Rehabilitation: Queens, New York
Post-op : Cardiac : Subacute : Stroke
Rehabilitation services at Silvercrest include both short and long-term in-patient programs, as well as out-patient services. The therapy provided our patients and residents is second to none, and is driven by our belief that the goal of therapy must be progress, and not just maintenance. We know that true quality of life is achieved for our residents when we obtain the highest level of independence for each among them.
In-patient Rehabilitation
At the core of the inpatient rehabilitation program is a 40 bed, sub-acute unit that is home to a variety of patient groups. Post-operative orthopedic patients (e.g. joint replacements), stroke recovery patients, people needing cardiac rehab and individuals with exacerbations of multiple sclerosis are among those whom we regularly treat. The unit also serves as a bridge to home for previously hospitalized medical patients whose state of de-conditioning requires therapy for a return to independence.
Rehabilitation team members also see and help long term care residents, each of whom is evaluated at admission, at regular intervals thereafter, and whenever nursing staff most familiar with that resident develop any concern about changes in his/her capacities. Timely interventions can have major impact upon the daily lives of even those with the greatest limitations. For example, if the physical therapist can forestall the need for a Hoyer lift (used to take a patient from bed) by maintaining the resident's ability to assist with bed to chair transfer, it can make an enormous difference to quality of life. Similarly, when the occupational therapist helps another resident to maintain the skills and mobility needed to feed himself, this provides important support to his sense of independence.
Ventilator-Dependent Patients
Rehabilitation services also provides important contribution to the care
of our ventilator-dependent residents. Those patients stable enough to travel
to our main therapy area will attend regular physical and occupational therapy
sessions very much like those provided for other residents. (To insure patient
safety, staff are all trained in airway suction, the use of Ambu bags and
basic life support, and portable ventilators are powered by Silvercrest's
own cogeneration power unit.) In order that patients with more tenuous respiratory
status also benefit from therapy, Silvercrest established
a satellite rehab area on 5North, (adjacent to the ventilator unit). Here,
patients can receive therapy while nurses and respiratory therapists remain
immediately available to see to their respiratory needs.
Physical Therapy
Each week the Director of Physical Therapy makes orthopedic rounds with New York Hospital Queens' Chairman of Orthopedic Surgery (or his assistant). Carried out at the bedside and in the rehabilitation unit, these rounds also incorporate the individual therapist who is working with each patient. Not infrequently, these rounds are a follow up on plans made by Silvercrest's Director of Admissions prior to hospitalization for the original surgery . That Director meets many patients in the NYHQ pre-admission area and on the 6 South Neurology unit to acquaint them with Silvercrest, and to lay the groundwork for post-hospital rehabilitative care.
This program of coordination has reaped great benefits for the Silvercrest population. Protocols have been developed to address the specific rehabilitative needs of a variety of surgical patients, including those with total knee and hip replacement. These protocols, and the equipment used to carry them out, are available to all rehabilitation residents, regardless of the hospital or center from which they arrive.
Occupational Therapy
Occupational Therapy is devoted to the provision of "functionality" for the patient, being focused on what each individual needs in order to perform the tasks required for independence.
This comes first from a concentration on "Activities of Daily Living" (ADLs), wherein the resident is coached back to the ability to do for herself those many and essential things we all do in our daily lives without thinking.
Patients with higher levels of disability may arrive at Silvercrest with limited mobility and even with chronic pressure sores. As essential
members of the multi-disciplinary team performing "Wound Rounds,"
occupational therapists provide insight into the contribution of body
positioning and ambulation methods to poor healing, and help to design
"work-arounds" that keep the resident moving forward on a plan
of ambulation while contributing to progress with healing. These insights and interventions of our "wound care" team have also contributed to a system wide strategy of prevention that is keeping rates of new sore development at very low levels. Although Silvercrest receives and cares for medically complex individuals with high risk for pressure ulceration, new sores only rarely originate here. 
Our OTs also work with our speech/communications team to develop successful strategies for the most severely impaired, designing orthotics and finger positioning tools that allow quadriplegic patients to activate infra-red switches for communication and computer interaction.
Speech Pathology
Speech Pathology staff are involved with a large percentage of Silvercrest's
most challenged residents. And, it has been ground-breaking work
at Silvercrest that has promulgated a
better understanding of the importance of speech and swallowing therapy
to the treatment community at large. Communications maintenance is critical
to quality of life and essential to the existence of even the most rudimentary
independence. Integrating speech evaluation and treatment planning into the early rehabilitation process has been proven by Silvercrest staff to have significant impact upon the trajectory of the patient's progress curve.
Among the groups regularly treated for speech concerns are:
- Post-CVA (stroke) patients (dysarthria and aphasia)
- Ventilator dependent patients
- Patients with tracheostomies
- Cognitive impairment patients ( e.g. those with brain tumors and neuro-trauma)
- Non-verbal, neurologically impaired individuals, (e.g. ALS patients)
Combining years of experience with the latest in technology, Silvercrest's Speech/Communications team has had extraordinary success and has educated other groups from around the country and the world. Stroke and language
Swallowing: Evaluation and Treatment
Rehab Videos
Silvercrest participates in a cooperative program in swallowing with New York Hospital Queens. The hospital's "Swallowing Center" is staffed by Silvercrest specialists, and our residents benefit from the combined resources of these institutions. A wide variety of individuals may suffer from difficult or painful swallowing, known as "dysphagia." Among these are:
- patients with strokes or neuromuscular disease
- head and neck cancer patients
- patients with tracheostomies
- ventilator-dependent patients
At Silvercrest, all medically stable and alert dysphagia patients undergo "standardized instrumental assessment" with fiberoptic laryngoscopy, ( laryngoscopic view). Employing such techniques, our speech pathologists test patients with foods of various viscosities and are able to prescribe exercises and postures that can help many to swallow more safely, possibly freeing them from dependency on enteral tube feedings.
Of additional note is the particular contribution of our Speech/Swallowing team to the comprehensive care of Silvercrest's ventilator-dependent population. Early incorporation of speech/swallowing therapies into the ventilator wean process has produced exciting improvements in outcomes for many. Learn more about this by exploring Ventilator / Respiratory Care.
