Referrals

Call 832-826-1264 to refer a patient or request an appointment

Each case is evaluated individually and admission decisions are based on the needs of the patient, family, and the services our program offers.  We have outlined the basic parameters of our program for referring physicians below.

Admission criteria:

• Age: 1 year – 21 years
• Child has an acute problem and/or an acute exacerbation of a chronic problem resulting in a significant decrease in functional ability that will benefit from inpatient rehabilitation services.  A condition is considered to be acute or an exacerbation of a chronic condition only during the 6 months from the onset date of the acute condition or the exacerbation of the chronic condition.
• The intensity of necessary rehabilitative service cannot be provided in the outpatient setting.
• Child has diagnosis/medical condition that is expected to benefit from a comprehensive interdisciplinary rehabilitation program including specialty care under the supervision of a pediatric physiatrist.
• Must have goals that are established which are specific and pertain to improving functional independence and/or family training.
• Must be medically stable (refer to detailed description of medical stability on this page)
• Must be able to participate in intensive therapy (at least 3 hours daily within 1 week of admission) unless primary goal of admission is family training and/or equipment evaluations.  At least two therapy disciplines are involved and therapies are provided at least five days per week.
• Must be willing to participate (exceptions include decreased insight due to primary neurologic condition).
• Must have an established discharge plan, including location and identified caregivers.
• Family/caregivers must also be willing and available to participate in training.
• Diagnostic studies should be performed, if possible, before transfer.  Examples include CT, MRI, ultrasound, EEG, GI tests, duplex ultrasound, etc.  Surgeries also should be performed prior to transfer.
• Consults by other specialists that are pending should be completed prior to transfer.
• Treatment of medical condition or co-morbidity does not interfere with patient’s ability to participate (i.e. dialysis, transfusion therapy, radiation, etc.)
• Child has impairment in 2 or more of the following:

  • Self care activities, including dressing, bathing and feeding
  • Mobility, including walking, wheelchair propulsion, and transfers
  • Speech and cognition skills, including speech, language and swallowing disorders.
  • Orthopedic Prosthetic Management, including use and care of prostheses, braces, or adaptive aids.

• Financial approval for admission to the Inpatient Rehabilitation Unit (i.e., insurance, self pay, charity)

Detailed description of medical stability:

• Diagnosis is clear or workup deemed complete by discussion between referring and accepting physician
• Neurologic status
Seizures must be controlled
AIDP patients must have reached nadir of paralysis and must be showing stability and/or improvement in weakness prior to transfer
Spinal cord injuries must be stable – surgical or orthotic management – and if surgery not immediately planned then spinal orthoses fit prior to transfer
• Cardiovascular status
Hemodynamic parameters stable for 48 hours
No unstable arrhythmia or cardiac disease
Treatment plan for autonomic storming outlined and implemented
• Respiratory status
Oxygen requirements at 2 L or less
Not requiring greater than every 4 hours nebulized medications
Established tracheostomy
Stable off ventilator for 48 hours/stable on BiPAP or CPAP for 48 hours
Stable on a home ventilator, with family having received home ventilator and tracheostomy training.
• Hematologic status
Stable sickle cell treatment
Hemoglobin stable for 48 hours after major surgery or acute blood loss
Children requiring active transfusions/factor treatments for hematologic condition must have hematologist identified who will follow patient throughout rehab course
Platelets count stable for 48 hours or sufficient range to allow mobilization of patient
• GI status
Adequate oral intake by calorie counts/I&O or gastrostomy tube
If gastrostomy tube placement anticipated it is preferred that surgery take place prior to transfer to unit
Nausea and vomiting controlled on oral/IV medications so as not to interfere with therapy participation
• Metabolic
Stable electrolytes
Children with fragile blood sugars or frequent need for lab draws/urinalysis to monitor will need to be followed by endocrinology service while on rehab unit
• Infections
Source of fever identified and treatment plan outlined prior to transfer to unit with child afebrile for >24 hours prior to transfer and with declining white count trend if elevated during acute infection
Children who develop acute infections while on rehab unit will be considered for transfer back to medical or surgical bed if unable to consistently participate in therapy or testing significantly interferes with participation
Contact isolation status clarified prior to transfer
• Musculoskeletal status
Spinal stabilization device if planned should be fitted prior to admission
Weight bearing status must be considered. If NWB >2 limbs, intensive rehab may not be possible but short stay admission may be considered for family training
• Skin
Pressure ulcers do not interfere with ability to participate in therapies/prolonged sitting.
Patients with burns will be considered on a case by case basis.