New Dimensions - Spring/Summer 2013

The McLean center represents the growing trend in health care to bring high quality services close to peoples homes and workplaces, says John Brickley, vice president for ambulatory care services and network development. Its a continuation of our goal to meet a broad spectrum of needs of our communityand to increase access to our nationally recognized rehabilitation experts throughout the D.C., Maryland and Northern Virginia region.

One-Stop ShoppingWe worked closely with MedStar Health and MedStar Georgetown University Hospital to design a center that would provide a continuum of care, and include the services of rehabilitation experts, orthopaedic surgeons, neurologists, neurosurgeons and radiologists, Brickley adds.

Patients can get radiologic diagnostic testing and access the services of physician specialists, and a rehabilitation team all in one convenient location. Co-locating highly skilled rehab medicine experts and therapists with medical specialists from other MedStar Health facilities is a strategy were pursuing across the region, he explains.

Its a model that makes sense for patients and referring physicians, explains Kathleen Fink, MD, attending physical medicine and rehabilitation physician at the McLean center. Theres a real benefit to coordinated care, ease of referral and open communication between referring physician and the rehabilitation team, says Dr. Fink.

Spring/Summer 2013 Vol. 4, No. 1

Pioneering Facial Palsy Program >>Page 4

ALSO INSIDE:

Fast Track for Stroke Patients >>Page 3

Research VP Dromerick Sets Agenda for the Future >>Page 6

Building a High Reliability Culture

>>Page 8

MedStar NRHs most recent outpatient center opened earlier this year in McLean,

Virginiathe networks second venture into the rapidly growing Northern Virginia area.

The center, which features both orthopaedic and neurologic rehabilitation services, also

boasts specialty physician services in partnership with MedStar Georgetown University

Hospital to provide one-stop shopping in a community location where there has been

a void in convenient rehab care.

MedStar NRH Opens New Outpatient Center in McLean, VirginiaFocus on Orthopaedic, Neurologic Services

Knowledge and CompassionFocused on You

Continued on page 2.

AlterG Anti-Gravity Treadmill, used to advance therapy for athletes and patients with lower extremity problems

2 MedStar National Rehabilitation Network

Therapy focuses on restoring a patients communication skills, cognitive abilities, physical strength, and independence in their everyday life.

In addition, the McLean center offers the highly specialized services of MedStar NRHs unique Concussion Clinic, which provides assessment and treatment for people who suffer from the lingering and often life altering effects of concussion.

Ultimately, we hope to expand hours and services offered at the McLean center with additional physiatrists and other specialty services, such as oncology and cancer rehabilitation, Brickley adds.

NASA-developed AlterG Anti-Gravity Treadmill, an Olympic-level injury prevention tool used in training programs for amateur and competitive runners. Therapists also utilize the AlterG to help patients with lower extremity problems, ranging from stress fractures to joint replacement, advance their therapy more quickly and achieve better results.

We are not only treating sports injuries, we plan to work with local high schools and community organizations to promote sports injury prevention for children and adults, says Laura Nemets, MPT, OCS, center director.

We want to help people maximize their performance, safely. Were athletes ourselves, says Nemets, a physical therapist who specializes in sports medicine and orthopaedic rehab.

Brain Injury, Stroke ExpertiseThe clinics neurologic rehabilitation services are part of MedStar NRHs comprehensive stroke and brain injury programs, which are among the countrys most prestigious and advanced. Board-certified neurologists and physiatrists coordinate a plan of care that puts an emphasis on helping patients reach their highest level of functioning.

Continued from page 1MedStar NRH Opens New Outpatient Center in McLean, Virginia

We work closely with community physicians to identify goals and develop treatment plans, while providing routine updates on their patients progress.

Kathleen Fink, MD

MedStar NRH Rehabilitation Network, McLean, In Brief6858 Old Dominion Drive, Suite 200, McLean, VA 22101 Telephone: 703-288-8260 Fax: 703-288-9316 Hours: Mon to Thurs- 7 a.m. to 7 p.m.; Fri 7 a.m. to 5 p.m. Free parking available.

Programs & Services Offered ACL Injury Prevention Program Arthritis Program Brain Injury Program Concussion Services Diagnostic Radiology Services Falls Prevention Program Foot and Ankle Services

Foot Orthotics Evaluation & Casting Gait Analysis General Orthopaedics Hand and Upper Extremity Program

with Certified Hand Therapists Occupational Therapy Manual Therapy Physical Therapy

Repetitive Motion Disorder Services Running Clinic Speech-Language Pathology Spinal Cord Injury & Disease Sports Medicine Program Spine Services Stroke Recovery Vestibular/Balance Rehabilitation

To refer a patient for rehabilitation services at the McLean center, call 703-288-8260.

MedStar Georgetown physician specialists and the MedStar NRH rehab team share a patient documentation system and access to test results, medical records and pending issues. That makes referral and care delivery easier for patients and health care providers, she adds.

We also offer community physicians the added benefit for their patients of an evaluation by a physical medicine and rehabilitation specialist, Dr. Fink says. And we work closely with them to identify goals and develop treatment plans, while providing routine updates on their patients progress. Its a partnership that ultimately improves outcomes.

Ortho-Rehab ExpertiseDr. Fink works in tandem with a team of highly experienced physical and occupational therapists, and speech-language pathologists, who provide a broad range of neurologic and orthopaedic rehabilitation services.

The center also provides special orthopaedic rehab programs, including the MedStar NRH Sports Medicine program, which focuses on early intervention after injury for active adults, and both amateur and professional athletes, as well as the development of training regimens to promote safe performance and prevent re-injury.

A unique Runners Clinic at the McLean center offers dual camera video gait analysis to assess running gait abnormalities, and incorporates the

Dual camera video gait analysis used to assess running problems

MedStar Stroke Recovery Program In Brief CARF Accredited Specialty Program Inpatient, day treatment, outpatient

services and home care through MedStar Visiting Nurse Association

Onsite rehab engineering, orthotic services

ZeroG overground weight support system; AlterG Anti-GravityTreadmill

Aphasia Clinic with speech-language pathologists, and a cognitive neurologist

MedStar NRH Stroke Comeback Club support group

For referral: inpatient care: 202-817-1152; day treatment: 202-877-1945; outpatient services: 202-877-1621.

New Dimensions Spring/Summer 2013 3

In health care institutions across the

country, leaders are working overtime

to cut costs, streamline care delivery

and put more value into every dollar

spent. Its a sign of the timesand

simply good medicine.

Fast Track Stroke Care Crosses SettingsThe System at WorkThis is how a health care system works at its best and we can already see what it means for patient careshorter acute care hospital stays of just three or four days, faster transfer to the most appropriate rehab setting, and better functional recovery in less time, Dr. Yochelson says.

We are expanding this successful model and hope to add to the staff of rehab experts at the Hospital Center, adding two more physicians to the team of Fatemeh Milani, MD, chair of PM&R at MedStar Washington Hospital Center, and Irim Ciolino, MD. And we also hope to replicate this care model at other MedStar Health acute care hospitals.

As the prospect of the bundling of acute and post-acute payment for Medicare patients becomes more likely in the near future, we also see that when a network of providers aligns financial incentives across care settings with what is best for patients, we can promote efficient and cost-effective care, Dr. Yochelson adds.

At MedStar NRH, an important program is boosting the value of health care dollars and improving stroke patient outcomes through coordinated care that reaches across settings.

MedStar NRHs stroke expertise is an integral part of the clinical pathway for stroke management at MedStar Washington Hospital Center, explains Michael Yochelson, MD, MBA, MedStar NRH vice president and chief medical officer.

The hospital is a Primary Stroke Center and implements a strict protocol of care for suspected stroke patientsrapid response to speed diagnosis and acute treatment.

Now were going one step further to give stroke patients an even greater advantage, Dr, Yochelson adds. Through a unique collaboration, MedStar NRH rehabilitation experts are now part of the team of rapid responders. Within 24 hours of admission, a MedStar NRH occupational therapist and physical therapist evaluate every patient diagnosed with stroke. Within 72 hours, a MedStar NRH physiatrist examines every stroke admission, he says.

Early Intervention, Better ResultsThis kind of early intervention can prevent complications and improve functional outcomes. It is especially important for patients who might not have been candidates for anti-thrombolytic drugs, and for those who didnt seek treatment quickly enough after experiencing stroke symptoms, Dr. Yochelson adds.

The rehab teams analysis of a patients functional abilities and impairment helps to jump-start the development of a plan of treatment and an integrated system of case management that will see the patient through to recovery.

A rehabilitation plan may be implemented before a patients discharge from acute careand continue through the patients most appropriate level of treatment within the MedStar NRH Network, from inpatient rehabilitation, under the direction of Brendan Conroy, MD, and outpatient therapy to home care.

Electronic medical records now follow patients, as well, through MedStar Healths shared inpatient and outpatient information systems platforms. At any point along the care continuum, MedStar Health providers can access information, including discharge summaries, lab and radiologic test results, and medications.

Stroke Recovery Program Medical Director Brendan Conroy, MD

Facial palsya painful, and sometimes devastating disorderaffects thousands of people

in the U.S. annually. Most patients are treated with therapeutic methods in use for

decades. Now enterprising MedStar NRH Network physical therapists have developed

innovative new interventions and are re-establishing care protocols across the country.

Pioneering Facial Palsy Therapy


Mirror Book Therapy, a form of facial exercise that uses a bi-fold mirror that twice reflects the unaffected side of the face to create a full image

Lollipop therapy to improve sucking and decrease involuntary eye movements Kinesio-Taping, adapted from sports training to reduce synkinesis Biofeedback, using electrodes to help stimulate motor control Traditional manual therapy, posture exercises and orthotics Referrals for Botox to help reduce synkinesis and decrease over-activity of the unaffected side Ultrasound treatments to promote muscle relaxation, increase circulation and break

down scar tissue that impedes muscle movement

MedStar NRH Facial Palsy Therapeutic Techniques

Some standard techniques in use for many years have actually been shown to be counterproductive, explains Jodi Barth, PT, CCI, facial palsy program coordinator. For example, we now understand that electrical stimulation used to help patients regain motor control following facial paralysis from nerve damage can often actually increase involuntary movement called synkinesis. At MedStar NRH, we could see that there was a real void in therapeutic options that needed filling.

Twenty years ago, Barth began to test a series of fresh ideas and by trial and error developed a pioneering approach to facial retraining, which is gaining momentum nationwide.

Barthone of only a handful of approved Bells palsy therapists in the U.S.and Gincy L. Stezar, PTA, have conducted

professional education programs across the U.S. and in Europe,

and trained a cadre of therapists at MedStar

NRH Network outpatient centers in their successful approaches.

Twice Reflection for HealingAmong these techniques is the ingenious Mirror Book Therapy, a form of facial exercise that uses a bi-fold mirror that twice reflects the unaffected side of the face to create a full image.

Initially we had been using biofeedback and reflection of the full face to help normalize movement. But it was clear the full-face image was emotionally difficult for patients, Barth says.

Mirror book therapy is an adaptation of a tool originally created to treat phantom limb pain and paralysis. In our version, the patient sees a full, unaffected face and then performs a number of facial exercises to trick the brain into normal facial expressions.

In an initial study conducted at MedStar NRH, the addition of mirror book therapy to standard facial rehabilitation treatments significantly improved outcomes.

We understand further studies are necessary, but we also know that this is an easy-to-use, low cost therapy, with no serious side effects, Barth adds.

Multiple Strategies for SuccessTeam Members employ a combination of therapeutic techniques to help patients re-learn to utilize facial muscles spontaneously, including traditional

To refer patients to MedStar NRH Networks Facial Palsy Program, contact [email protected]. For outpatient center locations, visit MedStarNRH.org.

manual therapy, posture exercises and orthotics.

Weve also adapted methods that are used in other parts of the body, because we believe a muscle is a muscle, says Stezar. And were using some tools, such as ultrasound, that have never been employed before for facial palsyrethinking their use and how they can benefit facial palsy patients.

The program also incorporates the expertise of physician specialists, dentists, speech-language pathologists, biofeedback therapists, occupational therapists, and psychologists, depending on individual needs.

Patients include those newly diagnosed, as well as patients who want to improve their condition years after an acute episode. Patients suffer from a variety of diagnoses, including Bells palsy, acoustic neuroma, parotid tumors, stroke, trauma, Lyme disease, congenital problems, diabetes and Ramsay Hunt Syndrome.

Jodi Barth, PT, CCI, (left) heads the Facial Palsy Program at MedStar NRH.

MedStar NRH-developed Mirror Book Therapy tricks the brain into normal facial expressions.


NoteWorthyArthur De Luigi, DO, Recognized New Medical Staff

Sepideh Haghpanah, MD, attending physician at NRH Rehabilitation Network, Bethesda, specializes in musculoskeletal/sports medicine,

fluoroscopic spine injection techniques and occupational medicine. She also recently completed training in acupuncture.

Dr. Haghpanah completed her Fellowship in Spine Medicine -Interventional Spine Procedures at Cleveland Clinic Neurological Institute and served as chief resident in PM&R at MetroHealth Rehabilitation Institute of Ohio/Case Western Reserve University. She received her medical degree from Shiraz (Pahlavi) University of Medical Sciences, School of Medicine in Shiraz, Iran.

Abha Lokhande, MD, was named an attending physician at the MedStar National Rehabilitation Hospital, MedStar Georgetown University Hospital and MedStar Montgomery Medical Center. Dr. Lokhande is responsible for consultation on acute care inpatients and the care for patients with TBI, stroke,

musculoskeletal disorders, SCI, and limb amputation. She has a special interest in nerve blocks, and joint and trigger point injections.

Dr. Lokhande received her medical degree from Ross University, completed an internship at Montefiore Medical Center and her residency in PM&R at MedStar Georgetown University Hospital/MedStar NRH.

Arthur Jason De Luigi, DO, director of Sports Medicine at MedStar NRH, (pictured left with American Academy of Physical Medicine & Rehabilitations Kurtis Hoppe, MD) was the recipient of the Outstanding Council Service Award in Musculoskeletal Medicine at the 2012 American Academy of Physical Medicine & Rehabilitation (AAPM&R) annual meeting which recognizes the service and volunteerism of members of the AAPM&R.

Dr. De Luigi is board certified in Physical Medicine and Rehabilitation, Sports Medicine and Pain Medicine, and recently earned an additional board certification in Musculoskeletal Ultrasound by the American Registry for Diagnostic Medical Sonography. Dr. De Luigi serves as director of Sports Medicine at MedStar NRH and is an internationally recognized leader in adaptive sports.

Peter E. Turkeltaub, MD, PhD, Named 2012-13 KL2-Post-Doctoral ScholarThe Georgetown-Howard Universities Center for Clinical and Translational Sciences has named Peter E. Turkeltaub, MD, PhD,

director of the MedStar NRH Aphasia Clinic, a 2013 KL2 Scholar.

The award will help fund Dr. Turkeltaubs research project, Psycholinguistic and neurobiological factors that predict and track response to electrical stimulation for post-stroke aphasia. The research builds upon his MedStar NRH-based clinical trial, which focuses on the use of transcranial direct current stimulation (tDCS) to improve

recovery from post-stroke aphasia.

The KL2 award will allow Dr. Turkeltaub to add multimodal MRI and psycholinguistic assessments to the tDCS trial. He will pursue this research project under the mentorship of Rhonda B. Friedman, PhD, professor of neurology, Georgetown University Medical Center, and Alexander W. Dromerick, MD, professor of physical medicine and rehabilitation, neurology, and vice president for research for the MedStar National Rehabilitation Network, and professor of rehabilitation medicine and neurology at Georgetown University.

Elissa Newport, PhD, Awarded Lifetime Achievement Award Elissa Newport, PhD, professor of neurology and director of the Georgetown University/MedStar National Rehabilitation Network Center for Brain Plasticity and Recovery, received the Association for Psychological Sciences

(APS) highest honor, the William James Lifetime Achievement Award for Basic Research. In addition, the APS board of directors has chosen her as among 25 of the fields most elite scientists.

Prior to her leadership role at the newly created Center for Brain Plasticity and

Recovery, Dr. Newport served as chair of the department of brain and cognitive sciences at the University of Rochester for 12 years. She is a member of the National Academy of Sciences and has devoted her career to studying human language acquisition, and has provided some of the seminal evidence about differences between children and adults in their ability to learn languages.

Today, she is expanding her research focus to include the study of stroke, and differences in recovery between children and adults, in hopes of using childrens capacity for recovery as a potential model for enhancing neuroplasticity in adults.

John Rockwood, president of MedStar NRH and senior

vice president, MedStar Health, ushered in a new era

naming Alexander Dromerick, MD, the networks first-

ever vice president for research and chief research officer,

overseeing all research endeavors.

Dr. Dromerick, who previously served as associate medical director

for research and academic affiliations and director of the neuroscience research program, continues to serve as co-director of the Center for Brain Plasticity and Recovery, a joint collaboration with Georgetown University.

His appointment comes at a time of challenge for all medical researchand a coming of age for rehabilitation research, a fledgling field with increasing importance

to the health of an aging U.S. population.

Diminishing funding demands that our approach to research evolves, Dr. Dromerick explains. We have to find creative ways to ensure that new ideas reach the investigation stage.

At MedStar NRH, were consolidating efforts, and putting our energies into the strongest research with the potential to impact the greatest number of people, he adds. Going forward, well choose our research questions carefully, and find ways to accelerate the investigational process.

Our goal is to turn MedStar NRH into a great research hospital in the image of some of the nations best cancer facilities that offer patients top quality clinical care, and access to cutting-edge research. Were shaping the hospital into the academic model in which every patient can have the option of participating in a clinical trial, Dr. Dromerick says.

There are only a handful of facilities with the capabilities to achieve this end, Dr. Dromerick explains. Weve built our capacity through strong collaborations with other regional academic institutions, and non-traditional partners, such as Walter Reed National Military Medical Center, and not-for-profit organizations and foundations.

The Center for Brain Plasticity and Recovery is a model for the kind of collaborative effort we want to continue to pursue, he adds.


Alexander Dromerick Named MedStar NRHs First VP for ResearchSets Agenda for the Future

Current and Ongoing MedStar NrH reSearcH GraNtS and awardS*

Brain InjuryImproving Outcomes in Acute Rehabilitation for TBI November 1, 2007 June 30, 2012 Funding Source: International Severity Information Systems, Inc.; National Institutes of Health

Individual Planning for the First Year Following Acute Rehabilitation October 1, 2008 September 30, 2013 Funding Source: The Ohio State University Research Foundation; National Institute on Disability and Rehabilitation Research, U.S. Department of Education

StrokeReach Forward: Mechanisms of Practice-Induced Reaching Improvement after Stroke January 20, 2010 December 30, 2014 Funding Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health; National Institute on Disability and Rehabilitation Research, U.S. Department of Education

Stroke Disparities Project: PROTECT DC September 30, 2007 August 31, 2012 Funding Source: Georgetown University; National Institute of Neurological Disorders and Stroke, National Institutes of Health

Interdisciplinary Comprehensive Arm Rehab Evaluation (I-CARE) Stroke Initiative July 1, 2007- July 31, 2013 Funding Source: University of Southern California; National Institute of Neurological Disorders and Stroke, National Institutes of Health

Grip Force Control as a Diagnostic Tool for Mild TBI September 1, 2010 January 31, 2012 Funding Source: Navy Bureau of Medicine

SISTERS: Spasticity in Stroke Randomized Study September 19, 2012 September 18, 2017 Funding Source: Medtronic International

The center is focused on the brain, its resilience and response to therapy. While we are beginning with a concentration on stroke recovery, what we learn will be relevant to all kinds of disabling conditionsstroke, brain injury, SCI, MS, CP, amputation, even Alzheimers and Parkinsons disease.

And what Dr. Suzanne Groah and her team are learning about maximizing function and reducing secondary complications for people with spinal cord injury and disease is relevant to other types of neurologic problems, as well.

Just 27-years-old, MedStar NRH already has an impressive portfolio of investigations and researchers. Currently there are three young investigators with active NIH-funded career development awards. Few if any rehab hospitals in the U.S. can compare.

In the next five years, Dr. Dromerick predicts, our group will be stronger and largerand MedStar NRH will be a national model for innovative translational and clinical rehabilitation research and the most advanced rehabilitation interventions.

Current and Ongoing MedStar NrH reSearcH GraNtS and awardS*

Left Lateralization Using Transcranial Direct Current Stimulation July 1, 2012 June 30, 2013 Funding Source: Doris Duke Charitable Foundation

Assistive TechnologyAssistive Technology and Research Center at MedStar National Rehabilitation Hospital December 6, 2004 October 28, 2014 Funding Source: U.S. Army Medical Research and Materiel Command (USAMRMC)

Functional Ambulation: Standard Treatment vs. Electrical Stimulation Therapy (FASTEST) Trial in Chronic Post-Stroke Subjects with Foot Drop June 1, 2010 May 31, 2013 Funding Source: Bioness, Inc.

Overground Gait Training with a Novel Dynamic Body-Weight Support System October 1, 2010 September 30, 2013 Funding Source: National Institute on Disability and Rehabilitation Research, U.S. Department of Education

Center for Post-Acute Innovation and ResearchA Practice-Based Evidence Study in SCI Rehabilitation (SCI-REHAB) October 1, 2006 September 30, 2012 Funding Source: Craig Hospital; National Institute on Disability and Rehabilitation Research, U.S. Department of Education


Spinal Cord InjuriesRehabilitation Research and Training Center on Secondary Conditions in SCI October 1 2009- September 30, 2014 Funding Source: National Institute on Disability and Rehabilitation Research, U.S. Department of Education

Were shaping the hospital into the academic model in which every patient can have the option of participating in a clinical trial. Alexander Dromerick, MD

* Research grants and awards ongoing and pending January 1, 2012 to Dec 31, 2012

ZeroG overground weight support system Transcranial Magnetic Stimulation Rehabilitation Robotics

102 Irving Street NWWashington, D.C. 20010-2949202-877-1000MedStarNRH.org

James V. Reyes, Chairman, Board of Directors John D. Rockwood, President, Senior VP, MedStar HealthMichael Yochelson, MD, MBA, Vice President and Chief Medical Director Kenneth A. Samet, FACHE, President and CEO, MedStar Health

New Dimensions is published by Marketing & Strategic DevelopmentRobert S. Hartmann, Vice President Emily R. Turk, Writer-Editor

MedStar NRH is accredited by:

CARF, the Commission on Accreditation of Rehabilitation Facilities

The Joint Commision

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Building a High Reliability CultureThe notion of high reliability isnt a new concept in health carenor many other industries in which risk plays a dominant role. But today, there

is renewed emphasis in hospitals on boosting a culture of high reliability in which patient safety is job one.

At MedStar National Rehabilitation Network and throughout the MedStar Health system were rolling out an initiative that puts the power of medical error prevention in the hands of front line care providers. We are creating a leadership team for our program, a physician, nurse and therapist, who are involved in day-to-day care delivery. The goal is to create an environment in which every potential error is noted, and regarded as a learning opportunity for individuals and the institution.

One critical aspect of the initiative is a new computer program for reporting near misses, which we implemented this past February. Weve mandated that everyone at the hospital become well versed in its use, and kicked off the program by providing training to our residents. As part of the initiative, the leadership team will review

all reports, and be responsible for analyzing trends, educating staff, and, when needed, developing procedures and protocols to prevent future incidents.

We want to encourage staff at all levels to recognize and report any problems from a slippery floor to a medical order left unfilled. Transparency and open communication and a team approach to error prevention are critical to our success.

Through the program, we hope to shift away from fear of punishment or reprisal to one that relishes reports as an opportunity to serve our patients more effectively. Each report of a near miss gives us the opportunity to educate team members, re-examine our practices, and reinforce an important tenant for every health care professionaldo no harm.

This initiative comes at a time of expansion for MedStar NRH. In addition to the two new medical staff introduced in this issue of New Dimensions [page 5], new medical staff with special expertise in Sports Medicine and Interventional Pain management will soon join our outpatient centers in Friendship Heights, Bethesda, MedStar Georgetown University Hospital, and MedStar Montgomery Medical Center.

Connect to MedStar NRH at MedStarNRH.org.

quick Referral to MedStar NRH Expertise Inpatient care: 202-877-1152 Day treatment: 202-877-1945 Outpatient services: 202-877-1621

NON-PROFIT ORG.U.S. POSTAGE

PAIDLUTH/TIM, MD

PERMIT NO. 550

MedStar NRH Perspectives Michael Yochelson, MD, MBA, VP of Medical Affairs and Chief Medical Officer

Documents

New Dimensions - Spring/Summer 2013