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The intent of this chapter is to provide a brief overview of common conditions and topics that may be encountered on a general inpatient rehabilitation unit; for an in-depth review of the topics, please see the corresponding chapters in this textbook.

Acute inpatient rehabilitation is a post–acute hospital level of care defined by the Center for Medicare and Medicaid Services (CMS). Acute inpatient rehabilitation can take place in a specific defined inpatient rehabilitation facility (IRF) within a hospital or as a stand-alone rehabilitation hospital. In the United States, to be recognized as an IRF, the center must provide at least 3 hours of therapy a day 5 days a week, nursing care 24 hours a day, and supervision at least 3 days a week by a physician with an expertise in rehabilitation.1

To be eligible for inpatient rehabilitation, patients must require complex nursing care, ongoing medical management, and sufficient rehabilitation needs. The required rehabilitation needs include active and ongoing interventions by physical therapy and occupational therapy with possible contributions from speech-language pathology and/or prosthetic or orthotic specialists. In complex cases such as a patient who requires dialysis, CMS allows therapies to be spread out over 7 days, provided that the patient completes 15 hours of intensive therapy per week. Furthermore, patients should make measurable gains during inpatient rehabilitation that result in improved functional capacity, adaptation to impairments, or independence in a reasonable amount of time. This is usually quantified by a functional independence measure (FIM) score2 (Fig. 55–1).

Figure 55–1

Functional Independence Measure (FIM) instrument. (Copyright © 1997 Uniform Data System for Medical Rehabilitation, a Division of UB Foundation Activities, Inc. Reprinted with permission.)

IRFs provide holistic and coordinated interdisciplinary care for their patients. The treatment team is led by the rehabilitation physician, and the team may include some or all of the following: physical therapists, occupational therapists, speech and language pathologists, nutritionists/dietitians, neuropsychologists, pharmacists, case managers, social workers, therapeutic recreation therapists, and other consulting services. The treatment team is expected to have regular conferences to communicate goals and coordinate care for each patient.1

Other levels of post–acute care include long-term acute care hospitals (LTACs or LTCHs) and skilled nursing facilities (SNFs). LTAC centers provide daily physician evaluations for patients with elevated medical needs, 24-hour nursing care, and variable amounts of rehabilitation. SNFs are typically short-term facilities within or affiliated with a nursing home and must provide nursing supervision for 8 hours a day and physician supervision at least every 30 days.


CMS requires IRFs to operate under the “60-40 rule.” This means that 60% of patients admitted to that IRF must fall within specific diagnostic categories to maintain IRF accreditation3 (Table ...

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