The Pediatric Rehabilitation Unit
Established in 1979, Kennedy Krieger’s inpatient rehabilitation unit was the first program of its kind in Maryland to be accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF). The unit cares for individuals from birth to young adulthood who have decreased function for a variety of causes including brain disorders and injuries, spinal cord disorders and injuries, chronic pain, orthopedic surgery, and complex medical conditions including those requiring ventilator assistance or tracheostomy tubes. The patients receive comprehensive, interdisciplinary treatment from a variety of specialties and fields to create treatment plans tailored to the needs of each patient. The team includes practitioners from medicine, nursing, occupational and physical therapy, speech-language pathology, behavioral and neuropsychology, social work, nutrition, child life, therapeutic recreation, music therapy, assistive technology, education, and nurse care management.
Speech-Language Pathologists on the rehabilitation team conduct evaluations and treat speech, language, cognitive-linguistic disorders, and voice disorders including speaking valve use. They also coordinate oral motor and feeding/swallowing assessment and treatment, which may include completing Modified Barium Swallow studies at Johns Hopkins Hospital and Fiberoptic Endoscopic Evaluations of Swallowing. Lastly, speech-language pathologists work closely with the assistive technology department on the use of augmentative and alternative communication systems or technology to access the environment. Speech language services are provided through individual sessions as well as co-treatment sessions, when clinically appropriate. There are also opportunities to push-in to group sessions led by therapeutic recreation and music therapy.
Family training is an important aspect of the child’s admission, so that caregivers are equipped with the necessary skills and techniques to support their child’s communication, cognition, and feeding/swallowing abilities once they return home. Prior to discharge, care is coordinated with school and community providers to help patients successfully transition back into their school system, home, and community lives.
Neurobehavioral Unit (NBU)
The Neurobehavioral Unit (NBU), a 16-bed inpatient unit, is dedicated to the assessment and treatment of patients with developmental disabilities experiencing severe dangerous behaviors. Patients who are admitted to the unit have behavioral disorders that are intense enough to cause significant self-injury or harm to others. Length of stay varies, but patients generally spend several months on the NBU.
Overall treatment involves an interdisciplinary approach to integrating behavioral and pharmacological interventions for these patients. People admitted to the NBU inpatient unit receive behavioral, psychiatric, educational, medical, communication, and social assessments and interventions. Behavioral strategies follow an applied behavior analysis model.
SLPs evaluate and treat patients’ functional language via total communication (verbal speech, AAC, signs, etc.), play, literacy, feeding/swallowing, and voice skills. They partner with other professionals to identify links between communication and problem behaviors and help patients replace problem behaviors that served a communicative function with safe and appropriate means of expression. High, mid, and lite tech augmentative systems support communication alongside verbal expression. Staff and caregiver training are integrated to improve outcomes.
Pediatric Feeding Disorders Program
The Pediatric Feeding Disorders Program addresses children’s and their families’ needs relative to the complex nature of a pediatric feeding disorder. The Program includes a continuum of care: our interdisciplinary outpatient clinic where children are evaluated or seen for follow up; an intensive 6-8 week day-treatment program; or inpatient stay for more medically complex patients. Babies and toddlers may also be seen in our inpatient setting and treated by our SLPs and OTs if medically indicated. Behavior psychology offers intensive outpatient services, while SLP, OT and nutrition offer individualized outpatient services. Factors like severity of needs, medical stability, and type and intensity of service dictate the programs recommended. Children can move across levels of service, as needed.
Program directors have expertise in medicine (gastroenterology) and behavioral psychology. Other primary disciplines include nursing, nutrition, SLP, OT, and social work. Across programs, coordination of care leads to management of medical concerns, improved feeding and swallowing skills, nutritional status, and acquisition of appropriate behavior so that mealtime can become a positive experience.
SLPs utilize a variety of responsive feeding techniques incorporating their knowledge of development and specialized training in swallowing to provide comprehensive care. They collaborate with OT and provide guidance to the interdisciplinary team on recommended consistencies, textures, and feeding strategies. Experienced SLPs perform instrumental assessments when warranted. Responsibilities for the SLPs working in the Pediatric Feeding Disorders Program include initial evaluations, individual and/or co-treatment sessions with occupational therapy as appropriate, interdisciplinary team meetings and discussions, and discharge planning.