The ideal standard of care for team models in neurorehabilitation


Karol, Robert L.  (2014). Team models in neurorehabilitation: Structure, function, and culture change. NeuroRehabilitation, 34, 655-669.


This article describes four team models used in rehabilitation. The single discipline model was the traditional medical model used primarily prior to WWII.  In this model, there is minimal to no integration among different disciplines of treatment providers. The complex nature of people with neurological disorders does not lend well to use of this narrow focus of care.  In the multi-disciplinary treatment team model, each discipline treats the person with very discipline-specific approaches simultaneously via communication through the physician who orders specific treatments.  Each discipline in the inter-disciplinary model develops their own goals while sharing responsibility for some domains of treatment. The inter-disciplinary model takes the team approach a step further and recognizes that disciplines overlap in expertise and clinical focus.  This model decreases territorial boundaries among the various providers.  The exemplary standard of team integration is the trans-disciplinary model. In this model, the treatment professionals do not divide up the person’s goals according to discipline but develop team-wide goals to address a sequence of issues beginning with basic, foundational issues.  The author details the trans-disciplinary team model including commentary on the importance of neurobehavioral interventions, core staff descriptions along with rounds attendance, set up of physical areas where the treatment team is housed, leadership suggestions, scope of practice statements, staff selection suggestions, and peer relationships. He further discusses the culture change necessary in implementation of a trans-disciplinary team approach and suggests specific initiatives for development of this model within a treatment facility.  A main emphasis of this article is integrated and person-centered care. 

I SELECTED THIS ARTICLE BECAUSE of the conceptual nature delineating treatment approaches.  While there are various challenges within our current health care system for the trans-disciplinary approach, the author’s description and support of this model promotes a great way to conceptualize treatment for complicated neurological issues. 

Even within constraints of a health care system set up for a more inter-disciplinary model, the rehabilitation psychologist can utilize this article to promote a more person-centered approach with a high level of team integration to effect better outcomes for patients. 

THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Kier Bison, Ph.D., ABPP RP, Rehabilitation Psychologist in the Neuropsychology Department of Baylor Institute for Rehabilitation Day Neuro Program, Dallas TX and a Member of Division 22's Science Committee.