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...... T H E I N S TITUTE FOR REHABILIT AT ION AND RESEAR CH

|||||||||||||||||||||F A L L 2 0 1 0 Mobility for Kids: TIRR Memorial Hermann Expands

IN THIS ISSUE Lokomat Therapy to Its Pediatric Program 2 MESSAGE FROM THE CEO When Houstonians Nancy and contributed $88,000 to the Memorial FEATURES Raymond Risk found that pediatric Hermann Foundation for the purchase 1 Mobility for Kids Lokomat® walking therapy improved of the pediatric Lokomat legs. “The 3 Q&A with Lex Frieden: The Ameri- their son Noah’s strength and mobil- vast majority of those who contributed cans with Disabilities Act Turns 20 ity, they set a goal of raising funds to were new donors to TIRR,” says Thom 5 Safety First: TIRR Takes Steps to purchase the kid-size “legs” that would Sloan, senior director of development Stop Errors Before They Occur at the Foundation. “We’re grateful 6 Healing the Inner and Outer to each of them and especially to Person: Identifying Factors That Influence Spiritual and Emotional the Broughton Foundation, which Wellness During Rehabilitation contributed $20,000 to the cause, and After Spinal Cord Injury TIRR Foundation for their generous 7 Helping Family Members Cope gift of $7,500.” with Disability The pediatric legs arrived at TIRR 8 ON THE MOVE Memorial Hermann Kirby Glen in 8 TIRR Welcomes New Recruits June, and a training session was held 8 TIRR Expansion and Renovation allow children to use TIRR Memorial on July 10 during a special luncheon 9 Pharmacy Residency Program Hermann’s adult Lokomat. Now, honoring the Wednesday Charity Launched children across the state are benefiting Club and other donors who made the 9 Foundation News from the Risks’ determination to make purchase of the Lokomat pediatric 10 ON THE PODIUM the therapy available in Texas. module possible. Noah Risk was one 10 ACCOLADES Fundraising is second nature to of three children who demonstrated Nancy Risk, who is a longstanding the equipment at the luncheon. 11 IN PRINT member of a local organization called The Lokomat is the world’s first 11 TIRR IN THE NEWS the Wednesday Charity Club, a group driven-gait orthosis. Designed to 12 MESSAGE FROM THE CMO of women of Lebanese Christian benefit patients with neurological heritage who have raised money movement disorders, the system since the 1950s for charitable causes. consists of the robotic gait orthosis “Several of the women in the club itself and the Levi body-weight support have spouses or loved ones who have system used in combination with a been helped by TIRR’s rehabilitation treadmill. The patient’s legs are programs,” Risk says. “When we guided on the treadmill according to brought the idea of raising money for a preprogrammed physiological gait the pediatric legs to our group, they Mobility continues on page 4 said, ‘We’ve never taken on a project that large.’ But when people learned what we were trying to accomplish, they came out of the woodwork to help.” Between November 2009 and the end of March 2010, 105 donors ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||

FEATURED IN THIS ISSUE

Corwin Boake, Ph.D. Lex Frieden Angelle Sander, Ph.D. Neuropsychologist Director, Independent Living Research Utilization Director, Brain Injury Research Center Teresa Cramer, P.T., M.S., P.C.S. Professor of Biomedical Informatics and Rehabilitation, Associate Professor of PM&R, Baylor College of Medicine Physical Therapist The University of Texas Health Science Center at Houston Monika Shah, D.O. Lourdes Cuellar, R.Ph., F.A.S.H.P. Martin Grabois, M.D. Director, Brain Injury and Stroke Program Administrative Director of Pharmacy and Clinical Executive Vice President for Policy Assistant Professor of PM&R, Baylor College of Medicine Support Services Professor and Chair of the Department of PM&R, Baylor Mark Sherer, Ph.D. College of Medicine Teresa Del Castillo, L.C.S.W., L.M.F.T., M.B.A. Senior Scientist and Director of Research and Director Adjunct Professor, Department of PM&R, The University of Neuropsychology Licensed Clinical Social Worker of Texas Medical School at Houston Licensed Marriage and Family Therapist Clinical Professor of PM&R, Baylor College of Medicine Carl Josehart Reverend Hazel R. Thomas, M.Div., B.C.C. Gerard E. Francisco, M.D. TIRR CEO Chief Medical Officer Chaplain Manager Chair of the Department of PM&R, The University of Texas Cindy B. Ivanhoe, M.D. Sarah Lake Wallace, Pharm.D. Medical School at Houston Attending Physician, Brain Injury and Stroke Program Director of Performance Improvement and Patient Safety Associate Professor of PM&R, Baylor College of Medicine Adjunct Associate Professor of PM&R, The University of Texas Medical School at Houston

MESSAGE FROM THE CEO TIRR Memorial Hermann Journal is published M four times a year by TIRR Memorial Hermann. Please direct your comments or suggestions With the signing into law in 1990 of two other essentials for living an to Editor, TIRR Memorial Hermann Journal, the Americans with Disabilities Act, empowered life, are also addressed in TIRR Memorial Hermann, 1333 Moursund, Americans no longer had to view this issue. Thanks to the determined Houston, TX 77030, 713.797.5946. living with disability as a barrier to efforts of Nancy and Raymond Risk – Carl E. Josehart, CEO success. In the 20 years since its and the Wednesday Charity Club of Gerard Francisco, M.D., passage, the ADA has fulfilled much which Nancy is a member – pediatric Chief Medical Officer of its promise Lokomat® walking therapy is now Mary Ann Euliarte, R.N., to protect the available in Texas at TIRR Kirby Chief Nursing Officer /Chief Operations Officer rights of people Glen. And thanks to the work of our Mark Sherer, Ph.D. Director of Research with disabilities chaplain manager Reverend Hazel in employment, Thomas, who created an original Editorial Staff transportation, spiritual wellness assessment to Kate Eller, Editor Susan Thomas, TIRR Marketing communications identify factors that influence spiritual Karen Kephart, Writer and public and emotional wellness during Steve Stanley, Designer accommodations. rehabilitation after spinal cord injury, Carl E. Josehart, CEO But we have not we’re addressing the spiritual needs Material in this publication may not be reproduced in whole or part without permission fully realized the dream of those of our patients as a team. from TIRR Memorial Hermann. who wrote the act – equality of We continue to strengthen our opportunity, full participation in pledge to the people we serve, working Fall 2010 society, independent living and daily to advance rehabilitation We have opportunities for outstanding economic self-sufficiency. medicine, improve quality of life for rehabilitation professionals. If you are In this issue, Lex Frieden reviews the people who trust us to guide them interested in joining our team at U.S.News the history of the ADA and discusses in their personal recoveries and & World Report’s No. 5 rehabilitation the work that remains to be done in promote equal access so that all people hospital, contact Jude Lemaire, recruitment disability law and awareness. Through have the opportunity to live their consultant, at 713.797.7281 or TIRR Memorial Hermann’s Indepen- lives independently. [email protected]. dent Living Research Utilization All available opportunities can be viewed at program, which Lex directs, we’re Carl E. Josehart memorialhermann.org. working on eliminating barriers one Chief Executive Officer www.tirr.org by one in the communities we serve. TIRR Memorial Hermann www.ilru.org Mobility and spiritual wellness,

2 TIRR MEMORIAL HERMANN |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| FFEATURES Q&A with Lex Frieden: The Civil Rights Act of 1964 sparked the Subsequently, the ADA bill was consumerism movement led by Ralph introduced in Congress and hearings Americans with Disabilities Nader, the women’s movement and were held in Washington, Houston Act Turns 20 the antiwar movement. People with and other cities. Less than two years disabilities took notice, which spurred later, Congress passed the ADA by Lex Frieden is a professor of biomedi- the disability rights and independent one of the largest majorities in history. cal informatics and rehabilitation at living movement. A few weeks after the bill was passed, The University of Texas Health Science In response to advocacy by the President George H. W. Bush signed Center at Houston and director of TIRR disability community, members of the act into law. Memorial Hermann’s Independent Congress introduced legislation that Living Research Utilization program added a civil rights provision – Title Q: What were the most significant (ILRU). Frieden, who uses a wheelchair 5 – to the Rehabilitation Act of 1973, immediate changes following the signing following a 1967 traffic accident in which prohibits discrimination based of the act into law? which his spinal cord was severed, on disability in federal programs and In my opinion, almost all changes helped craft the Americans with federally funded programs. Ten years were immediate and significant. On Disabilities Act later, in 1983, I had the opportunity to July 25, 1990, an employer could (ADA), which testify before Congress during a review interview a person with a disability was signed into of the rehabilitation legislation. At and say, “I’m not going to hire you law on July 26, that time, I recommended a national because you have a disability.” The 1990. In July assessment of legislation and policy next day this was illegal. Every new 2010, on the 20th affecting people with disabilities. Then building or older building being anniversary of in 1984, I was appointed by President remodeled had to be made accessible. the enactment Ronald Reagan as the first executive Numerous changes happened imme- Lex Frieden of the ADA, he director of the newly created National diately. It was like night and day. was interviewed on National Public Council on the Handicapped, now Many more changes occurred in a Radio about his role in writing the ADA. known as the National Council on relatively short period of time. To listen to the NPR interview, visit Disability. The council was given the Twenty years ago there were two www.npr.org and search “Lex Frieden.” responsibility of doing the assessment cities in the United States in which Frieden also leads the Laboratory for I had recommended. people in wheelchairs could use a bus Adaptive Technologies at The Univer- – New York City and Denver. Today, sity of Texas School of Bioinformatics Q: What was your charge as executive every bus in every city with a public at Houston and is convener of the director of the council? transportation system is wheelchair Amerigroup National Advisory Board We had a little less than two years to accessible. Twenty years ago you didn’t on Improving Health Care Services put together a comprehensive report see handicapped parking spaces or for Seniors and People with Disabilities. on Americans living with disabilities. ramps on curbs. Schools could choose Q: For the first time in this country, a law When we presented the report, entitled not to admit people with disabilities mandated that public spaces accommodate Toward Independence, in January 1986, because of their impairments. Deaf people with disabilities. What evolution our No. 1 recommendation was the people could not serve on juries, took place in the American ethos to lead creation of a law to protect the rights and blind people could not access to such a profound change for those of people with disabilities in employ- information in libraries. Today, people living with disabilities? ment, transportation, communications with disabilities have accessible In the 1960s and early 1970s, Ameri- and public accommodations. While parking spaces, ramps on curbs, equal cans were moving toward a society in Congress expressed interest in our opportunity in employment and which individualism, equality and proposal, they failed to act on the education, access to courts and libraries personal responsibility took center recommendation. As a result, we and many other accommodations. stage. The same ideals that led to the produced another report in 1988 that Frieden continues on page 4 included draft language for the ADA.

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Mobility continued from page 1 says. The Lokomat offers patients framework for a treatment plan that pattern, which can be adjusted to and therapists a more efficient way of can incorporate various therapies,” accommodate individual needs and doing the therapy, and it’s producing she says. “If functional walking rehabilitation goals. Advantages of good results. Noah continues to show training is a part of the treatment plan, Lokomat-based therapy include faster progress. He’s lifting his legs better a portion of the treatment could progress through longer and more and walking better with each session.” involve the Lokomat for pediatric intensive training sessions compared Noah’s physical therapist Teresa patients who qualify.” to manual treadmill training, ease of Cramer, P.T., M.S., P.C.S., stresses that Cramer says Lokomat training monitoring and assessment of patient pediatric Lokomat walking therapy begins with a baseline gait assessment, walking activity and improved motiva- is just one part of a patient’s overall measurements to fit the robotic tion through visualized performance treatment plan. “At the initial evalua- settings to each patient and one or two feedback. tion we work closely with parents to trial sessions to evaluate how well the “This is not a new therapy,” Risk set the child’s goals, which provide a Mobility continues on page 5

Frieden continued from page 3 impact of the ADA, recently completed have been made to minimize the Q: How did the amendments to the by my colleagues at UT and ILRU, effect of the so-called “benefit cliff” ADA, effective January 1, 2009, expand supports that belief. Based on the but none of them seem to have worked. the definition of “disability” to cover opinions of 870 disability community Finally, efforts need to be made to new groups, such as cancer patients and leaders polled in a non-scientific survey improve housing and independent cancer survivors? that included people from all over the living options for people with There is a widespread misconception country, more than 90 percent felt disabilities in the community. that the ADA “expanded” the defini- that quality of life for people with Housing options are limited for tion of disability. In fact, the new disabilities has improved greatly people with disabilities and for amendments simply clarified the since passage of the ADA. About 60 seniors, particularly for those who definition of disability. In decisions percent of those surveyed agreed that are struggling to maintain their passed down over the past 20 years, the ADA’s greatest impact has been independence despite low incomes. the court system, including the in improvements in access to public Because housing is difficult to obtain, Supreme Court, narrowed the original accommodations, retail shops and for a variety of reasons, people with intent of the ADA. What Congress did commercial establishments. chronic, daily health-related needs with the 2009 amendments was to go But the survey also revealed three often find themselves in intermediate back and restate the definition of areas where we believe the ADA care facilities or nursing homes. Most disability as they originally intended should be supplemented: employment, of these people would prefer to be it, using words they hoped the courts healthcare and community living. living in the community, among could better understand and interpret. Figures vary, but most studies indicate families and friends. Cancer survivors and people with that half or more of working-age people In a few communities, integrated chronic disorders have always been with disabilities seeking employment housing and service demonstrations covered under the ADA, but it would are unable to find work. This rate have proved to be quite successful. have been difficult to prove discrimi- is more than three times that of the Given the predictable, impending nation in court because of the narrow non-disabled population. needs of 79 million baby boomers who definition used by the Supreme Court Economists argue about the reasons will eventually face the same challenges and others over the past two decades. for the high unemployment rate, but with housing and home care that Hopefully, courts will now find it everyone seems to agree that more people with disabilities and seniors easier to interpret the law according to aggressive action should be taken to who wish to be independent are facing the intent of Congress, and all people provide employment opportunities today, it is imperative that we develop with disabilities will be protected for this population. And disincentives creative solutions that support from discrimination. to working must be eliminated. For community-based independent living years, people with disabilities have for both young and old people with Q: What work remains to be done in the complained that by going to work, they disabilities and enable seniors to age area of disability awareness and law? sacrifice needed disability benefits in place. u I believe the ADA has fulfilled much like health insurance, home care and of its promise, and research on the housing assistance. Various efforts

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Mobility continued from page 4 Pediatric Lokomat therapy can into the robot and is old enough to child can work with the robotic system. benefit patients with neurologic understand how to use the therapy, “During each walking session, the conditions, including brain injury, he or she could be a candidate. In therapist adjusts parameters related spinal cord injury, stroke and cerebral Noah’s case, the therapy is helping to to walking speed, range of motion at palsy. The decision to incorporate improve his mobility.” the joints and how much body weight Lokomat training into the patient’s Six-year-old Noah smiles, sings support the robot is providing,” she treatment plan is done on a case-by- songs and plays games while he’s on says. “The goal is to show progress case basis. “The smallest femur length the treadmill. “He’s good natured over many sessions, with the patient the pediatric legs will accommodate and rarely fusses,” his mother says. supporting an increasing percentage is 21 centimeters, so most 4-year-olds “He looks forward to the sessions of his or her body weight. We couple will fit,” Cramer says. “If the child because his therapist makes the work Lokomat therapy with over-ground has the potential for improved fun. He’s been rocking and rolling walking, which is our ultimate goal.” walking, can tolerate being strapped since he started.” u

Safety First: TIRR Takes Steps to Stop Errors Before They Occur

Studies have shown that when of adverse medical events, many questions: Was the care appropriate? organizations hold safety as their problems have been traced to poor Does the documentation support the core value, the positive results carry communication, both nationally and care we provided? Is there anything over to other measurable areas of at TIRR, particularly at shift change we could have done to prevent the patient care, including time savings, and on weekends. “During hand-offs, transfer? Are there any general lessons quality, improved outcomes and we encourage our staff members to we need to learn from this case? Are patient, physician and employee ask questions,” says Wallace. “We’ve there issues we need other departments satisfaction. improved our weekend hand-off to evaluate?” Staff at TIRR communication by scheduling Friday Wallace says TIRR also encourages Memorial meetings with the residents covering staff members to examine the processes Hermann for the weekend, the attending they use in caring for patients to renewed their physician on call, if possible, and the improve their skills and reduce errors. focus on the weekend and evening nurse supervi- “Critical thinking is a matter of three Cs – com- sors. They discuss the baseline for maintaining a questioning attitude. munication, each patient and issues that may arise Is the information you’ve received from Sarah Lake critical thinking over the weekend, and do bedside a credible, knowledgeable source? If Wallace,Pharm.D. and compliance rounds to identify patients of higher- the information is outside the norm, – and put them to use as tactics in a level concern.” have you verified the information hospital-wide initiative to reduce the To improve communication, wound through the source or through another chance of adverse medical events. care rounds were initiated with the party? But most importantly, if “In some cases we’ve formalized spinal cord service, providing the something does not make sense or and are working to improve our attending physician, wound care nurse seems unusual, stop and figure it out.” performance around tactics we’ve and residents a designated time each Wallace says, “We actively challenge had in place for many years,” says week to examine wounds and assess ourselves to identify events that may Sarah Lake Wallace, Pharm.D., director improvement. not have had a long-term impact on a of performance improvement and To create opportunities to learn from particular patient but are long-term patient safety at TIRR. “In others events and improve critical thinking, lessons for us in improving the care we’ve implemented new processes to residents and representatives from we provide other patients. Patient improve patient safety in ways that patient safety, quality, pharmacy, safety is everyone’s responsibility. It’s will have the greatest impact on the nursing, risk management and a meticulous, ongoing process. If we quality of care we deliver.” admissions attend a monthly, physician- each perform at our personal best, In examinations of the root cause led peer review of all unplanned everyone wins.” u transfers. “We ask ourselves five

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Healing the Inner and Outer Person: Identifying Factors needed some questions answered and concerns addressed.” That Influence Spiritual and Emotional Wellness During Length of stay of study participants Rehabilitation After Spinal Cord Injury ranged from 16 to 84 days. Two- thirds of the group studied were Reverend Hazel R. Thomas, M.Div., B.C.C., wellness assessment on two used male; 38.5 percent were paraplegic board-certified chaplain at TIRR previously at The University of Texas and 61.5 percent were tetraplegic. Memorial Hermann, recently com- System M. D. Anderson Cancer Center Rev. Thomas, who is the sole chaplain pleted a six-month pilot study evalu- in Houston and Providence St. Vincent serving a 119-bed inpatient facility, ating specific psychosocial domains Medical Center in Portland, Oregon, spent from 25 to 575 minutes with that may positively or negatively modifying the questions and scales each patient, for an average of 158.97 change throughout the course of to meet the objectives of her study. minutes per patient. inpatient Study participants included 39 A secondary goal of the study rehabilitation. spinal cord injury patients admitted was to assess global change in each She was invited within four months of onset, ranging patient’s overall spiritual and to present her in age from 18 to 78 years. Each was emotional wellness. When she tallied research at two administered the assessment within results, Rev. Thomas learned that conferences: the seven days of admission and again 92.31 percent demonstrated an 2010 Annual within five days of discharge. Between increase in global change; 5.13 Meeting of the the two assessments, Rev. Thomas percent demonstrated a decrease in Hazel R. Thomas, Academy of spent varying amounts of time with M.Div., B.C.C. global change; and 2.56 percent Spinal Cord each patient. demonstrated no change. “More Injury Professionals, held September “The frequency and lengths of my than 90 percent of patients in the 22 to 24 in Las Vegas, Nevada, and visits were dependent on the patient’s pilot study left TIRR with an overall the 4th Annual National Spinal Cord response to the initial spiritual wellness better sense of spiritual wellness,” Injury Conference, held October 28 assessment,” she says. “If the overall she says. “While it’s difficult to to 30 in Niagra Falls, Ontario. response tended toward the negative, determine a specific reason for the To prepare for the study, Rev. I knew I needed to spend more time overall positive change, I believe it Thomas created an original spiritual with that patient. My work with each relates to our team effort to address wellness assessment consisting of patient varied enormously. I saw some the areas where each person scored eight questions measured on a patients one on one. Others I’d see as lowest on the first assessment. seven-point evaluation scale. “I a participant in team rounds. Some- “As chaplains we’re making strides reviewed many articles and surveyed times I’d go on community outings toward evidence-based reporting with a patient and family of outcomes, but it’s difficult to Spiritual Wellness Assesment members, or work with determine the contribution a patients during a group I feel... chaplain makes to spiritual wellness Overwhelmed -3 -2 -1 0 1 2 3 Comfortable/Serene physical or occupational on a daily basis,” she says. “We’ve Hopeless -3 -2 -1 0 1 2 3 Hopeful therapy session. A thera- Anxious -3 -2 -1 0 1 2 3 Peaceful long questioned how we can assess Alone/Abandoned -3 -2 -1 0 1 2 3 Connected pist might alert me that a whether a patient feels better after Powerless -3 -2 -1 0 1 2 3 Empowered particular patient needed Rejected -3 -2 -1 0 1 2 3 Accepted having seen a chaplain. Having a attention.” numeric spiritual wellness assess- My life seems... Rev. Thomas recorded Meaningless -3 -2 -1 0 1 2 3 Meaningful ment has allowed us to address the scores of the initial spiritual spiritual needs of our patients as a I have a... wellness assessment and Low Self Image -3 -2 -1 0 1 2 3 Positive Self Image team. Spiritual and emotional comments about her visits Global change ______rehabilitation are just as important in the medical chart. as physical rehabilitation. Our goal “Sometimes I’d make a is to help our patients heal on the chaplains via e-mail to learn about note that a patient was feeling really inside as well as on the outside.” u existing assessment tools,” she says. alone and needed support – or that Ultimately, she based her spiritual the patient was really anxious and

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Helping Family Members Cope with a Loved One’s Disability accident and that she had become a caretaker. She was struggling with a Roland Valdes was a successful close relationships. “I learned every- sense of loss at many levels. Before we mechanical engineer when he suffered thing I could about how to help him,” met she was in survival mode. When a traumatic brain injury (TBI) in a she says. “For three years, I think I did there was a tiny bit of stability in her motorcycle accident on December 6, pretty well, although I know I made relationship with her husband, she 2006. After acute care at Ben Taub some mistakes along the way. Then was ready to deal with her own needs.” General Hospital, Valdes was last year my patience was wearing “After the accident, many people transferred to TIRR for a month-long thin and I started losing my temper, asked why I stayed with Roland,” inpatient stay in early 2007. Following which is what made Roland tell his Valdes says. “I couldn’t leave because his discharge, he enrolled in the TIRR doctor that I needed some help.” I love him. By nature, I’m a nurturing Challenge Program, a comprehensive Debbie Valdes first learned of the person, and he needed that kind of community-reintegration program family counsel- care. He didn’t ask for the accident for survivors of TBI and stroke. ing services to happen. It was just one of those “After the Challenge Program, provided by things. If I were disabled, I’d like to Roland came home and started getting TIRR Memorial think that I wouldn’t be abandoned.” back into life,” said Roland’s wife, Hermann’s She says the sessions with Del Debbie Valdes. “He went to the gym Teresa Del Castillo, Castillo were helpful. “Things are and worked out. As soon as he was L.C.S.W., L.M.F.T., okay now. Roland drives and runs able, he signed up for classes in the M.B.A., when she errands during the day while I’m at Internet-based master’s degree program Teresa Del Castillo, accompanied work. It’s just that he doesn’t put as he was working on before the accident, L.C.S.W., L.M.F.T. Roland to a much into the marriage as he did and that occupied his time.” follow-up outpatient clinic visit with his before the accident, and Teresa helped But the Valdes’ lives had changed physical medicine and rehabilitation dramatically. “Our lives before and specialist. When Valdes mentioned aldes educated herself about after the accident were like night and that it might be helpful for his wife the personality changes to day,” she says. “Roland had an to talk with a Vexpect after traumatic brain energetic, vibrant personality. If he counselor, injury, including physical, cognitive and psychological impairments wanted something, he went after it, Monika Shah, D.O., that can cause aggression, anxiety and that aspect of his personality referred her to and depression. hasn’t changed. But we went from a Del Castillo, a relationship in which he was very much licensed clinical me cope with that. She gave me a new in control to one in which he was social worker perspective on my husband, myself dependent on me financially, socially and licensed and our relationship, and worked with and emotionally. He wanted to be the Monika Shah, D.O. marriage and me to set goals for myself, including same person he’d been before the family therapist at TIRR’s Physician making time to do the things I enjoy.” accident and had a hard time accepting and Specialty Clinic. Del Castillo says she enjoyed his limitations. Like many brain injury Mrs. Valdes met with Del Castillo working with Valdes. “She was patients, he could be verbally abusive briefly that same day and scheduled a insightful and ready to move ahead. until we got his medications adjusted. counseling session for the following She was committed to the relationship He lost almost all of his friends because week. The two women met over a and to learning new ways to cope they didn’t understand what we were four-month period in 2010. “Debbie with it. Our sessions gave her an going through.” worked through some of her grief, understanding of how she could help Valdes educated herself about the and we also spent time talking about her husband and help herself as well. personality changes to expect after how to improve communication with Now she can harness what he has traumatic brain injury, including the her husband, interact with him more because she understands his limita- physical, cognitive and psychological effectively and accept his limitations,” tions and knows how to create impairments that can cause aggression, Del Castillo says. “She felt like her closeness in the best way.” u anxiety and depression, and affect role as a wife disappeared after the

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Since April 2010, TIRR has ON THE MOVE completed several expansion initia- O tives, including a newly remodeled TIRR Memorial Hermann Rehabilitation Unit at Memorial procedure suite for urodynamics, the Welcomes New Recruits Hermann-Texas Medical Center and opening of three procedure suites and also sees outpatients in the Spasticity, the addition of three private rooms Three physicians have joined the Brain Injury and Stroke Clinic at TIRR. on Patient Care Unit (PCU) 6, which staff of TIRR Memorial Hermann. Psychiatrist Guy Patterson, M.D., increased the hospital’s licensed beds P. Jacob Joseph, M.D., is a 2006 earned his medical degree at The from 116 to 119. The new procedure graduate of The University of Texas University of Texas Medical Branch suites allow physicians to perform Medical School at Houston. An at Galveston and completed his procedures under moderate sedation assistant professor in the department residency in in house, including percutaneous of Physical psychiatry at endoscopic gastrostomy (PEG) line Medicine and Baylor College placement, peripherally inserted Rehabilitation of Medicine, central catheter (PICC) line placement at the UT later pursuing and wound debridement. Medical School, psychoanalyst A recent pharmacy expansion he comes to training at ensures that TIRR has the capability TIRR after the Houston- to manage the medication needs of completing his Galveston additional patients, and the Physician Guy Patterson, M.D. residency in Psychoanalytic and Specialty Clinic has been P. Jacob Joseph, M.D. PM&R at the Institute. An associate professor in expanded to accommodate dental University of Washington in Seattle. the department of Psychiatric and practices, primary care services and He serves as an attending physician in Behavioral Sciences at UT Medical a concussion clinic, all under one the Brain Injury and Stroke Program. School, he has held positions at the roof. Four new treatment rooms have Meilani Mapa, M.D., joins the TIRR M.H.M.R.A. of Harris County’s Ripley been added, increasing the clinic’s medical staff after serving as an Clinic, Baylor College of Medicine and available treatment rooms to 20. assistant professor of physical medi- the Gulf Coast M.H.M.R. Clinic in cine and rehabilitation at the Ohio Galveston. He has also been engaged recent pharmacy expansion State University in Columbus. She in the private practice of inpatient ensures that TIRR has the was awarded her and outpatient adult psychiatry. He A capability to manage the is a consulting physician at TIRR for medication needs of additional medical degree patients, and the Physician and both inpatient service and subspecialty at Northeastern Specialty Clinic has been expanded Ohio Universities outpatient clinic and also serves as to accommodate dental practices, College of staff psychiatrist in the department primary care services and a Medicine in of Psychiatry Outpatient Clinic at The concussion clinic Rootstown, University of Texas Health Science Ohio, in 2003, Center at Houston. Renovated space in the basement of and completed Dunn Tower is now a classroom/ Meilani Mapa, M.D. her residency at TIRR Expansion and Renovation training/conference room with the the UT/Baylor Physical Medicine and capacity for 60 people, allowing Rehabilitation Alliance in Houston From humble beginnings as the TIRR physicians and staff to conduct in 2007, followed by a fellowship in Southwestern Poliomyelitis Respiratory training and hold conferences on brain injury medicine at the same Center, which managed 10 percent of site. TIRR is also in the process of institution. An assistant professor of all new polio cases in the early 1950s, expanding its Radiology department physical medicine and rehabilitation TIRR Memorial Hermann has grown to modernize the space and make at the UT Medical School, she is to a 119-bed teaching hospital for room for the addition of a CT scanner. medical director of the Inpatient The University of Texas Medical On the Move continues on page 9 School at Houston and Baylor College of Medicine.

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On the Move continued from page 8 clinical support Jim Winne, whose daughter McKenzy “In fiscal year 2011, we will services at TIRR. Winne is a former TIRR patient, has continue to invest in improvements “In creating the given $125,000 to fund TIRR’s aimed at enhancing the experience of program we Traumatic Brain Injury Recruitment patients, families, visitors, physicians wanted to ensure and Research Fund. and staff; creating a care environment that our residents The One Step Closer Foundation that supports exceptional quality would have the (OSCF) is a nonprofit, charitable outcomes; and supporting physicians advantage of organization whose main goal is to by providing greater continuity among getting practice ease, as much as possible, the lives of care teams,” says Carl Josehart, CEO. Lourdes Cuellar, experience those with cerebral palsy. The OSCF R.Ph., F.A.S.H.P. “Our recent growth allows us to build focused on the was started by Jacob Zalewski, a former on strengths of the past and improve strengths of each of the participating our services and facilities to care for hospitals. Most pharmacy residencies he One Step Closer Foundation is a nonprofit, charitable the needs of our patients and their are located in a single, usually large, Torganization whose main goal families. We pride ourselves on our acute care hospital, which makes our is to ease, as much as possible, the collaboration with affiliated physicians program unique.” lives of those with cerebral palsy. and the consistent improvements in Participants in the residency care those relationships have fostered.” program will get hands-on experience TIRR patient born with cerebral as key members of the healthcare team, palsy, who has been a donor to TIRR Pharmacy Residency Program using evidence-based medicine to through the OSCF for the past three Launched independently manage patient disease years. His third annual celebrity poker states and drug therapies. Graduates tournament “All in for CP” will be TIRR Memorial Hermann and three will be able to successfully adapt their held on December 11, 2010, in Las Memorial Hermann acute care knowledge and skills to critically assess Vegas. To enter the tournament and hospitals have joined together to new problems and provide solutions support TIRR, visit www.onestep- create a pharmacy residency program for care, as well as effectively educate closerfoundation.org/index.php. healthcare practitioners, caregivers aimed at developing practice leaders The Staman Ogilvie Fund for Spinal and patients. prepared to meet current and future Cord Injury Recovery, Rehabilitation challenges of the pharmacy profession. and Research has been created to Participating acute care hospitals are Foundation News assist individuals whose lives have Memorial Hermann Memorial City been disrupted by spinal cord injury Medical Center, Memorial Hermann Joel Stein, M.D., physiatrist-in-chief at (SCI), brain trauma or neurological Katy Hospital and Memorial Hermann New York Presbyterian Hospital, will disorders. The fund’s objective is to Southwest Hospital, which will serve deliver the firstCharles C. Beall Lecture raise $10 million for the development as the main facility for the program. on November 9, 2010, at the TIRR of new technologies to increase In April, the new program was granted Research Luncheon in Houston. movement for those with SCI through a three-year accreditation by the The luncheon is the first of a series of regenerative research, rehabilitation, American Society of Health-System annual events focusing on research robotics and adaptive technology. To Pharmacists (ASHP) Commission on under way at TIRR Memorial Hermann. date, more than $5 million has been Credentialing. Beall, who died in February 2010, contributed toward the goal, which “At least 20 percent of graduates served TIRR for 10 years as CEO and will benefit TIRR and the Mischer from colleges and schools of pharmacy for 29 years as a board member. Dr. Neuroscience Institute at Memorial will do a one- or two-year postgraduate Stein is professor and chair of the Hermann-Texas Medical Center. residency program to gain intensive department of Rehabilitation Medicine An anonymous donor has pledged training in their specialty,” says at the Columbia University College $1 million and paid the first install- Lourdes Cuellar, R.Ph., F.A.S.H.P., admin- of Physicians and Surgeons, and ments to TIRR for the purchase of istrative director of pharmacy and professor and chief of the division of much of the equipment to be used for Rehabilitation Medicine at Weill Cornell rehabilitation and adaptive technology Medical College in New York City. research as part of the Ogilvie Fund. u

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Sander AM. Traumatic Brain Injury IDGA Military Healthcare Convention ON THE PODIUM Rehabilitation and Sexuality: Finding and Conference, June 22, 2010, San O the Comfort Zone. Invited lecture Antonio, Texas. presented at the meeting of the Brain Ivanhoe CB. Neurological Disorders and Sander AM. Integrating Sexuality into Injury Association of Michigan, the Impact on Employment. Presented Traumatic Brain Injury Rehabilitation. September 23, 2010, Lansing, Michigan. at the Houston Area Rehabilitation Lecture presented at the Brain Injury Association, Division of the Texas Sander AM. A Videoconferencing Association of Texas Conference, Department of Assistive and Reha- Approach for Training Caregivers June 6, 2010, Austin, Texas. bilitation Services on July 15, 2010, to Help Persons Sander AM. Compensating for Memory in Pasadena, Texas. with TBI Com- Problems After Traumatic Brain pensate for Ivanhoe CB. Advances in the Diagnosis Injury: An Evidence-Based Approach. Cognitive and and Treatment of Upper Limb Spasticity Lecture presented at the Brain Injury Emotional featuring ELVIRA™ Injection Simu- Association of Texas Conference, Difficulties in lation Schedule. Presented on August June 5, 2010, Austin, Texas. 26, 2010, in Charlotte, North Carolina. the Home. Paper presented Sherer M. The TBI Model Systems Ivanhoe CB. FDA Approval of Botox® Angelle Sander, Ph.D. at the meeting Program: Resources for Consumers. for Post-Stroke Spasticity and FDA of the American Psychological Workshop presented at the annual Approval of Botox for Spasticity: FDA Association, August 12, 2010, San meeting of the Brain Injury Associa- Approval versus Real-World Use. Diego, California. tion of Texas, Austin, Texas, June 6, Presented at Carolinas Rehabilitation 2010. in Charlotte, North Carolina, on Sander AM, Clark AN. Translation of August 26 and August 29, 2010, Evidence-Based Findings for Reha- Sherer M. Assessment and Treatment respectively. bilitation of Cognitive Impairments of Impaired Self-Awareness. Invited After Traumatic Brain Injury. Pre- presentation to the clinical staff of conference workshop presented at the On the Podium continues on page 11

physicians and staff members make affairs. The ACCOLADES in helping us achieve our reputation American A for quality outcomes and maintain Academy of For the 21st consecutive year, TIRR our ranking.” Pain Medicine Memorial Hermann has earned distinc- Corwin Boake, Ph.D., was elected to the represents tion among the top five rehabilitation American Psychological Association physicians who hospitals in the country. The rank- (APA) Council practice pain ings were published in the July 21, of Representa- medicine Martin Grabois, M.D. 2010, issue of U.S.News & World tives for Divi- nationally. Dr. Report. sion 40 (clinical Grabois was recently nominated president-elect. The 20 hospitals ranked in rehabili- neuropsychol- tation were named among the best for ogy). The Cindy B. Ivanhoe, challenging cases and procedures by council, which M.D., was a at least 3 percent of rehabilitation is the legislative special guest of specialists who responded to U.S. Corwin Boake,Ph.D. body of the honor at the News surveys in 2008, 2009 and APA, includes about 175 officers and Texas Brain and 2010. representatives. Dr. Boake’s term Spine Institute runs from 2011 through 2014. 4th Annual “We’re pleased to be recognized by Neuroscience U.S.News & World Report in its Martin Grabois, M.D., attended a board Cindy Ivanhoe, M.D. Symposium held annual listing of the nation’s top meeting of the American Academy of September 10, 2010, in College hospitals,” says Carl Josehart, CEO. Pain Medicine on August 6 and 7 in Station. u “We’re proud of the efforts our his role as vice president for scientific

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On the Podium continued from page 10 Alliance. Invited presentation to the Pain Syndrome: Evaluation and the Shepherd Center, Atlanta, Georgia, Contemporary Forums Brain Injuries Treatment”; and “International August 10, 2010. Conference, San Antonio, Texas, Physical and Rehabilitation Medicine: Sherer M. Agitation in Patients with April 30, 2010. Through the Looking Glass with a Traumatic Brain Injury. Invited Stelk, Cheryl, R.N., C.R.R.N. Help! My View to the Future.” presentation to the meeting of the Ventilator Left the ICU But My Dr. Grabois also attended the 8th Southeast Texas Chapter of the Performance Mediterranean Congress of Physical Association of Rehabilitation Nurses, Measure Didn’t. and Rehabilitation Medicine in Houston, Texas, April 27, 2010. Presented at the Limassol, Cyprus, September 29 Sherer M. Evidence-Based Practices for Association of through October 3. He presented the the Assessment Rehabilitation following invited lectures: “Chronic and Management Nurses National Pain Syndrome Post Cardiovascular of Confusion Conference, Accident: Evaluation and Treatment” Following Brain October 2, 2010, and “Multidisciplinary Pain Program: Injury. Invited Cheryl Stelk, R.N., in Orlando, New Concepts in Organization and C.R.R.N. presentation to Florida. Implementation.” In addition, he the Contempo- Martin Grabois, M.D., attended the XXIV organized, moderated and presented rary Forums Congress of the Latin American at a course entitled “Organizing an Mark Sherer, Ph.D. Brain Injuries Medical Association of Rehabilitation Educational Program for Rehabilita- Conference, San Antonio, Texas, (AMLAR) in Cartagena, Colombia, tion Personnel.” Also, during this April 29, 2010. August 25 through 28, 2010. He was meeting, Dr. Grabois attended the invited to present the following interim board meeting of the Inter- Sherer M, Malec JF. Addressing Self- national Society for Physical and Awareness with Those Who Are Brain lectures: “Neuropathic Pain Syndrome: Evaluation and Treatment”; “Muscle Rehabilitation Medicine (ISPRM) in Injured: Establishing a Therapeutic his role as treasurer. u

characteristics and their relationship attending camp in July, Logan IN PRINT to health service utilization in underwent intensive rehab at TIRR I minority patients with first episode Memorial Hermann and made a Bold print indicates that the person is stroke. NeuroRehabilitation. remarkable recovery. See Logan’s affiliated with TIRR. 2010;27(1):95-104. u story on KBTX in College Station Sander AM, Pappadis MR, Clark AN, and KTRK in Houston: Struchen MA. Perceptions of community www.kbtx.com/tamu/head- integration in an ethnically diverse TIRR IN THE NEWS lines/101198464.html T http://abclocal.go.com/ktrk/ Fifty-five-year-old Robert Rehm, a quad- video?id=7629720 riplegic, needs a respirator to breathe. Because of severe neurological issues, Rehm uses his wheelchair and paint- Noah Risk has struggled to walk since brushes with special mouthpieces to birth. Today, the 6-year-old can lift create contemporary works of art. his knees and take a step. His mother, See Rehm in action: Nancy Risk, credits Noah’s achievement www.39online.com/news/local/ to an innovative therapy – pediatric Monique Pappadis, Margaret A. kiah-quadripelgic-artist-story,0, Lokomat® walking therapy. Nancy M.Ed. Struchen, Ph.D. 7492294.story and her friends helped raise the money sample. Journal of Head Trauma Fourteen-year-old Logan Schaefer is the to make the therapy available at Rehabilitation, 2010; e-publication son of Texas A&M Women’s Associate TIRR Memorial Hermann Kirby Glen. ahead of print. Head Basketball Coach Vic Schaefer. See Noah’s story: Clark AN, Sander AM, Pappadis MR, Evans After suffering a severe head injury www.myfoxhouston.com/dpp/ GL, Struchen, MA, Chiou-Tan F. Caregiver in a wakeboarding accident while health/100810-lokomat u

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MMESSAGE FROM THE CMO At TIRR, we’re committed to providing wellness assessment has allowed We view our former patients as the best inpatient care available and rehabilitation team members to more than people whose lives have extending our address the emotional and spiritual been transformed by disability. They services beyond needs of inpatients, so that we can are people who live, work, socialize the hospital into work on healing the inner as well as and participate as active, productive the community. outer person. On the outpatient side, members of our community. Our role To ensure Teresa Del Castillo, a licensed in their rehabilitation is to empower inpatient safety, clinical social worker and licensed them to make the decisions that we’ve renewed marriage and family counselor, is affect their lives and help them our focus on helping patients and family members engage in all the activities that make communication cope with the emotional and psycho- life meaningful. Gerard E. Francisco, and critical logical issues surrounding disability. M.D., CMO thinking, and In the community, we’re strong Gerard E. Francisco, M.D. put these tactics to use in a hospital- proponents of the Americans with Chief Medical Officer wide initiative to prevent adverse events Disabilities Act and, through our TIRR Memorial Hermann and ensure that we meet the needs of Independent Living Research Utili- Chair, Department of Physical Medicine our patients and family members. zation program, we work to remove and Rehabilitation In this issue you’ll learn how barriers to independence, both in The University of Texas Medical School Reverend Hazel Thomas’ spiritual ordinary times and during disasters. at Houston

About TIRR Memorial Hermann Report for 21 consecutive years. system, Memorial Hermann is TIRR provides rehabilitation known for world-class clinical TIRR Memorial Hermann is a services for individuals with spinal expertise, patient-centered care, 119 -bed nonprofit rehabilitation cord injuries, brain injuries, strokes, leading-edge technology and hospital located in the Texas amputations and neuromuscular innovation. The system, with its Medical Center in Houston. disorders. exceptional medical staff and Founded in 1959, TIRR has been TIRR is one of 11 hospitals in the 20,000 employees, serves southeast named one of “America’s Best not-for-profit Memorial Hermann Texas and the greater Houston Hospitals” by U.S.News & World system. An integrated healthcare community.

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