By: Julian Garcia IV, MS, CCC-SLP, DHR Health Therapy Institute
Inpatient rehabilitation facilities (IRF) are freestanding rehabilitation units that are affiliated with acute care hospitals. They provide intensive rehabilitation programs for patients presenting with various neurological, musculoskeletal, orthopedic, and other medical conditions following stabilization of their acute medical issues.
Inpatient rehabilitation facilities have set guidelines that set them apart from other settings. Patients who enter an IRF must be screened, admitted, and continually monitored by a physician. IRFs follow a multidisciplinary team approach and should be able to provide hospital-level care. Patients who are admitted to an IRF must be able to tolerate a minimum of three hours of rehabilitation services per day for at least five days a week.
IRFs will vary in size in relation to the hospital they are affiliated with. A smaller IRF may only have 25 beds while a larger IRF in a big city may have close to 150 beds. The general patient population ranges from age 13 through 99. Patients younger than 13 may be admitted under special circumstances. Caseloads and speech-language pathologist (SLP) staff will be dependent on the size of the IRF and current census. At admission to the facility, the referring MD will create orders for patients observed to be in need of speech therapy services. Each referred patient will generally receive a full speech-language-cognition evaluation and a bedside swallow evaluation. Based on the results of the evaluation, a treatment plan will then be initiated that meets the aforementioned IRF requirements.
Daily duties will include initial evaluations, progress evaluations, monitoring dysphagia patients during dining hours, treatment sessions, attending weekly case conferences, team meetings, and family education/discharge planning.
In this setting, you can expect to work closely with a variety of nursing staff, specialty physicians, therapists, and case managers. You also will have frequent and direct interaction with concerned family members.
Procedures often performed by the SLP in an inpatient rehabilitation setting:
- Clinical swallow evaluations
- Fiber optic evaluation of swallowing (FEES)
- Videofluoroscopic swallow studies (VFSS) evaluations
- Speech-language-cognition-voice evaluations
- Voice evaluations (primarily due to paresis or paralysis of vocal folds)
- Trach and vent care, speaking valve (PMV) evaluations
- Speech-language-cognitive therapy
- Voice and swallow therapy
- Augmentative and alternative communication trials
Patients often seen in this setting:
- Non-traumatic brain injuries (CVA, tumors, infections)
- Traumatic brain injuries (motor vehicle accidents [MVAs], assaults, falls)
- Advanced disorders and end-of-life care (Parkinson’s, MS, Guillain-Barre, etc.)
Additional resources for SLPs getting started in inpatient care can be found here: https://www.asha.org/slp/healthcare/start_acute_in/.