Enhanced Medical Rehabilitation

Our research has shown that outcomes will improve through more intense and engaging therapy. We have developed Enhanced Medical Rehabilitation, a new approach designed to encourage patients to more intensely engage in physical and occupational therapy.

EMR Training Course available online for PT and OT

Occupational Therapy Training

Click for the AOTA online training course  

Occupational therapy practitioners may earn 1.5 contact hours. 

NEW! Physical Therapy Training

Click for the Academy of Neurologic PT online training course

Physical therapy practitioners may earn 1.5 contact hours. 

Access the EMR Tools & Therapist Guide

Enhanced Medical Rehabilitation  materials are free to download and use. 

Click to access EMR materials

You will be asked to log in with your Box credentials or create a free Box account. If you have any questions, please email to lenarde@wustl.edu.

Purpose of Enhanced Medical Rehabilitation

Enhanced Medical Rehabilitation (EMR) is a collaborative training program that applies a structured, innovative approach to therapy for older adults. Our approach draws from science that underlies behavioral change and rehabilitation intensity.

Millions of older adults each year suffer a disabling illness or injury that threatens to restrict their activities and independence.

After receiving initial care, many enter a skilled nursing facility for therapy designed to help them regain lost physical function. It’s a critical and brief opportunity to help them succeed and return home.

Too often, patients fail to regain their independence and remain institutionalized. In spite of the increasing cost of post-acute care, the quality of therapy is not improving, as measured by functional outcomes.

We aim to engage patients as much as possible in their rehabilitation. EMR patients better understand their therapy and feel they have more control over its direction. They respond with increased motivation and willingness to exert effort—resulting in better outcomes.

We have developed training and supervision techniques to give therapists the tools and strategies to motivate even their toughest patients. EMR therapists and assistants enhance their practice by learning communication and motivational techniques to engage all their patients and make the most of their treatment time.

Related Research Publications

NEW! Bland MD, Barco P, Lang CE, Lenard E, Kallmi S, Pennock S, Lenze EJ. (2020). Activity level and intensity of older adults in skilled nursing rehabilitation measured via actigraphy. J Geriatr Phys Ther. Jan 30.PMID: 32004240

Bland, M. D., Birkenmeier, R. L., Barco, P., Lenard, E., Lang, C. E., & Lenze, E. J. (2016). Enhanced Medical Rehabilitation: Effectiveness of a clinical training model. NeuroRehabilitation39(4), 481–498. PMCID: PMC5555367

Hildebrand MW, Host HH, Binder EF, Carpenter B, Freedland KE, Morrow-Howell N, Baum CM, Dore P, Lenze EJ (2012): Measuring treatment fidelity in a rehabilitation intervention study. American Journal of Physical Medicine and Rehabilitation 91(8):715-724. PMCID: PMC3967862

Lenze EJ, Host HH, Hildebrand M, Morrow-Howell N, Carpenter B, Freedland KE, Baum CA, Binder EF (2011): Enhanced Medical Rehabilitation is feasible in a skilled nursing facility: preliminary data on a novel treatment for older adults with depression. American Journal of Geriatric Psychiatry, epub. PMCID: PMC3686856

Lenze EJ, Host HH, Hildebrand MW, Morrow-Howell N, Carpenter B, Freeland KE, Baum CA, Dixon D, Dore P, Wendleton L, Binder EF (2012): Enhanced Medical Rehabilitation increases therapy intensity and engagement and improves functional outcomes in post-acute rehabilitation of older adults: a randomized controlled trial. Journal of the American Medical Director’s Association 13(8): 708-712. PMCID: PMC3601780

Lenze EJ, Lenard E, Bland M, Barco P, Miller JP, Yingling M, Lang CL, Morrow-Howell N, Baum C, Binder EF, Rodebaugh TL. Effect of enhanced medical rehabilitation on functional recovery in older adults receiving skilled nursing post-acute rehabilitation: a randomized clinical trial. JAMA Network Open, published online July 31, 2019.

Host HH, Lang CE, Hildebrand MW, Zou D, Binder EF, Baum CM, Freedland KE, Morrow-Howell N, Lenze EJ (2014) Patient Active Time during therapy sessions in post-acute rehabilitation: development and validation of a new measure. Physical & Occupational Therapy in Geriatrics, 32: 169-178. PMCID: PMC4235132.


The Enhanced Medical Rehabilitation research is funded by the National Institute of Mental Health through its grant #5R01MH099011-02. For more information, you may read excerpts from EMR funding grant: Aims and Strategy Supplemental funds for this project were provided by the Taylor Family Institute for Innovative Psychiatric Research.

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