Inpatient Pediatric Rehabilitation at Children’s Hospital of Philadelphia is an 18-bed unit located within Children's Hospital of Philadelphia (CHOP) in Philadelphia, Pennsylvania. CHOP is the nation’s first hospital devoted to the care of children. Since 1855, CHOP has been the birthplace for breakthroughs and dramatic firsts in pediatric medicine. Built on a foundation of delivering safe, high-quality, family-centered care, the hospital has fostered medical discoveries and innovations that have improved pediatric healthcare and saved countless children’s lives. CHOP provides the continuum of care for patients from acute care to outpatient care as needed in Philadelphia and the surrounding counties. 

The Inpatient Rehabilitation Unit recently earned accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF International is an independent, nonprofit accreditor of health and human services that uses a set of internationally recognized organizational and program standards to help rehab providers optimize care and enhance the lives of patients served.  

Our unit's performance - highlighted in our annual report and our strategic plan - will continue to lead us to provide the best care for our patients and families.

Specific services offered:

Inpatient Pediatric Rehabilitation at CHOP provides services 24 hours a day, 7 days a week, 365 days a year. Providers include Rehabilitation Providers (available 24 hours a day, 7 days a week), Rehabilitation Nurses (available 24 hours a day, 7 days a week), and occupational therapy and physical therapy (at least Monday through Friday for 8 hours and weekend treatment as ordered). Social work, speech-language pathology and audiology services are also available. Hours and frequency of services are personalized to the needs of the person served.

Outpatient Rehabilitation is available in Pennsylvania and New Jersey with hours between 7 a.m. and 8 p.m. Monday through Friday, and the hours vary by location. The Inpatient Pediatric Rehabilitation unit provides medical services, diagnostic imaging, laboratory services and pharmacy services on site at an unlimited capacity, for all patients admitted to the unit. Pastoral care, nutrition, psychology, case management, and wound care are hospital-based and available throughout the patient's stay. Other services such as orthotics, prosthetics, wheelchair and seating evaluations are available by referral as needed. All services are provided in person, telemedicine is not available for rehabilitation services.

• Nursing Care Services: Nursing services are provided 24 hours a day, 7 days a week, 365 days a year. Nurses provide care to patients with inpatient rehabilitation goals and use assessment skills and critical thinking to manage medical problems and prevent complications. Nursing is responsible for meeting the patient’s rest, comfort and hygiene needs as well as nutrition and medicine needs while maintaining a safe environment. Prior to discharge, Nursing services provide education to patients/families on how to care for the person served to ensure the patient/family is prepared for discharge.  
• Provider Care Services: Provider care services are available 24 hours a day, 7 days a week, 365 days a year to patients admitted to inpatient rehabilitation. The medical team members, consisting of many different levels of providers, examine patients daily, discuss patient care in interdisciplinary daily rounds, and update patients and families as needed throughout the day. They also are available for acute concerns as needed including overnight. They work closely alongside other team members to ensure patients are safe and able to participate in their therapies to the best of their ability each day.
• Child Life, Education and Creative Arts Therapy Services: Child Life Specialists/Recreational Therapists are experts in child development and utilize play as their primary intervention. Through individual and group sessions, they educate patients about their diagnosis, improve coping with hospitalization, and reintroduce play to children recovering from illness or injury. They also partner closely with families and the entire rehab team to prepare for successful community re-entry. Creative Arts Therapists (CATs) are trained in both their modality, human development and psychotherapy. Music, art and dance/movement therapies support patients in identifying and expressing feelings, coping with treatment, and decreasing anxiety, stress and pain. As part of the treatment team, CATs may work toward rehabilitation goals such as speech, cognition, problem-solving, fine motor skills and body awareness.  
• Social Work Services: Social work provides professional services to patients and families, which facilitates the use of individual, public and private resources so that optimal functioning can occur for both the patient and the family.  These core services include assessment of psychosocial functioning and capacities; counseling for care planning and decision-making; social work treatment; and community resource planning.  Social workers collaborate with many disciplines, programs, departments and organizations in the accomplishment of these duties.
• Physical Therapy Services: Physical therapists manage movement dysfunction and enhance physical and functional activities. They restore, maintain and promote optimal physical function, wellness, fitness, and quality of life as it relates to movement and health. Physical therapists prevent the onset, symptoms and progression of impairments, functional limitations and disabilities that may result from diseases, disorders, conditions or injuries.
• Occupational Therapy Services: Occupational therapists are trained in interventions that support individuals to achieve independence in all aspects of their daily life. This may include activities of daily living (dressing, bathing, grooming), functional mobility, upper-extremity functioning (including fine motor skills), cognition, vision, scar management and splinting.
• Speech-Language Pathology Services: Speech-language pathologists provide evaluation and therapy services to children with speech, language, swallowing and/or cognitive impairments. Rehabilitative services include loaning of augmentative and alternative communication (AAC) devices during the inpatient rehab admission, and, when indicated, assistance with scheduling AAC device evaluations upon transition to outpatient care.
• Neuropsychology Services: Rehabilitation neuropsychologists evaluate cognitive functions associated with medical conditions that affect the central nervous system, including traumatic and non-traumatic acquired brain injuries, brain tumors, epilepsy, hypoxia and encephalitis. Neuropsychologists may be involved at all stages of recovery. Evaluations include serial monitoring of mental status and cognitive functions throughout the inpatient admission, as well as a targeted neuropsychological evaluation prior to discharge. Results of these evaluations help the interdisciplinary treatment team to understand a patient’s cognitive strengths and weaknesses and provide the patient’s caregivers and school team with information they can use to determine necessary supports following discharge. Neuropsychologists may also provide education on brain injury to patients and their families and caregivers.
• Audiology Services: Audiologists provide comprehensive diagnostic and rehabilitative audiology services including, but not limited to, behavioral audiologic assessments, balance assessments, auditory brainstem response (ABR) testing, hearing device technology evaluations and checks, and loaning or dispensing of hearing device technology.
• Integrative Health: The Integrative Health Program at CHOP enhances traditional medicine with complementary therapies. Integrative health’s holistic approach considers the whole child’s physical, emotional and spiritual well-being. This approach includes nonpharmacological therapies for pain control and other symptom management such as yoga, acupuncture, massage, mindfulness, reiki energy therapy, and aromatherapy. Our therapists work with the inpatient rehabilitation team to help patients reduce stress, anxiety and pain and improve mobility, physical function, sleep, digestion and general health.  
• Pet Therapy: Facility Dogs are specially trained from a Service Dog organization to support patients with goal oriented interventions with their handler.  Child Life staff members facilitate Animal Assisted Therapy (AAT) interventions with a Facility Dog. Services are based upon assessments made by the Rehab team and handler and the availability of the Facility Dog. Facility Dogs help assist patients with motivation for therapy sessions, meet ambulation goals, Activities of Daily Living (ADLs), and community reintegration. Additionally,  our program has wonderful volunteer Therapy Dogs who make occasional visits to the inpatient unit to provide socialization and comfort at the bedside.  
• Education Coordination/School Services: Education Coordinator works with families and schools to bridge a safe plan for a child to return to school by communicating a patient's needs and recommendations. Given an extended hospitalization, patients have access to the hospital school program to work on schoolwork or academic needs. Education Coordination includes support through guidance of special education planning, documentation, and school re-entry meetings to collaborate with families and schools to ensure a supportive return to education.  

Payer sources: We currently have various contracts with insurance providers including commercial and government plans, such as Medicaid FFS, Medicare, Tricare and Managed Care Medicaid. Always check with your healthcare insurance plan for up-to-date coverage information.

Fees: Current approved Medicaid and Medicare fee schedule for Pennsylvania and established fee schedules with contracted payers. Contracted and non-contracted rate schedules.

Referral sources: Referrals must be made by a licensed health professional who is actively involved in the patient’s treatment team. Persons referred to the program will be screened according to the program's admission criteria to determine their potential to participate in and benefit from a comprehensive inpatient rehabilitation program. Most of the Inpatient Rehabilitation admissions come from within a CHOP acute care setting. Other referral sources come from CHOP outpatient clinics, surrounding outside hospitals and from home.

Populations served: Comprehensive rehabilitation services are provided to all who have experienced an injury or illness that has resulted in the loss of function/abilities in activities of daily living, mobility, cognition and communication.

Diagnoses considered appropriate for a referral to inpatient rehabilitation include but are not limited to:

• Brain injury both traumatic and non-traumatic
• Spinal cord injuries both traumatic and non-traumatic; complete and incomplete levels of C1 and below and do not require a ventilator will be accepted if the above criteria are also met. Patients who are experiencing a late-onset complication of spinal cord injury and require a period of hospitalization will also be considered.
• Neurologic disorders
• Orthopedic conditions
• Cardiac/pulmonary conditions
• Debility related to significant medical illness

We do not serve:

• Predominantly psychiatric or severe, functionally limiting psychiatric condition
• Medical condition(s) that disrupt the ability of therapists to consistently provide rehabilitation therapies
• Medical condition(s) that limit the patient’s ability to receive consistent therapies
• Ventilator patients
• LVAD patients
• Patients that need dialysis

Parameters:

• Age: Patients are typically 0-21 years old and occasionally older
• Medical acuity/stability:
  • Stable, clear airway — can have a tracheostomy but cannot require pressure support (i.e. vent). Can have stable noninvasive pressure support (CPAP, BIPAP) through facemask or nasal cannula
  • Stable O2 requirements for the past 24 hours
  • O2 requirement of 40% or less
  • No fever within last 24 hours
  • Not requiring transfusions >=2x/week
  • Stable nutritional status (tolerating PO diet or stable enteral or TPN feeds)
  • Transitioned from IV to oral pain medications
  • Tolerating at least 5x/week rehab therapy without significant deferrals
  • No worsening neutropenia
  • Stable BP without need for pressors for the past 48 hours (no acute interventions)
  • No unexplained worsening in neurological status within the past 24 hours
  • Not actively experiencing ketoacidosis
  • Baseline labs within an acceptable range for 48 hours
  • Platelets > 20,000, Hgb >7.5, ANC>500
• Impairments: Patients may present with problems in body function or structure such as a limited strength and range of motion, bowel/bladder problems, loss of vision and/or dysphagia. Other common impairments might be increased/decreased muscle tone, poor balance, poor memory, aphasia, dysarthria, apraxia, etc.
• Activity limitations: Due to impairments described above, there may be limitations in the ability to perform activities of self-care including feeding, talking, grooming, toileting, bathing, dressing, walking, and/or other functional daily tasks.
• Participation restrictions: Patients may experience restrictions related to their participation in school, the home environment and the community.
• Psychological status: Patients may require monitoring and treatment in relation to family dynamics, adjustment and coping with a diagnosis.
• Behavioral status: Patients may have behavioral issues associated with their diagnosis that can be addressed in rehab. Our rehab is not equipped to handle predominantly psychiatric or severe, functionally limiting psychiatric conditions.
• Cultural needs: The unit is sensitive to the cultural, gender, gender identity, ethnic, religious, and personal needs of the persons served. The program gathers information on these needs from the individual and their family members prior to and upon admission. Every effort is extended to meet these needs through program modification and, if required, additional services. Patients and families are encouraged to advise staff members of their personal preferences.

Entry/admission criteria:

• Medically stable at the time of the admission
• Medical work-up complete
• Insurance precertification
• At least two therapy disciplines (PT/OT/SLP) needed
• Patient demonstrates potential for progressive functional improvement through rehabilitative therapies at the time of admission
• Patient has objective and measurable goals that can be met by the services/programs offered in a reasonable timeframe
• Patient can tolerate inpatient therapy frequency, duration, and intensity
• Patient has functional impairment that will improve with physical, occupational, and/or speech therapy, with an interdisciplinary team approach
• Patient must be able to fully participate in the inpatient rehab program with the ability to follow the age-appropriate patient responsibilities

If a referral is made that is outside of the entry criteria, the case will be reviewed by the multidisciplinary team to determine eligibility. The Rehab Medicine Provider is responsible for making the admission decision and communicates admission decision to the referral source. When the person is found ineligible for services, they are informed of the reasons and recommendations for alternative services.

Admission process:

Rehabilitation Medicine Providers receive a consultation from the referral source. The consultation team decides whether the patient would benefit from inpatient rehabilitation, and a decision is made to accept pending medical clearance. Internal referrals are then added to the inpatient referral list. Case Management Coordinator performs all insurance approval communications. Once insurance authorization is approved, the patient is admitted to inpatient rehab.

Continued stay criteria:

The patient must demonstrate that they are benefiting from the program, making progress toward reasonable goals, and that inpatient rehab is the most appropriate level of care.

Transition/exit criteria:

• Discharge/transition planning occurs throughout all phases of the program.
• The person served meets voluntary and/or nonvoluntary discharge/transition criteria when:
  • The goals of the individual plan are achieved, and referral is completed, when appropriate
  • Patient is no longer medically stable
  • Patient is unable to participate in the interdisciplinary rehab program
  • The patient has limited potential for recovery and caregiver training and equipment evaluation is completed (for example., the patient's functional status has remained unchanged or additional functional improvement is unlikely within a reasonable timeframe)
  • Patient/family chooses to exercise legal rights and refuses continued services
  • The goal of discharge from the inpatient rehabilitation unit is being discharged back into the home environment. In some instances, alternative discharge locations may be necessary.

Published in June 2024