those who wish to continue their careers, a clinical ladder to continue growth and development, preceptor courses to prepare nurses to orient new staff and mentorship opportunities. Brooks benefits are competitive with regional organizations and provide retirement 403(b) matching and profit sharing.

Questions?

R E S I D E N C Y F E L L O W S H I P &

Transform Your

The Brooks Institute of Higher Learning Residency & Fellowship programs for Physical and Occupational Therapists provide highly focused educational experiences for clinicians seeking professional growth and clinical specialization Through mentoring, classwork, psychomotor labs, and other unique learning experiences, our programs will advance your skills in the areas of Advanced Clinical Competence, Scholarship, Education, Professionalism and Patient Management.

Our Programs

We currently offer the following residency and fellowship programs:

Neurologic Occupational Therapy

Neurologic Physical Therapy

Jacksonville and Orlando

Orthopaedic Physical Therapy

Jacksonville and Orlando

Pediatric Physical Therapy

Sports Physical Therapy

Women's Health Physical Therapy

Orthopaedic Manual Physical Therapy

Accreditation

Our residencies and fellowships are accredited in accordance with:

93%

339

ABPTS Exam Pass Rate5 Year Average Program graduates

136

Graduates practicing in the Brooks system All programs begin in early July

The Brooks IHL offers a total of eight on-site Physical Therapy Residencies, an Occupational Therapy Fellowship and an Orthopaedic Manual Physical Therapy (OMPT) Fellowship. Through mentoring, classwork, psychomotor labs and other unique learning experiences, our programs will advance your skills in the areas of clinical competence, scholarship, education, professionalism and patient management. Our residents and fellows are offered full salary and benefits with Brooks Rehabilitation, which gives them an opportunity to work side by side with experts in all areas of rehabilitation medicine.

We currently offer the following programs:

Neurologic Physical Therapy Residency (Jacksonville and Daytona)

Orthopaedic Physical Therapy Residency (Jacksonville and Orlando*)

Pediatric Physical Therapy Residency

Sports Physical Therapy Residency

Women’s Health Physical Therapy Residency

Neurologic Occupational Therapy Fellowship

Orthpaedic Manual Physical Therapy Fellowship

Geriatric Physical Therapy Residency (on hold)

PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PROGRAM HIGHLIGHTS

150+ hours of 1:1 on-site clinical mentoring (350 hours for OT)

Full salary and benefits with Brooks Rehabilitation

Shared experience between our other 10 residency and fellowship programs

Enjoy opportunities to collaborate with 130+ graduates practicing in the Brooks System

Experiential learning opportunities in multiple settings throughout the Brooks Rehabilitation System of Care

Multi-person cohorts per program

Scholarly advisors include faculty from University of Florida, University of North Florida, University of St. Augustine and Jacksonville University

The majority of our mentors are program graduates, board certified and clinicians within the Brooks System

Motion Analysis Center

WALKING ASSESSMENT

PATIENT EDUCATION GUIDE

About the Brooks Motion Analysis Center (MAC)

The MAC uses state-of-the-art 3D motion capture technology to deliver customized recommendations to promote recovery for individuals with walking disorders. Our programs focus on individuals with neurologic and orthopedic impairments. Measurements can include: muscle activity (timing and coordination), joint motion (range of motion occurring during each phase of gait), and forces produced by each leg.

Our team consists of physical therapists, biomechanical engineers, and skilled support staff. However, it is important to remember that you are the most important member of the team. Please read the following information about your session and how the information will be used. You may ask questions at any time.

WHAT TO KNOW BEFORE YOUR VISIT

To ensure the setup process goes as smoothly as possible, it is important that all patients come dressed appropriately for their assessment, as described below.

• Short-length shorts, loose or thin enough to able to be rolled up to expose the upper thigh

• Tank top or short sleeve shirt, loose enough to be rolled up to expose upper shoulders

• Well-fitting sneakers that expose the ankle

• Hair-bands if needed

• No lotion/body oil 24hrs before your appointment

Have questions? Email: BrooksMAC@BrooksRehab.org | P: (904) 345-8967 | F: (904) 345-8978

Analysis Center: Walking Assessment Patient Education Guide

DURING YOUR ASSESSMENT

A typical visit lasts approximately 2 hours and is led by a trained physical therapist. It includes a clinical assessment (30–45 minutes), patient setup for motion capture (30–45 minutes), and the motion assessment (30 minutes).

During the clinical assessment, your therapist will measure joint mobility, strength, and muscle tone to better understand how you move and function. This also helps us interpret the rest of the data collected.

Patient setup involves attaching small reflective marker balls your skin with double sided tape to identify joints and specific landmarks on the body. The reflections are tracked by infrared cameras and help us learn how your joints move as you walk.

Surface electromyography (EMG) may also be used to detect your muscle activity during movement tasks. EMG signals are sensitive to your skin condition. The application process for EMGs requires removal of excessive leg hair and wiping the skin with an alcohol swab. The sensors are then wrapped with cohesive tape to ensure a high quality signal.

The motion assessment involves repeated walking trials of approximately 20ft in distance. Assistive devices such as walkers or canes can be used during the capture, and breaks will be allotted between bouts. The tasks you may be asked to perform include walking at various speeds, walking backward, standing from a sitting position, or stepping over an obstacle.

YOUR REPORT

Data collected during your motion capture, along with your clinical assessment and medical history, will be reviewed by our team to provide a comprehensive interpretation of your movements.

This report includes rehabilitation recommendations, and is shared with your referring healthcare provider to help determine appropriate treatment plans to improve functional movement and promote greater recovery.

Motion

Motion Analysis Center

SPORTS ASSESSMENT PATIENT EDUCATION GUIDE

About the Brooks Motion Analysis Center (MAC)

The MAC uses state-of-the-art 3D motion capture technology to deliver customized recommendations to promote recovery for individuals post ACL reconstruction. Our program focuses on athletes returning to sport to reduce the risk of re-injury. Our analysis emphasizes symmetry of both lower limbs using measurements including joint motion (range of motion occurring during each task performed) and forces produced by each leg.

Our team consists of physical therapists, biomechanical engineers, and skilled support staff. However, it is important to remember that you are the most important member of the team. Please read the following information about your session and how the information will be used. You may ask questions at any time.

WHAT TO KNOW BEFORE YOUR VISIT

To ensure the setup process goes as smoothly as possible, it is important that all patients come dressed appropriately for their assessment, as described below.

• Short-length shorts, loose or thin enough to able to be rolled up to expose the upper thigh

• Tank top or short sleeve shirt, loose enough to be rolled up to expose upper shoulders

• Well-fitting sneakers that expose the ankle

• Hair-bands if needed

• No lotion/body oil 24hrs before your appointment

Have questions? Email: BrooksMAC@BrooksRehab.org | P: (904) 345-8967 | F: (904) 345-8978

Motion Analysis Center: Sports Assessment Patient Education Guide

DURING YOUR ASSESSMENT

A typical visit lasts approximately 2 hours and is led by a trained physical therapist. It begins with setup for motion capture (15-30 minutes), the motion assessment (30 minutes), and a clinical assessment (45-60 minutes) to assess flexibility, strength, and balance through hop tests and other proven metrics to evaluate your recovery progress.

Patient setup involves attaching small reflective marker balls your skin with double sided tape to identify joints and specific landmarks on the body. The reflections are tracked by infrared cameras and help us learn how your joints move as you perform different tasks.

The motion assessment involves five repetitions of five functional tasks shown to correspond to your ability to perform in your sport. In-ground force plates measure the amount of force produced during jumping-landing tasks and squats to evaluate symmetry and detect impairments. Breaks will be allotted during tasks as needed.

• Overhead squat; to maximal depth with bar raised overhead

• Drop vertical jump; drop, jump, and land on both feet from a 12" box

• Single leg land; drop on to one foot and hold from a 8" box

• Lateral step down; perform an opposite leg heel touch from a 8" box

• Single leg drop vertical jump; drop on to one foot, jump, and land on the same foot from an 6" box

YOUR REPORT

Data collected during your motion capture, along with your clinical assessment and medical history, will be reviewed by our team to provide a comprehensive interpretation of your movements that is shared with your referring healthcare provider.

This report includes appropriate corrective exercises to improve functional movement while minimizing risk of injury and maximizing performance.

Motion Analysis Center (MAC) Neurological / Orthopedic Program

The MAC Assessment combines 3D motion capture technology and clinical expertise to assess movement and gait. We provide customized recommendations to help optimize treatment, outcomes and participation in daily activities.

Who Can Benefit?

•Individuals with walking impairments

•Able to walk at least 10 feet repeatedly

• Orthotics and assistive devices permitted

What Can This Program Provide?

• Movement analysis to quantify joint motion, muscle activation, and force production during walking

• Customized recommendations to guide:

-Physical Therapy care

-Orthotic management and efficacy

Motion Analysis Center (MAC) Pediatric Program

The MAC Assessment combines 3D motion capture technology and clinical expertise to assess movement and gait. We provide customized recommendations to help optimize treatment, outcomes and participation in daily activities and play!

Who Can Benefit? •

What Can This Program Provide?

Helen’s House

HELEN’S HOUSE

A Welcoming Home for Hope and Support

We are a nonprofit hospitality house offering affordable temporary lodging to Brooks patients and their caregivers.

Helen’s House is named in honor of Helen Brown, the wife of Brooks founder J. Brooks Brown, MD. Helen was a welcoming and gracious host who made everyone she met feel like they were part of the family.

GUEST REQUIREMENTS

• Helen’s House is intended for patients of Brooks and their caregivers.

• A guest can remain eligible to stay if their loved one remains admitted to a Brooks inpatient setting.

(Hospital, Skilled Nursing Facility or is taking part in the Neurorehabilitation Day Treatment, SCI Day Treatment, Pain Rehabilitation or the Intensive Aphasia Center Program.)

• All guests and caregivers must reside outside the following five counties: Duval, Nassau, St. Johns, Clay and Baker.

• A referral is required for patients (guests) from their Brooks Case Manager, Nurse Liaison or give us a call.

• The nightly room rate is $55 for the first night and $40 per night thereafter. There is also a $15/month cleaning supplies fee. Guests may pay by cash, check or credit card.

• Guests may stay at Helen’s House for a minimum of two nights.

• Check-in hours for all guests are between 3 p.m. and 8 p.m. daily.

• Patients who need assistance with daily activities must have a caregiver with them 24/7. Caregiver must be 18 years of age or older.

• All minors must be in the presence of, or accompanied by, a parent or legal guardian 24/7.

GUEST AMENITIES

• 38 guest rooms, handicappedaccessible, for up to three guests. Each room has a queen-sized bed, a pull-out sofa and a private bath

• A large community kitchen for meal preparation and a large dining room

• Free WiFi

• Cable televisions in four community rooms

• A laundry room on each floor

• Fitness room

• Business office with computers and printers for guest use

• Free shuttle to Brooks locations

HH-BM-9/2024

Home Health & Custom Care

Brooks Belle

An easy way to stay connected with us

Reduce Hospital Readmissions

• Emergency push-button on-the-go access to help 24/7

• 24/7 monitoring by a Medical Call Center

• Cellular communication that works across the United States

• No landline or cellphone needed

• Isolation Calls/Cognitive Support

• Unlimited emergent and non-emergent utilization

• Lightweight and water-resistant neck pendant or interchangeable neck lanyard and belt clip options

• Speaker and microphone built into button for easy hands-free communication

Provided to patients at risk of hospital readmission while on service with Brooks Rehabilitation Home Health

Patients have the option of continuing their service with Critical Signal Technologies independently after discharge. BrooksRehab.org/homehealth

Brooks Connect do?

Each patient in the Brooks Connect telemonitoring program is provided with a Samsung tablet loaded with easy-to-use software that allows healthcare providers to continuously monitor patient vitals and symptoms, reducing the chance of hospital readmissions and ER visits.

The software allows patients to:

• Monitor their sodium intake

• Measure weight, blood pressure, heart rate, SPO2 (oxygen levels) and track their readings

• Let clinicians know of symptoms through a daily survey

• Learn about their disease condition and how to manage it

• Track their medication adherence and progress

• Communicate with their clinician via text, phone or video chat

The software allows clinicians to:

• Monitor a patient’s vitals in real time

• Respond to high-risk readings to help reduce readmissions

• Communicate with patients via text, phone or video chat

• Track patient’s medication adherence

• Supplement education through videos and quizzes

Brooks is a part of the Brooks Rehabilitation continuum of care. We offer compassionate care for individuals needing in-home clinical and nonclinical services. Our team of highly specialized professionals will work with patients and the families to develop an individualized care plan to achieve the best recovery possible.

PROGRAMS:

• Cardiac Care

• Diabetes Management

• Fall Prevention-Home Safety

• Transitional Care

• IV Therapy

• Medication Management

• Memory Care

• Orthopedics

• Lymphedema

• Vestibular & Balance Training

• Wound Care

• Vital Stim • E-Stim

Friendly, Patient & Skilled Staff Include:

• Medical Social Workers

• Certified Nursing Assistants

• Physical Therapists

• Speech Therapists

• Occupational Therapists

• Nurses Certified in Wound Care

• Residency Trained Therapists

• Licensed Nurse Practitioners

• Respiratory Therapists

• Nutritionists

• Home Health Aids The Brooks Team’s Commitment to Care

• Commitment to patients and their medical, emotional, & social wellbeing as they transition home

• Access to resources across the entire Brooks system of care

• Highly trained, clinical experts readily available through consultation

• Specialized staff to meet the needs of specific conditions and diagnoses

• Ability to treat medically complex patients

Private Pay Programs

• Home Health Aid

• Activities of Daily Living/Bathing

• Homemaking

• Vacation Care

• Respite Care

• Sitter

• Companion

Brooks Rehabilitation Home Health

Bringing Medical and Caregiving Services into Homes

• Proudly serving MORE THAN 8,500 Florida patients annually in 23 COUNTIES

• The MOST QUALIFIED nursing and therapy staff

• CARE TRANSITION TEAM to smoothly transition patients throughout their rehabilitation needs

• Focused on QUALITY OUTCOMES and LOW HOSPITAL READMISSION Rates

• Brooks is UNIQUE with a System of Care and Community Programs UNMATCHED

• CUSTOM CARE (PRIVATE DUTY) Services

CUTTING-EDGE TECHNOLOGY

• BROOKS CONNECT – Home Telehealth Monitoring

SPECIFIC PROGRAMS

• COPD & CHF-Specific Management Programs & Tools

• Specialized Orthopedic Care, Post Surgical Rehab

• Individual Post-Event/Surgical Cardiac Care

• Fall Prevention Home Safety & Assessment

• IV/Ostomy/Port/Catheter/ Skilled Nursing

• Medication Management

• Memory Care/ Family and Caregiver Education

• Decreased/Low Vision Training

• Certified Lymphedema Therapy and Wound

• Speech/Communication/Cognition/Swallowing

(904) 722-1515 (904) 722-1517

BrooksRehab.org

CUSTOM CARE

Brooks Rehabilitation Custom Care provides a wide range of caregiving services wherever you call home. In addition to private residences, we also provide support services in hospitals, skilled nursing and assisted living facilities.

Whether you are recovering from surgery, seeking ongoing support for a loved one or just need a little extra help at home, we can develop a customized service plan just for you.

Services include:

• Assistance with bathing, dressing, grooming and personal care

• Self-medication assistance and reminders

• Mobility, transfer and positioning assistance

• Nutrition, meal preparation and feeding assistance

• Light housekeeping & laundry assistance

• Companionship

• Respite for family

• Post-hospitalization or post-surgical care

• Movement assistance and exercise

• Accompany to appointments

CUSTOMIZED CARE PLANS

Our highly trained caregiving staff will assist with a customized care plan that meets the needs of each individual and his or her family.

PROFESSIONAL CAREGIVERS

Our Caregivers are Brooks Rehabilitation employees-not contracted staff. All Caregivers are interviewed in person, complete a state and federal background check (includes fingerprinting), are drug tested and CPR certified. In addition, our caregivers receive specialized training, continuing education and supervision.

Independent Living Resource Center & Temporary Loan Closet

BROOKS TEMPORARY LOAN CLOSET AT CIL JACKSONVILLE

ABOUT

THE TEMPORARY LOAN CLOSET

T h e B r o o k s T e m p o r a r y L o a n C l o s e t ( T L C ) , p r o v i d e s

f r e e d u r a b l e m e d i c a l e q u i p m e n t t o r e s i d e n t s i n

B a k e r , C l a y , D u v a l , N a s s a u , a n d S t J o h n s C o u n t i e s

I n v e n t o r y i n c l u d e s w h e e l c h a i r s ( m a n u a l a n d p o w e r ) ,

r o l l a t o r s , b a t h i n g e q u i p m e n t , a n d o t h e r s p e c i a l t y

i t e m s L o a n s r a n g e f r o m 3 0 - 9 0 d a y s b u t c a n b e

e x t e n d e d u p o n r e q u e s t

REQUESTING EQUIPMENT

R e q u e s t e q u i p m e n t o n l i n e a t C I L J a c k s o n v i l l e o r g / T L C

Y o u w i l l b e c o n t a c t e d w i t h i n t w o b u s i n e s s d a y s t o

c o n f i r m a v a i l a b i l i t y a n d s c h e d u l e p i c k u p E q u i p m e n t

m u s t b e r e t u r n e

Inpatient Rehabilitation Hospitals

WHY CHOOSE

We Go Beyond Expectations

CONDITIONS TREATED AT BROOKS

•Brain Injury

(including our unique Disorders of Consciousness Program)

•Spinal Cord Injury

•Major Medical Trauma

•Orthopedic conditions

•Neurological

(including Guillain-Barré, Parkinson’s, ALS, etc.)

• Cancer Rehabilitation

• Stroke

•Amputation

•Pediatrics

•Transplant

•Burns

•Cardiac

•And more...

INPATIENT CARF-ACCREDITED PROGRAMS

Inpatient Rehabilitation Programs

(Adults, Children, Adolescents)

Brain Injury

Spinal Cord Injury

Stroke

Pediatrics

General Medical Rehabilitation

EXPERIENCE AND EXPERTISE

A nonprofit organization, Brooks Rehabilitation has more than 50 years of experience in treating the most complex and medically challenging rehabilitation cases across a wide range of issues: stroke, brain injury, spinal cord injury, neurological disorders, orthopedics, pain, trauma and more. At Brooks, you will find the experts for the individualized medical care you need, and each year thousands of patients from our region and across the country do just that.

WORLD-CLASS MEDICAL TEAMS

At Brooks Rehabilitation, you will receive care, compassion and hope from a designated team of clinical experts. Our clinicians are among the highest trained and educated in their field and actively participate in clinical research and education on both the local and national levels. Many of our nurses are rehabilitation certified and many of our therapists have doctorate level degrees along with residency or fellowship training.

Brooks Physicians are Distinctly Trained Specialists

Our physicians are board certified in physical medicine and rehabilitation (PM&R). A PM&R physician is a distinct type of medical doctor who specializes in diagnosing, treating and managing conditions that affect movement, function and quality of life.

The specialized training for a PM&R physician is four years of undergraduate education with four years of medical school, and then four years of residency. Some physicians continue with an extra year of fellowship training in spinal cord injury, traumatic brain injury, pain, musculoskeletal and sports medicine. This deep subspecialty training provides the physician with even more expertise in the complexity of rehabilitation care.

At Brooks, we have two physicians who are board certified in traumatic brain injury and one who is fellowship trained in TBI. We have two physicians who are fellowship trained and received board certification in spinal cord injury. We have one physician who is fellowship trained in spasticity management and one who fellowship trained in pain. We also have a physician who is nationally recognized in amputee rehabilitation. PM&R physicians at Brooks work toward the goals of the patient and family to help achieve the highest functional recovery. This is a true interdisciplinary team model.

INNOVATIVE TECHNOLOGY FOR BETTER OUTCOMES

Brooks Rehabilitation is committed to offering the latest equipment, technologies and research-based treatments. Many times, our expertise in evidencebased rehabilitation helps develop these emerging technologies and gets them into wide-spread use sooner. Whether the technology is part of our community programs to promote socialization or in our rehabilitation settings to promote greater function, we know that ultimately the latest technologies will help drive better outcomes for our patients. We’re dedicated to always being on the forefront of “what’s next.” Some of the latest resources our clinicians are using include:

Robotics

Exoskeletons such as Indego and the Cyberdyne Hybrid Assisted Limb (HAL) help patients exercise in ways that they otherwise would not be able to. These two devices not only help patients, but they also assist our clinicians in better understanding a patient’s recovery and progress. HAL, in particular, provides real time data so therapists can see and adjust settings and movements to produce the desired result.

Virtual Reality (VR)

VR is an area we are growing rapidly. We use an immersive environment to assess a patient’s function and then provide appropriate activities to enhance their recovery. VR uses include balance, visual and mobility issues. We are currently developing our own VR applications, which our therapists will control to provide functional tasks for each patient.

Assistive Technology

As the name implies, this covers a broad spectrum of new ways to give patients more functional independence in their lives. We train patients and caregivers to use new innovations to help with everyday activities – even simple tasks like eating a meal or getting in the front door. Assistive technology can move a patient from very dependent to more self-sufficient, creating a better quality of life.

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

Stories of Recovery

As a construction worker, Isaiah “Zay” Brown was heading to a school to repair a ceiling fire sprinkler system. On his descent from the 26-feet ceiling, his forklift touched a live wire that sent a 270-volt shock through his entire body. Zay fell to the ground.

He doesn’t remember much after the initial accident. He woke up in a hospital in Savannah, Ga., paralyzed from the chest down. He would later find out that he sustained a traumatic spinal cord injury (SCI). He ruptured his L5 vertebrae, experienced short-term memory loss and lost feeling in his left arm.

Zay spent seven days in the intensive care unit and over a month in acute care. To continue his recovery, Zay was referred to Brooks Rehabilitation Hospital –Bartram Campus in Jacksonville, Fla.

“My first couple of days at Brooks were rough,” said Zay. “I was trying to figure out why this happened to me. I wanted to give up. Then, I met Amy and the team.”

Amy Gibbes, PT, Zay’s physical therapist, remembers the first time she walked into Zay’s hospital room.

“We could tell Zay had so much potential. He has a great attitude and he has a heart of gold,” said Gibbes.

With the help of Gibbes and his entire therapy team, Zay began to see gains in his SCI recovery. As he began making physical improvements, his mindset slowly began to change.

“They told me I was going to have to be in a wheelchair for a long period of time and it would be two to three years before I would be able to walk again,” said Zay. “I kept praying and working toward my goal of being able to walk out of there.”

After almost two months of rigorous therapy sessions, the day finally arrived for Zay to leave Brooks’ hospital. Overwhelmed with emotions, he walked out of the hospital using only his walker.

After spending time home in Georgia, Zay realized he wasn’t receiving the same level and quality of therapy. He returned to Helen’s House, Brooks’ family housing in Jacksonville, while he continued his SCI recovery at the Brooks Neuro Recovery Center.

When asked for any advice for people in a similar situation as him, Zay said, “stay motivated, block out the negative thoughts, keep God first and anything is possible.”

ISAIAH “ZAY” BROWN: SPINAL CORD INJURY

By

The Numbers

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

By linking the best minds in rehabilitation with the latest treatments and technology, we enable our patients to achieve the highest quality of life possible.

Providing care for more than 50 years to patients from across the country and internationally

According to U.S. News & World Report, Brooks was ranked the #1 Rehabilitation Hospital in Florida and among the top Rehabilitation Hospitals in the nation. Brooks was selected for their excellence in patient services and expertise in treating patients after a stroke, traumatic brain injury and traumatic spinal cord injury.

CARF-accredited in stroke, spinal cord injury, brain injury, pediatrics and general medical rehabilitation

Magnet® designated as a reflection of nursing professionalism, teamwork and superiority in patient care. Brooks was the first in Florida and one of only five freestanding inpatient rehabilitation facilities in the country to achieve designation.

Joint Commission accredited, demonstrating a commitment to performance standards and patient care.

Hospital readmission rates are lower than the national average.

BROOKS TREATS THE TOP 1% IN COMPLEXITY IN THE NATION

TOTAL PATIENT DISCHARGES IN 2023* 5,054

Diagnosis Mix

BROOKS REHABILITATION HOSPITAL

Bartram and University Campuses, Jacksonville, FL

Amputation

3% (125)

Neurological (including Guillain-Barré, Parkinson’s, ALS, etc.)

5% (223)

Major Multiple Trauma

9% (382)

Spinal Cord Injury

10% (410)

Complex Orthopedics

11% (453)

Pediatrics

2% (84)

Medical Complex

Rehab Cases (including transplant, cancer, burns, cardiac, etc.)

21% (867)

Stroke

20% (801)

Brain Injury (including our unique Disorders of Consciousness Program)

18% (750)

*Data set is University and Bartram Campus Hospitals combined

HALIFAX HEALTH | BROOKS REHABILITATION

Center for Inpatient Rehabilitation, Daytona Beach, FL

Amputation

Neurological (including Guillain-Barré, Parkinson’s, ALS, etc.)

4% (43)

Major Multiple Trauma

10% (98)

Spinal Cord Injury

6% (62)

Complex Orthopedics

16% (154)

3% (28)

Medical Complex

Rehab Cases

(including transplant, cancer, burns, cardiac, etc.)

22% (209)

Stroke

21% (199)

Brain Injury (including our unique Disorders of Consciousness Program)

17% (166)

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

Meet Your Rehabilitation Team

At Brooks, you are cared for by a designated team of experts in physical rehabilitation. Depending on your needs, your customized team may include:

PHYSIATRISTS

are doctors who specialize in physical medicine and rehabilitation, to oversee your recovery

REHAB NURSING

provides hands-on nursing care 24 hours a day, coordinated with other members of your health care team

PHYSICAL THERAPISTS/ ASSISTANTS

help strengthen your muscles for increased balance, walking and coordination

OCCUPATIONAL THERAPISTS/ASSISTANTS

focus on muscle strength for increased hand and arm use with daily living activities such as bathing and dressing

SPEECH-LANGUAGE PATHOLOGISTS

help you regain skills in the areas of speech and language, cognitive-communication and swallowing safely

RESPIRATORY THERAPIST

helps people with respiratory disorders and breathing difficulties. A respiratory therapist is a medical professional who provides therapy focusing on the lungs and heart.

NEUROPSYCHOLOGISTS

perform evaluations to determine if there are any deficits in concentration, memory, reasoning and problem solving

REGISTERED DIETITIANS

develop individualized nutritional assessments, interventions, nutrition support and diet education

CASE MANAGERS

coordinate your inpatient stay and help plan your continued care

RECREATIONAL THERAPISTS

help you find enjoyment in returning to leisure activities and introducing activities adapted to your new abilities

MUSIC THERAPISTS

use elements of music such as rhythm, dynamics, pitch and harmony to optimize movement and elicit verbal expression

Stories of Recovery

PUSCHEL AND ERIC SORENSEN

Puschel Sorensen came to Brooks Rehabilitation Hospital (BRH) after suffering with Guillain-Barré Syndrome (GBS) for 54 days in a hospital’s intensivecare unit. Guillain-Barré syndrome (GBS) is a rare neurological disorder in which the body’s immune system mistakenly attacks part of its peripheral nervous system and can range from a very mild case with brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently.

Geneva Tonuzi, MD, serves as Medical Director of Brooks Rehabilitation Spinal Cord Injury Program.

“Puschel arrived to us in on a ventilator and she had a feeding tube. She had no movement in her legs and a little bit of movement in her arms at the time, but not enough to even to be able to lift her arm off the bed.”

Within a week of being at BRH, Brooks respiratory therapists weaned Puschel off the ventilator. For her family, who had been at her side since the GBS first came on, being off the ventilator was a game changer. Soon after, she began to sit up, even if just for 10 seconds at a time.

Puschel spent a total of five weeks at BRH. She then progressed in her recovery enough to receive Brooks’ home health care and outpatient rehabilitation services, including the use of the specialized technology in the Brooks Neuro Recovery Center.

“I feel like I would not have been able to get through what I went through – the recovery, all of that stuff –had it not been for Brooks,” said Puschel. “I would 100 percent, anytime, anybody needs any kind of rehab, I know where you need to go and it’s Brooks, it’s always going to be Brooks for me.”

Little did she know that just two years later, her son Eric would need Brooks’ services. Eric had a

seizure and fell, striking his head on the ground. He suffered a major traumatic brain injury (BI) requiring a hemicraniectomy, a surgical procedure where part of the skull is removed to reduce the intracranial pressure. Five and a half weeks later, Eric was transferred to Brooks Rehabilitation Hospital – University Campus, where his mother was previously a patient.

Less than four months after his injury and during Covid-19 shutdowns, Eric began home health services with Brooks. Eric had severe apraxia and needed intensive treatment that neither our outpatient nor our home health therapists were able to provide. He was also still improving from significant physical challenges.

Chris Sorensen, Eric’s father, proposed the development of an intensive program for adults with acquired apraxia of speech, so that Brooks will be able to better serve future patients and families living with Eric’s diagnosis. Thanks to the generous support of the Sorensen family, the Eric Sorensen Motor Speech Program was developed. In order to reach more members of the community, this program will benefit not only adults with apraxia, but also adults living with any motor speech disorder such as dysarthria, or slurred speech caused by muscle weakness.

“Eric has taught me so much about apraxia, neuroplasticity and the power of a positive attitude. I am beyond proud of his continued progress, and so hopeful for the many other people who will now have direct access to the best motor speech treatment options thanks to the Sorensen’s legacy,” said speechlanguage pathologist, Jackie L. Hurst, MS, CCC-SLP.

When Brittany Pitts’ son Wyatt was admitted to the hospital for suspected pancreatitis, it was her motherly instinct that may have saved his life. While CT scans were inconclusive, Wyatt began suffering from slurred speech, hallucinations, seizures and right-side paralysis before slipping into a coma.

After many tests and guidance from experts across the country, it was determined that Wyatt had a severe auto-immune response to the Coxsackie virus, a common childhood ailment known as Hand, Foot and Mouth Disease. A steroid regimen brought him out of the coma.

Wyatt was then transferred as an inpatient to Brooks Rehabilitation Hospital to help him regain his ability to walk and speak. Steve Walczak, PT, DPT, PCS, was Wyatt’s physical therapist. “Wyatt did great at Brooks. He arrived quiet and shy but really got his personality back while he was here. On day one, he could not take a full step without collapsing.

By the time Wyatt was discharged, he was chatting with the staff and able to walk more than 1,000 feet. Both Brittany and Wyatt were eager to return home to Panama City, Fla., to be reunited with Wyatt’s younger brothers and sister – a reunion two months in the making.

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

LAUREN RAY: TRAUMATIC BRAIN INJURY

Lauren Ray was a typical 15-year-old girl until tragedy struck. Lauren and her dad were driving home when a drunk driver failed to stop at a stop sign and collided with their vehicle. Her father died at the scene. Lauren suffered critical injuries, including a traumatic brain injury.

After weeks of intensive treatment, Lauren was transferred to Brooks Rehabilitation Hospital –University Campus to continue her recovery.

Lauren’s inpatient care team took an individualized approach, creating tasks that simulated what Lauren needed to do in her life – such as simulating throwing a saddle up on a horse and navigating the hallways as if it was school. She was also tasked with high-level balance, increased distances in walking and simulated activities targeting her teenage interests.

In addition to nursing and therapy, Lauren received assistance from the Brooks School Re-entry team for her education and the Music Therapy team to get back to playing piano. As her rehabilitation journey progressed, Lauren also began treatment in the Pediatric Day Treatment Program.

After several months, Lauren returned to her hometown of Pensacola, Fla., and gradually transitioned back to school full-time. She is hopeful to resume competitive horseback riding soon. Her experience has led her to consider a future in neurosurgery and she also aims to educate people on the risks of drunk driving.

WYATT PITTS: PEDIATRIC REHABILITATION

What to Expect at Brooks Rehabilitation

PHYSICIAN & ADVANCED PRACTICE PROVIDER OR CLINICAL CARE TEAM

•On the day of admission, you will meet some of your nursing team and a member of your medical team. You can expect to meet your rehab physician on your first full day at Brooks.

•Your attending physician is a physiatrist, a doctor who specializes in physical medicine and rehabilitation – he or she will lead your medical care during your stay.

•You can expect to see your rehab doctor and other members of your medical team, consisting of physician assistants and nurse practitioners, on a daily basis.

EXCELLENCE IN NURSING

•During your stay you will have 24-hour nursing care, you can expect your nurse and nurse assistant to check on you every hour to make sure you have everything that you need.

•As our nurses and nurse assistants change shifts, they will discuss your care and progress with your next nurse at your bedside.

•We want you to be an active participant in your care, so please ask questions during hourly rounds as well.

WORLD-RENOWNED THERAPY

• Generally, you can expect to begin therapy the day after your arrival. In general, therapy sessions can begin as early as 7 a.m. and end as late as 7 p.m. seven days a week. However, your personal therapy schedule will be available on your TV screen under “My therapy schedule” the day after admission.

• You can expect to have at least three hours of therapy every weekday and a modified therapy schedule on the weekends. If your treatment team feels you would benefit, you will also be set up for our inpatient hybrid program in addition to your regularly scheduled sessions, which gives you access to more treatment through our advanced rehabilitation technology.

• On your first day of full therapy you can expect to meet the members of your therapy team consisting of a physical therapist, occupational therapy and a speech therapist.

• If you are in need of more specialty care, you may also receive visits from our assistive technology, exoskeleton, and seating and positioning specialists.

ITEMS TO BRING

•One of our goals at Brooks is to help you regain your strength and maximize your independence. To achieve this, you will be getting dressed daily in regular clothing. Bring comfortable pants, shorts, shirts, lace or Velcro tennis shoes.

FAMILY LODGING OPTIONS

• Our Brooks hospitality house, Helen’s House, located on our University campus, offers affordable temporary lodging to out-of-town families and caregivers for a small fee. Our rooms can accommodate a maximum of 3 adults or 2 adults and 2 children. Each room has one queen-sized bed, a pull-out sofa, and a private, handicapped accessible bathroom. Check-in hours for all guests are between 3 p.m. and 8 p.m. daily. Helen’s House provides daily transportation to locations around the campus. Helen’s House is based on availability, so please ask a member of your rehab team for more information.

•Should your caregiver prefer to stay with you, we allow one overnight visitor. We ask that they check

in daily at the security desk. Sleeping options in private rooms include a single sleeper. Please be aware that nursing staff will be making hourly rounds to check on you throughout the night.

CAREGIVERS & VISITORS

•We strongly encourage your caregiver to participate in your rehabilitation throughout your stay – especially if they will be your primary caregiver upon discharge.

•Caregivers who are participating in your care are welcome to stay overnight with you in your private room. However, please be aware that our nursing staff will make hourly rounds throughout the night. Please be sure that your overnight guest checks in at the security desk daily for an overnight pass.

• Any guests that will not be a caregiver, after discharge should visit between 4-8 p.m. to avoid interrupting your therapy schedule.

DISCHARGE

•One of our goals at Brooks is to prepare you for home or your next care setting. We will begin working with you and your caregiver immediately to prepare you for success.

•While your entire care team plays a role in your discharge, your case manager will help plan your continued care - including setting up doctors’ appointments or outpatient services. You can expect your first visit from a case manager within your first three days of admission.

•Weekly, your rehab physician and case manager will receive feedback from your therapy and nursing team on your progress and continued needs. This will help your rehab doctor plan for your discharge needs.

Helen’s House: Family Housing for out-of-town guests. Call us at (904) 990-6530

System of Care

Multiple care settings and community programs are what makes Brooks the best choice for rehabilitative care and beyond. After the hospital, you’ll have access to everything the Brooks system has to offer: more than 50 outpatient therapy clinics; skilled nursing facilities; assisted living and memory care facilities; home health and home care services; research; day treatment programs; and community programs. We provide care in the right setting for your individual needs, resulting in the best outcomes.

BROOKS REHABILITATION

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

Beyond Rehabilitation

COMMUNITY HEALTH AND WELLNESS PROGRAMS PROVIDE ONGOING RECOVERY SUPPORT AT LITTLE OR NO COST BROOKS INVESTS MORE THAN $12 MILLION ANNUALLY IN THESE PROGRAMS

One of the most comprehensive Adaptive Sports and Recreation programs in the country providing fun and fitness for individuals living with disabilities.

The Neuro Recovery Centers offer cutting-edge rehabilitation equipment and technology to our hospital patients, outpatients and community members.

The Aphasia Center offers both a social language community group and an Intensive Comprehensive Aphasia Program.

The Brain Injury Clubhouse provides a bridge between medical rehabilitation and community and vocational reintegration for individuals with an acquired brain injury.

The Clinical Research Center is devoted to generating knowledge and integrating the latest research discoveries into clinical practice.

The Brooks School Re-entry Program provides a continuum of school transition and support services to assist families throughout a child’s educational journey.

The Brooks Motion Analysis Center uses innovative technology with expert clinical examination and biomechanical analysis for walking and movement impairments.

Pediatric Recreation is a free program that provides a safe and supportive environment for youth with physical and/or developmental disabilities so they can engage in recreational activities with their peers.

Experts from Brooks Rehabilitation have teamed up with local YMCAs of Florida to offer an individualized and supervised exercise program for Stroke and Brain Injury survivors, as well as those battling Parkinson’s disease and Multiple Sclerosis

BROOKS REHABILITATION HOSPITAL CARE SETTINGS

MICHAEL GREENE, PTA: FROM EMPLOYEE TO STROKE/TRANSPLANT PATIENT

Michael Greene, PTA, has been inspiring patients at Brooks Rehabilitation Hospital – University Campus for the past 20 years. As soon as he finished school, he was hired at Brooks as a physical therapy assistant for the stroke and cardiac unit. Patients and families alike praise him for the impact he had on their recovery. Michael would work tirelessly, during breaks and after hours, to ensure his patients had the best recovery possible.

Then the unthinkable happened, and Michael became a patient himself. After returning home from the store, Michael had a massive heart attack. While in the ICU, he recognized the symptoms so many of his patients experienced and knew he was now also having a stroke. Since he was already in the hospital, they were able to rush him in to surgery, saving his life. The day after being discharged from the hospital, he had a second heart attack. The damage was so extensive, the only option was a heart transplant.

To prepare for the transplant, he returned to his second “home” – Brooks. “I feel the most safe in

ADRIANA FIORILO: A STROKE AT 23

Adriana Fiorilo knew from an early age that she wanted to be a veterinarian. She graduated from the University of Florida with a biology degree and had work experience as a veterinary technician. She was on her way.

However, the 23-year-old, who was perfectly healthy at her graduation a day earlier, was now paralyzed on the left side of her body and had limited communication abilities. A CT scan at the ER revealed a stroke.

Adriana spent an uncertain and precarious month in ICU before she was moved to a regular room. She was barely able to give thumbs up, squeeze her

their hands and I wouldn’t want to go anywhere else,” said Greene. “It’s a different feeling when you are the patient. But it made me proudof the organization I work for. The care was top-notch and I knew it was the best care I could get.”

Seven months after his initial heart attack, Michael was given the tremendous gift of a new heart. Throughout his tenure at Brooks, Michael was a champion in raising funds and support for the American Heart Association (AHA) each year. He will now continue to be an advocate for AHA, this time as a survivor.

parents’ hands and wiggle her toes. “Her neurologist recommended Brooks Rehabilitation because he said it was the best in Florida. But we live in Miami and thought surely there would be some place closer to home. The more we researched and asked others, the more Brooks came up,” said Ileana and Ronald Fiorilo, Adriana’s parents.

Adriana arrived at Brooks Rehabilitation Hospital (BRH) hardly able to lift her head. She initially needed three people to assist her to walk. However, in the six weeks at BRH that followed, her fighting spirit and hard work, paired with the expertise of her Brooks team, made for tremendous improvement. By discharge, she was able to walk 200 feet with someone just holding onto her for safety. She also progressed significantly in all aspects of her self-care tasks.

Once discharged, Adriana immediately started at the Brooks Brain Injury Day Treatment Program (BIDT) to assist with her transition from an inpatient setting to home.

Our Inpatient Hospital Care Settings

BROOKS REHABILITATION HOSPITAL: UNIVERSITY CAMPUS

3599 University Blvd S | Jacksonville, FL 32216 (904)345-7600

The original 170-bed rehabilitation hospital on University Blvd. in Jacksonville, Fla.

The hospital features almost all private rooms with dedicated therapy areas on each floor with equipment and technology supporting your specific illness or injury.

BROOKS REHABILITATION HOSPITAL: BARTRAM CAMPUS

6400 Brooks Bartram Drive | Jacksonville, FL 32258 (904)809-8080

Our newest 60-bed rehabilitation hospital located on Brooks’ existing 115-acre Bartram campus. Due to the overwhelming demand for our specialized services, this hospital will begin a 36-bed expansion.

HALIFAX HEALTH | BROOKS REHABILITATION CENTER FOR INPATIENT REHABILITATION

303 N Clyde Morris Blvd | Daytona Beach, FL 32114 (386)425-4000

Located within Halifax Health – Medical Center of Daytona Beach, this 40-bed inpatient rehabilitation hospital specializes in treating stroke, spinal cord injury, brain injury and complex orthopedic conditions. A full spectrum of physical and neuro rehabilitation services are provided.

MUSIC THERAPY

MUSIC THERAPY VS. NEUROLOGIC MUSIC THERAPY (NMT)

Music Therapy is the use of evidence-based music interventions to address physical, cognitive, social, and emotional issues in persons of varying abilities. Traditional music therapy practices are based on social-science model. Neurologic music therapy is based on a neuroscience model. At Brooks, our patients receive standardized and individualized NMT service across the system of care.

NMT TECHNIQUES

Speech & Language Cognition Movement

• Musical Speech Stimulation

• Melodic Intonation Therapy

• Therapeutic Singing

Rhythmic

Speech Cueing

Vocal Intonation Therapy

• Oral Motor and Respiratory Exercises

• Developmental Speech & Language Training Through Music

• Symbolic Communication Training Through Music

• Musical Attention Control Training

• Musical Executive Function raining

• Musical Neglect Training

• Auditory Processing Training

Musical Sensory Orientation Training Musical Mnemonics Training

• Music & Psycho Counseling

• Associative Mood & Memory Training

MUSIC AND THE BRAIN

• Therapeutic Instrumental Music Performance

• Rhythmic Auditory Stimulation

• Patterned Sensory Enhancement

Playing and listening to music works several areas of the brain

Corpus Callosum: Connects both sides of the brain

Motor Cortex: Involved in movement while dancing or playing an instrument

Prefrontal Cortex: Controls behavior, expression and decision-making

Nucleus Accumbens and Amygdala: Involved with emotional reactions to music

Hippocampus: Involved in music memories, experiences and context

Sensory Cortex: Controls tactile feedback while playing instruments or dancing

Auditory Cortex: Listens to sounds; perceives and analyzes tones

Visual Cortex: Involved in reading music or looking at your own dance moves

Cerebellum: Involved in movement while dancing or playing an instrument, as well as emotional reactions

FUNCTIONAL OUTCOMES

Cognition

Initiation

• Attention

• Direction following

• Executive Functioning

• Reaction Time

• Processing Speed Memory

Visual Neglect

Speech & Language

• Verbal expression & intelligibility

• Verbal fluency & articulation

POPULATIONS SERVED

Stroke

• Brain Injury

• Spinal Cord Injury

• Neurodegenerative Diseases (Parkinson’s Guillan Barre, MS, ALS)

• Orthopedic

• Vocal Quality Vocal Intensity

• Respiratory coordination & endurance

Sensorimotor

• Walking

• Balance Range of motion

• Strength

• Endurance

• Fine motor coordination

Cancer

• Developmental Disabilities

• Dementia/Alzheimer’s

• Autism

• Cerebral Palsy Down Syndrome

SETTINGS SERVED

Brooks Bartram and University Inpatient Hospital’s THE GREEN HOUSE Residences

• Transitional Care Program (UC)

• Brain Injury Clubhouse

Brain Injury Day Treatment (BIDT)

• Brooks Rehabilitation Aphasia Center (BRAC)

• Pediatric Day Program (PDP)

• Pediatric Recreation Program

RECREATIONAL THERAPY

WHAT IS RECREATIONAL THERAPY?

Recreational Therapy is a goal-based therapy focused on improving an individual’s quality of life through recreation and leisure activities by targeting physical, cognitive, emotional, and social needs. Recreation Therapists can introduce or reintroduce individuals to leisure interests and adaptive techniques to participate fully and independently in chosen life pursuits.

HOW DO WE SERVE OUR PATIENTS?

Adaptive Pediatric Recreation participants engage in adaptive sports, horticulture, cooking, art, aquatics, and music.

• At our inpatient facilities, patients have the opportunity to participate in adaptive sports, yard games, video games, card and board games, arts and crafts, gardening, biking, cooking, baking, grilling, and community reintegration outings.

• We support our patients beyond discharge by providing leisure education throughout their treatment - promoting ongoing participation in a healthy leisure lifestyle.

PATIENT OUTCOMES:

• Fine motor skills

• Balance Ambulation

• Safety

• Leisure Education

• Communication

• Social support

• Visual scanning

• Wheelchair mobility Quality of life

• Independence

• Cognition: problem solving, sequencing, attention, memory

COMMUNITY REINTEGRATION

Community reintegration outings target adjustment in the community providing patients the opportunity to practice their therapy goals, assess safety using adaptive equipment, and identify potential barriers to discharge. Community outing locations can include familiar places such as restaurants or stores, but patients favor our special locations like TopGolf and bowling.

RECREATIONAL THERAPIST QUALIFICATIONS

A Certified Therapeutic Recreation Specialist (CTRS) is the qualified professional providing recreation therapy services. The CTRS is a certified Recreational Therapist who has demonstrated professional competence by acquiring a specific body of knowledge and passing a national certification exam. All Recreation Therapists within the Brooks system maintain a CTRS certification by completing Continuing Education Units (CEUs), thus demonstrating their continuing professional knowledge and competence.

LOCATIONS/PATIENTS SERVED ANNUALLY

Neuro Recovery Centers & Adaptive Wellness

NRC FAQ

1

QUESTION: What Programs and Services are offered in the Neuro Recovery Centers?

Answer:

• Outpatient Physical Therapy

• Outpatient Occupational Therapy – Assistive technologies

• Wheelchair Clinic for customized seating evaluations

• Aquatic Physical Therapy

• Independent Gym Program

2

QUESTION: Am I able to just show up and join the gym membership?

Answer: No. Anyone wishing to join the Independent Program must get an order for Physical Therapy and be seen for 3-5 visits billed through outpatient physical therapy benefits.

3

QUESTION: How do I join the gym program?

Answer: Steps to Join the Independent Program

• 1st – Get orders and demographic information for desired patient to the NRC or CIU

• 2nd – Patient will have a PT evaluation completed in the NRC. (billed through patients insurance)

• 3rd – Patient will be seen for 3-5 outpatient follow up appointments after eval for setup on appropriate equipment. (billed through patients insurance)

• 4th – Patient will have an orientation appointment that officially makes them a member.

• A patient cannot start programming before each of these steps are completed!

4 QUESTION: What technologies/services are included in the Independent Gym Program?

Answer:

• Functional Electrical Stimulation Cycles –RT200 and RT300 models

• Armeo Spring-Upper Extremity Exoskeleton

• Diego-a robotic-assisted arm-shoulder device

• Amadeo-robotic-assisted technology that targets hand and finger function

• Xcite-provides FES-integrated functional activities for both upper & lower extremities

• Circuit training – Combination of strength, endurance, and functional exercises with traditional machines

• Personal training

• Independent aquatic exercise

5 QUESTION: How much does the independent gym program cost?

Answer: $110.00 per month

6 QUESTION: Will my insurance cover the gym membership?

Answer: No. Unfortunately the program is not covered by insurance. It is a private pay program.

7 Question: How often can I attend the gym program?

Answer: We are open Monday – Friday from 9-5 and attendance is up to the patient and their goals.

NRC Independent Program

The Neuro Recovery Centers (NRC) Offer Specialized equipment for customized rehabilitation during and after traditional therapy has been completed. This Unique Gym Program allows individuals with disabilities to continue ongoing exercise and conditioning to maintain and improve functional movement and abilities. Our members receive access to our state of the art technology and can utilize the gym up to six days per week. Following an initial evaluation with our physical therapist an individualized care plan will be created to decide equipment usage within the program. Members will be trained on the equipment and exercises will be performed under the guidance and supervision of our neuro exercise specialists.

PROGRAM COST

INDEPENDENT

PROGRAM EQUIPMENT AND SERVICES OFFERED

• FES Cycle

• Armeo Spring

• Bioness H200

• Sabeo Glove

• Diego

• Amadeo

• Circuit Training

• Personal Training

2 CONVENIENT LOCATIONS

3599 University Blvd S | Jacksonville FL 32216

Phone: (904) 345-6812

500 Park Avenue | Orange Park FL 32073

Phone: (904) 579-1892

$100 Monthly Membership fee gives you access to the gym equipment up to 6 days per week!

Financial Assistance is available to those who apply and qualify.

• Aquatics

NRC INDEPENDENT PROGRAM EVALUATION PRESCRIPTION

First steps to Participate in the Brooks Rehabilitation Adaptive Fitness and Independent Program:

1. Have a physician fill out the form below.

2. Call Brooks Rehabilitation to set up an appointment for an evaluation. (See the list of numbers at the bottom)

Physician Order for Therapeutic Treatment

Patient name:

Patient’s phone numbers (home/cell):

Physical Therapy Evaluation and Treatment for Independent Excercise Program (check all that apply)

n Stroke n Spinal Cord n Brain Injury n Other

n Parkinson’s n Cerebral Palsy n Multiple Sclerosis

Other/Comments:

I certify that I have examined the above patient and determined that outpatient therapy is necessary. I approve this treatment plan and will review it as necessary or as the patient’s condition requires.

Physician’s Signature

Printed Name

Date ______________ Physician’s Phone

Physician’s Fax (for progress notes)

Physician’s Location

TO SET UP AN APPOINTMENT

Physician’s Office Stamp Here

In Jacksonville | P: (888) 323-8005 or (904) 345-7277 | F: (904) 345-7280 | referrals@brookshealth.org

NRC Jacksonville Clinic Line | P: (904) 345-6812 | F: (904) 345-7663

NRC OPR Clinic Line | P: (904) 579-1892

Adaptive Community Wellness

Brooks Rehabilitation Adaptive Community Wellness Program

at the YMCA.

Experts from Brooks Rehabilitation have teamed up with the YMCA of Florida’s First Coast to offer an individualized and supervised exercise program for stroke and brain injury survivors, as well as those battling Parkinson’s Disease and Multiple Sclerosis. The Adaptive Community Wellness Programs allow participants to stay active and improve their health after completing formal physical therapy. An individualized exercise program will be developed for each participant following an initial evaluation with a Brooks physical therapist. The cost of membership is $15/month for YMCA members, and $30/month for non-YMCA members.

Questions? Contact us at (904) 792-4423 or AdaptiveWellness@brooksrehab.org

https://brooksrehab.org/services/ adaptive-wellness/

Area Locations

Brooks Family YMCA

Dye Clay YMCA

Johnson YMCA

McArthur YMCA

Nocatee YMCA

St. Augustine YMCA

Williams YMCA

Winston YMCA

HOW TO SIGN UP FOR BROOKS REHABILITATION ADAPTIVE WELLNESS PROGRAMMING

1. Have your doctor fill out the form below OR give you a prescription for “a physical therapy evaluation and treatment for Brooks Wellness Programming”

2. Call Brooks Rehabilitation at (904) 345-7277 to schedule your evaluation, and bring your signed prescription. OR

Your doctor can fax the prescription to (904) 345-7280 / email referrals@brookshealth.org

3. Attend your scheduled one-time physical therapy appointment – your therapist will conduct a specific evaluation to help select the most appropriate location and services.

4. You will be contacted by a Brooks Rehab staff member to schedule your first session to meet with the Program Specialist.

Physician Order for Therapeutic Treatment

Patient Name:

Patient’s Phone Numbers (home phone / cell phone):

Physical Therapy Evaluation and Treatment for Wellness Program: (please check all that apply)

Stroke

Parkinson’s

Other / Comments:

Brain Injury

Multiple Sclerosis

Adaptive Aquatics

I certify that I have examined the above patient and determined that outpatient therapy is necessary. I approve this treatment plan and will review it as necessary or as the patient’s conditions requires.

Physician’s Signature

Date _____________ Physician’s Phone _____________________

Physician’s Fax

Physician’s Location _____________________________________

Physician’s Office Stamp Here

Community Wellness Program Schedule

Please note: The wellness programs require a physician’s clearance to exercise as well as a one-time Brooks Rehabilitation Physical Therapy Evaluation prior to any program participation. Program times and locations are subject to change at any time. Please contact us for more information.

Brooks Family YMCA

10423 Centurion Pkwy N, Jacksonville, FL 32256

Monday, Wednesday, Friday

Stroke Wellness: 1PM – 4PM

Parkinson’s Disease Wellness: 9AM – 12PM

Tuesday, Thursday

Brain Injury & MS Wellness: 1PM – 4PM

Dye Clay Family YMCA

3322 Moody Ave, Orange Park, FL 32065

Tuesday, Thursday

Adaptive Community Wellness: 9AM – 12PM

Johnson Family YMCA

5700 Cleveland Rd, Jacksonville FL, 32209

Tuesday, Thursday

Adaptive Community Wellness: 10AM – 12PM

McArthur Family YMCA

1915 Citrona Dr, Fernandina Beach, FL 32034

Monday, Wednesday, Friday

Adaptive Community Wellness: 1PM – 4PM Parkinson’s Disease Wellness: 9AM – 12PM

Nocatee YMCA

884 Cross Town Dr, Ponte Vedra Beach, FL 32081

Monday, Wednesday, Friday

Adaptive Community Wellness: 9AM – 12PM

St. Augustine YMCA

500 Pope Rd, St. Augustine, FL 32080

Monday, Wednesday, Friday

Adaptive Community Wellness: 1:30 – 4:30 PM

*Adaptive Community Wellness includes Stroke, Parkinson’s, BI and MS participants in one program

Williams Family YMCA

10415 San Jose Blvd, Jacksonville, FL 32257

Tuesday, Thursday

Adaptive Community Wellness: 1:30 – 4PM

Winston Family YMCA

221 Riverside Ave, Jacksonville, FL 32202

Monday, Wednesday, Friday

Adaptive Community Wellness: 9AM – 12PM

Outpatient Services

Northeast Florida Outpatient Rehabilitation Locations

Patient Access Center: P: (904) 345-7277 | F: (904) 345-7280

Email: Referrals@BrooksRehab.org | Web: BrooksRehab.org/outpatient

1. Amelia Island

4800 First Coast Highway, Suite 240

Fernandina Beach, FL 32034

P: (904) 321-5491

F: (904) 321-5478

2. Arlington

9100 Merrill Road, Suite 10

Jacksonville, FL 32225

P: (904) 725-9994

F: (904) 725-9138

3. Balance Center

(Within Center One)

10475 Centurion Parkway N., Suite 104

Jacksonville, FL 32256

P: (904) 854-2050

F: (904) 854-2058

4. Callahan

45390 Green Ave.

Callahan, FL 32011

P: (904) 879-1223

F: (904) 879-4986

5. Center For Low Vision

(Enter through the Brooks Medical Group Practice)

3901 University Blvd. S., Suite 103

Jacksonville, FL 32216

P: (904) 389-9989

F: (904) 389-1060

6. Center for Sports Therapy

(Within Brooks Family YMCA)

10423 Centurion Parkway N. Jacksonville, FL 32256

P: (904) 854-2090

F: (904) 854-2093

7. Fernandina

1885 South 14th St.

Fernandina Beach, FL 32034

P: (904) 277-4449

F: (904) 277-4177

8. Fleming Island

4575 US 17 South, Suite 350

Fleming Island, FL 32003

P: (904) 637-0148

F: (904) 637-0155

9. Healthcare Plaza

3901 University Blvd. S. Jacksonville, FL 32216

P: (904) 345-7310

F: (904) 345-7240

10. Julington Creek

450 S.R. 13 N., Suite 112

St. Johns, FL 32259

P: (904) 900-5512

F: (904) 999-4815

11. Mandarin

11705 San Jose Blvd., Suite 111 Jacksonville, FL 32223

P: (904) 345-7450

F: (904) 345-7451

12. Neuro Recovery Center

3599 University Blvd. S. Jacksonville, FL 32216

P: (904) 345-6812

F: (904) 345-7663

13. Nocatee

400 Colonnade Drive, Suite 100

Ponte Vedra, FL 32081

P: (904) 395-1755

F: (904) 395-1754

14. Northside

1034 Dunn Ave., Suite 104

Jacksonville, FL 32218

P: (904) 757-1782

F: (904) 757-9808

15. Orange Park

500 Park Ave.

Orange Park, FL 32073

P: (904) 278-7890

F: (904) 278-7762

16. Ortega

5539 Roosevelt Blvd.

Jacksonville, FL 32244

P: (904) 483-2272

F: (904) 483-2273

17. Palagio

1525 Kingsley Ave.

Orange Park, FL 32073

P: (904) 990-5802

18. Ponte Vedra

816 N. Highway A1A, Suite 307

Ponte Vedra Beach, FL 32082

P: (904) 543-4021

F: (904) 543-4022

19. Riverside – Healthy Living Center

221 Riverside Ave.

Jacksonville, FL 32202

P: (904) 661-2790

F: (904) 661-2793

20. San Jose (within JCA)

8505 San Jose Blvd.

Jacksonville, FL 32217

P: (904) 419-6101

F: (904) 419-6191

21. San Pablo 14286 Beach Blvd., Suite 34

Jacksonville, FL 32250

P: (904) 345-7510

F: (904) 345-7540

22. St. Augustine

190 Southpark Blvd., Suite 100

St. Augustine, FL 32086

P: (904) 824-1478

F: (904) 824-8071

23. St. Augustine Pediatrics Center

200 Southpark Blvd., Suite 102

St. Augustine, FL 32086

P: (904) 417-6236

F: (904) 417-6024

24. St. Johns

104 Ashourian Ave., Suite 105

St. Augustine, FL 32092

P: (904) 230-7761

F: (904) 230-7763

25. Westside

7749 Normandy Blvd., Suite 147

Jacksonville, FL 32221

P: (904) 786-5576

F: (904) 786-9907

26. World Golf Village

319 W. Town Place, Unit 5 World Golf Village

St. Augustine, FL 32092

P: (904) 342-5262

F: (904) 217-3580

27. Wyndham Lakes

10660 Old St. Augustine Road

Jacksonville, FL 32257

P: (904) 862-2487

F: (904) 862-2489

28. Yulee

463721 S.R. 200, Suite 7 Yulee, FL 32097

P: (904) 602-6088

F: (904) 602-6091

1. APOPKA

3030 E. SR 436, Suite 240 Apopka, FL 32703

P: (689) 698-3731

F: (689) 698-3732

2. BUENAVENTURA LAKES

2705 Simpson Road, Suite 111 Kissimmee, FL 34744

P: (689) 223-5490

F: (689) 223-5491

3. CLERMONT

2616 South Highway 27 Clermont, FL 34711

P: (352) 565-5992

F: (352) 565-5993

4. HORIZON WEST - HAMLIN

15820 Shaddock Drive, Suite 110 Winter Garden, FL 34787

P: (321) 999-9056

F: (321) 999-9057

5. KISSIMMEE SOUTH

3337 S. Orange Blossom Trail Kissimmee, FL 34746

P: (321) 999-9250

F: (321) 999-9251

6. METROWEST

2441 S Hiawassee Road Orlando, FL 32835

P: (407) 965-5818

F: (407) 965-5819

7. OCOEE SOUTH

2960 Maguire Road, Suite 1001 Ocoee, FL 34761

P: (321) 999-9285

F: (321) 999-9286

8. OSCEOLA

1172 West Osceola Parkway Kissimmee, FL 34741

P: (689) 204-2221

F: (689) 204-2225

9. OVIEDO

1121 Alafaya Trail, Suite 1073 Oviedo, FL 32765

P: (407) 796-5265

F: (407) 796-5260

10. POINCIANA

339 Cypress Parkway, Suite 101 Kissimmee, FL 34759

P: (407) 530-3577

F: (407) 530-3578

11. RIO PINAR

515 South Chickasaw Trail, Suite 515 Orlando, FL 32825

P: (407) 710-1946

F: (407) 710-1951

12. SAND LAKE

1700 West Sand Lake Road Suite 115/116, Orlando, FL 32809

P: (407) 723-7581

F: (407) 723-7582

13. SODO

2849 South Orange Ave, Suite 360 Orlando, FL 32806

P: (689) 207-4255

F: (689) 207-4256

14. WATERFORD LAKES

801 Woodbury Road, Suite 103 Orlando, FL 32828

P: (407) 373-6082

F: (407) 373-6083

15. WINTER GARDEN

15508 W Colonial Drive, Suite 100 Winter Garden, FL 34787

P: (407) 347-4101

F: (407) 347-4102

16. WINTER PARK

4270 Aloma Ave, Suite 150 Winter Park, FL 32792

P: (321) 999-9260

F: (321) 999-9261

= Aquatic Therapy

= FCEs

= Pediatrics

= Pelvic Health

= Multidisciplinary clinic offering PT, OT, ST

1. DAYTONA BEACH

201 N. Clyde Morris Blvd., Suite 320 Daytona Beach, FL 32114

P: (386) 236-7017 F: (386) 236-7018

2. DAYTONA BEACH PEDIATRICS

311 N. Clyde Morris Blvd., Suite 50 Daytona Beach, FL 32114 P: (386) 425-7800 F: (386) 425-7801

3. DELTONA

3400 Halifax Crossings Blvd., Suite 140 Deltona, FL 32725 P: (386) 425-6800 F: (386) 425-6801

For more information contact

Central Intake: (904) 345-7277

4. ORMOND BEACH

1240 W Granada Blvd, 1st Floor Ormond Beach, FL 32174 P: (386) 898-0220 F:(386) 898-0221

5. PALM COAST

9 Pine Cone Drive 104B Palm Coast, FL 32137

P: (386) 446-9716 F: (386) 446-0046

Fax: (904) 345-7280 Email: Referrals@BrooksRehab.org

Revised 08/2024

6. PORT ORANGE

3863-H South Nova Road Port Orange, FL 321297 P: (386) 236-7010 F: (386) 236-7002

7. WEST VOLUSIA

2621 Enterprise Road, Suite 100 Orange City, FL 32763

P: (386) 775-7488 F: (386) 775-9515

halifaxhealth.org/brooks

Behavioral Medicine

Brooks Behavioral Medicine 3901

Spinal Cord Injury and Other Disorders Day Treatment Program (904) 345-7506

The Spinal Cord Day Treatment Program is an intensive interdisciplinary CARF accredited treatment program for patients with spinal cord injury and related neurological injuries/disorders.

Brain Injury Day Treatment Program (904) 345-7223

The Brain Injury Day Treatment Program is a comprehensive CARF accredited program for the treatment of brain injury.

Neuropsychological Evaluations (904) 345-7210

Neuropsychological evaluations assess cognitive and emotional status in order to assist in diagnosis, tracking change, and treatment planning.

Driving Evaluation Program (904) 345-7210

The driving evaluation program is designed to ensure that drivers are safe after injury or illness.

Cognitive Rehab Therapy (904) 345-7210

Cognitive Rehabilitation Therapy improves the attention, problem solving, and memory skills that are impaired after an injury to the brain.

Medical Psychotherapy (904) 345-7210

Medical Psychotherapy is provided to foster coping and improve the psychological health of those with medical illnesses.

Functional Capacity Evaluations (904) 345-7210

A Functional Capacity Evaluation is a comprehensive physical assessment to determine an individual’s safe maximum physical abilities for employment or disability.

Spinal Cord Injury and Related Disorders Day Treatment Program

The Spinal Cord Injury and Related Disorders Day Treatment Program is an interdisciplinary outpatient rehabilitation program designed to provide intense therapy for patients who have had a spinal cord injury (SCI) or similar neurologic disorder such as:

• Traumatic and non-traumatic injuries to the spinal cord (includes injuries related to accidents, surgical interventions, infections and spinal pathology)

• Autoimmune disorders (including Gulliain-Barre Syndrome or Transverse Myelitis)

• Critical illness polyneuropathies and polymyopathies

• Multiple Sclerosis

The program is overseen by a medical director and the interdisciplinary team includes a physical therapist, occupational therapist, speech therapist, psychologist and a nurse case manager, all with specialized training in spinal cord injuries. The SCI Day program focuses on managing ongoing medical needs with special attention towards home and community reintegration. Additional components can include community outings, school re-entry and return to work training, as well as driving evaluations, wheelchair evaluations or assistive technology consultations.

WHO

• Individuals who are 16 and older and who are able to participate in up to 5 hours of various therapeutic interventions (individually or in a small group setting)

WHAT

• 5 hours a day, 5 days a week

• Personalized treatment plans will determine program length

WHERE

• Healthcare Plaza at 3901 University Blvd S, Jacksonville, Fl 32216

REQUIREMENTS

• At least 2 disciplines for treatment

• Caregiver availability (as determined by need)

• Dependable transportation

• Funding/insurance

REFERRALS

• Please contact the nurse case manager at SCIDay@Brooksrehab.org or (904) 345-7506.

• Referrals can be made by inpatient rehabilitation hospitals, outpatient therapists, primary care physicians, home health clinicians and case managers.

• For more information you can also visit our website at https://brooksrehab.org/services/sciday/

By offering this program and using the other extensive Brooks services offered, we are striving to empower our patients to achieve their highest level of recovery and participation in life.

Revised 8/10/2023

REHABILITATION

PSYCHOTHERAPY AT BROOKS BEHAVIORAL MEDICINE

What we offer - Medical Psychotherapy

Brooks Behavioral Medicine offers brief individual psychotherapy services to patients experiencing a wide range of concerns and mental health difficulties following medical illness and injuries. Many experience emotional distress, difficulty coping with pain, grief/loss, altered cognitive and physical functioning, family role changes and more.

Mental health concerns that existed before can worsen, and some may experience mental health problems for the first time. These services help patients adapt to and recover from physical changes, decrease emotional distress, and develop greater independence and wellbeing.

Typical course of treatment is 6-10 sessions.

Inclusion and Exclusion criteria

Inclusion

• Age – 16 and older

• A medical diagnosis

• Presence of psychological diagnosis (related to medical diagnosis)

Exclusion

• Less than 16 years old

• Primary diagnosis of neurodevelopmental disorder, eating disorder, substance use disorder, active psychosis

• Imminent risk and/or in need of long-term mental health treatment

• Need of couples/marital therapy and/or family therapy

Insurances accepted

• We accept all major insurances except Medicaid and United Healthcare

• Uncompensated Care Fund (for those without insurance and those under-insured and those that have Medicaid)

How to refer

• Call the Brooks Behavioral Medicine front desk at (904) 345-7210 or fax (904) 345-7255

Brain Injury Day Treatment Program

The Brain Injury Day Treatment (BIDT) Program uses a comprehensive and interdisciplinary treatment model to help individuals who have sustained either a traumatic (e.g., moderate-to-severe TBI) or nontraumatic (e.g., CVA) brain injury. This team includes a neuropsychologist, psychologist, cognitive rehabilitation therapists, speech-language pathologists, occupational therapist, and a physical therapist, and they have specialized training in brain injuries. The program has a case manager who works with the patients and their families during their time in the program. There is also a program assistant who can provide help to the patients, as well as the therapists, throughout the treatment day.

The BIDT program was created to help improve cognitive/thinking skills, communication ability, social skills, physical functioning, and emotional stability, with the goal of increasing independence and returning to the community. Additional components of the program include (when appropriate) community outings, grocery shopping, cooking, school re-entry, and return to work training.

WHO

• Individuals that are 16 and older who have suffered a brain injury. These injuries could include traumatic brain injuries, strokes, and anoxic brain injuries, and other acquired brain injuries.

• The individual must be able to participate in six hours of diverse therapeutic activities with the majority of the time spent in a group setting.

WHAT

• After a patient participates in the program for over a week, a treatment plan is created to match the needs of the patient. This model provides the individual with up to as many as 30 hours of therapy per week. Therapy services include individual speech, occupational, and physical therapies along with psychotherapy, cognitive group-based therapies, and a support group.

WHERE

• The BIDT Program is located within Brooks Behavioral Medicine at the Healthcare Plaza at 3901 University Blvd. S, Jacksonville, FL 32216.

REQUIREMENTS

• Ability to work in a group-based setting on cognition (“thinking skills”)

• Dependable transportation

• Funding/insurance

REFERRALS

• Please contact the case manager of the BIDT Program, Kelli McNames, COTA/L at (904) 345-7223, or email her at kelli.mcnames@brooksrehab.org.

• Referrals can be made by hospitals, rehabilitation facilities and case managers. A signed order will be needed from a medical provider/physician.

• For more information on our program, you can visit our website at https://brooksrehab.org/services/brain-injury-day-treatment/.

DRIVER

REHABILITATION

Brooks Rehabilitation’s Driver Evaluation and Training Program provides assessments and training for individuals with cognitive, physical or developmental issues to help determine their driving capabilities.

Services Provided

Our comprehensive driving evaluation includes assessments of functions critical for safe driving. These functions include cognition, vision, reaction time and physical skills.

What to Expect

The evaluation takes approximately 2 hours in the clinical setting and 1 hour behind the wheel. During that time, we will obtain the individual’s medical history and driving history.

Tests will include knowledge of driving safety, reaction timing, cognition, vision and general strength. Once completed, the individual then participates in an on-the-road assessment in a vehicle provided by Brooks.

An assessment for adaptive driving equipment can also be completed during the evaluation.

Populations Served

Our program is geared toward servicing the following diagnoses and populations:

4Spinal cord injury

4Traumatic brain injury

4Stroke 4Amputations

4Other diagnoses or health disorders

4Elder drivers with cognitive changes such as Alzheimer’s

4New drivers with developmental or learning disabilities i.e. cerebral palsy, spina bifida and autism.

Equipment and Training

We can help determine if an individual’s current vehicle meets their needs. We also provide (once training is complete) the prescription for the adaptive equipment needed for an individual with disabilities to drive independently. We can also provide recommendations for local vendors who will provide the necessary modifications.

Eligibility Requirements and Fees

Our program is available for individuals 15 years and older. Participants must have a valid learner’s permit or driver’s license to participate.

4All participants must also have a referral from their treating physician.

4If your license is revoked or under medical review, we can assist in obtaining a one-day temporary permit.*

4Fees are based on the number of sessions required to complete testing and training. An estimate is available upon request.

Meet Our Newest Neuropsychologist

Gloria M. Morel Valdés, PsyD.

Dr. Morel Valdés is a bilingual (Spanish/English) Clinical Neuropsychologist with Brooks Behavioral Medicine. She earned her doctoral degree in Clinical Psychology with a focus in Clinical Neuropsychology from Albizu University-Miami Campus.

Dr. Morel completed her doctoral internship with a dual focus in general psychology and neuropsychology at the William S. Middleton Memorial Veterans Hospital and Clinics in Madison, Wisconsin. Her post-doctoral training was completed at the University of Wisconsin-Madison School of Medicine and Public Health providing neuropsychological assessments to individuals with various neurological, medical, neurodevelopmental, and psychiatric conditions.

After completing her post-doctoral training, Dr. Morel worked as an Assistant Professor at UW-Madison, and she defined her clinical subspecialty in multicultural assessments establishing the first multicultural clinic in the state of Wisconsin. Her emphasis is in providing culturally informed neuropsychological assessments of diverse ethnic populations with an array of clinical conditions. As a bilingual provider, she is fully proficient in Spanish. She also has extensive experience working with certified medical interpreters.

Dr. Morel’s clinical interest lies in traumatic brain injuries, cerebrovascular disease, and dementias. Her research focus is on healthcare disparities in TBI and normative data development of neuropsychological assessments for Hispanics living in the U.S. and abroad. She is an active member of the Culture and Diversity Task Force in TBI from the American Congress of Rehabilitation Medicine and Hispanic Neuropsychological Society.

To make a referral for neuropsychological services, please call (904) 345-7210 or fax a referral to (904) 345-7255. Please indicate on the referral if you are specifically asking for Dr. Morel for multicultural needs.

BROOKS REHABILITATION NEUROLOGIC SERVICES

At Brooks Rehabilitation we have more than 15 multidisciplinary clinics throughout the greater Jacksonville, St. Augustine, Daytona, Orlando and Hudson areas. We offer physical therapy, occupational therapy and speech therapy services aimed to maximize recovery. Our teams work collaboratively with patients and families to develop an individualized plan to meet the needs of our patients, wherever they are in the recovery process.

We specialize in treating patients with various neurologic diagnoses such as

• Parkinson’s disease

• Multiple Sclerosis

• Stroke

• Brain Injury

• Spinal Cord Injury

• Vestibular disorders

• Concussion

Our outpatient facilities are staffed with rehabilitation professionals that have completed extensive training, residency programs and board certifications in the field of neurologic rehabilitation. In addition to our skilled staff, we provide access to a variety of equipment best supported by current research to facilitate recovery including but not limited to electrical stimulation for neuromuscular re-education, harness systems, balance training and biofeedback devices for dysphagia treatment.

In addition to our rehabilitation teams, our Outpatient Division has a variety of resources aimed to facilitate recovery and promote independence, including the Aphasia Center, Research Department, and Motion Analysis Lab.

We also offer Independent Wellness programs at our Neuro Recovery Centers and local YMCA’s to further optimize functional independence, community re-integration and management of our patients overall health.

#WeAreBrooks BrooksRehab.org

BROOKSREHAB.ORG

NEUROLOGIC PROGRAM

BROOKSREHAB.ORG

BROOKS NEUROLOGIC PROGRAMS

• 9 outpatient clinics with a closely linked multi-disciplinary team located across Jacksonville, St. Augustine and Daytona regions.

• Motion Analysis Center

• NeuroRecovery Center

• Community Programs

WHAT TO EXPECT AT BROOKS REHABILITATION

• A thorough examination and development of a comprehensive treatment plan by our highly skilled and compassionate clinicians with collaborative efforts of a multi-disciplinary team.

• Our evidence based treatment philosophy is to create an individualized recovery based intervention program when appropriate, that is specific to that individual’s needs and goals.

• Physical and Occupational Therapy Residency program

• Clinical Research

• Neurologic Round Table

BROOKSREHAB.ORG

RESIDENCY PROGRAMS

PILLARS OF IHL RESIDENCY PROGRAMS

DIAGNOSES TREATED

Diagnoses we treat include but are not limited to: BROOKSREHAB.ORG

• Stroke

• Spinal Cord Injury

• Brain injury (traumatic and non traumatic)

• Multiple Sclerosis

• Parkinson’s

• Cerebral Palsy

• Guillian Barre

• Amyotrophic Lateral Sclerosis (ALS)

• Within the division, we offer a wide variety of technology to address impairments. This technology includes but is not limited to:

- Body weight support systems for locomotor training such as the lite gait and Zero G

- Balance Master

- Cyberdyne

- Bioness L300 and H200

- Functional Electrical Stimulation cycles

- BITS

- Vital Stim

- Biofeedback

- Access to circuit training

- Armeo

- Harness systems

- Aquatics

COMMUNITY CONNECTION

• Neuro Recovery Center

• Wellness Programs - located at specific YMCA’s around town

- Stroke

- Brain Iwnjury

- Parkinson’s

- Multiple Sclerosis

• Adaptive Sports

• Brooks Clubhouse

• Brooks Aphasia Center

• Research

BROOKSREHAB.ORG

BROOKSREHAB.ORG

Outpatient Geriatric Rehabilitation

We take a comprehensive approach to address age-related and condition-related changes to maximize health and participation in meaningful activities.

It’s more than just treating aging adults. Our physical, occupational and speech-language clinicians receive:

• Additional training on geriatric care standards

• Community resources for patients and caregivers

• Patient and caregiver education

• Literature and case study review sessions

Common reasons to seek our geriatric rehabilitation

• Osteoporosis

• Balance and Fall Safety

• Concussion

• Deconditioning and Weakness

• Dysphagia

• COPD

• Initiate an Exercise Program

• Senior Athlete Injuries

For more information please contactour Central Intake Unit. (904) 345-7277

Brooks Rehabilitation offers blood flow restriction rehabilitation training.

Blood Flow Restriction (BFR) training is a game-changing injury recovery therapy that is producing dramatically positive results:

Who is BFR appropriate for?

Š Pre-operative patients

Š Post-operative patients

Š Patients with heavy lifting restrictions (older population, injured population, etc)

What are the benefits of BFR?

Š Increased strength at lower loads

Š Improved healing post operatively

Š Same improvements at lower loading

Š Decreased atrophy

Š Improved ischemic loading tolerance (pre/post op)

How to refer:

Send an order with the diagnosis to our Patient Access Center. Indicate for PT with BFR - Evaluate and Treat Patient Access Center (PAC) P: (904) 345-7277 F: (904) 345-7280

TRIGGER POINT DRY NEEDLING

WHAT IS DRY NEEDLING?

Trigger point DN is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues for the management of neuromusculoskeletal pain and movement impairments.

Trigger point dry needling is used as a component of a comprehensive plan of care to assist with restoring function and movement. DN should result in a more efficient progression to corrective exercises to improve activity limitations and participation restrictions.

CONDITIONS TREATED

• Headaches

• Shoulder pain

• Elbow pain

• Neck pain

• Back pain

• Hip pain

• Knee pain

• Foot and ankle pain

• Scar tissue

WHY A PHYSICAL THERAPIST?

Due to our high level of education on the musculoskeletal system and pathologies associated with this system, we are the ideal providers of this modality.

Selection of these patients requires high levels of clinical reasoning in order to identify potential patients which may benefit based on our examination and review of systems, while screening out patients which may not be appropriate.

For locations and more information contact our Central Intake Unit at (904) 345-7277.

Male & Female Pelvic Health

Rehabilitation Physical Therapy Options

Pelvic Floor Rehabilitation: Provided by a specially trained women’s and pelvic health physical therapist, pelvic floor rehabilitation is the conservative and comprehensive treatment for common pelvic floor disorders including urinary incontinence (UI), fecal incontinence, constipation, dyspareunia (painful sex) and pelvic pain.

Physical Therapy During Pregnancy and Postpartum: Physical therapy treatment for back pain and pelvic girdle related to pregnancy is effective at improving mobility and reducing pain. A specially trained women’s health physical therapist will provide treatment for painful joints and muscles, and will teach you ways to move to avoid injury and reduce pain. Your physical therapist can also recommend support belts and other aids to help with back pain during pregnancy.

What to Expect

Interview: At the beginning of your visit, you will meet with a physical therapist to discuss your symptoms and concerns.

Private Examination: Following the initial interview, you will receive a private examination to identify causes and reasons for pain.

Please note: The pelvic floor evaluation includes a comprehensive history and physical examination in a private room with your physical therapist. Examination of the pelvic girdle and pelvic floor MAY include a direct vaginal and/or rectal assessment of the pelvic floor muscles. The examination of the pelvic floor musculature is important in order to determine the muscles ability to contract and relax normally, and to identify painful areas, so that you will receive the proper treatment.

Plan of Care: Following a private examination, your physical therapist will develop a plan of care and establish treatment goals including a timeline for achievement of goals. You will be a partner in establishing your goals and timelines. Your plan of care will be sent to your physician for review and signature.

What to wear: Please wear or bring comfortable clothes and shoes.

Duration: Your initial evaluation will last approximately 1 hour. Please arrive 30 minutes early to allow time to fill out pre-appointment forms and account for traffic or other delays.

Pediatric Pelvic Health

Is your child...

• Wetting the bed at night?

• Having accidents at school?

• Missing out on social activities?

• Having difficulty with potty training?

• Feeling embarrassed?

Physical therapy can help!

Physical therapy is a conservative and noninvasive treatment strategy for the management of pelvic floor dysfunction in the pediatric population. Specially trained physical therapists at Brooks Rehabilitation can evaluate and treat pelvic floor dysfunction in children ages 0-18 years. Physical therapists are the ideal providers to help address dysfunctions of the musculoskeletal system that can lead to symptoms like:

• Urinary incontinence

• Urinary urgency

• Urinary frequency

• Fecal incontinence

• Constipation

• Bed wetting

• Abdominal pain

What is the Pelvic Floor and Why is it Important?

The pelvic floor is a group of muscles that are located on the underside of the pelvis. These muscles serve the important role of supporting the pelvic organs, working with the other core muscles to assist with trunk stability and controlling urinary and bowel functions. Just like the other muscles in our body, the pelvic floor muscles can be dysfunctional. They can be weak, tight or have poor coordination. If these muscles are not working properly, bowel and bladder issues or pelvic pain can occur.

What to Expect?

A physical therapist who specializes in treating pelvic floor conditions will meet with you and your child for an initial evaluation. During the evaluation, the therapist will ask questions about your child’s medical history and symptoms. The examination portion of the visit will assess your child’s strength, range of motion and core muscles. Initial examination may include an assessment of pelvic floor muscle function. The information gathered will help to determine what treatment interventions are required to help improve your child’s symptoms and the therapist will work with you to establish goals for treatment.

Brooks Rehabilitation offers physical therapy for pelvic floor dysfunction in multiple settings and convenient locations near you! Ask your physician for a referral for physical therapy at Brooks Rehabilitation.

• For more information on outpatient therapy call (888) 323-8005.

• For Home Health call (904) 306-9729.

• For Inpatient Hospital call (904) 345-7185.

Continence and Pelvic Health Program

Central Intake Unit

Call for appointment (888) 323-8005 or (904) 345-7277 Fax referral to (904) 345-7280

Locations

Fleming Island

P: (904) 637-0148 F: (904) 637-0155

1675 Eagle Harbor Parkway, Suite B Orange Park, FL 32003

Healthcare Plaza

P: (904) 345-7310 F: (904) 345-7240 3901 University Blvd. S. Jacksonville, FL 32216

Julington Creek

P: (904) 900-5512 F: (904) 999-4815 450 S.R. 13 N St. Johns, FL 32259

Mandarin

P: (904) 345-7450 F: (904) 858-7451 11701 San Jose Blvd., Suite 210 Jacksonville, FL 32223

Nocatee

P: (904) 395-1755 F: (904) 395-1754 400 Colonnade Drive, Suite 100 Ponte Vedra, FL 32081

Orange Park

P: (904) 278-7890 F: (904) 278-7762 500 Park Ave Orange Park, FL 32073

Ortega

P: (904) 483-2272 F: (904) 483-2273

7207 Golden Wings Road, Suite 300 Jacksonville, FL 32244

Therapist(s)

Julia Delesdernier, PT, DPT WH Residency Graduate

Michelle Feldhaus, PT, MPT, WCS, CMPT

Victoria Faulkner, PT, DPT WH Residency Graduate

Anna-Lynn Hickey, PT, DPT WH Residency Graduate

Amy Pelletier, MPT

Tia Dankberg, PT, DPT, WCS WH Residency Graduate WH Program Coordinator

Bogh, PT, DPT

Crystle Kearley, PT, DPT

Marie

Continence and Pelvic Health Program Central Intake Unit

Call for appointment (888) 323-8005 or (904) 345-7277 Fax referral to (904) 345-7280

Ponte Vedra

P: (904) 543-4021 F: (904) 543-4022 816 N Highway A1A, Suite 307 Ponte Vedra Beach, FL 32082

San Pablo

P: (904) 345-7510 F: (904) 345-7540 14286 Beach Blvd., Suite 34 Jacksonville, FL 32250

St. Augustine

P: (904) 824-1478 F: (904) 824-8071

190 Southpark Blvd., Suite 100 St. Augustine, FL 32086

St. Johns

P: (904) 230-7761 F: (904) 230-7763 104 Ashourian Ave., Suite 105 St. Augustine, FL 32092

Westside

P: (904) 786-5576 F: (904) 786-9907 7749 Normandy Blvd., Suite 147 Jacksonville, FL 32221

World Golf Village

P: (904) 342-5262 F: (904) 217-3580

319 West Town Place, Unit 5 St. Augustine, FL 32092

Chanelle Sourou, PT, DPT

Jessica Finney, PT, DPT WH Residency Graduate

Ellen Hendrix, PT, DPT

Cassidy Maisano, PT, DPT WH Resident in Training

Jessica Magee, PT, DPT, WCS WH Residency Program Coordinator

Ami Iszler, PT, DPT WH Resident in Training

Pediatric Programming

Pediatric Feeding and Swallowing Services

The feeding services at Brooks Rehabilitation take a supportive, comprehensive approach that incorporate the child’s developmental needs while addressing behavioral and oral-motor feeding issues as well as family education and training.

This comprehensive team may include:

• Child’s physician/pediatrician

• Occupational therapist

• Speech language pathologist

• Physical therapist

Listed below are common signs and symptoms that may indicate a child would benefit from feeding therapy:

• Not transitioning appropriately from bottle to cup, or from purees to solid foods

• Has difficulty holding bottle or cup

• Turns head or cries during adult directed feeding (when caregiver presents food on spoon)

• Eats very quickly, “overstuffs” or “pockets” foods

• Prefers to eat with his/her hands, has difficulty with utensils or refuses to use utensils

• Is resistant to touching foods or does not like to get hands “messy”

• Refuses new brands or foods or chooses food based on color, shape or packaging

• Feeding time exceeds 30 minutes

For additional questions or to schedule an evaluation, please contact your local Brooks Rehabilitation pediatric clinic.

DEVELOPMENTAL DISABILITIES

Developmental disabilities are a group of conditions due to an impairment in physical, learning, language or behavior areas. Early identification and intervention has been shown to positivelyimpact the child’s development and caregiver competency, all while reducing the cost of needed care over time. Brooks Rehabilitation provides comprehensive pediatric services to support early identification and treatment of developmental disabilities.

Areas of development we address include gross motor skills, fine motor skills, communication, visual integration skills, feeding, processing/adaptation, self-care skills and social pragmatics. Environmental modifications, accommodations, equipment recommendations and family training may also be part of the plan of care. Our goal is to help each child reach their full potential!

Developmental diagnoses commonly referred for therapy:

•Autism spectrum

disorder

•Down syndrome

•Failure to thrive

•Prematurity

•Cerebral palsy

•Spina bifida

•Tourette syndrome

•Fetal alcohol syndrome

•Intellectual disability

•Vision loss/low vision

•Fragile X

Supplemental pediatric services available:

•Pediatric Recreation Program

• Adaptive Sports and Recreation Program

•School Re-entry Program

•Wheelchair clinic

•Motion Analysis Center

For more information, please send an email to pediatrics@brooksrehab.org or contact our Central Intake Unit at (904) 345-7277.

BrooksRehab.org

#WeAreBrooks

COMMON PEDIATRIC ICD-10 CODES

RECOMMEND: Primary diagnosis Medical dx/condition (if applicable)

Continued on next page

COMMON PEDIATRIC ICD-10 CODES

RECOMMEND: Primary diagnosis Medical dx/condition (if applicable)

1. DAYTONA BEACH PEDIATRICS

311 N. Clyde Morris Blvd., Suite 50 Daytona Beach, FL 32114 P: (386) 425-7800

2. HEALTHCARE PLAZA

3901 University Blvd. S. Jacksonville, FL 32216

P: (904) 345-7310

3. MANDARIN

11705 San Jose Blvd., Suite 111 Jacksonville, FL 32223 P: (904) 345-7450

4. NORTHSIDE 1034 Dunn Ave., Suite 104 Jacksonville, FL 32218 P: (904) 757-1782

5. ORANGE PARK 500 Park Ave. Orange Park, FL 32073 P: (904) 278-7890

6. SAN PABLO 14286 Beach Blvd., Suite 34 Jacksonville, FL 32250 P: (904) 345-7510

7. ST. AUGUSTINE PEDIATRICS CENTER 200 Southpark Blvd., Suite 102 St. Augustine, FL 32086 P: (904) 417-6236

8. WESTSIDE 7749 Normandy Blvd., Suite 147 Jacksonville, FL 32221 P: (904) 786-5576

Physician Practice

BROOKS REHABILITATION MEDICAL GROUP Our Physicians

Howard Weiss, DO Medical Director, Orthopedic/ Trauma Program and Amputee Program

Jantzen Fowler, MD Internal Medicine

Trevor Persaud, DO Associate Medical Director of the Brain Injury Program; Medical Director of the Brain Injury Day Treatment Program

Virgilio de Padua, MD Internal Medicine

Mabel Caban, MD Staff Physiatrist

Charles Dempsey, MD Staff Physiatrist

Rebecca Andrew, MD Internal Medicine

Lauren Shapiro, MD Stroke Medical Director Brooks Rehabilitation Hospital –University Campus

Ryan Haley, MD Staff Physiatrist

Ivy Garcia, MD Staff Physiatrist

Carolyn Geis, MD Associate Stroke Program Medical Director

Katelyn W. Jordan, OD Director of Vision Rehabilitation Services

Keisha Smith, MD Staff Physiatrist

Sarala Srinivasa, MD Staff Physiatrist

Bianca A. Tribuzio, DO Associate Director, Mayo PMR Residency Program in Collaboration with Brooks Rehabilitation

Brian Higdon, MD Associate Medical Director of Spinal Cord Injury Program; Medical Director of Spinal Cord Injury & Related Disorders Day Treatment Program

Pierre Galea, MD Associate Director of Admissions

Geneva Tonuzi, MD Medical Director, Spinal Cord Injury Program

Jorge Perez Lopez, MD Medical Director, Halifax Health | Brooks Rehabilitation Center for Inpatient Rehabilitation

Parag Shah, MD Medical Director, Brooks Rehabilitation Hospital –Bartram Campus and Data Solutions

Kenneth Ngo, MD Medical Director, Brooks Rehabilitation Hospital – University Campus, Brooks Brain Injury Program and Center for Innovation

Kerry Maher, PT, MD Senior VP of Patient Access and Community Education | Interim Medical Director, Brooks Rehabilitation Hospital – Arizona

Trevor Paris, MD System Chief Medical Officer

Cassandra List, MD Medical Director, Stroke and Spasticity Management Programs

Transitional Care Program

Transitional Care Program

Innovation is a core value that has always been a driving force at Brooks Rehabilitation. It is the spirit of innovation that led to the creation of our newest service: a Transitional Care Program (TCP).

The TCP is designed for patients who may no longer require an inpatient level of care, but still require intensive rehabilitation services and are unsafe to return home. This unit will have the ability to accommodate longer lengths of stays depending on the individual needs of each workers’ compensation patient.

The 12-bed unit features:

 Individual patient rooms

 Care from our specialized brain injury and spinal cord injury physicians

 Improved nurse-to-patient staffing ratios than other traditional discharge facility options

 A dedicated program director

 A dedicated workers' compensation case manager

 Individual physical, occupational and speech therapy services

 Individual psychology services

 Recreational activities A work conditioning program with targeted functional movements and progressions is offered as well.