RND Program Criteria
- Primary cause of pain is a diagnosed amplified musculoskeletal pain syndrome. these diagnoses may include Reflex Neurovascular Dystrophy (RND), Reflex Sympathetic Dystrophy (RSD), fibromyalgia, Chronic Regional Pain Syndrome (CRPS) or amplified Musculoskeletal Pain Syndrome (AMPS).
- Patient must have orthopedic and/or other necessary medical clearances to participate in intensive PT/OT programming.
- Patient must possess a high degree of self-discipline and self-motivation.
- Narcotics and pain medications are not prescribed during inpatient stay. appropriate medications may be handled on a case-by-case basis through approval by the medical team.
- Patient must have the basic cognitive and motor planning skills to be able to participate in intensive programming and pain management education.
- There is no underlying sensory-based diagnosis that impacts the patient's perception of pain.
- There is an expectation that after therapy, between the hours of 4:00 and 8:00 p.m., the patient will visit with family and friends and participate in activities outside of their hospital room.
- Patients must begin outpatient psychological counseling services prior to admission to begin learning stress reduction, relaxation and pain coping skills.
Goals of the Inpatient Program
By the end of his or her stay in our inpatient program, patients in the RND Program should be able to:
- return full function to the affected area
- return to school and other daily activities
- increase strength, endurance and agility
- have decreased sensitivity to touch to allow for full participation in daily activities
- use skills to better manage pain and stress
- demonstrate independence with long term management of chronic pain
- identify specific stressors
- identify pain triggers and stress warning signals
- learn and implement appropriate coping skills and relaxation techniques
- practice appropriate expression of thoughts and feelings
The RND Program is challenging, and patients must have the self-motivation to participate in all the activities that will be required of them. An Agreement of Expectations was created to help patients and their families understand the treatment team's expectations as a child participates in our intensive RND inpatient or day treatment programming. Click here to view the document, which should be signed and returned on the day of admission to the RND Program.
Inpatient Treatment Program
Physical Therapy: Each child is usually seen for two hours of individual therapy and one hour of group pool therapy. During individual sessions, the child will participate in time trials, strength, endurance, stretching and sports specific activities. While in the pool for a group session, the child will participate in swimming and endurance activities. Each program is individualized to meet each child's needs.
Occupational Therapy: Each child is usually seen for two hours of individual therapy. During these sessions, the child will participate in time trials, strength, endurance, functional activities and desensitization (if appropriate).
During the first week of treatment, each child is responsible for performing an inpatient home exercise program each evening and on the weekends. The program is designed by both physical and occupational therapy, and is given mid-way through the first week. Patients are scheduled for one hour each of physical and occupational therapy on Saturdays. There is no therapy on Sundays. During the child's final week of the inpatient program, a home exercise program will be given. This home exercise program will take approximately 60 minutes to complete.
Day Treatment Program
Physical Therapy: Each child will be typically seen for two hours of individual therapy and one hour of group pool therapy. During individual sessions, the child will participate in time trials, strength, endurance, stretching and sports specific activities. While in the pool for a group session, the child will participate in swimming and endurance activities. Each program is individualized to meet each child's needs.
Occupational Therapy: Each child will be typically seen for two hours of individual therapy. during these sessions, the child will participate in time trials, strength, endurance, functional activities and desensitization (if appropriate).
During the first week of treatment, each child is responsible for performing a hom eexercise program each evening and on the weekends. This program will be given midway through the week. This program will take the child approximately 30 minute sto complete. Depending on insurance coverage, the child may or may not have therapy on the weekend. During the child's final week of the program, a home exercise program will be given. This home exercise program will take approximately 60 minutes to complete.
Outpatient Treatment Program
Each child is seen for an outpatient evaluation to determine for which program the child is appropriate. If it is determined that the child does not require inpatient/day treatment programming, they will continue to receive therapy on an outpatient basis.
During outpatient therapy the focus will be on the development of a home exercise program that will incorporate strengthening, endurance training, stretching and functional tasks that the child is required to perform daily. They will also be educated on pain management and treating a pain flare up. The outpatient therapist will determine the frequency and duration of the program, and this may vary depending on the child. Typically, the child will have either physical or occupational therapy while participating in outpatient treatment. However, it is not uncommon for the child to have both physical and occupational therapy. This will be determined by the evaluating therapist and will depend on the individual's needs.
If the child is under the care of a physical therapist, the child may be eligible to participate in a group treatment. The outpatient physical therapists run a yoga group and an exercise group once a week. The yoga group will incorporate strengthening, stretching and deep breathing techniques as well as provide a different mode of exercise. The exercise group will incorporate strengthening, stretching and circuit training as well as interaction with peers. The child must have a few individual sessions prior to joining either group to establish a home exercise program as mentioned above.
If it is determined that the child requires inpatient or day treatment programming, he/she will continue to be seen in outpatient therapy until admission. This will enable the child to become physically and mentally prepared for the intense level of activity that is expected of the child in these programs. It also allows the child's progress to be monitored by a physical or occupational therapist.
Following an inpatient or day treatment program admission, the child will follow up with several outpatient visits for at least six weeks. The physical or occupational therapist will continue to monitor the home exercise program and how well the child is dealing with their pain management. Changes may be made to the home exercise program to fit the child's needs following discharge from inpatient treatment. Once all the outpatient visits have been completed, the child is expected to continue performing their home exercise program on a daily basis.
Psychology Treatment Provided to Inpatients and Day Treatment Patients
Psychological treatment for RND at The Children's Institute uses a primarily cognitive-behavioral approach, in which emphasis is placed on understanding how the patient thinks about their pain and behaves in response to it. After a thorough assessment, we develop a plan that addresses the individual needs of each patient. This includes educating the patient about the relationship between stress and exacerbation of pain, and helping the patient develop and improve his or her ability to cope with the stress in relation to pain. These non-pharmacological pain management techniques are taught through one or more of the following modalities:
- Cognitive-Behavioral Therapy
- Relaxation Training
- Biofeedback Training
- Coping Skills Training
- Patient and Family Education
- Short-term Individualized Counseling
- Short-term Family Counseling
- RND Lunch Group
There is a direct relationship between stress and the exacerbation of pain. It is important to identify a patient's individual stressors and their physical, emotional, behavioral and cognitive responses to stress. The treatment focuses on learning about individual stressors, pain triggers, responses to stress, implementing a variety of coping skills and problem solving strategies, as well as practicing relaxation techniques. The goals of our psychology treatment program are to identify specific stressors, identify pain triggers and stress warning signals, learn and implement appropriate coping skills and relaxation techniques and practice appropriate expression of thoughts and feelings.