Pre-hospital and trauma care: The Northern CA TBIMS is currently comprised of 5 trauma centers: Santa Clara Valley Medical Center (SCVMC, Level I), Stanford Medical Center (Level I), San Francisco General Hospital (SFGH, Level I), Eden Medical Center (Level II), and Doctors' Medical Center (Level II). EMS personnel provide initial evaluation in the field. Transport of injured individuals is by ambulance or helicopter to the trauma center. SCVMC and SFGH have transitional neurological units after ICU care. SCVMC has an 8-bed specialized Rehabilitation Trauma Center managed by PM&R staff physiatrists, along with a respiratory therapy team designated to this unit and appropriate consultation from acute medical/surgical specialties. Once their respiratory care needs are stabilized, individuals are discharged to the acute rehabilitation unit. Each rehabilitation admission is screened by a physician and a rehabilitation case manager: referring physicians are contacted personally; current medical and therapy treatments are reviewed; and families/potential caregivers and third party payers are educated regarding reasonable expectations in the acute rehabilitation setting; and discharge options are outlined.

Comprehensive rehabilitation: The Rehabilitation Center at SCVMC is a 68-bed, 2 floor unit located in the same building as the general hospital. An open 38-bed unit is designated to neurorehabilitation and a 30-bed SCI unit is located on the floor below. Individuals with combined TBI and SCI are treated on the unit which is most appropriate to their rehabilitation goals. SCVMC has had a Brain Injury program since 1977 when Dr. Sheldon Berrol, PM&R Chairman, spearheaded the effort to identify the essential elements of a TBI Rehabilitation Model as part of a Rehabilitation Services Administration collaborative project. Individuals are admitted when they meet the following guidelines: brain injury; require rehabilitation nursing and physician care; deemed able to benefit from and tolerate 3 hours/day of therapy by two or more disciplines; at least 14 years of age (younger patients are treated on the pediatric unit); and has a discharge plan. For minimally conscious individuals (Rancho 3), a specialized program titled "Journey to Recovery" is available to facilitate their transition to traditional acute rehabilitation. Individuals in both programs are evaluated and treated by an interdisciplinary rehabilitation team. Initial evaluations are conducted simultaneously by the entire team; team conferences are held within 72 hours of admission and then every 7-14 days. Family/caregiver goals are incorporated into the rehabilitation plan from the beginning. Peer support and therapeutic recreation are integral parts of the rehabilitation experience. Families who live outside a 50-mile radius can stay in suites on campus at minimal cost.

Post-Acute Services in Rehabilitation: Outpatient programs provide continuity of rehabilitation services. The Outpatient Brain Injury Program includes a rehabilitation medicine clinic with physiatry and rehabilitation nursing, physical therapy, occupational therapy, speech and language pathology, social service and psychology. The Day Treatment Program, designed to facilitate community integration and shorten inpatient lengths of stay, is offered as a 2-4 or 4-6 hour day 3-5 days/week. Typical activities include advanced community mobility, using public transportation and/or bicycle, extended visits to problem solve safety at home and in the community, and work site evaluation to help vocational re-integration. Additional programs to facilitate community integration and provide support, partially funded by the TBIMS, include the TBI Peer Support Program, "Brain Matters" community educational events, and the TBI-Resource Directory/ResourceLine. The latter two are also supported by the Firedoll Foundation. More information about these programs can be found at www.tbi-sci.org. TBIMS staff also provide support services during their contacts with study subjects and their families.

Click here to view projects in the registry for Santa Clara Valley Medical Center | view center abstracts