UAB Insight Rehabilitation Volume 2 - Page 2

F E AT U R E D SERVICES N E W FAC U LTY Martin Setliff, MD, has joined the PM&R faculty as assistant professor and UAB Hospital trauma team liaison. A graduate of Louisiana State University (LSU) Health Science Center, Shreveport, he completed an internship at LSU and a physical medicine and rehabilitation residency at UAB. His focus is on inpatient rehabilitation with interest in traumatic brain injury, spinal cord injury, and burn rehabilitation as well as the coordination of patient and family education concerning rehabilitation issues and the prevention of secondary complications early in the acute phase of care. Amy Knight, PhD, a clinical neuropsychologist, has joined the UAB PM&R faculty as assistant professor. She earned her PhD in clinical psychology from the University of Wisconsin-Milwaukee and completed an internship in behavioral medicine and psychiatry at West Virginia University School of Medicine, Morgantown. She completed a postdoctoral fellowship in clinical neuropsychology at UAB in the Department of Neurology. Her clinical specialization includes neuropsychological assessment and therapy for medically complex patients, including both older and younger adults with a wide range of disorders including neurodegenerative disease, movement disorders, epilepsy, multiple sclerosis, trauma, brain injury, and stroke. Knight’s research explores the neural and cognitive components critical to independent financial functioning in aging adults and the causes of financial decline and loss of independence in the presence of injury or disease. UAB MEDICINE NEWS Moving Beyond Stabilization: Trauma Team Adds Physiatrist A physiatrist from the Department of Physical Medicine and Rehabilitation has joined UAB Hospital’s busy Trauma Service in an effort to improve patient flow and the transition to rehabilitation of patients with spinal cord injuries, traumatic head injuries, and polytrauma. The inpatient rehab specialist will help monitor 10 to 15 patients daily to help prevent secondary complications, coordinate therapy teams, and provide enhanced patient and family education. “This partnership of PM&R, the hospital administration, and the trauma service is an extension of our patient-and-familycentered principles. We are focusing on how we can better guide the injured and their families through the initial emotional haze and uncertainty that comes with catastrophic injury,” says PM&R Chair Amie Jackson, MD. Martin Setliff, MD, who joined the PM&R faculty this year to become UAB’s first rehabilitation-trauma specialist, says, “Providing our specialty’s perspective on a daily basis will provide the trauma team the opportunity to move beyond stabilization. We will champion consideration of early interventions in the acute stage, such as initiating range of motion; opportunities for bracing, such as for foot drop; and medications and medical equipment that can lead to early mobilization. As the only member of the hospital team to be a constant presence from the intensive care units to rehabilitation and discharge, we also anticipate seeing more consistent support from families for our philosophy of rehabilitation.” A specialized set of eyes on the patient daily, efficiencies in staff time, optimization of mobility and function, and lowering the number of complications such as bowel and bladder problems and decubitus ulcers will prevent delays in the patient’s transfer to Spain Rehabilitation Center or another facility, he says. UAB Trauma Team members observe physical therapy at UAB Hospital’s Trauma Burn Intensive Care floor. From left are surgeons Chris Richardson and Sherry Melton, physiatrist Martin Setliff, and surgeon Loring Rue. The 49-bed Spain Center, a member of the federal SCI model care system, is part of 1157-bed UAB Hospital. The hospital, the only one in Alabama accredited by the American College of Surgeons as a Level 1 Trauma Center, sees a large population of patients with spinal cord or head injuries or multiple trauma. Trauma surgeon Sherry Melton, MD, firmly supports the new program. She says: “Trauma recognizes the importance of building a relationship with the patient and the family. The rehabilitation perspective will be very helpful in helping them know what to expect and enlisting them in supporting the goals of the treatment plan.” Previously, designated faculty attending physiatrists provided consultation services upon request, usually for rehabilitation evaluation when patients neared discharge, but the team was responsible for the entire hospital and usually would be unfamiliar with the patient. The Trauma Service was one of the primary requestors for rehab consultation. The new program carves out A Clinic for Women With Disabilities Spain Rehabilitation Center’s monthly Reproductive Health Clinic for women with neurological disabilities is one of few such services in the nation and the only one in Alabama. The clinic provides rehabilitation, medical, and gynecological care for women for whom routine doctor visits often present special problems. For patients in wheelchairs, a special pelvic examination chair lowers for easy transfers, and a wheelchairaccessible scale is available. More than 40 babies have been delivered to clinic patients over the years. Medical Director Amie Jackson, MD, heads a staff trained in performing pelvic (including Pap smears) and breast exams and in addressing sexuality, marriage, birth control, and pregnancy issues in women with disabilities. She says, “It’s essential that women with disabilities receive adequate information, education, and support to make informed choices about their reproductive and general health care.” Fast Forwarding Functional Neuro-Recovery UAB has initiated a Functional Neuro-Recovery (FNR) Program to accelerate the flow of basic science discoveries to clinical practice and provide practical training for researchers, particularly in brain and spinal cord injury and multiple sclerosis. “Formalizing this program substantially enhances UAB’s translational research presence in physiatry and rehabilitation medicine,” says program director Candace Floyd, PhD. Funding is available for a formal speakers program and for medical students or postdoctoral trainees to conduct translational research. Three pilot grants were awarded last year from 12 intramural applications, and one medical student’s project was presented as a poster at the 2012 National Neurotrauma Society’s annual meeting. The UAB program melds neuroscience research She believes this will be the first swine model SCI Early in 2013, the swine facility will be ready to test the ability of promising pharmacotherapeutics to promote The program also will have a strong education component, including a dedicated Web site for the public new treatments from around the world. The porcine damage. “The swine facility will significantly promote that will include the latest information on SCI research at SCI model was pioneered by Brian Kwon, MD, of the increased translational research and reduce the time to UAB and worldwide; an annual meeting for clinicians, University of British Columbia Faculty of Medicine, who move treatments from bench to bedside,” says Floyd. researchers, and the public that will convey state-of-the-art is a consultant for the UAB lab. The Yucatan pigs are bred “An international competition will find the most developments in the field; and scholarship programs for exclusively for research. UAB will utilize a dedicated promising compounds from rodent models, and we will medical students and others desiring to enter SCI research. veterinary and nursing staff for animal care and make test at least one in swine each year.” 2 F OR REF ERR A L S: 1- 8 0 0 - 8 2 2- 6 47 8 The swine lab is only part of the funded program. A small-animal SCI core will be developed for UAB Rehabilitation Medicine Research Funding investigators, who can compete for pilot project funding. regeneration of spinal cord tissue and attenuate SCI recovery in this clinically relevant model of SCI. UAB to Test Concussion Drug for NFL NFL Charities has funded PM&R research in hope of ameliorating the risk of cognitive deficit following concussion. The grant will allow testing of a novel pharmacotherapeutic hypothesized to be protective of the brain following concussion. “The underlying mechanisms of cognitive deficit following concussion are still unclear, but it appears oxidative stress and activation of the proinflammatory signal nuclear factor kappa B (NF-κB) are two key pathological events,” says PI Candace Floyd, PhD. “We have developed and described a catalytic oxidoreductant compound (MnTE-2-PyP) which both dissipates reactive oxygen species and inhibits activation of NF-κB.” The agent potentially could be given acutely after a concussion to protect the brain and may reduce the heightened risk to the brain associated with a second or third concussion. 26.4% of all rehab consults. lab in North America that can be used to test promising use of MRI and other markers to evaluate lesion size and Mobile App Streamlines Worker’s Comp Service The UAB Worker’s Compensation Mobile App allows PM&R’s Workplace Occupational Health Clinic clients to connect quickly and efficiently with the UAB emergency department, which provides the clinic’s after-hours work injury treatment, drug screening, and breath-alcohol testing. The app allows business and industry clients to use a smartphone or desktop computer to send a template e-mail to the ED requesting services. It also provides the clinic with information to allow return or follow-up calls to update the client on patient care status and collect additional information. those patients with SCI, TBI, and polytrauma, which account for MEASURES OF SUCCESS translational tool,” she says. with the clinical resources of UAB’s Spinal Cord Injury and Traumatic Brain Injury Model systems and the National Spinal Cord Injury Statistical Center housed at UAB. FOR MORE INFORMATION: visit www.uab.edu/medicine/physicalmedicine/ Approved research funding for PM&R more than doubled over the last 2 years, and pending research funding has risen significantly. Orthotics and Prosthetics Lab The lab evaluates, fabricates, and customfits artificial limbs and orthopedic braces. The full-service orthotics, prosthetics, and pedorthics facility offers on-call services for all UAB-affiliated hospital inpatients. Traumatic Brain Injury Clinic The clinic provides rehabilitative services including medical, neuropsychological, and orthotic evaluations, PT, OT, speech therapy, social services, and counseling. The Workplace Occupational Health Clinic The clinic cares for nonemergent, on-the-job injuries and provides work-related injury treatment, physicals, hazmat physical exams, audiograms, nerve conduction testing, breath alcohol testing, and drug screen collection. Musculoskeletal Rehabilitation Program The program helps improve functional capacity, reduce symptoms, and improve well-being for people with impairments due to disease, disorders, or trauma to muscles or bones. Neuro and Clinical Psychological Program Services assist both inpatients and outpatients with adjustments to recovery and ongoing disability associated with traumatic events. Spinal Cord Injury Program An interdisciplinary approach in rehabilitation is tailored to meet each patient‘s needs. PM&R operates the National Spinal Cord Injury Statistical Center, which supports and directs the collection, management, and analysis of the world‘s largest SCI database. Pain Treatment Program Techniques may include non-invasive physical, manual, and electrical therapy as well as minimally invasive procedures such as ultrasound- or fluoroscopic-guided injections and specialized electromyography. Stroke Rehabilitation Program Patients receive PT, OT, and speech therapy in daily individual and group sessions. Similar specialized programs for cardiac, oncology, Guillain-Barré, and orthopedic rehab bring together various services to provide comprehensive care. Behavioral and neurorehabilitative constraint-induced (CI) therapy also are offered. Spasticity Clinic This outpatient clinic cares for patients with spasticity or increased muscle tone and/or rigid, hyperactive reflexes, dystonia, spasms due to TBI and SCI, stroke, cerebral palsy, multiple sclerosis, and other diseases. MOR E INF OR M AT ION: uabmedicine.org /physician 3