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Therapy and Treatment Services

Special Tree offers a broad array of treatment services and therapies provided individually or as part of an interdisciplinary team approach. Most services and therapies may be provided in inpatient, outpatient, or home and community settings, consistent with the needs and preferences of the person. In addition to more traditional services, Special Tree frequently makes creative use of alternative therapies and modalities when there is an indication that alternative procedures would be useful in helping the person achieve their rehabilitation goals.

Special Tree offers the following treatment and rehabilitation specialties:


Nursing Care

Special Tree employs a variety of Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) who provide neurorehabilitative care for clients at our NeuroCare inpatient center and oversee care and manage cases at our residential locations. Nurses also function at Special Tree in a variety of other roles such as nurse education, case management, conducting assessments for client admissions, recruiting, and marketing.

In addition to traditional nursing care, Rehabilitation Nurses provide highly specialized services for clients dealing with issues relating to traumatic brain injuries, spinal cord injuries, and multiple trauma injuries. Special Tree nurses are skilled in caring for clients with tracheotomies, G/J-Tubes, and ventilator dependency, and provide education relating to bowel and bladder retraining, skin care, and more. They are an integral component of the interdisciplinary rehabilitation team, working closely with the respiratory staff, dietitian and nutrition services, physicians, therapists, case managers, and others to provide for clients' day-to-day needs.

Nurses also receive important assistance from our team of Rehabilitation Service Technicians (RSTs) who help clients with personal care and activities of daily living. Special Tree RSTs participate in an extensive amount of classroom and hands-on training through our Learning Systems program, recognized as an exemplary training program by our accreditors. In addition to their initial orientation, Nurses, RSTs and all Special Tree staff are required to participate in continuing education and training updates to maintain their skills and stay in touch with current best practices in care, safety, and rehabilitation.

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Respiratory Therapy

Respiratory Therapists are uniquely trained to treat conditions of the cardiopulmonary system—they evaluate and manage the respiratory needs of clients who have impaired lung function and related needs. On site at the NeuroCare Center 24 hours per day, Special Tree Respiratory Therapists work aggressively to help clients regain their freedom by reducing or eliminating their dependence on mechanical ventilation and artificial airways, weaning clients from ventilators and tracheotomies whenever possible. They may also serve as consultants to clients and staff at our residential locations.

In managing the respiratory component of a client's care, a Respiratory Therapist may perform tasks such as operating and maintaining equipment to administer oxygen or assist with breathing (often through a "vent" or "ventilator"), managing therapy that will help a client recover lung function, administering medications to help alleviate breathing problems and prevent respiratory infections, monitoring a client's levels of oxygen, carbon dioxide, and other gases, or maintaining a client's artificial airway, commonly called a "trach" or "tracheotomy." Certified by the National Board for Respiratory Care, they are either Certified Respiratory Therapists (CRTs) or Registered Respiratory Therapists (RRTs).

At Special Tree, our respiratory team is an amazing bunch. Not only do they treat the 'clinical' needs of clients, but they participate in their overall rehabilitation goals, too, by helping them participate in individual and group activities and community outings. Special Tree clients are not prevented from getting out into the community just because of their respiratory needs. Respiratory Therapists have accompanied clients swimming, to sporting events, movies, fireworks, local cultural attractions and more. Whether it is getting outside to enjoy the warm summer sunshine, heading downtown to a Tigers game, or just going out to dinner, Special Tree clients are often able to participate in important family and community events.

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Physical Therapy

Physical Therapists (PTs) are experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect peoples' abilities to move and function the way they want. They treat clients through the use of therapeutic exercise and functional training. Using a variety of activities, physical therapists concentrate on helping clients achieve the highest level of mobility, head and trunk control, sitting and standing balance, and walking if possible. Depending on a client's particular needs, physical therapists may employ methods to help 'reeducate' muscles that have been affected by an injury, or treatment to improve motor coordination. In addition to hands-on care, physical therapists also educate clients about ways to take care of themselves or perform certain exercises on their own, and help clients make use of adaptive equipment (such as wheelchairs or orthotic devices) to enhance their mobility. Physical therapists also use methods (often called modalities) such as ultrasound (which uses high frequency waves to produce heat), functional electric stimulation for muscles, aquatic therapy, muscle massage to promote proper movement and function, hot packs, and ice.

PTs work very closely with the Special Tree interdisciplinary rehabilitation team to help clients improve mobility to go about their activities of daily living. For clients who have experienced brain injuries, the primary focus of physical therapy may be on strength, mobility, and endurance. PTs work to reduce tone and spasticity, and reduce the effects of immobility on bones and muscles. This is also true for clients with spinal cord injuries, but the emphasis here may shift to include education and training on the use of adaptive equipment, learning ways to obtain assistance from caregivers and other individuals, and focusing on clients managing their environment to maximize independence.

Special Tree employs licensed Physical Therapists (PTs) and Physical Therapy Assistants (PTAs). After completing a masters or a doctorate degree in Physical Therapy, PTs are required to take a national examination and be licensed by the state of Michigan. Physical Therapy Assistants complete a two-year program, working under the supervision of licensed PTs. Some physical therapists may seek advanced certification in a clinical specialty, such as orthopedic, neurologic, cardiopulmonary, pediatric, geriatric, or sports physical therapy.

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Occupational Therapy

Occupational Therapists help individuals increase their independence by focusing on improving their skills to perform everyday activities. This may include routine tasks such as eating, dressing, bathing and personal care, or more complex activities such as time management, decision-making, meal preparation and planning, return-to-work activities, and more. The overall goal is to increase a person's independence in all facets of their life, working on "skills for the job of living." Occupational Therapists work with the interdisciplinary team to help clients achieve their overall rehabilitation goals.

Treatment may include customized programs to improve one's ability to perform daily activities, comprehensive home or job site evaluations with adaptation recommendations, skills assessments, recommendations and usage training for adaptive equipment, and education and training for clients, their family members, and caregivers who may be helping clients return to their home and work environments.

Occupational Therapists are skilled professionals whose education includes the study of human growth and development with specific emphasis on the social, emotional, and physiological effects of illness and injury. Occupational Therapists (OTs) earn a bachelors, masters, or doctoral degree, and often work closely with Certified Occupational Therapy Assistants (COTAs) who earn associate degrees. Clinical internships in a variety of health care settings are a routine part of OT training, followed by the completion of a national examination and registration within the state of Michigan.

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Speech and Language Pathology

Speech-Language Pathologists (SLPs) specialize in the assessment and treatment of communication disorders. This includes disorders of speech, language and swallowing. At Special Tree, SLPs (sometimes referred to as speech therapists) treat clients with brain injuries and other neurological impairments whose injuries have affected skills such as eating, swallowing, verbal and non-verbal communication, memory, sequencing, problem-solving and more. Individual differences in brain function, and location and spread of a client's injury require treatment unique to each individual. Speech-Language Pathologists work with the interdisciplinary team to develop appropriate rehabilitation for each client.

In treating speech and language disorders, SLPs employ a variety of treatment techniques. They may work on drills and exercises to improve specific language skills such as naming objects or following directions. Clients may learn compensatory techniques, or may learn ways to make use of stronger language skills (such as gesturing) to compensate for weaker language skills (such as talking). Some may also learn to use an augmentive or alternative communication aid (such as sign language or a computerized communication device) if needed. Individual or group treatment sessions and community outings offer clients opportunities to practice communication strategies in real life situations. Pre-vocational and vocational assessments may also be conducted to help clients learn skills that will facilitate their return to work.

An area which is often overlooked but is essential to Speech-Language Pathology is swallowing. Swallowing is as necessary to your life as breathing. Under normal circumstances, we depend on swallowing in order to get the nutrients we need to live. SLPs assess clients strength and movement of the muscles involved in swallowing, and observe feeding to see a client's posture, behavior, and oral movements during eating and drinking. Speech therapy may involve special tests to evaluate swallowing. Therapists may recommend exercises, positions, or strategies to help clients swallow more effectively. Working closely with the Dietary Manager and Nutritionist, specific food and liquid textures that are easier and safer to swallow may be recommended.

Speech-Language Pathologists earn a Master's level degree and must be certified by the American Speech Language and Hearing Association (ASHA). At Special Tree, Therapeutic Service Technicians (TSTs) who have undergone training within the Special Tree Learning System may assist SLPs in carrying out some of the recommendations for clients. Rehabilitation Assistants (RSTs) also play an important role in treatment in their daily interactions and communication with clients, as well as assisting clients at mealtimes. RSTs work closely with SLPs to learn each client's needs if they have specific communication, eating and swallowing issues related to their care and rehabilitation.

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Therapeutic Recreation

Therapeutic Recreation helps clients improve functioning and independence, and helps reduce the effects of illness or disability. Therapists provide recreation resources and opportunities in order to improve clients' health and well being. Services are delivered by qualified professionals who are formally trained and credentialed, through national testing, by the National Council for Therapeutic Recreation Certification.

Differing from diversional or recreation services, recreational therapy employs various activities as a form of active treatment to improve clients physical, cognitive, emotional and social functioning. Therapeutic recreation helps clients develop skills needed to function independently in the community and with their families. Therapy may be provided on-site, at a clients home, or in the community. Clients participate in activities they enjoy which will also help reduce the effects of their disability. Therapy may be designed around learning new skills and activities, or to help clients learn new ways to participate in activities they enjoyed prior to their injury. In addition to helping clients improve their quality and enjoyment of life, many such activities provide opportunities to increase mobility, develop memory and problem solving skills, practice communication, and work on functional and therapeutic tasks that may be part of a clients overall rehabilitation program.

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Massage Therapy

Therapeutic massage involves manipulation of the soft tissue structures of the body to prevent and alleviate pain, discomfort, muscle spasm and stress. It also improves functioning of the circulatory, lymphatic and nervous systems and may improve the rate at which the body recovers from injury and illness. Massage comes in many forms, including Swedish, which is a gentle, relaxing massage; trigger point therapy for specific muscle work; and myofascial or neuromuscular which focuses on muscle groups relevant to the particular technique. Massage Therapists use a variety of techniques to address muscle spasms and tone, decrease swelling, improve sensation, address skin problems, and promote a sense of well being.

Massage doesn't just feel good. It can reduce the heart rate and blood pressure, increases blood circulation and lymph flow, relax muscles, improve range of motion and increase serotonin and endorphins, enhancing medical treatment. For clients with brain injuries and spinal cord injuries, massage therapy can be an important component of a client's overall rehabilitation program. Based on physicians orders, Special Tree clients may receive therapeutic massage to complement traditional medical treatment for illness, injury and pain as a growing body of research documents its efficacy. In addition to the benefits to the body's circulatory and muscle systems, massage helps clients learn to relax, improves breathing, and can promote body awareness and help clients increase or decrease their level of sensitivity, all of which can help clients be more successful in their participation in other therapies. As part of the interdisciplinary treatment team, Massage Therapists are always working in support of a client's overall rehabilitation goals.

Special Tree massage therapists are licensed through the Board of Massage Therapy of Michigan. The licensure process incorporates certification from an accredited massage therapy program including a nationally recognized test i.e. NCTMB or MBLEx; testing in ethics, standards of practice, pain and competency; requiring renewal every 3 years achieving continuing education credits to remain current and competent in the field. Some Special Tree therapists may also have additional training in fields such as Occupational Therapy or modalities of Lymphatic Drainage and/or Myofascial Release Approach.

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Social Work

Social Workers at STRS are an integral part of company’s interdisciplinary treatment team. Our Social Workers help to identify the various social and emotional needs of clients and families, and develop and implement person-centered plans to meet those needs in order to support adjustment to the rehabilitation process. Coping with a brain injury or a spinal cord injury can present unique and complex challenges, especially if clients have experienced difficulties such as changes in personality, physical impairments, memory loss, and psychological changes. Social Workers help clients and families address these challenges, taking into account the client's cultural characteristics like age, race/ethnicity, socio-economic status, education level, religious preferences, health/medical issues, behavioral issues, family support system, amongst others.

A Social Worker will typically conduct an assessment following a client’s admission, followed by periodic updates and regular communication with the client and family. The practice of social work requires knowledge of human development and behavior; social, economic and cultural institutions; and the interaction of these factors. STRS Social Workers are highly trained and experienced professionals who have completed Master’s level post-graduate studies and are licensed by the State of Michigan. STRS also prefers that all Social Workers are Certified Brain Injury Specialists. Social Workers make sure clients and families know their rights, maintain contact with and help clients/families utilize community agencies and organizations, and provide guidance for self-help, support, and advocacy. Social workers can also treat clients individually and in groups, providing support forums for survivors including inpatient, outpatient, and even alumni clients. Additionally, they may conduct facility inservices and educational programs for other STRS staff.

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Psychology Services

In addition to treating clients’ physical and/or cognitive disabilities, it is crucial that treatment must also consider factors such as how individuals react to and cope with these significant changes, how others in their environment are adapting, and how well clients are able to reintegrate into areas that are important and valued, such as home and community. STRS’ team of highly trained, caring, and empathic psychologists help individuals adapt to the physically and emotionally intrusive rehabilitation process, and provide genuine support to clients throughout the journey of recovery.

Psychological services include individual counseling, group therapy, family/couples counseling, neuropsychological assessment, behavioral treatment programs, and psychoeducation programs for staff, clients, and families. Clinical psychologists at STRS possess Doctoral or Master's level degrees from accredited universities. Our competent and skilled clinicians who are licensed by the State of Michigan treat psychological concerns through a broad range of therapeutic approaches. Clients are viewed and respected as individuals, and treatment plans are thoughtfully tailored to meet their specific needs. Our psychologists find it imperative to learn about and take into account the client's cultural characteristics such as age, race/ethnicity, socio-economic status, education level, religious preference, sexual orientation, health/medical issues, support system, etc.

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Psychiatry Services

A psychiatrist is a physician who specializes in the diagnosis, treatment and prevention of mental illnesses and emotional problems. Because of their medical training, psychiatrists understand the body's functions and the complex relationship between emotional illness and other medical illnesses. A psychiatrist is a medical doctor who can order medical tests and prescribe medication. After earning a bachelor's degree, psychiatry students must graduate from medical school and go on to complete four years of residency training in the field of psychiatry. Psychiatrists experienced in neurorehabilitation are available to Special Tree clients for consultation and treatment if necessary.

Special Tree also offers psychological services. While related to psychiatry, psychologists undergo different types of training whose length and core emphases differ according to their field of study.

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Nutrition Services

Nutrition is important during a person's entire life but is especially important after a significant injury or illness. Good nutrition helps heal wounds and broken bones. After an injury, the need for many nutrients increases. Nutrition also plays a vital role in fighting infections, which are not uncommon following a trauma or life-altering injury. For a person who may be less mobile, good nutrition also helps maintain good skin integrity. Adequate protein and other nutrients are necessary to keep the skin healthy. As part of the interdisciplinary treatment team, the Special Tree Dietitian, Certified Dietary Manager, Dietary Staff, and Residential Staff work to provide nutritious and tasty food for clients that promotes optimal health. Special Tree complies with all food safety and sanitation practices as established by the State of Michigan.

When a person sustains a serious injury to their brain or spinal cord, their ability to eat may be affected. Many clients must receive nutrition through feeding tubes placed through their nose or through small openings in their stomach or small intestines. Tube feedings are selected based on their client's medical and nutritional needs. The amount of tube feeding and water given as well as other nutrients is determined by the dietitian and approved by the physician. When a client is ready to eat or drink again, the dietitian and the speech therapist work together to manage the transition to oral feedings.

All clients receive a nutrition assessment upon admission to help develop a nutrition care plan based on their individual needs. The nutrition status of each client is monitored by the observation of dietary intake on a daily basis; tube feeding intake, fluid intake, weights, laboratory values and input from the client, their family, and Special Tree staff. Care plans are adjusted whenever necessary.

In addition to the nutritional aspect of food, Special Tree also recognizes that food and mealtimes can be an important part of the day for clients, both socially and psychologically. A critical goal is to provide food that is nutritious as well as tasty and enjoyable. Food is presented in an appealing manner. At the NeuroCare Center, for example, food that must be pureed for clients is reshaped into its original form, so that the plate is appeals to clients because it looks good as well as tastes good. Regular "diversity dinners" highlight ethnic foods and cultural dishes, meal exchanges between facilities, and holiday and seasonal gatherings also promote the enjoyment of meals in addition to their nutritional value.

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Attending Physician Services

In addition to a full time Medical Director and certified Physician Assistant who provide general medical services to all Special Tree clients, a team of consultant physicians, including specialists in Physical Medicine and Rehabilitation and Psychiatry, provide critical input into clients care and treatment. Clients are encourage to continue relationships with medical specialists and family and hospital physicians who may currently be providing treatment and guidance in client's post-injury rehabilitation. Special Tree's Transportation Coordinator, Case Managers, and other staff assist in coordinating follow-up care and frequently accompany clients to appointments with physicians and medical specialists.

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Internal Case Management

Special Tree Case Managers (sometimes called Program Managers) drive the entire rehabilitation process. As the link between clients & families and their physicians, insurance company, external case manager, outside stakeholders, community resources, and the Special Tree treatment team, Case Managers are the 'go to' person for everyone involved. Upon admission, Case Managers meet with clients and their families to explain the rehabilitation process. They advocate for client's needs throughout treatment, and serve as the main contact between Special Tree and client families.

Special Tree Case Managers often have a medical or therapy background, such as a degree in nursing or therapy, so that in addition to their project management and customer relations skills, they also have a strong understanding of the neurorehabilitation process. Case Managers help coordinate the activities of the interdisciplinary team by ensuring all members are working toward the same overall rehabilitation goals. They provide feedback regarding objectives and outcomes, effectiveness of treatment, and client and family concerns. Case Managers manage care conference meetings, develop progress reports, assist with transition and discharge planning, ensure therapy orders are being carried out, resolve day to day problems, coordinate doctor appointments, assist with transportation needs, and essentially coordinate all of the services that clients may require.

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