PRACTICE SETTINGS

Therapeutic Resources places rehabilitation and educational providers in the following practice settings:

Hospital Settings/Acute Care
Patients receiving therapy when in a hospital are usually suffering from an acute illness. The treating therapist provides an evaluation, and based on the expected hospital length of stay, may provide intervention to restore independence in self care, strength and coordination.  With shorter hospital stays the therapist may have to deal with home discharge issues, making home equipment recommendations and providing family training.  Some hospitals have a rehabilitation unit where the client who has sustained a disabling condition (such as a stroke, amputation or head trauma) may go for a longer term program of rehabilitation

Hospitals may also employ therapists in the neonatal unit, to work with at risk infants.The program may include evaluation of the infants feeding and motor status. Intervention may include infant stimulation, feeding and range of motion. 

Specialty hospitals provide services to a particular group of clients such as those with spinal cord injuries, head traumas or burns.

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Sub-Acute Care 
Services provided in subacute units are considered intermediate or post-acute. Sub-acute care usually combines rehabilitation with convalescent services.  With the reduction in length of hospital stays, more patients are receiving rehabilitation services at this level of care. Sub-acute rehabilitation units typically exist as either a skilled nursing floor in a hospital or as part of a skilled nursing facility. Patients admitted to sub-acute care units have stabilized medically after their acute episode, but are not yet ready to go home and usually require intensive rehabilitation.Patients admitted to sub-acute rehabilitation may exhibit conditions such as post-orthopedic surgery (hip or knee replacement), post stroke, post head trauma, ventilator or post ventilator  dependent, or any number of conditions which result in a deterioration of prior functional status.

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Skilled/Long Term Care Setting
For patients who have lost some capacity for independence in activities of daily living due to a chronic illness or condition, and cannot remain at home, a skilled setting may be required.  Patients in this setting often receive rehabilitation services in order to restore function and allow them to participate in their environment to their fullest potential.  Wheelchair mobility, self feeding, toileting, dressing and bed mobility are among the   important skills that improve the quality of life for residents living in a long term care setting. 

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Outpatient 
Many patients in the community require rehabilitation services – whether they are post surgical, sport injury related, or based on an acute or chronic condition.  Outpatient services are provided in both hospitals and private practice settings. Outpatient facilities may specialize in a specific issue (such as sports injuries) or may provide general services covering a wide variety of medical conditions.

Additionally, children may receive interventions on an  outpatient basis for developmental or learning issues. Occupational therapy, physical therapy  and speech therapy services are commonly provided to children in the community.  The prevalence of sensory processing deficits has resulted in an increase in the provision of treatment in sensory gyms.

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Home and Community
Due to changes in our national health care delivery system, the provision of therapy in the home has become especially prevalent.  After discharge from an acute care, sub acute or long term facility, the therapist works with the client in their natural environment (usually in the home) on physical and cognitive/perceptual function, self care, play and leisure skills. 

Therapy for children is often provided in the home under the Early Intervention Program.

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Developmental Disabilities (Adults)
Adults with disabilities are often seen in day treatment and sheltered workshop settings. These individuals generally live in the community, either with their family or in group settings. Day treatment programs provide structured activities for their clients. Some clients participate in sheltered workshops within the day treatment setting.The goals of work-skill development, task modification, facilitation of community living skills and other adaptive skills help the client function more meaningfully in their natural environment.

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Public Schools
Since the passing of Education for All Handicapped Children Act (PL 94-142) in 1975, free and appropriate public school education must be made available to all children regardless of handicap or disability. Occupational therapy, physical therapy and speech therapy was included in this act as a related service to help a child benefit from, or gain access to, educational programs. Therapists are employed within these settings to help children with special needs to promote educational goals and transition a child toward achieving full potential. Functional life skills (the ability to perform age appropriate functional skills) rather than meeting developmental goals is the focus in this setting.

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Early Intervention
Early Intervention is a comprehensive, coordinated, community based system for developmentally vulnerable or delayed young children (and their families) from birth to age three years. Early Intervention consists of multidisciplinary services designed to enhance child development, minimize potential delays, remediate existing problems, prevent further deterioration, limit the acquisition of additional handicapping conditions and promote adaptive family functioning.  The goals of Early Intervention are to provide developmental and therapeutic services for children, and support and instructions for their families. These services are federally mandated, individualized and family focused. 

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Applied Behavior Analysis (ABA)
Applied Behavior Analysis is a technique used to teach children social, emotional, adaptive and academic skills. Most commonly utilized with children exhibiting autism spectrum disorders, Applied Behavior Analysis utilizes a teaching structure in which behaviors are broken down into smaller components, and then modified using reinforcement techniques. Following a behavioral assessment, a program is developed, using prompting and reinforcement to teach age appropriate skills. Strict data collection methods are utilized to monitor and assess the effectiveness of the teaching program.  As skills are mastered, the educational program is adapted. Many different disciplines may use these techniques to work with children, although the most frequent provider of services is the special education teacher.

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Preschools
Preschool settings provide educational and related services (Occupational Therapy, Physical Therapy and Speech Therapy) to children aged 3-5 years old. The child may be seen in the home, in a day care center or in a center based nursery school setting. Special Education Itinerant Teachers (SEITs) provide one on one services to children so mandated by their local department of education.

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Evaluations (All Ages)
Outside agencies often require evaluations by therapists and special educators, in order to determine whether a child qualifies for early intervention or school based related services as well as to determine the need for assistive technology.

Additionally, agencies require evaluation services to determine therapy and equipment needs for patients recently discharged from a facility to a home care setting and for adults suffering from a variety of acute and chronic conditions (such as muscular dystrophy, multiple sclerosis, cerebral palsy, etc).

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