New Challenges in Inpatient Rehabilitation During Times of Extreme Stress

By Lee McAfee-Scogin, MOT, OTR, CBIS, Baylor Scott & White Institute for Rehabilitation

As so many of us have experienced, life in inpatient rehab during the coronavirus pandemic has been turned in very new and quite stressful directions. I work at Baylor Scott & White Institute for Rehabilitation in downtown Dallas, Texas. Our hospital has 92 beds and most days our census is around 85 patients. Our building has three floors of patient rooms with our primary treatment gym areas on the second floor (of four), and typically our patients are out of their rooms for the majority of their therapy day. Since COVID-19 restrictions went into effect in our facility, no visitors have been allowed and all treatments were moved to the patients’ rooms with rare exceptions for caregiver training or other treatments that required specialty equipment. We only do individual treatments now, no groups, and therapists are seeing a small caseload of patients in order to reduce the amount of touchpoints for everyone. We have managed to maintain our 3-hour rule expectations and compliance since the restrictions went into place. Our managers worked very hard to redistribute equipment and supplies to each of the three patient floors to allow us to treat in the patients’ rooms, and our therapy staff has been very creative with how we’ve used the hospital room environment in different ways in order to accomplish what we typically do in the gym areas.

As visitation from family members has been significantly limited and due to the fact that many of our patients come to us from very far away, our patients have been far more reliant on our staff for simple things like doing their laundry and buying grooming supplies. Having all treatments in patients’ rooms quickly led to an overwhelming sense of cabin fever for just about everyone, but our facility is fortunate to have a patio area that is separated from community access where our patients can safely sit and maintain social distancing. Something as simple as sitting outside with the sun shining down has led to many happy tears in the past few weeks.

Our brain injury team has seen its own share of specific challenges during this time. Keeping a patient who is agitated and confused confined to their hospital room just wasn’t possible at times, so working with staff throughout the building to help maintain social distancing and keep the patients safe has been key. We had to quickly come up with creative new techniques for helping keep the patients’ masks on while out of their rooms and training social cues to not hug or shake hands while meeting the patients where they were in their recovery stages. Since we are unable to conduct our daily brain injury education group, we’ve lost a very valuable time for our patients to learn from each other and their peer support is absent right now. We still provide the same education on an individual basis, but the loss of the group setting has been profound for our team.

Helping our patients understand why their family members can’t be with them and why everyone has to wear a mask has been equally challenging. Their injuries occurred as COVID-19 restrictions were ramping up, so nothing about the virus was familiar or recognized as being part of their life prior to injury. We have found that for some using video calls with family members has been helpful, but for those who are unable to voice or have delayed processing due to their injuries the calls can be more confusing than helpful.

As an OT, therapy life for me is all about adapting and adjusting. But COVID-19 has thrown everyone’s coping mechanisms out the window, and resiliency has been much harder to find for both patients and staff. Two of our therapists are also fitness instructors and have been providing free workout classes for our staff via Zoom each day. We do a high intensity workout on Mondays, yoga on Tuesdays and Thursdays, and Zumba on Wednesdays. I’ve never been so grateful to be able to breathe deeply and freely at the end of my workday as I have been these recent weeks, and even though we are all exercising from our respective homes it’s been a great way for our staff to bond and relax.

I’ve worked in brain injury for ten years, and the last eight weeks have challenged me personally more than any other time in my career. Being a new grad was less stressful than treating during the time of COVID-19! Keeping a healthy emotional distance from my work has not always been easy, but I’ve felt I’ve been able to keep a healthy balance. Until now. The first time I helped a patient with a video call to their family and the patient’s son broke down in tears thanking me for being there with his mother, for showing up every day to help her recover from a devastating injury, I cried. Every time I call a patient’s family to give them updates on how therapy is going, I have to keep myself from crying along with the wife or daughter on the other end of the line who is beyond grateful for me, for all of us at the hospital, for doing what we do every day. Our success with our patients’ recoveries has remained high despite all of the changes and new stressors on everyone, and our expectations for ourselves remains equally high. But we’re all in it together, that’s for sure, and I am thankful beyond measure for the team of dedicated people I get to work with every day. I wouldn’t have survived this without them!