Your Goals
Our Mission

Spinal Cord Injury

Rehabilitation programs are about goals and expectations. For a person with a spinal cord injury, it's probably less about where you once were, and more about where you're now heading. At Special Tree, we're committed to helping you get to wherever that is. To helping you build an empowered lifestyle with increased personal control and independence—connecting with people, your community, and the world.

To help you achieve this, staff professionals partner with you to design a customized rehabilitation plan—built around your unique abilities and set up to meet your specific needs. And it's all driven by you; by your goals and where you want to be. With a variety of settings, Special Tree serves persons with spinal cord injuries on either an extended stay or respite basis in our subacute unit, in residences with 24 hour personal support, and in supported living apartments. We can also do a comprehensive assessment for your home or apartment setting, provide mobility assistance, transportation, help with employment, or personal assistance services. Traditional therapies are available in all of these settings and on an outpatient and in-home basis, too.

We offer you as many options as possible, then work creatively with the resources available to get the work done. Because at Special Tree, what is really important to us is making sure the people we serve have the choices they deserve.

We invite you to browse our helpful Links and Resources for persons living with spinal cord injury. 

Spinal Cord Injury Program Scope of Practice for Inpatient Rehabilitation

Our Mission:

Special Tree’s Spinal Cord program exists to provide hope, encouragement, and expertise for people who have experienced life-altering changes.

Our Vision:

To lead the Midwest as the premier provider of rehabilitation, care, and treatment for adults and adolescents with spinal cord injury in the sub-acute, residential and outpatient settings.

Our Approach:

Our whole person approach to rehabilitation encompasses one’s body, mind, heart and spirit. This approach is called the “Science of Caring” and it is at the center of everything we do. 

Our Clients:

Special Tree’s Spinal Cord Program serves both adults and adolescents and is designed to meet the individual needs of those clients recovering from a traumatic spinal cord injury throughout their life-span.

At the Neuro Care Center, we accept and are able to care for all levels of Spinal Cord involvement including:

  • ASIA A, B, C, D, E
  • Clinical syndromes including Central Cord
  • Brown-Sequard
  • Anterior Cord
  • Conus Medullaris
  • Cauda Equina

We are able to care for those with spinal cord injuries with multiple co-morbidities including but not limited to:

  • Respiratory Compromise
  • Dysphagia
  • Obesity
  • Orthopedic injuries
  • Brain Injuries
  • Renal Dysfunction
  • Psychiatric Diagnosis
  • Substance Abuse
  • Communication Disorders
  • Visual Dysfunction

With our expert Respiratory Therapy Department, we are able to take the highest level of ASIA A spinal cord injuries including those dependent on ventilator support. Our Neuro Care Center provides integrated medical and rehabilitation services 24 hours a day, 7 days per week. Therapy is offered 7:00am-5:00pm 5 days a week.

Special Tree accepts referrals from all over the country.  Our primary referral source is University of Michigan Hospital, Rehabilitation of Michigan Hospital, and Beaumont Health Care.  We accept multiple insurance plans along with those that are able to pay for services, through fee sponsorship or personal funds. We make every effort to provide our services through Auto No-Fault insurance, Worker’s Comp, Veteran’s or private insurance plans, or through private pay arrangements

Our Interdisciplinary Team:

Physician Services: Special Tree offers comprehensive medical management. Our Physician Services include our SCI medical liaison, Dr. Maryam Berri, who is board-certified in Spinal Injury Medicine and Physical Medicine and Rehabilitation, Physician Assistants, PM&R and Family Medicine Physicians.

Physician Services protocol include a complete comprehensive physical examination upon admission. Upon which a review of all medical systems including but not limited to:

  • Abnormal Tone
  • Autonomic Dysfunction
  • Bowel and Bladder Function
  • Body Composition
  • Nutrition
  • Pain
  • Circulation
  • Infection Management
  • Medication
  • Musculoskeletal Complications
  • Neurological Changes
  • Respiration
  • Sexual Function
  • Skin Integrity
  • Ventilation Support
  • Men’s and Women’s Health
  • Co-morbidities are addressed  
  • Sleep Disorders

Special Tree’s comprehensive Laboratory Services as well as capability of mobile X-ray services enable prompt diagnostic testing so that the plan of treatment can be modified timely and as needed. In addition, Special Tree is able to do PICC/Medline placement and consult on dialysis. Access to mobile consultants/referrals are made as indicated including Urology, Pulmonology, Psychiatry, PMR, Neurology, Orthopedics, Gynecology, etc.

Physician Services also will discuss the findings with the client and social support system throughout their stay including at initial assessment and during care conferences. The plan is reviewed and modified as needed based on the individual needs of the client.

Nursing Services: Special Tree’s Neuro Care Center provides 24-hour nursing care via LPN, RN, CRRN, CNA. At admission, nursing services will complete a comprehensive nursing and respiratory assessment including but not limited to:

  • Entering physician orders
  • Initiating bowel and bladder program/tracking
  • Updating the care plan
  • Scheduling ADL care
  • Health Promotion and Wellness
  • Performing a comprehensive skin assessment and turning schedule.

At admission, labs are drawn so any co-morbidities or secondary issues can be managed by Physician Services and Nursing.  The nursing staff at interdisciplinary rounds and acuity meetings will discuss and modify the care plan on skin integrity/alterations including wound treatment plan and wound status, vital sign trends including hyper/hypotension, medication review and updates, blood sugar and autonomic dysreflexia episodes and triggers, review of lab results, bowel and bladder programming status, infection and other medical complications including co-morbidities and barriers to recovery.  

The nursing staff throughout the clients stay will provide education on all areas of their care including prevention of secondary complications, medication management and social support system education on going required immunizations. Our nurses also perform the education section on bowel and bladder care during the Spinal Cord learning series.

Respiratory Therapy: Special Tree provides 24 hour licensed Respiratory Therapist care to our Clients with a Spinal Cord Injury (SCI). From pre-admission when equipment is ordered to admission assessments were breathing exercises, therapy and equipment is utilized. The respiratory therapist will manage ventilator support, trach care, weaning schedule and utilize equipment and therapy of CPAP, IPV-Intermittent Positive Ventilator (Metaneb), cough assist, incentive spirometry, oral care and ongoing education with the client and social support system.  

Psychology Services: Special Tree provides mental health support for all clients with a SCI. Upon admission, a neuropsychologist will meet with each client with a SCI to introduce psychology services and complete an evaluation of mental status, behavioral health and overall emotional functioning. From this initial encounter, the neuropsychologist provides recommendations which may include psychotherapy, community/peer support, and additional neuropsychological assessment. The neuropsychologist will also identify any recommendations concerning other disciplines involved in the rehabilitation process. In psychotherapy, counseling with the client and/or family members is tailored to each client’s specific needs, but areas of clinical focus often include psychosocial adjustment to disability, mood and anxiety, grief/loss, behavior, trauma, substance abuse, relational issues, sexuality, barriers to recovery, etc. Furthermore, the psychology department plays an active role in teaching the spinal cord educational classes on Mental Health Care and Relationships, Communication, and Sexuality.

Case Management: Each client with a SCI admitted to Special Tree’s SCI program is assigned a Case Manager. At admission the Case Manager will perform a complete assessment including documenting level of injury including ASIA level, coordinating care needs and obtaining orders for services, scheduling follow up appointments and discussing concerns with the social support system and outside consultants.The case manager will initiate the outcome assessments done at admission, quarterly and discharge. The Case Manager will lead the weekly rounds, care conferences, and set up transition plan in conjunction with team, client, social support system, and external Case Manager to facilitate discharge needs.The Case Manager will obtain prescriptions for home modifications, equipment needs, supplies, medications, nursing/attendant care, outpatient/in-home therapy. They will facilitate any needed facility tours, interviews with home health care providers, personal care assistants, home evaluation, meetings with contractors, acquisition of equipment/supplies not handled by other parties.The Case Manager will provide completion of discharge paperwork, satisfaction survey, outcome measures and 30-day post-discharge follow-up.

Social Work: Special Tree’s Social Worker at admission will meet with the client with an SCI to provide guided resources and guardianship needs. The Social Worker will explain the education process including the “Spinal Cord Injury Learning Series” and Peer Support program. They will provide the client with a SCI with an educational back pack with resources on peer support programs, research opportunities, personal care assistance and education on spinal cord injury and function. The social worker will also assist with needs throughout their stay.

Physical Therapy: The client with a SCI will be assigned a Physical Therapist (PT) at admission who is knowledgeable and skilled in treating all levels of SCI injury. At pre-admission the PT will determine durable equipment needs including wheelchair, call light system and use of smart technology. At admission the PT will perform an initial evaluation, send out alert and an ID note on transfer status, up and down times, splints/braces, and precautions. The PT will order an appropriate wheelchair on loan to initiate independent mobility and schedule and initiate the treatment plan. During their the rehab stay the PT will carry out the treatment plan with goal of improving range of motion/strength and functional mobility to the highest level of independence. Our PT department will utilize specialty equipment including aquatic therapy, functional electric stimulation, RTI electric stim bike, tilt table/standing frame, body weight support systems including use of the Zero G body weight support gait training and balance system and is a certified provider of the ReWalk Robotic assisted exoskeleton.  The PT will work closely with an ATP to provide a comprehensive wheelchair evaluation to address those complex seating and mobility needs. The PT also works closely with an orthotist who is in the facility weekly to address any orthotic/prosthetic needs. The PT will report at rounds and care conferences and discuss the client’s mobility, spasticity level, musculoskeletal/neurological complications, pain issues and barrier to recovery including motivation, receptiveness to learning/education and mood. Prior to discharge durable medical equipment/orthotic needs are addressed as well as social support system education.

Occupational Therapy: Each client with a SCI will have an Occupational Therapist (OT) who at pre-admission will determine the client’s equipment needs including the most appropriate call light system and use of smart technology. At admission the OT will perform a comprehensive initial evaluation including but not limited to:

  • Cognitive Assessment
  • ADL (Activities of Daily Living) and IADL function  
  • Range of motion and Strength
  • Splint/Braces
  • Transfer status
  • Appropriate shower chair  
  • Develop the treatment plan
  • Pre-Driving program
  • Community integration

During their stay the OT will carry out the treatment plan with goal of improving strength and range of motion, cognition, ADL and IADL function including self-feeding, bed mobility, bowel and bladder management, shower chair needs, dressing, housekeeping, cooking, tone/spasticity management, medication management and community reintegration. The OT will address occupational goals such as employment, education and parenting. The OT department may use equipment such as Mobile Arm Supports, Virtual Reality, Electric Stim and RTI Electric Stim Bike, Zero G body weight support system, pre-driving assessments, ECU controls including phone, computer and room controls as well as consulting with University of Michigan Rehabilitation Engineering as necessary.  The OT will also consult with an orthotist for any orthotic needs. The OT will take part in rounds and care conferences and discuss the client’s current mobility including ADL’s and IADL’s, spasticity and range of motion limitations, musculoskeletal and neurological complications, pain and barriers to recovery including motivation, mood, receptiveness to education. Prior to discharge the OT can perform a home evaluation where equipment/orthotic needs are addressed, review and set up of medication management as well as social support system education along with safety and emergency preparedness and environmental modifications.

Dietitian: Special Tree’s dietitian at admission will perform a nutritional assessment and recommend nutritional interventions including addressing any co-morbidities. They will provide nutritional education including information on secondary complications such as metabolism changes, obesity, bowel management and skin integrity issues. At rounds and care conferences the dietitian will report on nutritional concerns including oral intake, skin integrity, weight, labs and bowel program. Throughout the client’s stay the dietitian will provide handouts with nutritional information including prevention of secondary complications.

Speech and Language Pathologist:  Clients with a SCI with speech, swallowing, cognitive and communication difficulties are assisted by our SLPs. The SLPs will address dysphagia (swallowing) issues/needs and recommend an appropriate, safe oral diet. They will conduct bedside swallowing evaluations, with blue-dye as appropriate, and recommend swallow studies as needed. The SLPs will advance the diet and provide education on protective swallowing techniques. The SLP may use therapy equipment such as, Synchrony and PENS. The SLP may also work on cognitive programs, especially with those clients with co-morbidities such as a TBI with a SCI. The SLP will provide education and assistance with medication management and adaptive devices for communication needs. They will report the above at rounds and care conferences as indicated. Education will be provided throughout to the client, staff, and social support system to prepare for a safe discharge.

Recreational Therapist: Special Tree provides a Recreational Therapist to address and improve the leisure function and independence of our SCI clients. The Recreational Therapist will assist the client with a SCI at admission and throughout their stay with assistive technology. The Recreational Therapist will assist in setting up and educating the client at admission on the SMART technology. SMART technology will allow the client to control the environment in their room including voice activated systems to control the lamps, TV, call light, phone, music. As well as assistive technology for school, job, and leisure. They will work closely with the interdisciplinary team including rehab engineering. The Recreational Therapist will also work with the client on adaptive leisure and sports. Special Tree has an adaptive sports event where the client can engage in multiple activities of adaptive kayaking, tennis, adaptive cycles, fishing and golf. The Recreational Therapist will also set up opportunities to explore the clients interests in other various sports such as skilling, softball, bowling. Community re-entry is another goal of the Recreational Therapist where the client will go on outings addressing accessibility, barriers, emergency preparedness and resources. Our Recreational Therapist also have a program were the clients can go to the airport to simulate the process from arrival, through security, management of equipment and accessibility and transfers to the plane.Communication and education with the team and social support system is provided at rounds and care conferences including community resources.

Massage Therapy: Special Tree’s massage therapist are an integral part of the SCI program. The massage therapist will provide an assessment on admission. They will address in treatment goals of decreasing pain, tightness, stress, anxiety. They will work on sensory issues, edema and lymphatic drainage as well as addressing sleep issues. The massage therapist at rounds will discuss the goals and progress of therapy and recommend at discharge appropriate equipment/program. Education on massage therapy modalities and community massage therapy clinics provide resources for continued body movement if indicated, yoga, Tai Chi, stretching programs.

Education of Person Served and Support System:

Spinal Cord Injury Learning Series: All Special Tree clients with a SCI are enrolled in our Spinal Cord Injury Learning Series (SCILS). This is a 6-class program designed to educate the spinal cord injured client and social support system on the issues related to their injury. The class topics are: 1. SCI Anatomy and Function, 2. Taking Care of your Skin, 3. Bowel and Bladder Care, 4. Having a SCI is Complicated (Complications with SCI), 5. Mental Health Care and 6. Relationships/Sexuality and Communication-Mind Body Approach. The classes are taught by therapists, nurses and psychologists.

Computer on Wheels: Our clients with a SCI and their families have access to an education library via a computer with environmental controls so all levels of clients with a SCI  have accessibility. This computer has educational material including the power point presentations of the SCILS classes, education in-services provided to staff and new hires, links to educational resources, research opportunities including clinical trials, peer support links, adaptive equipment dealers and social media blogs.

Client and Social Support System Education and Training: Our clients with a SCI also receive the United Spinal Association Backpack filled with educational material and resources. One to one education is also provided by the interdisciplinary team on all aspects of care, prevention of secondary health conditions, activity restrictions and the environment.

Peer Support Services: Special Tree provides a peer support mentoring program to our clients with a SCI. The Peer Support Liaison is informed of the new client with a SCI at admit and then begins one to one visit.  The Peer Support Liaison will provide resources to other peer support mentors or programs as needed. The Peer Support Liaison also conducts monthly peer support education classes including topics on getting back to school and work, personal care assistants, new and improved medical supplies, environmental modifications, skin care, bowel and bladder care, sexuality and intimacy. The peer support liaison also organizes a yearly Recreational and Mobility Spinal Cord Expo where community and clients come together for educational resources of accessibility, accommodations and products.

Community Education: Special Tree sponsors the Adaptive Sports Program and SCI Mobility and Recreational Expo which allows the community to participate in multiple activities of adaptive kayaking, tennis, adaptive cycles, fishing and golf.  The SCI Mobility Expo shows the latest adaptive equipment along with vendors that supply educational information and marketing materials. During the Covid-19 pandemic Special Tree provided online educational information on staying active and maintaining a healthy lifestyle with a spinal cord injury.

The Professional Community

Special Tree’s SCI Medical Physician Liaison provides our staff quarterly educational in-services on topics related to SCI. Currently the Medical Physician Liaison, Dr. Berri, also leads Grand rounds at the University of Michigan and lectures for the SCI patients transitioning through the continuum care.

Staff Education

Along with the above the Special Tree staff have continuous education on Spinal Cord Injury including all new hire mandatory education class, Introduction to Spinal Cord and Psychosocial Issues following SCI. The staff also have yearly learning harbor class on Spinal Cord Injury and outcome tools including using the SCIM outcome measure.

Research: Special Tree is not only a premier provider of rehabilitation we are also in membership with United Spinal Association and American Spinal Injury Association (ASIA) researching the latest resources. Special Tree’s Spinal Cord Injury program uses current research and is continually educating staff in ongoing research to benefit the person served with best practices. STRS SCI program collaborates with University of Michigan to constantly improve standards of care, discipline specific. 

Transitions Across the Lifespan:

Special Tree provides continuum of care throughout our client’s lifespan but not limited to the annual Healthy Aging assessment, annual health care appraisal and peer to peer support services.

 

SCI Mobility Expo

Each year, Special Tree hosts an SCI expo and invites guests to explore exhibits, see demonstrations, and find resources for living with spinal cord injury. Topics include adaptive sports recreation, mobility aides + more.