TRANSITIONAL CARE-FACTORS TO REVIEW

SUMMARY

Factors to consider when patients transition:
1. History & physical examination findings
2. Medications
3. Social supports & accomodation
4. Environmental factors at home
5. Services
6. Follow-up plans
7. Rehabilitation goals
8. OT, PT reports regarding current functional issues
9. Social work report regarding psychosocial issues
10. Education and vocational aspirations
11. Ensure there are no other medical issues which require urgent treatment such as hydrocephalus, uncontrolled seizures
12. Ensure that the patient and mother are willing to cooperate and comply with rehabilitation
13. Ensure that the accepting team has adequate expertise in managing TBI patients
14. Sexual health

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.