THE INSTITUTE FOR REHABILITATION AND RESEARCH

TIRR OURNALWINTER 2021 30TH J ANNIVERSARY OF THE ADA

ILRU SUPPORTS INDEPENDENT LIVING DURING COVID-19 COVER STORY

Lex Frieden is professor of health informatics in the School of Biomedical Informatics and professor of physical medicine and rehabilitation at McGovern Medical School at UTHealth, and is adjunct professor of physical medicine and rehabilitation at Baylor College of Medicine. He directs the ILRU program at TIRR Memorial Hermann.

FEATURES: ADVOCACY PATIENT STORIES 3 On the 30th Anniversary of the ADA, 26 Dr. Grant Lashley’s Long Road Back from Lex Frieden continues to advocate for change COVID-19 8 ILRU Supports Independent Living During COVID-19 Emergency ACCOLADES 12 Message from the CMO 20 Big Comebacks for Little Patients: TIRR CLINICAL CARE Memorial Hermann 21 TIRR Education Academy Goes Virtual with 12 Customized Rehabilitation for Post-COVID-19 Learning for Professionals Around the World Patients 13 Redefining Rehabilitation in the COVID-19 22 TIRR Memorial Hermann Earns Top Pandemic Recognition by U.S. News & World Report 22 Profile in Caring COVID-19 RESEARCH 28 Dr. Gerard Francisco Receives AAP Distinguished 16 COVID-19: Screening and Triage Challenges in Academician Award People with Disability Due to SCI Dr. Angelle Sander Named President-Elect of 17 Rehabilitation of Critically Ill COVID-19 Survivors ACRM’s Brain Injury Interdisciplinary Special 19 TIRR Memorial Hermann Researchers Examine Interest Group Tidal Volumes in Patients with SCI Monica Verduzco-Gutierrez, MD, Named Chair of PMR Department at UTHealth RESEARCH San Antonio 23 Patient-care Technology in the Palm of Your 29 Hand: Can a Mobile Mood Tracker App TIRR Memorial Hermann Welcomes Detect Emotional Distress in People with New Physicians Traumatic Brain Injury? 30 In Print/Grants 25 Funded by a TIRR Memorial Hermann Rehabilitation Innovation Grant, Becky Thayer 31 Message from the CEO Leads a Study on Mirrors and Limb Loss Patients

2 TIRR MEMORIAL HERMANN FEATURE On the 30th Anniversary of the ADA, Lex Frieden continues to advocate for change

Thirty years ago, last July, a major victory was achieved in the ongoing civil rights movement for legal rights and protections for people with disabilities. On July 26, 1990, the Americans with Disabilities Act (ADA) was passed and signed into law, prohibiting discrimination on the basis of disability and helping to ensure equal access to opportunities. This groundbreaking On July 21, TIRR Memorial Hermann to work to ensure equality and pro- legislation is recognized and the George & Barbara Bush mote equity for people with disabili- today as the most Foundation convened key activists, ties as an advocate for change and the comprehensive disability advocates and policymakers who power of medical rehabilitation. law in the United States, helped make the ADA a reality for a mirroring and supplementing celebration of that landmark legisla- A Chance Meeting the Civil Rights Act of 1964 tion. Equally important, they focused Throughout our lives, there are key on the challenges that will shape the moments that define who we are and and the Rehabilitation Act future of the disability movement. encourage us to take the first step on of 1973. The 90-minute program, entitled a future path we may not have ever “Let the Shameful Wall of Exclusion imagined for ourselves. For Frieden, Come Down,” taken from President one of those moments occurred in Bush’s remarks on July 26, 1990 as November 1967, when he, a freshman he signed the ADA, was moderated by in college, was involved in a car acci- Judy Woodruff, the managing editor dent and sustained a life-threatening and anchor of PBS NewsHour. Both spinal cord injury. the National Organization on Disability, “I went to an acute care hospital in re- and Lex Frieden, director of Indepen- ally bad condition,” he says. “I couldn’t dent Living Research Utilization move. I couldn’t feel anything.” (ILRU), a TIRR Memorial Hermann After his condition stabilized in program, worked closely with the January 1968, his doctors gave him two Bush Foundation in planning this options: go home and be in a local hos- year’s commemoration. pital for the rest of his life or go to a re- Frieden, widely considered the habilitation hospital, a new post-acute chief architect of the ADA, continues continues on page 4

THE INSTITUTE FOR REHABILITATION AND RESEARCH 3 continued from page 3 Then came another defining moment care offering at the time, to attempt to in his life. regain some level of independence. “I was shocked to discover that I Faced with this decision, he and his could not even be readmitted to col- father visited some hospitals for reha- lege because I had indicated on my bilitation, a relatively new specialty in application that I used a wheelchair the late 1960s. After touring the few for mobility,” he says. “That had a facilities in existence in the late 1960s profound impact on my life. At that around the country, one stood out as point, I would say I became a disabil- the clear choice: TIRR (The Institute ity rights advocate.” for Rehabilitation and Research), now After he was accepted into gradu- TIRR Memorial Hermann. ate school at another institution, Dr. Frieden remembers his father’s Spencer, who became one of Lex’s personal welcome from TIRR’s mentors, invited him to a meeting at founder, William A. Spencer, MD, TIRR with Congressman Olin Teague. as well as assistance from employees “The meeting with [Congressman] who had been patients at the facility Teague led me to believe that in fact and the overall relaxed, patient-cen- our representatives in Congress could tered environment. relate to some of the issues we had as “My life was changed when my people with disabilities,” he says. family and I decided to engage in a comprehensive rehabilitation program, The Journey rather than just stop the world and go Meeting Congressman Teague quickly home to Oklahoma and live in a hospi- led to the realization of Frieden’s jour- tal,” he says. ney in advocacy, when he was invited After 2.5 months of intensive and to serve on a panel of experts commis- successful rehabilitation, Frieden sioned by a congressional committee went home and reapplied to college. that dealt with science and technology.

4 TIRR MEMORIAL HERMANN Frieden traveled around the country, Looking now to ensure equal rights discussing how people with disabilities under non-discrimination protec- could benefit from the latest technology tions, Frieden took the next step. being developed in the then-booming In 1983, he gave a testimony before space program, while giving his Congress about independent living unique perspective in the process. programs recommended in amend- “That also kind of conditioned and ments made in 1978 to the Rehabilita- reinforced the notion that people with tion Act of 1973, which was due soon disabilities must be involved in pro- for reauthorization. A year later, he grams that affect their lives, in making was appointed director of the Nation- decisions about those programs and al Council on the Handicapped, now leading those programs,” he says. the National Council on Disability, by The panel became the National President Ronald Reagan. Institute on Handicapped Research Under his leadership, the council in 1978 and later, in 1986, the Na- produced two special reports, “Toward tional Institute on Disability and Independence” in 1986 and “On the “Apparently, nobody Rehabilitation Research, now named Threshold of Independence” in 1988, the National Institute on Disability, which produced information on the leg- understood how you Independent Living, and Rehabilita- islative needs of people with disabilities could apply non- tion Research. in the United States. Congress chose discrimination laws to Shortly afterward, the first step not to move forward with the former, in legislation ensuring equal access and thus the latter was produced with people with disabilities. for those living with disabilities was sample legislation called the Americans It just was not intuitive.” taken with the Rehabilitation Act of with Disabilities Act (ADA). 1973. However, Title V of the Act, Two weeks after Frieden met with Lex Frieden which would have delegated federal members of the U.S. Senate and partici- funds to be used for public space ac- pated in a televised interview in public cessibility, was not implemented. support of the ADA, George H.W. “Apparently, nobody understood Bush was elected president, and at that how you could apply non-discrimina- moment Frieden was certain his vision tion laws to people with disabilities. It was going to be reality. just was not intuitive,” Frieden says. But in 1990, the year that the ADA In 1976, in protest of the non-in- was passed, a number of small-busi- clusion of Title V, people with disabil- ness owners with financial concerns ities blocked the Golden Gate Bridge lobbied against the bill. In response, and organized a sit-in in federal office an historic protest was held in Wash- buildings in San Francisco, shutting ington, D.C. where people with some down for weeks. The following mobility disabilities abandoned their year, Frieden helped found the Inde- wheelchairs and dragged themselves pendent Living Research Utilization up the steps of the Capitol building. (ILRU) program at TIRR Memorial “I thought, ‘there aren’t going to Hermann, which he currently directs. be any more barriers,’” Frieden says. As part of the same protest, a “Members of Congress came out of candlelight vigil was held in Washing- the Capitol to encourage us and basi- ton, D.C., to urge then Secretary of cally said, ‘You all have done what’s Health, Education and Welfare Joseph needed to prove to the nation we need A. Califano, Jr. to officially sign Sec- this bill.’” tion 504 of the Rehabilitation Act. The The ADA was signed into law on protest worked, and the section was July 26, 1990. signed into law. continues on page 6

THE INSTITUTE FOR REHABILITATION AND RESEARCH 5 continued from page 5 meals and getting dressed. What Comes Next Finally, he sees opportunities While the 30th anniversary of the brought on by the public health emer- ADA is cause for celebration to com- gency of COVID-19 for those with memorate the strides that have been disabilities, in that remote work has made in securing equal rights for become a viable option for many indus- people with disabilities, it is also a tries and their employees, in addition to “There may be a silver time for reflection and review of areas the growth of telehealth offerings. lining somewhere in that still need attention. One such “I think COVID-19 may improve area is employment, where Frieden opportunities for people with dis- this cloud. I think there mentions rates are almost the same as abilities, as we’ve proved that remote are huge opportunities they were 30 years ago. work can be done effectively,” he says. in adapting our clinical “It’s very clear to me that employ- “There may be a silver lining some- approaches to a tele- ment remains one of the biggest where in this cloud. I think there are challenges for inclusion of people with huge opportunities in adapting our medical modality, and disabilities,” he says. “While we have clinical approaches to a telemedical we really need to exert changed the physical environment and modality, and we really need to exert some effort there... while we have changed the attitudinal some effort there... and build pro- and social environment, we have not grams people can use to seek good and build programs effectively changed the workplace.” medical care from rehabilitation pro- people can use to seek Another central issue that has yet grams in telemedicine and remotely.” good medical care from to be resolved is access to affordable rehabilitation programs housing, about which Frieden says, Becoming an Advocate “People are stuck in places where So how can someone, as Frieden did, in telemedicine and they don’t belong, simply because take the first step on a journey of advo- remotely.” there’s no other place to live.” cacy? “People should take initiative, Over the years, disability rights and they should be assertive, and they Lex Frieden advocates made major progress should expect to be treated equally in health care, especially with the and not simply resign themselves to a Affordable Care Act, but with the lifestyle that they may have perceived change in administrations this prog- living, but instead be aggressive and ress has been reversed. attack those barriers,” he says. Frieden says that since employer- Frieden gave numerous recom- paid insurance can now factor preex- mendations for how to get started, isting conditions into their insurance including being in touch with the assessments, many are worried that local mayor’s office, working in cam- they will lose their coverage and/or paigns for candidates who have solid compromise their Medicare and Med- platforms on disability issues and par- icaid benefits. He also advocates for ticipating in centers for independent and is proposing a better community- living. Organizations like the United based infrastructure, where a team Spinal Association for those with can provide services to people with spinal cord injuries and the American disabilities in their homes. In this Association of People with Disabili- new model, caregivers and assistants ties, which Frieden helped found, would be on-call and provide support also provide platforms for advocates for daily tasks, such as preparing and offer peer support.

6 TIRR MEMORIAL HERMANN The Power of Medical where to be treated can be difficult, Lex Frieden is professor of health Rehabilitation but for Frieden, as it was back in informatics in the School of Bio- In January of this year, Frieden was 1968, the choice was clear. medical Informatics and professor again a patient at TIRR Memorial “My advice to people who have the of physical medicine and rehabilita- tion at McGovern Medical School Hermann for rehabilitative care for option is to choose the elite care that at UTHealth, and he is adjunct 10 days after he was intubated and one would get in a comprehensive professor of physical medicine and medical rehabilitation facility,” he says. treated in the ICU for pneumonia. “If rehabilitation at Baylor College of Two years ago, when Frieden for- I had been discharged from the ICU to Medicine. He directs the ILRU pro- my home, it’s very likely that I would mally accepted the American Medical gram at TIRR Memorial Hermann. not be mobile in the wheelchair right Rehabilitation Providers Association now; I’d still be recovering from the (AMPRA) National Leadership Excel- results of the intubation, from the lence Award, he recalled that one of his ventilator and from the treatment I doctors told him, “You can do anything received to get over the pneumonia.” you want to do, as long as you can figure Frieden went on to explain the out how to do it on four wheels.” power of medical rehabilitation, say- It goes without saying that Frie- ing, “When I left there, I felt like I was den did figure it out, and while his actually more fit than I was before I advocacy journey still continues, his had the pneumonia and probably more life-defining moment back in 1967 fit than I had been for three years.” came to fruition with the passage of Given the variety of post-acute the ADA 30 years ago. g care options, making a decision about

This article was originally published by the American Medical Rehabilitation Providers Association (AMRPA) in collaboration with TIRR Memorial Hermann.

THE INSTITUTE FOR REHABILITATION AND RESEARCH 7 FEATURE ILRU Supports Independent Living During the COVID-19 Emergency

Richard Petty, co-director of ILRU, director of the IL-NET T&TA Center for Independent Living, director of the National Center for Aging and Disability at TIRR Memorial Hermann, and an assistant While COVID-19 has affected every- an assistant professor of physical medi- professor of physical one, one segment of the population has cine and rehabilitation at McGovern medicine and encountered a unique set of challenges Medical School at UTHealth. He is an rehabilitation at in navigating the pandemic. People advocate who has spent decades work- McGovern Medical with disabilities often have additional ing to advance consumer-controlled School at UTHealth hurdles to clear, as services have shut community services for people with down due to the health crisis. disabilities. Since 1977, the Independent Living ILRU has stepped up during CO- Research Utilization (ILRU) program VID-19 through its IL-NET National has provided information, training, Training and Technical Assistance research and technical assistance for (T&TA) Center for Independent Living, independent living across the United providing specialized technical consult- States. The group is housed at TIRR ing and training related to the virus for Memorial Hermann and led by Lex the nearly 500 Centers for Independent Frieden, director of ILRU and a pioneer Living (CILs) and the 56 Statewide in accessibility research and access, Independent Living Councils (SILCs) in and Richard Petty, co-director of ILRU, American states and territories. director of the IL-NET T&TA Center “CILs support people with dis- for Independent Living, director of the abilities so that they can live in the National Center for Aging and Disabil- community, and many services are ity at TIRR Memorial Hermann, and provided face to face,” says Petty,

8 TIRR MEMORIAL HERMANN “All organizations that do this kind of Living; and New Uses of Technology work have had to pivot and find other in Service Delivery by Centers for ways to stay in touch with the people Independent Living. they serve, including web-based apps “From the surveys, we’ve discovered like Zoom and more low-tech forms that the biggest pandemic concerns of of communication like phone calls and our consumers are health and health mail. We’re continuing to help CILs care, limited access to personal protec- address social isolation, food insecu- tive equipment (PPE), inability to see rity and other challenges the virus providers face to face, medical equity has created for home-based services. for people with disabilities, access to We’ve also helped people find ways to personal assistance, food, housing and access telehealth.” income,” Curtis says. “The biggest To help Centers for Independent concerns of staff members at CILs are Living adapt to the new environment health and safety, stress, caregiving “We’re continuing and succeed, ILRU has presented four responsibilities and job security.” to help CILs address webinars: CIL Response to COVID-19; “Early on, a number of CILs report- Technology Options for CILs During ed people experiencing food insecurity, social isolation, food the COVID-19 Pandemic; Statewide because the systems people had set up insecurity and other and Systemic Responses to COVID-19 to get food into their homes had been challenges the virus and Other Emergencies for CILs and disrupted by the pandemic,” Petty says. SILCs; and Early Findings on COVID-19 “We’re seeing that CILs have been has created for home- Research About CIL Responses to the providing PPE for clients and caregiv- based services. We’ve COVID-19 Emergency. The webinars ers, and ensuring that the organizations also helped people were well attended, with 690, 550, 250, that employ caregivers are living up to find ways to access and 111 participants, respectively. their responsibilities in this area.” When ILRU sent out the New telehealth.” Uses of Technology survey in April, Using Surveys to Discover Richard Petty Needs they were hoping to help CILs tran- Led by IL-NET Program Coordina- sition into providing most services tor Brooke Curtis, ILRU researchers remotely. “We had a great response, conducted three studies related to and about 95 percent of those who COVID-19, all in conjunction with responded said they were providing IL-NET training and technical as- services remotely, but about half that sistance activities: Survey to Identify number felt some services had to be Persons Forced into Nursing Homes provided in person,” Curtis says. and Institutions Because of the Loss “The CILs were using technology, of Home-based Services; COVID- but they found that many consumers 19-related Needs Assessment Survey didn’t have computers, smartphones of Centers for Independent Living in or internet access, so they had to collaboration with the Collaborative shift gears. The work we have done is on Health Reform and Independent continues on page 10

THE INSTITUTE FOR REHABILITATION AND RESEARCH 9 continued from page 9 mask wearing, businesses can enforce helping them devise new strategies to it. We presented a webinar on the topic provide service to consumers and ad- with 1,000 attendees, most of whom dress their organizational challenges were from business establishments related to staff working remotely.” and were confused about whether they had the right to set the rules.” Disability Rights Laws During During pandemics, healthcare the Pandemic providers and government officials may The ILRU’s Southwest ADA Center is have to decide how to allocate lim- the Southwest region’s leading resource ited healthcare resources if the entire on the Americans with Disabilities Act population cannot be served. “This has and related disability rights laws. The created concern in the disability com- Center is part of the ADA National Net- munity because people with disabilities work funded by the National Institute are generally perceived to have weaker on Disability, Independent Living and immune systems and underlying condi- Rehabilitation Research (NIDILRR). tions that may require healthcare pro-

Vinh Nguyen, JD, Since the beginning of the pan- viders to use more effort, time, space director of the Southwest ADA Center demic, the Center has received 30 to and scarce medical resources for treat- 40 calls a week, about half of which ment,” Nguyen says. “With PPE and are related to COVID-19. The three new treatments for COVID-19 more hottest issues are face masks, access readily available than they were in the to health care and return to work, first few months of the pandemic, we according to Vinh Nguyen, JD, director hope rationing of healthcare services of the Southwest ADA Center. won’t be necessary.” “Employers have called to ask if Regarding return-to-work issues, they can require customers to wear people with disabilities have rights masks,” Nguyen says. “Businesses under the ADA and can ask their em- have always had the right to set condi- ployers to accommodate their health tions on customers. We know that as needs. However, employers do not the ‘No shirt, no shoes, no service’ law. have to accommodate an employee Even if there is no state law enforcing who does not have a disability and is

10 TIRR MEMORIAL HERMANN afraid to bring the virus home to a and rehabilitation at UTHealth and vulnerable family member. director of the ILRU. The Southwest ADA Center operates “Many people with disabilities a hotline as part of the national net- have been given the opportunity to work. For answers to questions related excel in the new telework environ- to disability law, call 800.949.4232. ment,” Frieden says. “Because of The ILRU also has posted COVID- their disabilities, they already have 19-related announcements daily learned how to function well using through much of the pandemic. Links online communication. Many have to the webinars are available at ilru.org; become leaders in the telework envi- follow the link “Communication to the ronment and are teaching others how Field on COVID-19.” to organize their time.” COVID-19 has also made telemedi- On Telework and Telemedicine cine a necessity. “Healthcare providers Now that many companies are taking have been building out telemedicine advantage of telework to remain pro- capability so quickly that they’re still ductive, people with disabilities could learning how to use the platforms ef- benefit. That is the view of Lex Frie- fectively,” he says. “When it comes to den, professor of health informatics removing barriers to healthcare access, in the School of Biomedical Informat- telemedicine has a lot of promise.” g ics and professor of physical medicine

New CEO Appointment Rhonda Abbott was recently announced as the new senior vice president and chief executive officer of TIRR Memorial Hermann and the Memorial Hermann Rehabilitation Network. “For those of you who have worked with Rhonda, you are likely familiar with her unwavering dedication, operational strength and results-oriented focus demonstrated across many parts of our System. I am confident she will continue to ground our organization as a leader in medical rehabilitation and research, and as a provider of exceptional patient experiences,” says Greg Haralson, SVP and CEO, Memorial Hermann-Texas Medical Center Campus. In this role, Rhonda will oversee TIRR Memorial Hermann’s continued excellence in rehabilitative care, research, advocacy and education across the Memorial Hermann Health System. For 19 years, Rhonda has held integral roles within TIRR Memorial Hermann, starting her career as a staff therapist in the spinal cord injury and specialty rehabilitation program, and earning successive promotions to director of therapy services and director of clinical programs, vice president of operations and chief operating officer. Under her leadership, Rhonda has led clinical care redesign initiatives, translational research efforts, quality care improvements, expansion of therapy education programs and efficiency improvements. During her tenure, the Campus continued to demonstrate national recognition as a leader in rehabilitation by U.S. News & World Report. Rhonda has led several smart growth initiatives resulting in a 11 percent increase in inpatient rehabilitation discharges from FY18-FY20 and a 4 percent increase in outpatient volume – all pre-COVID. She also led TIRR Memorial Hermann expansion efforts and clinical practice leveling across our System and helped secure CARF accreditation at three of our Memorial Hermann Rehabilitation Network locations. Rhonda is on the board of directors for the American Medical Rehabilitation Providers Association, a member of the American Physical Therapy Association and American College of Healthcare Executives, a Texas Physical Therapy Association Tom Waugh Leadership Development Fellow, champion of Women Leaders of Memorial Hermann, graduate of the Center for Houston’s Future Business/Civic Leadership Forum and an advocate for the ReelAbilities Film Committee.

THE INSTITUTE FOR REHABILITATION AND RESEARCH 11 MESSAGE FROM THE CLINICAL CARE CHIEF MEDICAL OFFICER

TIRR Memorial Hermann has been Customized Rehabilitation recognized as No. 1 in Texas in Newsweek magazine’s inaugural list of Best Physical for Post-COVID-19 Patients Rehabilitation Centers, which was released last summer. This comes on the heels of our ranking by U.S. News World Report as No. 1 in Texas and No. 3 in the United States. Newsweek’s Best Physical Rehabilitation Centers 2020 ranking lists the best facilities in the 20 states with the largest number of facilities according to the Centers for Medicare & Medicaid Services (CMS). Instead of basing their list solely on reputation, Newsweek partnered with Statista, a global market research firm, to score facilities based on CMS data including quality of care, quality of service and quality of follow-up care, as well as an online survey taken by TIRR Memorial Hermann and the Memorial Hermann thousands of physicians, therapists and Rehabilitation Network are leading the charge in functional staff working in rehabilitation facilities. rehabilitation of individuals who no longer test positive after We’re committed to helping the men, having COVID-19. The hospital’s evidence-based interventions women and children who pass through allow patients to go beyond the clinical setting, providing them our doors reach as high as they can – with the opportunity to participate in important life roles in and then just a little higher – to achieve home, work, volunteer and community environments. things that once seemed impossible. Due to the nature of the virus, many patients experience difficulty breathing, even after the virus leaves the body. Patients We are honored that Newsweek and who required ventilators are at even higher risk of long-term U.S. News & World Report have effects. Individuals who have recovered from COVID-19 may recognized that commitment. also experience muscular atrophy and physical weakness, a loss of balance and coordination, and cognitive issues due to reduced oxygen to the brain. The impairments faced by people Gerard E. Francisco, MD recovering from COVID-19 are similar but unique to the person. Professor and Chair, Department of Our team customizes therapy and care for individuals based on Physical Medicine and Rehabilitation their personal goals. McGovern Medical School at UTHealth

Chief Medical Officer For more information, call 800.44.REHAB. g TIRR Memorial Hermann

12 TIRR MEMORIAL HERMANN CLINICAL CARE

Redefining Rehabilitation in the COVID-19 Pandemic

During last summer’s fast-developing the pandemic. Last July, COVID-19 pandemic scenario, TIRR Memorial was surging in Texas, while cases in Hermann participated in a national New Jersey were decreasing,” says virtual meeting sponsored by the Rhonda Abbott, PT, FTPTA, CEO of TIRR American Medical Rehabilitation Pro- Memorial Hermann. “We were fortu- viders Association (AMRPA), entitled nate early in the pandemic to be able to “COVID-19 and the Rehabilitation learn from rehabilitation professionals Hospital Impact: Perspectives from in the Northeast, who had more expe- Texas.” Three hundred participants rience with COVID-19 than we did. Rhonda Abbott, were on the line for calls, as TIRR Me- Their understanding added value and PT, FTPA morial Hermann leaders were paired depth to our inpatient and outpatient CEO of TIRR with Hackensack Meridian Health experience as we have moved through Memorial Hermann in Edison, New Jersey, to share their the different phases of the pandemic.” knowledge of and experience with Both hospitals presented their COVID-19. response plan to the surge in cases. “The two locations were chosen to “At TIRR, we went through an acute give a contrasting representation of continues on page 14

THE INSTITUTE FOR REHABILITATION AND RESEARCH 13 continued from page 13 Abbott says the patient-family “ In some ways our alertness phase where we closed our component has been challenging. “We treatment gyms, which has never oc- wanted to make TIRR Memorial Her- communication with curred in our history,” Abbott says. mann a safe environment for people to families is even more “At that time, we were still learning start or continue their rehabilitation frequent now, but we how the virus spread and how best to without fear of being exposed to the miss the personal use personal protective equipment. virus, so like other hospitals in Hous- As time and data revealed additional ton we instituted a no-visitor policy,” contact.” evidence, we reopened and created she says. “In our outpatient facilities, new treatment zones and placed Plexi- no visitors are allowed. For inpatients, Rhonda Abbott glas dividers throughout our campus we allow very limited visitation with in high-traffic, high-contact areas. special permission only. Family and Because our natural habit as humans is friends play a tremendous role in to keep doing what we’ve always done, recovery during rehabilitation, so we we had to create alternate spaces. We have issued iPads to all locations to en- have one chair per table in the cafete- sure that patients can stay connected ria, for instance, and all meetings are with family members via Zoom calls. on Zoom.” In some ways our communication with families is even more frequent now, but we miss the personal contact.”

14 TIRR MEMORIAL HERMANN Gerard Francisco, MD, professor and Nicole Harrison, MBA, BSN, RN, chair of the department of Physical NEA-BC, vice president and chief Medicine and Rehabilitation at nursing officer at TIRR Memorial McGovern Medical School at Hermann, talks about the importance UTHealth, and chief medical officer of putting plans into place to ensure at TIRR Memorial Hermann gives that patients coming into the hospital credit to medical professionals around are not positive for COVID-19. “Our the world. “Our colleagues in New work as nurses is very hands-on and in close proximity to patients,” she says. York, China, Italy, France and Spain – Gerard E. those who managed COVID-19 early “Our respiratory team helped us to Francisco, MD, on – shared good medical and clinical create processes, algorithms and treat- Chief Medical information and set an outstanding ment pathways to that end. Our mes- Officer TIRR example for those of us who followed,” sage to our nurses is that we’re in this Memorial Hermann together, and we’re making sure you’re Professor and Chair, he says. “That experience allowed me Department of to encourage our physicians. If they practicing in a safe environment.” Physical Medicine can do it in New York City, we can do Harrison admits it has been physi- and Rehabilitation it here.” cally and emotionally challenging, McGovern Medical Since then, the medical community although more so in the beginning School at UTHealth has learned that the virus affects many when testing was less readily avail- systems in the body. “We still don’t able and knowledge of COVID-19 was know everything about the body’s minimal. “Once testing kits were avail- response to COVID-19, but we know able, it gave us a huge sense of relief,” there are often neurological effects she says. “We huddle every week and similar to the issues we see in patients ask managers to have frequent huddles with stroke and brain injury, which on the units. You can never over-com- may not be obvious immediately or municate, and that’s especially true may occur later. We are evaluating now. Our nurses have been amazing, these problems and creating rehabili- and the work we’ve done is immense. tation plans,” Dr. Francisco says. People have discovered vast emotional Nicole Harrison, MBA, BSN, RN, TIRR Memorial Hermann’s post- and skill reserves they didn’t know NEA-BC COVID-19 therapy program for they had. They know we’re making Vice President and patients who no longer test positive history and setting standards for future Chief Nursing opened in May. Built on the hospital’s pandemics.” g Officer atTIRR strong program of respiratory sup- Memorial Hermann port, the program is evolving as more information about what the virus does to the body becomes available.

THE INSTITUTE FOR REHABILITATION AND RESEARCH 15 COVID-19 RESEARCH

COVID-19: Screening and Triage Challenges in People with Disability Due to SCI

In March 2020, the Centers for Dis- with SCI include temperature dys- ease Control and Prevention (CDC) regulation, impaired ability to cough, announced priority levels for testing and abnormal sensations at or below patients with symptoms of COVID-19 the level of neurological injury, all of and provided information on when to which hinder the presentation CO- seek medical attention. At the same VID-19 symptoms,” she says. “People time, the agency provided almost no with spinal cord injury may also devel- guidance for people with spinal cord op other symptoms during infection, injuries (SCI), who may not present such as new or worsening spasticity, Radha Korupolu, with typical symptoms due to physi- autonomic dysreflexia or fatigue in- MD, MS Assistant Professor ological changes. In an article pub- consistent with the CDC guidelines.” of Physical Medicine lished in Nature in May 2020, Radha In an international survey of 783 and Rehabilitation at Korupolu, MD, MS, and her research healthcare professionals who care for McGovern Medical School at UTHealth and team outlined important differences individuals with SCI, 10.3 percent re- affiliated attending in how people with SCI may present ported their patients with COVID-19 physician at TIRR differently with COVID-19.1 had increased spasticity, 6.9 percent Memorial Hermann “As soon as the COVID-19 pandemic reported that their patients had rigors, began, we recognized that patients and 6.0 percent reported that their with SCI would not fit into the screen- patients had been asymptomatic.2 ing criteria established by the CDC, SCI patients with COVID-19 may not and would present a diagnostic chal- present with cough due to disruption of “Having a spinal cord lenge,” says Dr. Korupolu, an assistant normal respiratory physiology to help injury may increase the professor in the department of Physical patients and families in the early days of Medicine and Rehabilitation at McGov- the pandemic,” Dr. Korupolu says. We risk of COVID-19 mor- ern Medical School at UTHealth and an also wanted to bring global attention to bidity, and at the same affiliated attending physician at TIRR the fact that there are atypical symptoms time it may disguise Memorial Hermann. “Having a spinal of COVID-19 among the SCI population, cord injury may increase the risk of CO- and that we need to have contingency the symptoms of acute VID-19 morbidity, and at the same time plans available to ensure better outcomes respiratory illness.” it may disguise the symptoms of acute for our patients with disabilities.” g respiratory illness. Last March we had Radha Korupolu 1 very stringent criteria for COVID-19 Korupolu R, Stampas A, Gibbons C, testing, and many patients with SCI Hernandez Jimenez I, Skelton F, Verduzco- Gutierrez M. COVID-19: Screening and tri- didn’t meet those criteria. As part of age challenges in people with disability due our review, we listed each symptom de- to Spinal Cord Injury. Nature: Spinal Cord scribed by the CDC and explored how Series and Cases. 2020;6(35). https://doi. org/10.1038/s41394-020-0284-7. it could be very different in patients with spinal cord injury. We also noted 2Stillman MD, Capron M, Alexander M, Di that it was taking us longer to diagnose Giusto ML, Scivoletto G. COVID-19 and spinal cord injury and disease: results of an interna- COVID-19 in people with SCI.” tional survey. Spinal Cord Ser Cases. 2020;6:21. “Physiological changes associated https://doi.org/10.1038/s41394-020-0275-8.

16 TIRR MEMORIAL HERMANN Rehabilitation of Critically Ill COVID-19 Survivors

Although researchers are still learn- PhD, in an article published in The ing about recovery after severe cases Journal of The International Society of “Being bedbound of COVID-19, literature about acute Physical and Rehabilitation Medicine.1 in the ICU can be respiratory distress syndrome (ARDS) Dr. Korupolu, the lead author, is an debilitating in itself. and severe acute respiratory syndrome assistant professor in the department (SARS) shows the benefits of rehabili- of Physical Medicine and Rehabilita- Survivors of critical tation after a long intensive care unit tion at McGovern Medical School at respiratory illness may stay. A comprehensive rehabilitation UTHealth and an attending physician experience long-lasting program with a multidisciplinary ap- at TIRR Memorial Hermann. physical, cognitive proach can reduce ICU-acquired weak- “Being bedbound in the ICU can ness, dysphagia, functional decline, be debilitating in itself. Survivors of and psychological psychological problems and cognitive critical respiratory illness may experi- dysfunction...” impairment, and improve quality ence long-lasting physical, cognitive of life, according to Radha Korupolu, and psychological dysfunction,” Dr. Radha Korupolu MD, MS, Gerard Francisco, MD, Harvey Korupolu says. “Early rehabilitation Levin, PhD, and Dale Needham, MD, continues on page 18

THE INSTITUTE FOR REHABILITATION AND RESEARCH 17 continued from page 17 of critically ill COVID-19 patients is crucial to improving quality of life and promoting timely transition of patients across different levels of care, but is challenging due to the severity of the illness, the need for strict infection control measures, staffing issues and scarcity of personal protective equip- ment in many areas.” At the time of publication of the article in June 2020, there was little data on outcomes of COVID-19 sur- vivors, but the researchers had access to a wealth of data on the outcomes of ARDS survivors, as well as those from other pandemics, including SARS in Toronto and Hong Kong and Ebola virus disease in West Africa. “Long-term sequelae of critically ill COVID-19 patients were unknown “I wanted to help our rehabilita- on prolonged mechanical ventilation. at this point, and they still are. We tion community, and given my past We broke that into domains of possible do know that survivors of critical experience at Johns Hopkins with Dr. physical and psychological dysfunc- illness experience a range of impair- Needham, I contacted him to ask if he tion, and created an algorithm to ments known as post-intensive care could guide me in writing this paper,” predict what to expect. At the time we syndrome, which may persist for years she says. They put together a team had limited personal protective equip- and result in poor quality of life,” Dr. that included Dr. Francisco, professor ment, and many patients in the ICU Korupolu says. and chair of the department of Physi- were suffering pressure injuries that The article, which discusses chal- cal Medicine and Rehabilitation at caused a decline in function. We knew lenges and potential solutions for re- McGovern Medical School and chief that nurses had to position patients habilitation of critically ill COVID-19 medical officer at TIRR Memorial correctly on the ventilator and prevent patients throughout the continuum of Hermann, and Dr. Levin, professor of joint contractures and pressure inju- care, came about through Dr. Korupo- physical medicine and rehabilitation at ries, but once patients were COVID-19 lu, who was part of the early mobility Baylor College of Medicine. negative, what then? We outlined what and ICU rehabilitation research team “Dr. Needham and I had tons of you should do for the patient from ICU at Johns Hopkins University under the experience with the rehabilitation to home, and provided guidance on leadership of Dr. Dale Needham. needs of ICU patients,” she says. “We healthcare needs after discharge.” g wrote this in early April, when we knew far less about COVID-19 than we 1Korupolu R, Francisco GE, Levin H, know now. There was so much panic at Needham DM. Rehabilitation of critically the time, and our goal was to create a ill COVID-19 Survivors. Journal of the guide about providing care. In general International Society of Physical and we knew what happened to patients Rehabilitation Medicine. 2020;3(2):45-52.

18 TIRR MEMORIAL HERMANN TIRR Memorial Hermann Researchers Examine Tidal Volumes in Patients with SCI

Radha Korupolu, MD, MS, Agryrios Stam- companying the change in practice.” pas, MD, and their research team have “Physicians from all over Dr. Korupolu presented the research published a paper that challenges con- the world have expressed team’s findings at the Academy of Spi- ventional wisdom about the safety and interest in participating in nal Cord Injury Professionals (ASCIP) efficacy of using higher tidal volumes virtual meeting in September 2020. in patients with spinal cord injury on a future clinical trial to pro- To study practice variation in the mechanical ventilation via tracheos- mote the use of evidence- management of mechanical ventila- tomy. Dr. Korupolu, the lead author, based practice and develop tion in people with SCI, she and Dr. is an assistant professor in the depart- Stampas, in collaboration with their ment of Physical Medicine and Reha- standardized guidelines. colleagues and the respiratory therapy bilitation at McGovern Medical School That’s our next objective.” team at TIRR Memorial Hermann, at UTHealth and an attending physi- conducted an international survey Radha Korupolu cian at TIRR Memorial Hermann. Dr. of healthcare providers who care for Stampas, also an assistant professor people with acute SCI on ventilation. in the department, is clinical research people who don’t have ARDS, lower Results from this survey suggest the director of TIRR Memorial Hermann’s tidal volume ventilation showed better need for evidence-based clinical guide- Spinal Cord Injury Medical Program. outcomes with lower rates of pneumo- lines for optimal ventilator settings The article, “Comparing Outcomes nia and acute lung injury compared to for people with acute SCI who require of Mechanical Ventilation with High those who received higher volumes. mechanical ventilation. Dr. Korupolu is vs. Moderate Tidal Volumes in Trache- Given the lack of robust evidence currently designing a randomized con- ostomized Patients in the Acute Inpa- in people with SCI, Dr. Korupolu and trolled trial in collaboration with Dr. tient Rehabilitation Setting: A Retro- Dr. Stampas re-examined the current Stampas and other staff at TIRR Memo- spective Cohort Study,” was published protocol for determining optimal tidal rial Hermann, including attending phy- in Spinal Cord,1 the official journal of volume in that population. After design- sicians Isaac Hernandez Jimenez, MD, and the International Spinal Cord Society. ing a study protocol and gaining institu- Matthew Davis, MD, as well as Darby Cruz, “When I came to TIRR Memorial tional approval, they conducted a cohort BSRT, RRT, respiratory therapy manager Hermann for my fellowship, I noted study, examining data from 84 adults at the hospital, to further refine optimal that we were using high tidal volume with SCI admitted to TIRR Memorial ventilator settings to improve outcomes for our patients with spinal cord Hermann on mechanical ventilation. for people with spinal cord injury. injury, in contrast to what I observed In 50 patients, they used moderate tidal “Physicians from all over the world while doing research at Johns Hopkins volume; the remaining 34 received high have expressed interest in participat- University,” Dr. Korupolu says. “For tidal volume. They concluded that high ing in a future clinical trial to promote people with acute respiratory distress tidal volume is associated with increased the use of evidence-based practice and syndrome, lower tidal volumes protect risk of pneumonia and higher odds of develop standardized guidelines,” she the lungs and are recommended based adverse pulmonary events in tracheosto- says. “That’s our next objective.” g on clinical trials. The argument for us- mized patients with SCI. 1 ing higher tidal volumes in people with “This has changed the way we do Korupolu R, Stampas A, Uhlig-Reche H, Ciammaichella E, Mollett PJ, Achilike EC, SCI who do not have acute respiratory things at TIRR,” Dr. Korupolu says. Pedroza C. Comparing outcomes of me- distress syndrome (ARDS) is that their “We have decreased the tidal volume chanical ventilation with high vs. moderate lungs are healthy, and higher tidal on patients with SCI who are hospi- tidal volumes in tracheostomized patients volumes expand the lower lungs.” talized on ventilators. We examined with spinal cord injury in acute inpatient rehabilitation setting: a retrospective cohort After reviewing the literature, our 2019 data a lower incidence of study. Spinal Cord. 2020. 9 July. https://doi. Dr. Korupolu observed that even in pneumonia during this time period ac- org/10.1038/s41393-020-0517-4.

THE INSTITUTE FOR REHABILITATION AND RESEARCH 19 Big Comebacks for Little Patients: TIRR Memorial Hermann Opens Inpatient Pediatric Unit

Beginning in December 2020, TIRR ment to ensure the best Memorial Hermann will offer the outcomes possible while same quality of nationally ranked, maximizing quality of life customized care for pediatric patients and facilitating return who have suffered a severe injury to their families, schools or illness and would benefit from and communities. Our rehabilitation in an inpatient setting. team is specially trained The new eight-bed pediatric unit is to meet the unique needs locked, has a private, fully equipped, of our young patients child-friendly therapy gym on the and their families, and unit, and an outdoor sports court spe- we take every precaution cifically designed for young patients. to prevent the spread of TIRR Memorial Hermann accepts COVID-19.” pediatricians, oncologists, neurolo- patients from the age of 6 months to Pediatric rehabilitation services are gists and many others to provide coor- teenagers. available for patients with traumatic dinated care,” Cramer says. “Our therapists use the latest and non-traumatic brain injury, spas- Following their inpatient stay at technology but remain child focused ticity, post-tumor brain and spine man- TIRR Memorial Hermann, pediatric to ensure that our pediatric patients agement needs, limb loss, traumatic patients can transition to the Memori- are comfortable while they make spinal cord injury, stroke, encephalitis al Hermann Rehabilitation Network’s progress during their therapy ses- or infectious encephalitis, tracheos- outpatient program at four locations sions,” says Teresa Cramer, PT, DPT, tomy who are technology-dependent, around Houston. Former inpatients board-certified clinical specialist polytrauma, spine surgery, selective can also follow up with a pediatric in pediatric physical therapy and dorsal rhizotomy, and spina bifida. physiatrist at the TIRR Memorial pediatric clinical coordinator at TIRR “In addition to our full range of Hermann Outpatient Medical Clinic. Memorial Hermann and the Memori- therapy care, we work with other To make a referral or schedule al Hermann Rehabilitation Network. specialists when needed, including an appointment, call 800.44.REHAB “We partner with parents and care- neurosurgeons, orthopedic surgeons, (7-3422). g givers in a family-friendly environ-

20 TIRR MEMORIAL HERMANN TIRR Education Academy Goes Virtual with Learning for Professionals Around the World

Virtual learning has enabled the who can connect from all parts of the in Limb Loss; Advancing Clinical Prac- TIRR Memorial Hermann Education world makes virtual education a win- tice for those with Limb Loss in February Academy to expand its reach to re- win,” she says. “We’re finding that our of 2021 and TIRR Memorial Her- habilitation professionals practicing discussions are much more enriched mann’s Disorders of Consciousness across the United States and around when they include people from across Conference, DoC 2021: Translating the world. the country and around the world.” Knowledge into Practice.” “Sharing knowledge about evi- Courses available through the For more information and to dence-based rehabilitation practice is TIRR Education Academy are either register, visit https://tirr. especially important now, when in the prerecorded and web based for on- memorialhermann.org/ middle of the COVID-19 pandemic, demand viewing, live streamed, or professional-resources-education/ we’re still required to stay current in a hybrid of both. Upcoming courses continued-education. g our management of our patients. As a and conferences include Innovations community, we’re also learning more about rehabilitation of survivors of the virus – information that is important to share,” says Anna de Joya, PT, DSc, board-certified clinical specialist in neurologic physical therapy and direc- tor of education at TIRR Memorial Hermann and the Memorial Hermann Rehabilitation Network. “When the pandemic hit in March, we ramped up quickly, flipping all our classes to a virtual format.” In August 2020, TIRR Memorial Hermann Education Academy was invited to host a COVID-19 webinar for the international rehabilita- tion community in the Middle East, including the United Arab Emirates, Kuwait and Saudi Arabia. “The we- binar was well attended, and par- ticipants were highly engaged and seeking more, which prompted us to begin work on a another webinar for clinicians in the Persian Gulf Coast states,” de Joya says. She expects virtual learning to con- tinue beyond the pandemic and fur- ther extend the reach of TIRR Memo- rial Hermann. “I’m not sure anything will replace in-person learning but on the flip side, the number of people

THE INSTITUTE FOR REHABILITATION AND RESEARCH 21 TIRR Memorial Hermann Earns Top Recognition by U.S. News & World Report TIRR Memorial Hermann ranked No. 3 among the country’s top rehabilitation hospitals in the U.S. News and World Report Best Hospital rankings for 2020-2021. TIRR has been included in the prestigious rankings since the report’s inception in 1989. “For more than 60 years, TIRR Memorial Hermann’s talented team of affiliated physi- cians, researchers, clinicians and employees have treated some of the country’s most complex patients with compassionate, individualized care to meet the needs of their rehabilitation journey,” says Rhonda Abbott, PT, FTPTA, CEO of TIRR Memorial Hermann. “Our team continues to be recognized as a national leader in rehabilitation medicine and committed to our mission of independence and inclusion.” The ranking establishes TIRR Memorial Hermann as the No. 1 rehabilitation hospital in Texas. The annual Best Hospitals rankings and ratings, now in their 31st year, are designed to help patients and their doctors make informed decisions about where to receive care for challenging health conditions and for common elective procedures. The U.S. News Best Hospitals methodologies in most areas of care are based largely on objective measures such as risk-adjusted survival and discharge-to-home rates, volume and quality of nursing, among other care- related indicators. g

PROFILES IN CARING Liza Criswell, OTR, ATP

The Academy of Spinal Cord Injury Pro- agement, impaired hand dexterity, use they can leave fessionals (ASCIP) recently announced of assistive devices, positioning and the house and be that Liza Criswell, OTR, ATP, an occu- other ways to help patients gain inde- out and about in pational therapist at TIRR Memorial pendence,” Criswell says. “OTs also the community. Hermann, has been named the 2020 address sexuality with SCI/D patients. Addressing bowel recipient of the Therapy Leadership This is such an important aspect of and bladder man- Council Distinguished Clinician Award. people’s lives, so I incorporate the topic agement is also a great segue for me to The recognition is given to a member of of sexuality in day-to-day interactions initiate conversation on sexuality.” the organization who has demonstrated with patients in a nonchalant way so “This award means so much to me,” outstanding clinical contributions in they feel comfortable. When we are Criswell says. “Being an OT at TIRR the area of spinal cord injury and spinal talking about grooming and hygiene, I Memorial Hermann for more than two cord disorder (SCI/D). The award was work the topic into that conversation. decades, 18 years of that with the SCI presented to Criswell via pre-recorded Sexuality is not just about performing and Specialty Rehab team, it gives me Zoom in September 2020. sexual activities, but it also encompass- joy to help nurture and enhance my Criswell says she is passionate about es body image, intimacy, reproductive patients’ skills to achieve their fullest educating both her patients and her capabilities, gender identities/roles and potential. We start building the founda- peers. For the past few years, she has sexual orientation.” tion in inpatient rehab and outpatient had opportunities to teach and co-teach Criswell also says that bowel and therapy helps polish those skills. It gives continuing education courses on the bladder management is one of the most me a sense of satisfaction and pride to topics of neurogenic bowel and bladder liberating skills that that a SCI patient see my former patients thrive in the management, and sexuality after SCI. can have. “When patients can perform community.” g “As OTs, we address clothing man- these tasks independently, it means

22 TIRR MEMORIAL HERMANN RESEARCH Patient-care Technology in the Palm of Your Hand: Can a Mobile Mood Tracker App Detect Emotional Distress in People with Traumatic Brain Injury?

Researchers at TIRR Memorial with others. At about a year after being The problem is compounded by the Hermann are conducting a study to injured, 44 percent of people report fact that many people with TBI are determine whether a self-management anxiety and 40 percent report depres- reluctant to seek help for emotional strategy, in the form of a mood tracker sion,” says Mark Sherer, PhD, ABPP, problems, and when they decide they smartphone app, can improve emo- FACRM, associate vice president for do want help, it’s hard to find.” tional distress in survivors of traumatic research at TIRR Memorial Hermann Many states, including Texas, have a brain injury (TBI), or make it less and a clinical professor of physical shortage of mental healthcare provid- likely that they will develop it. The medicine and rehabilitation at Mc- ers, especially in rural areas. “Even in investigation is part of the $2.3 million Govern Medical School at UTHealth larger cities, providers are busy and Traumatic Brain Injury Model Systems and at Baylor College of Medicine. “By may not be accepting new patients,” (TBIMS) grant to TIRR Memorial five years after injury, 28 percent have Dr. Sherer says. “The out-of-pocket Hermann, awarded by the National depression and 17 percent have anxi- cost of private providers is high for Institute on Disability, Independent ety. If we think of emotional distress as those with insurance, and many Living and Rehabilitation Research. having depression, anxiety--or both, at people with TBI lack mental health “Many survivors of TBI have im- one year 53 percent of people with TBI coverage. Low-cost programs run by paired cognition, problems controlling have emotional distress. At five years, the state and cities are overused, feelings and difficulty communicating 38 percent have emotional distress. continues on page 24 continuesd from page 23 also track how often participants use which further limits access. We hope the app. If an individual is not using that our mood tracker project decreas- it, the person making the weekly call es the level of distress TBI survivors explores the reason for the barrier. experience so that they will be less in If they’re using the app regularly, we need of services that are increasingly tell them they’re doing a good job. difficult to access.” These calls last five to 10 minutes, The project aligns with the current making this a very low-cost interven- self-management movement in health tion.” After six weeks, people on the care. For example, a patient might be wait list switch into active treat- asked to monitor his or her own blood ment, so that no one who enrolls is pressure or blood sugar levels at home, denied treatment. “Our tendency in and keep a record of the readings to the treatment of TBI is to target the share with physicians. Research has most severely affected people,” he shown that this form of self-manage- says. “If we can target a much larger ment can result in improved popula- group of people at low cost and reach tion health. them before they have severe mental “We hope that our “Previous studies have demon- health problems, we will have made mood tracker project strated that simply keeping track of a a jump forward in the care we offer problem may improve it,” Dr. Sherer TBI survivors. If our study is success- decreases the level of says. “For example, tracking how ful, it could be deployed and used by distress TBI survivors often one has headaches can result a huge population with traumatic experience so that they in fewer headaches. Keeping track of brain injury and could serve as a one’s blood pressure can lead to lower model for following up with other will be less in need of blood pressure. Along those same populations.” services that are increas- lines, we’re hoping that keeping track At the close of the study, the of emotional distress will result in researchers will conduct statistical ingly difficult to access.” lower levels of emotional distress.” tests to determine if use of the mood Mark Sherer Study participants are enrolled tracker app can result in less emotion- to active treatment or wait lists. al distress or prevent emotional dis- People with TBI who are assigned to tress from developing. The grant was the study’s active treatment arm are funded at the beginning of October trained to use the mood tracker app 2017, with the goal of enrolling 126 and asked to rate their levels of emo- participants. Co-investigator of the tional distress several times a week. study is Angelle Sander, PhD, director Participants receive a support call each of the Brain Injury Research Center at week for 6 weeks to address any prob- TIRR Memorial Hermann and associ- lems in completing the self-ratings. ate professor and director of the divi- After 6 weeks, they are asked to com- sion of Clinical Neuropsychology and plete a 6-week outcome report, and are Rehabilitation Psychology at Baylor encouraged to continue completing College of Medicine. the self-ratings, but do not receive fur- “We’re still on track to complete ther support calls. When the 12-week the study on the five-year TBI Model outcome is assessed, the participant’s Systems schedule,” Dr. Sherer says. involvement with the study ends. “Even with COVID-19, we expect to be “We refer participants who report able to collect all our data and analyze severe symptoms of depression for it by October 2022.” g treatment,” Dr. Sherer says. “We can

24 TIRR MEMORIAL HERMANN Funded by a TIRR Memorial Hermann Rehabilitation Innovation Grant Becky Thayer Leads a Study on Mirrors and Limb Loss Patients

When we look in the mirror, we’re To create a video as used to seeing a familiar face and body. part of the program However, after amputation or disfigur- to educate nurses, ing injury, the reflection in the mirror Thayer partnered with is not the person we know. Wyona Freysteinson, “Nurses are trained in the medical PhD, associate profes- treatment of patients with limb loss, sor of nursing at Texas but most have not been trained in how Woman’s University in to be comfortable offering a patient Houston, and Lisa W. the opportunity to view their new body Thomas, DNP, APRN, image, in private, and be supportive ACNS-BC, CRRN, during that healing step,” says Becky NEA-BC, former TIRR Thayer, MSN, RN, CRRN, project man- Memorial Hermann ager for evidence-based practice in employee and an as- nursing administration. sistant professor at To help change the paradigm, Cizik School of Nursing Thayer and her co-investigators used at UTHealth. Study a TIRR Memorial Hermann Rehabili- participants watched tation Innovation Grant to conduct a the video, which fea- study on the topic. Their findings were tured interviews with published in the May 2020 issue of limb- loss patients talking about their Clinical Nurse Specialist.1 experience looking in the mirror “This is a great achievement – just “Often the first time a limb-loss pa- after amputation, and sharing their the sort of thing our innovation grants tient sees herself or himself after surgery thoughts on how medical staff could are meant to support,” says Mark Sherer, is in the big mirrors in the therapy gym, prepare them for what they saw. PhD, ABPP, FACRM, associate vice and other people may be there,” Thayer “Immediately after the nurses president for research at TIRR Memo- says. “We think it’s important for patients watched the video, we conducted a dis- rial Hermann and a clinical professor to have private time to visualize them- cussion to gather their feedback, which of physical medicine and rehabilita- selves as they are, in the moment, and led us to believe that a sensitive program tion at McGovern Medical School at become familiar with their ‘new me.’” like this could be successful for nurses UTHealth and at Baylor College of Thayer and her colleagues were using an online platform,” Thayer says. Medicine. “Becky began with limited awarded the $10,000 grant to deter- A survey conducted a month later research expertise but with determina- mine if an online teaching platform showed that the nurses were more tion and some good help from others, about the sensitive topic could suc- comfortable supporting a patient if the she completed a great project.” cessfully strengthen nurses’ confi- patient asked the nurse to help them dence in supporting a patient in-mir- look in a mirror after an amputation. 1Thayer B, Freysteinson W, Thomas LW. ror viewing after a disfiguring event. The TIRR Memorial Hermann Inno- Transforming the Experience of Mirror Viewing for Individuals Face with Disfigur- To begin the study, 25 TIRR Memo- vation Grant was established to support ing Injuries. Clinical Nurse Specialist. 2020 rial Hermann nurses took an online innovative rehabilitation research and May;34(3):132-136. survey to assess their knowledge and the hospital’s research mission. TIRR feelings about helping patients with facilitates research that will improve the limb loss look at themselves in the lives of rehabilitation patients worldwide. mirror for the first time. Thayer was awarded her grant in 2018.

THE INSTITUTE FOR REHABILITATION AND RESEARCH 25 PATIENT STORIES Dr. Grant Lashley’s Long Road Back from COVID-19

“We designed a therapy program geared at improving strength of the proximal muscles in Dr. Lashley’s arms and legs to do the heavy lifting of his body required to sit up and Emergency medicine physician Grant ration levels kept dropping.” transfer out of a chair, Lashley, MD, is among the many Twenty-four hours after testing go to the bathroom healthcare professionals who contract- positive for the virus, he was admit- ed COVID-19 while treating patients ted to the COVID-19 Unit at Lafayette and eventually go back during the United States’ first wave of General Medical Center. After another to daily life.” virus cases in April 2020. While work- 24 hours, he was transferred to the ing the night shift in the emergency ICU and intubated, according to his Nikola Dragojlovic department at Abbeville General Hos- wife Melisa Harrington, MD, a ne- pital in Louisiana, he diagnosed one phrology specialist in Lafayette. Dr. patient with COVID-19 and intubated Lashley has almost no memory of his another. A few days later, the 50-year- time in intensive care, where he re- old noticed mild symptoms. mained intubated for 37 days. His wife “We were careful with our use later told him he suffered a stroke and of personal protective equipment, underwent dialysis twice, while receiv- because even then we knew there were ing every treatment recommended at asymptomatic carriers,” Dr. Lashley the time for COVID-19. says. “For about four days, in the On Mother’s Day, his care team evening around 7 p.m., I remember talked with Dr. Harrington about re- telling my wife that I didn’t feel good. moving her husband from life support. Nikola Dragojlovic, DO I had no fever or shortness of breath. “She said no, and she and my critical Assistant Professor We were headed into what I knew care specialists decided to try a high of Physical Medicine would be a busy weekend in the ER, dose of steroids, which became the and Rehabilitation at and I thought I might have the flu. The standard of care for severe COVID-19 McGovern Medical School at UTHealth results of my tests came back positive cases about a month later. I think for strep and COVID-19. It seemed that’s what turned me around,” Dr. like a mild case and I thought I would Lashley says. recover at home, but my oxygen satu- When he regained consciousness,

26 TIRR MEMORIAL HERMANN he didn’t realize he had lost more and his motivation and spirit were “Early on I recognized my limita- than a month of life. The long ICU infectious. We all wanted to be a part of tions,” Dr. Lashley says. “When this stay left Dr. Lashley with a right wrist that, to help him and see him do better. happens, you can either get depressed and left foot drop as a result of critical While we were encouraging him, he was or do something about it. As an ER doc- illness polyneuropathy. He also had encouraging us during the stressful time tor, I’m used to living fast. I’ve never generalized weakness after being im- of implementing our own COVID-19 functioned in life in a slow, steady man- mobilized on a ventilator for 37 days. staffing precautions to keep the virus ner. I had to take a step back and learn He had lost nearly 40 pounds, almost out of our hospital during Houston’s to view every small improvement as a half of which was muscle mass. After wave of infections. He was a great source big deal. By the time I left TIRR Memo- two weeks at a local long-term acute of encouragement with his optimism rial Hermann, I was able to walk around care facility, at the end of May 2020, and enthusiasm. He said, ‘We’re all in the gym with a walker, which I never he was transferred to TIRR Memorial this together and let’s take it one day at a would have imagined. I’m very aware Hermann under the care of physiatrist time.’ It was very refreshing.” that I’m still near the beginning of my Nikola Dragojlovic, DO, an assistant Dr. Lashley says his experience at real recovery, but I no longer need to be professor of physical medicine and TIRR Memorial Hermann was amaz- in an institution because of what TIRR rehabilitation at McGovern Medical ing. “I had heard good reports about Memorial Hermann did for me.” School at UTHealth who specializes in TIRR but didn’t know what to expect. “There’s more that can happen with the management of patients following I found that everyone on the team was COVID-19 than just very bad pneumo- traumatic brain injury, polytrauma, supportive, positive, and motivational nia,” Dr. Lashley said in conclusion. stroke and other neurologic disorders. – from nurses to physical therapists “You can have a stroke and develop “We designed a physical therapy and occupational therapists to speech blood clots. Those of us who have the program geared at improving strength therapists to the folks in dietary.” good fortune to survive the effects of the proximal muscles in Dr. Lash- “Kathy Gordon, my physical of the virus can get better, and TIRR ley’s arms and legs to do the heavy therapist, was fantastic. When I said I Memorial Hermann is a great place for lifting of his body required to sit up couldn’t do something, she said, ‘Yes that. One thing that happens is that and transfer out of a chair, go to the you can.’ And I did,” he says. “My oc- the people you work with become a lot bathroom and eventually go back to cupational therapist was Megan Cleve- like family, and at the end, it becomes daily life,” Dr. Dragojlovic says. “His land. Her spirit was unsurpassable. emotional to leave. In medicine, occupational therapy program was She had the kind of energy a patient things can become very sterile, and aimed at recovering dexterity in his needs to see. She finds your weak spots that’s definitely not the case at TIRR hands. His speech therapist helped and helps you improve. All the thera- Memorial Hermann.” g him with breath-support protocols pists I encountered were really great.” that included special breathing tech- niques that allow people recovering from COVID-19 to regain the endur- ance they lost due to poor efficiency of the lungs. By learning the protocols, he regained the use of his lungs, his voice improved, and he could maintain his breath during physical activity.” During Dr. Lashley’s five-week stay at TIRR Memorial Hermann, he learned to walk again. “When he arrived, he required total assistance to get out of bed and to move, and he was unable to stand,” Dr. Dragojlovic says. “He was incredibly optimistic in the face of all these physical and emotional changes,

THE INSTITUTE FOR REHABILITATION AND RESEARCH 27 ACCOLADES

Dr. Gerard Francisco Receives AAP Distinguished Academician Award The Association of Academic Physiatrists (AAP) has named Gerard E. Francisco, MD, professor and chair of the department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth, as its 2020 Distinguished Academician. Dr. Francisco received the award for achieving distinction and peer recognition by virtue of excel- lence as a teacher, researcher and administrator. He received the award at the 14th International Society of Physical and Rehabilitation Medicine (ISPRM) World Congress and 53rd Association of American Physiatrists (AAP) Annual Meeting last March in Orlando, Florida. Dr. Francisco serves as chief medical officer of TIRR Memorial Hermann and director of the UTHealth NeuroRecovery Research Center at the TIRR. His research spans various areas, including robot-assisted therapy in persons with stroke, multiple sclerosis and spinal cord injury, as well as novel botulinum toxins for post-stroke spasticity. “This award is special to me because I received the honor as an academician at a leading rehabilitation hospital,” Dr. Francisco says. “TIRR Memorial Hermann is a nurturing environment for academic activities in physical medicine and rehabilitation. We have a long history of recognizing the importance of research and education in support of clinical care.” Since 2001, Dr. Francisco has been listed annually in Best Doctors in America. In 2017, he was inducted into the prestigious National Academy of Medicine (formerly the Institute of Medicine). In addition, he has received several Dean’s Excellence in Teaching Awards at UTHealth. He served as president of the AAP from 2015 to 2017 and cur- rently holds offices in various PM&R organizations, including the International Society of Physical and Rehabilita- tion Medicine. Dr. Francisco received his medical degree at the University of the Philippines College of Medicine in 1989 and com- pleted a postdoctoral fellowship in brain injury rehabilitation at Baylor College of Medicine. He joined UTHealth and the Brain Injury Program at TIRR Memorial Hermann in 1997.

Dr. Angelle Sander Named President-Elect of ACRM’s Brain Injury Interdisciplinary Special Interest Group Angelle Sander, PhD, director of the Brain Injury Research Center at TIRR Memorial Hermann, has been named president-elect of the American Congress of Rehabilitation Medicine’s Brain Injury Interdisciplinary Special Interest Group (BI-ISIG). Her six-year term began at the 2020 annual conference in October. “BI-ISIG was formed to bring together experts in the field of brain injury,” says Sander, associate professor and director of the division of Clinical Neuropsychology and Rehabilitation Psychology at Baylor College of Medicine. “Over the years the group has been responsible for much of the crucial work done in pushing forward brain injury rehabilitation.” Several smaller working groups come together to form BI-ISIG. “For example, the Cognitive Rehabilitation Task Force has developed a series of systematic reviews of the effectiveness of cognitive rehabilitation treatments, which has led to best-practice recommendations,” she says. “The Disorders of Consciousness subgroup has put forth evidence- based guidelines for assessing people with disorders of consciousness. The working groups that make up BI-ISIG lead efforts to change or guide clinical rehabilitation practices across the country.” Dr. Sander will serve as president-elect of BI-ISIG for two years, and then as president of the group for two more years. As president, her duties will include oversight of the organization’s working groups, service as a liaison to the ACRM Board of Governors, and participation in conceptualization of the vision for ACRM. Following two years as president, she will serve as immediate past president for two years, helping to transition the newly elected leadership into their roles.

28 TIRR MEMORIAL HERMANN Dr. Monica Verduzco-Gutierrez Named Chair of PMR Department at UTHealth San Antonio Monica Verduzco-Gutierrez, MD, was appointed professor and chair of the department Physical Medicine and Rehabilitation at the Long School of Medicine at UT Health San Antonio, effective April 1. She succeeded Nicolas E. Walsh, MD, who served as chair for three decades and will continue in an emeritus role and as a part-time clinician. Dr. Gutierrez is an accomplished academic physiatrist who began her career in 2006 at TIRR Memo- rial Hermann and McGovern Medical School at UTHealth as a resident in the former Baylor College of Medicine/UTHealth Alliance for Physical Medicine and Rehabilitation. She served as medical director of the Brain Injury and Stroke Program at TIRR Memorial Hermann, associate professor in the department of Physical Medicine and Rehabilitation and vice chair of quality and patient safety at McGovern Medical School at UTHealth. “I am proud of Dr. Gutierrez and grateful to her for her many contributions to TIRR Memorial Hermann and McGovern Medical School during her time here,” says Gerard Francisco, MD, professor and chair of the department of Physical Medicine and Rehabili- tation at McGovern Medical School and chief medical officer at TIRR Memorial Hermann. “She played a significant role in our Outpatient Medical Clinic, Spasticity Clinic and the Brain Injury and Stroke Program, and I know she will excel in her new role.” Dr. Gutierrez grew up in South Texas and moved to Houston where she earned her undergraduate degree at Rice University and her medical degree at Baylor College of Medicine. At McGovern Medical School, she was elected chair of the Faculty Senate, where her work focused on developing wellness initiatives for faculty. She has won multiple awards for medical student and resident teaching and has had several administrative roles within the Memorial Hermann Health System.

MESSAGE FROM THE CEO

We define adaptation as the evolu- spending 37 days on a ventilator. During Hermann in 2001, I fell in love with our tionary process whereby an organ- his stay, we were implementing our own pediatric program and knew I wanted ism becomes better able to live in its pandemic precautions. While we were to spend my career here. We are so habitat. This issue of the TIRR Memo- encouraging him in his recovery, he was happy to welcome the kids and families rial Hermann Journal is focused on our encouraging us. As his therapy team back to inpatient rehabilitation. continued evolution to meet the needs shared with us on the day he rejoined his Having the opportunity to serve as of our habitat – the global disability family and headed home from TIRR CEO is a real privilege and honor. As an community – in the face of a rapidly Memorial Hermann, Dr. Lashley is just institution and as people, we have been evolving pandemic. one example of many demonstrating our pushed by the pandemic in unfamiliar The COVID-19 pandemic prompted ability to return COVID-19 survivors to and uncomfortable ways. Our leaders us to step back and consider how to the community. and teams have done an amazing job of deepen our missions of clinical care, re- Lex Frieden, profiled in our cover evolving, particularly in a time of fear. search, education and advocacy in terms story, has made phenomenal contribu- Without them, none of this would be of the virus. Our affiliated physicians, tions to the disability community by possible. We will continue to adapt and teams and researchers studied the litera- changing the habitat itself so that the rise to the challenge, as we’ve always ture, looked at evidence-based practice community can better embrace people done. We reach as high as we can and for our population in new ways, created with disabilities. His extraordinary ad- then we reach a little higher. treatment plans for our inpatients and vocacy journey began with work that led outpatients, adapted programs rapidly to the passage of the Americans with Rhonda Abbott, PT, FTPTA Chief Executive Officer for TIRR Memorial Hermann Sports Disabilities Act in 1990, and continues TIRR Memorial Hermann and our wellness programs, and trained today through the Independent Living System Executive for Rehabilitation Services, our teams. One of the beneficiaries of Research Utilization (ILRU) program, Memorial Hermann Health System our rapid adaptation is Dr. Grant Lash- which is helping people with disabilities ley, an emergency physician from Lafay- maintain their independence while ette, Louisiana, who survived COVID-19 they navigate the pandemic. and came to us for rehabilitation after When I came to TIRR Memorial

THE INSTITUTE FOR REHABILITATION AND RESEARCH 29 TIRR Memorial Hermann Welcomes Physicians

Jason Hua, DO, Peter Riedel, DO, Ryan Stork, MD, Jean Woo, MD and Alexander K. Wu, MD, have joined the medical staff of TIRR Memorial Hermann and the faculty of McGovern Medical School at UTHealth as assistant professors of physical medicine and rehabilitation.

Dr. Jason Hua received his medical Dr. Peter Riedel is dual board certified National Doctor’s Day Recognition degree at Kansas City University of in physical medicine and rehabilita- Award in 2019. In addition to making Medicine and Biosciences and com- tion and in brain injury medicine. presentations at national meetings of pleted residency training in physical He received his medical degree at the AAPMR and AAP, he authored the medicine and rehabilitation at Mc- Philadelphia College of Osteopathic chapter, “Pharmacologic Treatment Govern Medical School. Dr. Hua holds Medicine in Pennsylvania and com- Tools: Systemic Medications and certificates in healthcare management pleted residency training at Temple Toxins, Opportunities and Pitfalls” in from the University of Houston-Clear University Hospital/MossRehab in the August 2018 issue of the Physical Lake and as a physician educator from Philadelphia, where he was chief Medicine and Rehabilitation Clinics UTHealth, and is a Lean Six Sigma resident. He went on to complete a of North America. He will be based at Yellow Belt. His current research brain injury fellowship at MossRe- TIRR Memorial Hermann Outpatient interest is virtual reality and distrac- hab/Einstein Healthcare Network. Rehabilitation-The Woodlands. tion therapy in managing neuropathy Prior to joining TIRR Memorial pain flare in patients with acute spinal Hermann, he was an attending phys- Dr. Ryan Stork received his medical cord injuries. An assistant professor iatrist in Pennsylvania at MossRehab degree at the University of Toledo of physical medicine and rehabilita- Elkins Park and at Reading Hospital College of Medicine in Ohio, and tion at McGovern Medical School, Dr. Rehabilitation Wyomissing, where completed residency training at the Hua is a native speaker of English and his work was acknowledged with University of Michigan in Ann Arbor, Mandarin Chinese. the Reading Hospital Foundation where he was chief resident in physi-

IN PRINT

Afzal T, Tseng SC, Lincoln JA, Kern M, exoskeleton and body weight unweigh- of print. doi.org/10.4103/jisprm. Francisco GE, Chang SH. Exoskeleton- ing technology to promote walking jisprm_8_20. assisted Gait Training in Persons with activity in tetraplegia following SCI: Multiple Sclerosis: A Single-Group A case study. J Spinal Cord Med. 2020 Pinto D, Garnier M, Barbas J, Chang Pilot Study. Arch Phys Med Rehabil. Jan;43(1):126-129. SH, Charlifue S, Field-Fote E, Furbish 2020 Apr;101(4):599-606. C, Tefertiller C, Mummidisetty CK, Dawson J, Engineer ND, Prudente Taylor H, Jayaraman A, Heinemann Robinson-Whelen, S., Hughes, R. G., CN, Pierce D, Francisco G, Yozbatiran N, AW. Budget impact analysis of robotic Taylor, H. B., Markley, R., Vega, J. C., et al. Vagus Nerve Stimulation Paired exoskeleton use for locomotor training Nosek, T. M., Nosek, M. A. (2020). Pro- with Upper-Limb Rehabilitation After following spinal cord injury in four SCI moting psychological health in women Stroke: One-Year Follow-up. Neuro- Model Systems. J Neuroeng Rehabil. with SCI: Development of an online rehabilitation and Neural Repair. doi. 2020 Jan;17(1):4. self-esteem intervention, Disability org/10.1177/1545968320924361. and Health Journal, 13 (2):100867. doi: Prigatano GP, Sherer M. Impaired Korupolu R, Francisco GE, Levin H, 10.1016/j/dhjo.2019.100867 Self-Awareness and Denial During the Needham DM. Rehabilitation of Postacute Phases After Moderate to Chang SH, Zhu F, Patel N, Afzal T, Kern Critically Ill COVID-19 Survivors. J Severe Traumatic Brain Injury. Front M, Francisco GE. Combining robotic Int Soc Phys Rehabil Med. Epub ahead Psychol. 2020;11:1569.

30 TIRR MEMORIAL HERMANN cal medicine and rehabilitation. He Dr. Alexander Wu graduated from Dr. Jean Woo received her medical went on to complete a fellowship in Rice University in Houston summa degree from Wayne State University brain injury medicine and rehabili- cum laude and received his medical School of Medicine in Michigan, tation at McGaw Medical Center of degree at McGovern Medical School. and completed residency training in Northwestern University and the He completed residency training at Physical Medicine and Rehabilita- Shirley Ryan AbilityLab in Chicago. the same institution, where he was tion at Baylor College of Medicine. During his time at the University of academic chief resident. During She completed a fellowship in brain Michigan, Dr. Stork also served as residency, Dr. Wu was the presenting injury medicine and was a part of associate residency program director author of “Traumatic Spinal Cord the honor society at Baylor as well. and received a grant from the Michi- Injury and PM&R Consultation at a She has served on the AAP Resident gan Institute for Clinical and Health Level 1 Trauma Center: Five Years Fellow Council and Program Research for the Project, “Measure- and 1,000 Patients Later” at the As- Committee. Dr. Woo is a former ment of Autonomic Dysfunction sociation of Academic Physiatrists resident of TIRR and she participated Following Concussion Using the E4 Conference in Atlanta in 2018. In in research projects focusing on Wristband.” He was awarded the 2019, he was the presenting author spasticity, underserved patients Silver Crutch Teaching Award 2017, of “Pneumocephalus and Successful with disability, and more. Dr. Woo 2018 and 2020 in recognition of his Air Transport Home: A Case Report” is an attending physician at TIRR commitment to teaching and engage- at the American Academy of Physical Memorial Hermann in the Texas ment of PM&R trainees. Dr. Stork is Medicine and Rehabilitation confer- Medical Center for the Brain Injury an attending physician in the Brain ence in San Antonio. Dr. Wu is an at- and Stroke Program. Dr. Woo will Injury and Stroke and Specialty Pro- tending physician at TIRR Memorial treat patients with traumatic brain grams at TIRR Memorial Hermann. Hermann-The Woodlands. injury, stroke, and Disorders of Prior to joining TIRR Memorial Her- Consciousness. g mann, he was an assistant professor in the department of Physical Medicine and Rehabilitation at the University of Michigan.

GRANTS

Sander AM, Boileau NR, Hanks RA, Lex Frieden and Richard Petty received $1 non-invasive intervention (BreEStim) Tulsky DS, Carlozzi NE. Emotional million from the U.S. Department of for management of phantom limb pain suppression and hypervigilance in Health and Human Services Administra- after traumatic amputation.” military caregivers: Relationship to tion on Disability Independent Living Mark Sherer, PhD, ABPP, FACRM, associ- Negative and Positive Affect. J Head Training and Technical Assistance Grant ate vice president for research at TIRR Trauma Rehabil. 2020;35:e10-e20. Program, in support of the Independent Memorial Hermann and Eva Sevick- Living Research Utilization (ILRU) pro- Sherer M, Katz DI, Bodien YG, Arcinie- Muraca, PhD, professor and Nancy and gram. The funds will be used for training, gas DB, Block C, Blum S, Doiron M, Rich Kinder Distinguished Chair of consulting and publication of resources Frey K, Giacino JT, Graf MJP, Green- Cardiovascular Disease Research and that support community-based organiza- wald, B, Hammond FM, Kalmar K, director of the Center for Molecular Im- tions in providing social services for people Kean J, Kraus MF, Nakase-Richard- aging of the National Cancer Institute with disabilities and older adults who rely son R, Pavawalla S, Rosenbaum A, Network for Translational Research on the centers to live independent lives. Stuss DT, Yablon SA. Post-traumatic at UTHealth, received an award of Confusional State: A Case Definition Sheng Li, MD, PhD, with co-investiga- $69,858 to investigate the possible and Diagnostic Criteria. Arch Phys tors Danielle Melton, MD, and Shengai Li, clinical benefit of manual therapy to Med Rehabil. ACRM Endorsed Case MS, received a grant for an NIDILRR improve lymph and cerebral spinal fluid Definition. Field-Initiated Project entitled “A drainage from the head and neck area.

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TIRR Memorial Hermann Journal is published throughout the year About TIRR Memorial Hermann by TIRR Memorial Hermann. Please direct your comments TIRR Memorial Hermann, a leader patients. To achieve these goals, we or suggestions to Editor, in rehabilitation, does more than put the individual patient and their TIRR Memorial Hermann Journal, TIRR Memorial Hermann, provide therapy. We provide family at the center of the rehabili- 1333 Moursund, Houston, TX rehabilitation beyond the health- tation team, and provide them with 77030, 713.797.7229. care setting for children and adults the information and skills they need with a disabling injury or illness, to transition successfully to com- Rhonda Abbott, PT, FTPTA and change lives by helping people munity settings. Senior Vice President, CEO regain the skills and confidence TIRR Memorial Hermann is the they need to reintegrate into the best rehabilitation hospital in Texas Gerard E. Francisco, MD Chief Medical Officer community and continue living and among the best in the nation, full and meaningful lives. Our according to the U.S. News & World Mark Sherer, PhD, ABPP, FACRM highly trained rehabilitation teams Report’s Best Hospital rankings for Associate Vice President for see the potential in every person 2019-2020. The rehabilitation Research they work with, and develop that hospital’s ranking marks its 31st potential to the fullest through consecutive year among the maga- Susan Thomas, MPH Editor, Director of Marketing customized goal setting and treat- zine’s Best Hospital rankings. ment planning. To make referrals or schedule an Karen Kephart We work to maximize indepen- appointment, call 800.44REHAB Writer dence, restore function and im- (800.447.3422) toll free or Freeman Design Associates prove the quality of life for our 713.797.5942, or fax 713.797.5988. Designer

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Winter 2021

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