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Interprofessional Team Dynamics in Inpatient Acute Rehabilitation

Setting and Team Composition

The setting is an Inpatient Acute Rehabilitation Unit (ARU) within a hospital, treating patients who have experienced significant functional loss due to events like stroke, traumatic brain injury, spinal cord injury, or major complex orthopedic surgery.

The core interprofessional team is often composed of:

Physician (Physiatrist): Team leader, specializing in physical medicine and rehabilitation (PMR). Manages overall medical stability and dictates therapy intensity.

Registered Nurses (RNs): Provide 24/7 care, manage medication, monitor vital signs, and reinforce therapy techniques during non-therapy hours.

Physical Therapists (PTs): Focus on gross motor skills, mobility, balance, and gait training.

Occupational Therapists (OTs): Focus on fine motor skills, activities of daily living (ADLs) like dressing and feeding, and cognitive retraining.

Speech-Language Pathologists (SLPs): Address communication, swallowing, and cognitive-linguistic deficits.

Social Workers (SWs) / Case Managers (CMs): Coordinate discharge planning, assess psychosocial needs, arrange post-discharge services (home health, equipment), and address financial/insurance barriers.

Health Care Administrator (Unit Manager/Director): Manages operational efficiency, staffing, compliance, and budget.

Dynamics of Collaboration and Communication

The effectiveness of an ARU depends entirely on transparency and interdependence among these roles.

1. Collaborative Decision-Making and Goal Setting

The primary dynamic is the weekly interprofessional team meeting, where the patient's goals, progress, and barriers are discussed.

Input: Each discipline (PT, OT, SLP, RN, SW/CM) provides specific, measurable data. The PT might report that gait distance is increasing but the SW might report the patient's home is not wheelchair accessible.

Shared Goal Adjustment: The Physiatrist synthesizes this input to adjust the patient's overall Plan of Care (POC) and forecast the discharge date. The team collectively agrees on the functional goals that must be met for a safe discharge. This dynamic requires mutual respect for each profession's expertise; the physician respects the therapist's assessment of functional capacity, and the therapists respect the case manager's assessment of environmental reality.