Lower Hudson/Bronx

■ A Business & Practice Management Magazine | about physicians | from physicians | for physicians ■ Burke Rehabilitation : Improving Neurological Outcomes Through Individualized Rehabilitation At Burke Rehabilitation Hospital, medical staff and research scientists share the mission to ensure every makes the fullest possible recovery from debilitating conditions, such as stroke, or trauma, such as spinal cord or brain injury.

ehabilitation makes a difference, and it’s the Medical College. “That’s what Burke is designed for — to get people vehicle to improve neurological outcomes following functioning again by providing an individualized care plan.” devastating neurological impairments,” says Barry Accredited by The Joint Commission and the Commission on “R Jordan, M.D., M.P.H., Assistant Medical Director, the Accreditation of Rehabilitation Facilities, Burke Rehabilitation Director of the Brain Injury Program, and Director of the Memory Hospital serves the greater New York City area, Westchester Evaluation and Treatment Service at Burke Rehabilitation Hospital, County, Hudson Valley and beyond. It is the only hospital in and associate professor of clinical at Weill Cornell Westchester County solely dedicated to rehabilitation medicine. Photos © Don Dem © Don Photos p sey, White Light Photogra Light White sey, p hy

Burke Rehabilitation Hospital brings together top medical experts and uses the latest equipment to help make the fullest possible recovery. Standing in the neuro gym from left to right are: Argyrios Stampas, M.D., Director of the Spinal Cord Injury Rehabilitation Program; Barry Jordan, M.D., M.P.H., Assistant Medical Director, Director of the Brain Injury Rehabilitation Program, and Director of the Memory Evaluation and Treatment Service; Michael Reding, M.D., Director of the Stroke Rehabilitation Program; and Mark Herceg, Ph.D., Director of Neuropsychology. “I have an expression I use for all the folks with whom I work. It’s the simple concept that the brain injury, spinal cord injury or stroke shouldn’t define who they are, so within the whole rehabilitation process, they don’t lose sight Dr. Herceg and Mar Cortes, M.D., a researcher at the Burke Medical Research Institute, deliver noninvasive, transcranial magnetic stimulation to a patient’s brain as of their true selves. part of a research study showing that stimulation enhances the benefits of therapy. The deficits should not be reflective of them More Therapy, More Technology as the Zero-G Lite, which was tailor-made Burke Rehabilitation Hospital’s interdis- for Burke Rehabilitation Hospital and is as individuals. Often, ciplinary team is composed of a range of the only one of its kind in the Northeast. they focus so much on medical specialists, including neurologists, “The whole theme of the acute inpa- physiatrists, internists, rheumatologists, tient rehab program is to provide the the deficit, they forget pulmonologists, neurophysiologists, thera- maximum amount of therapeutic inter- they have remaining pists, social workers, neuropsychologists, vention the patient can tolerate,” says strengths. My role pharmacists and dietitians, all of whom Michael Reding, M.D., Director of the are an integral part of ensuring patients Stroke Rehabilitation Program at Burke is to help the mind, make maximum gains during their acute Rehabilitation Hospital and assistant spirit and sense of self inpatient rehabilitation programs. professor of clinical neurology at Weill heal during the course Recognizing the importance of indi- Cornell Medical College. “The more vidualized treatment, Burke Rehabilitation therapy the patient gets, the faster and of rehabilitation.” Hospital therapists daily provide patients better the outcome.” — Mark Herceg, Ph.D., Director with at least three hours of individual Physical therapists focus on improving of Neuropsychology, Burke therapy including , occu- functional mobility in relation to specific Rehabilitation Hospital pational therapy and speech therapy. In addition, Burke Rehabilitation Hospital utilizes a program model that involves a specialized team working with each patient on a one-on-one basis. This team is assembled based on specific needs as determined by the patient’s diagnosis and goals. For instance, a patient who has dysphagia due to a stroke will work with a speech therapist to learn swallowing techniques and improve throat func- tion, as well as a nutritionist to develop a dietary plan that ensures optimum nutrition through the incorporation of easy-to-swallow foods into the patient’s diet and education about food preparation. Added to this condition-specific approach is a comprehensive armamentarium of state-of-the-art therapeutic technology designed to improve function, reduce Dr. Reding and Dr. Stampas assist a patient using a wrist robot that helps patients with muscle atrophy and stimulate nerves, such paralysis with forearm rotation and wrist and hand movements. Latest Technology Enhances Burke’s Patient Therapy

To optimize patient outcomes, Burke Rehabilitation Hospital uses the latest technology, including: ++ Zero-G Lite — Allows spinal cord patients with paralysis to walk while being supported in a harness. This equipment was tailor-made for the hospital and is the only one of its kind in the Northeast. Dr. Stampas evaluates a spinal cord injury patient’s walking ability during a physical therapy session. ++ EMPI Electric Stimulators — Used to relax muscle spasms, increase local blood circulation, maintain or increase range of motion, and tasks. Using a combination of muscle families and caregivers to prepare them retard or prevent muscle disuse atrophy. strengthening, flexibility improvement and for the next stage of the rehabilitation ++ RT300 Functional Electrical Stimulation balance training, therapists teach patients process. For patients being discharged Cycle Ergometry System — Provides electrical how to get in and out of bed, transfer to and to their homes, therapists at Burke current that stimulates nerves to evoke muscle from a wheelchair, and step up and down Rehabilitation Hospital teach caregivers contractions in the arms and legs, enabling stairs. Occupational therapists combine exercises, stretches and other therapeutic muscles to work and perform active cycling these techniques with a thorough evalua- techniques that will equip them to assist even if voluntary control of muscles has tion of each patient’s visual and perception with at-home therapy. This helps reduce been lost. skills to retrain him or her to perform the feeling of burden and empowers the ++ LiteGait Partial Weight-Bearing Gait Therapy daily tasks, including dressing, bathing, caregiver to tangibly contribute to the Device — Allows patients to comfortably walk brushing teeth and eating with utensils. patient’s ongoing recovery, which also has in a secure environment, preventing falls. Burke Rehabilitation Hospital also positive implications for the caregiver’s ++ InMotion Technology Upper Extremity incorporates therapeutic recreation into own psychological and physical wellbeing. Robot — Assists patients experiencing reduced the total concert of therapy programs. “We’re not only looking to rehabilitate mobility from stroke or brain injury to gain Recreational therapists focus on function- patients,” says Dr. Stampas. “We’re look- better movement and dexterity. ality relating to social involvement and ing to restore our patients. Many of our ++ WalkAide System — A battery-operated medi- leisure pursuits, incorporating comple- training systems theoretically provide cal device that uses myo-orthotics technology, mentary programs such as adaptive restorative properties to help heal the the combination of electrical stimulation and yoga and humor therapy. In conjunction neurologic system. However, we can’t keep orthotics, to treat foot drop. with the Montessori Children’s Center, patients here forever. We are obligated ++ SaeboFlex — A custom-fabricated orthosis the hospital has also developed the to send them back out into the world, that allows patients suffering from neurological Intergenerational Group program that so we do also focus on function. We try impairments to use their hands by supporting provides opportunities for patients to to incorporate a lot of these restorative the weakened wrists, hands and fingers. interact with children through recre- measures with functional improvement.” ++ NESS H200 Hand Rehabilitation System — A ational activities such as story time, crafts, neuro-orthotic and rehabilitation system that games, art and horticulture. Treating the Spirit provides electrical currents to stimulate nerves According to Argyrios Stampas, M.D., Acknowledging the shock to the psyche and muscles to increase hand function, prevent Director of the Spinal Cord Injury that a life-changing injury or illness can muscle loss, re-educate muscles, increase blood Rehabilitation Program at Burke cause, Burke Rehabilitation Hospital’s circulation, reduce muscle spasms, and increase Rehabilitation Hospital and assistant pro- Director of Neuropsychology, Mark or maintain the hand’s range of motion. fessor at Weill Cornell Medical College, Herceg, Ph.D., provides services to patients ++ NESS L300 Plus Foot Drop System — A when these complementary therapies are shortly after admission to often well neuro-orthotic and rehabilitation system that factored in, patients ultimately benefit. after discharge. provides electrical currents to stimulate nerves “It’s almost more rare for patients to have Dr. Herceg assesses whether a new and muscles to assist with obtaining a more just three hours of therapy a day,” he says. patient’s behavior, cognition or emotional natural walking pattern, reduce muscle spasms, “They’re typically getting more than four state will interfere with treatment. Even if reduce muscle loss, maintain or improve range hours of therapy. They usually sleep well the impediment is a biochemical response of motion, and increase local blood circulation after having a full day of therapy.” in the brain, Dr. Herceg says it is important in the treatment of foot drop. The medical team also works with to acknowledge a patient’s struggles. Cross- Dr. Jordan, Burke Rehabilitation Hospital’s new Assistant Medical Director, helps develop and Pollinating implement policies, procedures and best practices for improving patient care, and coordinates the training and continuing education of the medical staff. Research and “A central nervous system injury is United States with an affiliated medical Experience such a shock for patients who, for the research institute on campus, and the most part, were previously independent,” institute has dedicated basic, transla- As Assistant Medical Director, Dr. Herceg says. “Now, all of a sudden, tional and clinical research programs. Director of the Brain Injury Program, they’re in wheelchairs. They can’t go to the Dr. Stampas and Dr. Reding both and Director of the Memory bathroom on their own. They can’t feed cite the institute’s study of transcranial Evaluation and Treatment Service themselves. That adjustment to needing magnetic stimulation and its potential at Burke Rehabilitation Hospital, help is an incredible weight. They struggle for lateral pulsion. Barry Jordan, M.D., M.P.H., assists in to cope with that, and it fuels anxiety “There has been some literature to developing and implementing policies, and depression.” suggest that when you get repetitive procedures and best practices for Dr. Herceg meets weekly with patients stimulation to your brain, you learn improving patient care; coordinates the and works to help provide them with a task better, so we’re looking into training and continuing education of tools to deal with their emotions. And, developing protocols to see if it makes the medical staff; and helps ensure the he says, a full agenda of physical, occu- a difference in patients’ progress,” hospital complies with all federal, state pational and speech therapy can prompt Dr. Stampas says. and local laws. neuropsychological improvement. Ultimately, Burke Rehabilitation Dr. Jordan also serves as Chief “The structure of the therapy itself Hospital’s research efforts have enor- Medical Officer of the New York State allows them to piece things together,” he mous potential benefits, says Dr. Reding. Athletic Commission, as team physician says. “Slowly, over the course of a week or “It puts us on the cutting edge of for U.S.A. Boxing and as a member of two, they’re able to see their progress. They molecular biology, neuropharmacology the NFL Players Association’s Traumatic can start to feel themselves getting better, and neurological repair and recovery Brain Injury Committee. and in that process, they feel better.” following stroke, These multiple roles support Dr. Stampas believes there is a benefit and spinal cord injury,” he says. one another. to a patient’s improved outlook. From robotic training for upper “I’m particularly interested in the “It’s always surprising to me how limb recovery to the management of link between chronic neurological patients’ attitudes really guide their reha- post-injury depression, the research conditions such as Alzheimer’s disease, bilitation,” Dr. Stampas says. “I find those under way at Burke Rehabilitation Parkinson’s disease and motor neuron who are more optimistic and hopeful Hospital provides patients not only the disease as it relates to repetitive anecdotally respond better to therapy. Even benefits of the latest research but also the brain injury,” says Dr. Jordan, who is when I follow up with them as outpatients, opportunity to continue therapy. also associate professor of clinical I know they have deficits and they’re by no “It gives patients an opportunity to neurology at Weill Cornell Medical means beating the odds epidemiologically, get involved with clinical trials, and it College. “So, these roles afford me the but they seem to cope better, and, in the also assists in developing translational opportunity to look in further detail at end, quality of life is the best thing we can medicine,” says Dr. Jordan. “We go from the link between traumatic brain injury add to the patient’s care.” the bench to the bedside.” and memory, cognitive and behavioral problems, which relates to my being in From the Bench to the Bedside For more information about the services charge of Burke’s memory evaluation Burke Rehabilitation Hospital is one of Burke Rehabilitation Hospital, visit and treatment service.” of the only rehabilitation in the www.burke.org. n

Reprinted from Lower Hudson/Bronx md news