Miami VA Healthcare System
Physical Medicine and Rehabilitation Service
Physical Medicine & Rehabilitation Service (PM&RS) is a consulting and supporting service that provides treatment to a both inpatients and outpatients within the age group of adult and geriatric population. PM&RS services individuals with disabilities resulting from musculoskeletal, neurological, orthopedic, general medicine, surgical origins and mental health.
The inpatient admission process involves assessment of the individual’s appropriateness for rehabilitation services on improved performance and function.
The most common impairment groups treated in the in-patient programs are strokes, amputations, pre or post-op orthopedic, post-traumatic cases and traumatic brain injuries. Patient assessments are done within 48 hours of referral. The intensive rehabilitation program is a program of coordinated and integrated medical and rehabilitation services that is provided 24/7. The program endorses the participation and choice of the persons' served throughout the entire program. The persons served, in collaboration with the interdisciplinary team members during the course of therapy, identify and address their medical and rehabilitation needs. The individual needs of the persons served drive the appropriate use of the rehabilitation continuum of care offered by the Miami VA Healthcare System. The composition of the interdisciplinary team, the provision of care, the establishment of predicted outcomes, and the discharge to the community of choice drive for the proper continuum of care. The integrated disciplinary team approach is reflected throughout all activities.
The outpatient services may be received as a comprehensive interdisciplinary program or as single therapies. The most common diagnoses treated are: patients with musculoskeletal problems, such as back, neck or extremity impairment, orthopedic conditions, neurological disorders and neuropathies, wound care ( hands only), pain rehabilitation, hand rehabilitation, amputations, DM/diabetic foot, cardiopulmonary, TMJ, general debilitation. Body parts involved may be upper extremity, lower extremity, cervical, thoracic, lumbar or sacral regions: face trunk, and hand wounds. Out patient programs are designed on a 2-3 times a week basis for a total of 4-6 weeks of therapy. Every patient is scheduled to be seen within 2 weeks of referral within a CBOC region.
PM&RS reaches out to community services and makes appropriate referrals when services cannot be provided in-house or are feasible closer to a patient's residence.
Methods used To Assess Patients Needs
Assessment done on the person served is relevant with the core values, mission of the organization. PM&RS staff on the patients served performs various methods of assessments. The assessments can be pre-and post a surgical procedure; during admission to the rehabilitation unit, consult response to any program. Data is collected from patient electronic record; personal interview and examination with patient. Programs are established on collective interventions among the interdisciplinary team or individual procedures that include:
- Initial Assessment
- Treatment Plan
- Quantity and Duration of Care
- Treatment Implementation
- Patient Family Education
- Discharge Planning
- Interdisciplinary Management
PM&RS provides communication among the team members to discuss care plans, goal setting and patient profiles in team conferences; e-mail system; medical records documentation and personal one on one contact. To further assure excellence in patient care the team assesses the quality of their services and measures results of the programs provided. The PM&RS Program Evaluation System gathers and analyzes objective data about outcomes of care in terms of patient functional level of independence that assists in the planning for care plan development. There are performance indicators in PM&RS that compares the Miami VA Healthcare System to regional and national aggregates that serve as guidelines for performance in the inpatient programs and for the outpatients there are established orthopedic protocols and the American Physical and Occupational Therapy guidelines and established orthopedic protocols.
Medical care is provided to patients with medical surgical problems seen in large urban medical centers. Patient assessment is carried out by a comprehensive history and physical examination, as well as obtaining appropriate laboratory, radiological, and other diagnostic data. This may include, when appropriate, invasive procedures and the use of consultations from other services.
PM&RS provides education and treatment to inpatients, outpatients and in hospital base primary care services, representing a wide variety of physical conditions. Services are designed to meet the needs of persons with impairment, limited activity (disability) and restricted participation (handicap). The focus of the rehabilitation is to facilitate the Veteran’s ability to remain in the most independent and least restrictive living environment through therapeutic interventions.
- Physical Medicine
- Chiropractic Care
- Occupational Therapy
- Physical Therapy
- Vocational Rehabilitation
- Mental Health Occupational Therapy
- Exercise Physiology
Examples of interventions available (but limited to):
- Drivers Training/Education
- Inpatient Therapy
- Outpatient Therapy
- Prosthetic/ Orthotic Evaluation Training
- Home Evaluations
- Pre-Post Prosthetic Training
- Home architectural Assessments
- Family /Patient Education
- Hand Rehabilitation
- Pain Rehabilitation
- Stroke rehabilitation
- Vestibular Rehabilitation
- Exercise programs for strengthening, range of motion, posture, coordination, balance, joint mobilization, endurance, muscle re-education (facilitation/inhibition), stabilization
- ADL Dressing /Feeding
- Prosthetic /Orthotic Evaluations/Prescription
- Special Wheelchair Assessment/Fitting
- Wheelchair Seating/Mobility
- Assistive Technology
- Upper Extremity Splinting Fabrication
- Evaluation & Treatment at Home
- Falls assessments
- Gait and Balance Training
- Health Enhancement Program
- In-out patient cardiac/pulmonary rehabilitation
- Psychosocial therapy
- Back School Program
- Edema Control: massage, compression pump, compression garments
- Gait Training
- Wound management (only hands)
- Modalities for pain management (moist heat, cold, massage, ice massage, friction massage, ultrasound, electrical stimulation, TENS, mechanical or manual traction, paraffin, iontophoresis, biofeedback)
- Upper extremity splinting
- ADL evaluation and treatment
- Functional Capacity Evaluations
Type & Ages of Patients Served
PM&RS provides a full range of services to inpatient & outpatients. The type and age of patient served at Miami VA Healthcare System is an adult 18–78 and a geriatric population of 90 and above in the long term programs.
Special Needs of the Population Served
The Rehabilitation Program provides services designed to meet the needs of persons with impairment, limited activity (disability) and restricted participation (handicap). The focus of rehabilitation is to facilitate the Veteran’s ability to remain in the most independent and least restrictive living environment through therapeutic interventions in self-care activities/ADL functions, sphincter control, transfer, mobility/ambulatory functions, community reintegration skills, gait and coordination, energy conservation/ work simplification and perceptual cognitive functions with the ultimate goal of:
- Preventing and minimizing impairment
- Reducing activity limitations
- Identifying the characteristics of the intended discharge environment
- Lessens participation restrictions
- Achieving predicted outcomes
Persons served are referred to a continuum of care as soon as rehabilitation goals are met or person served requires a lesser level of care in the continuum of care in (i.e. Extended Care, Long Term Care, Home Base Primary Care or Outpatient Therapy Care).
Patients served can be referred to the community resources or Miami VA Healthcare System contract with other facilities for further care, such as Jackson Memorial Hospital, or other VISN 8 VA facilities with special programs not offered at the Miami VA Healthcare System.
Rehabilitation Standard of Practice Guidelines
The Miami VA Healthcare System ensures that the PM&RS interdisciplinary team members provide services consistent with their scope of practices and:
- State practice acts
- Licensure requirements
- Registration requirements
- Certification requirements
- Requirements for their educational degrees
- Professional training to maintain established competency levels
- On the job training requirements
- Professional Standards of Practice for Physical & Occupational Therapy Standards of Practice by the American Physical Medicine & Rehabilitation Practice
Bruce W. Carter VA Medical Center
- 305-575-7000 Ext. 3498/6367
Hours of Operation
7 a.m.-4:30 p.m.