Since 1915, Burke Rehabilitation Hospital has been developing and implementing treatment methodologies that signal paradigm shifts in neurological rehabilitation. A strong emphasis on research is pushing the program toward further breakthroughs and, ultimately, brighter prospects for patients.
Optimal neurological rehabilitation is most effectively achieved through individualized treatment plans constructed by specialized providers. At Burke Rehabilitation Hospital, neurologists, internists, neuropsychologists, physiatrists, pulmonologists and rheumatologists collaborate to personalize care optimized for patients’ specific conditions.
“We follow the medical model,” says Barry D. Jordan, MD, MPH, Assistant Medical Director and attending neurologist, Burke Rehabilitation Hospital; Director, Brain Injury Program; Director, Memory Evaluation and Treatment Service (METS). “That’s an advantage because we see a variety of neurological conditions, and different specialists may have a higher degree of expertise regarding specific cases.”
Patients receive a minimum of three hours of therapy per day in plans that can include physical, occupational or speech therapies. This intensive structure has demonstrated efficacy in restoring functionality to patients who may not achieve such positive results in subacute care programs. Additionally, Burke Rehabilitation Hospital employs audiologists, dietitians, pharmacists, psychologists, respiratory therapists and social workers who can be recruited to enhance any patient’s therapy plan.
Restoration and Regeneration
Following discharge from acute hospital care, patients with traumatic or acquired brain injuries — including brain abscesses, brain tumors, cerebral contusions, encephalitis, intra-cerebral or subarachnoid hemorrhage, meningitis, and skull fractures — are admitted to Burke. There, they work through closely supervised, intense rehabilitation plans that consist of therapy six days per week.
A detailed evaluation performed by the medical staff forms the basis for the interdisciplinary personalized rehabilitation plan. The specialists on the team aim to restore as much functional capability as possible through physical, occupational or speech therapy, depending upon functional deficits identified in the initial evaluation.
Having completed therapy, patients are potentially ready to advance to further rehabilitative programs, some available because of the strong research presence of the Winifred Masterson Burke Medical Research Institute.
“The Research Institute gives Burke a strong bench-to-bedside presence in neurorehabilitation and neuroregeneration science, with the goal of developing neuromedical therapies that promote neuroplasticity and regeneration of the nervous system,” Dr. Jordan says. “It’s unique to have an associated research institute engaged in basic and translational research that also makes clinical trials available to patients.”
Especially beneficial tools for promoting nervous system regeneration include leading-edge robotic equipment custom built for Burke by experts at the Massachusetts Institute of Technology.
“Once patients progress out of our acute inpatient program, they may be able to participate in advanced research provided by our robust clinical trials program,” Dr. Jordan says. “For example, some patients with traumatic brain injuries, stroke or spinal cord injury benefit from our robotics program, which features machines designed to improve motor control and strength in their upper and lower extremities.”
This technology helps patients achieve functional recovery instead of relying upon compensatory techniques, such as the use of a cane. Instead of handing patients a cane and teaching them how to use it, the robotic equipment helps patients regain as much of their freestanding mobility as possible.
The Missing Link: TBI and Dementia
While the Research Institute avails numerous therapies to help today’s patients suffering from traumatic brain and spinal cord injuries or stroke regain functionality, research scientists develop therapies to enhance care for tomorrow’s patients. As Chief Medical Officer of the New York State Athletic Commission and a team physician for USA Boxing, Dr. Jordan is particularly interested in identifying the link between traumatic brain injury (TBI) and neurodegenerative syndromes, such as chronic traumatic encephalopathy (CTE) and Alzheimer’s disease.
Barry D. Jordan, MD, MPH, Assistant Medical Director and attending neurologist, Burke Rehabilitation Hospital; Director, Brain Injury Program; Director, Memory Evaluation and Treatment Service, works with a young spinal cord patient on his rehabilitation. Burke Rehabilitation Hospital utilizes the latest technology to help patients achieve the greatest possible recovery.
“Multiple concussions or subconcussive blows may cause long-term consequences, some of which resemble Alzheimer’s disease,” Dr. Jordan notes. “But in other ways, the consequences can be distinct. For example, CTE results in long-term cognitive and behavioral abnormalities, including motor deficits that translate to difficulties with balance, coordination and walking.”
Dr. Jordan consults with neuropsychologist Mark Herceg, PhD, Director of Rehabilitation Psychology and Neuropsychology at Burke.
A certain percentage of patients with TBI have abnormal protein deposits in the brain, similar to Tau protein deposits present in Alzheimer’s disease. While clinicians continue to find differences between CTE and neurodegenerative syndromes, overlap between the two continues to cloud diagnosis.
“The relationship between CTE and neurodegenerative disorders is still being studied. The only way progress will be made is by achieving a better understanding of how the conditions arise from traumatic brain injuries,” Dr. Jordan says. “So, in many ways, those in the field have been working backwards to get a better idea of the clinical picture of these individuals who have had pathological findings consistent with CTE.”
Teaming Up with the METS Program
Physical therapist Jennifer Metz, PT, who specializes in neurological conditions, discusses a patient’s progress with Dr. Jordan.
A similar challenge is present in differentiating age-related memory loss from Alzheimer’s symptoms. Specialists at METS can be a resource of expertise in cognitive problems for physicians who have patients exhibiting symptoms that may suggest a neurodegenerative disorder.
“METS is a specialized clinic devoted to evaluating individuals who have memory and other cognitive problems,” Dr. Jordan says. “Alzheimer’s disease is one type of dementia, but a variety of dementias have different patterns, and it’s important that patients be evaluated at a specialized clinic by experts in the field who can differentiate among the types.”
It’s vital to act expeditiously when symptoms characteristic of dementia arise.
“Some mild cognitive impairments are classified as prodromal Alzheimer’s disease,” Dr. Jordan says. “Patients with these conditions may eventually develop Alzheimer’s, and there has been a shift in the evaluation and treatment of these individuals. If you wait until it’s full-blown Alzheimer’s, it might be too late to treat, so we identify these patients early to initiate therapy and prevent disease progression.”
Collaboration and teamwork are a large part of what makes Burke’s program model a success. Here, Marlene Rose, MA, RN, NE-BC, CRRN, Nurse Manager for the Spinal Cord/Brain Injury Unit; social worker in the spinal cord unit Stella Marino, LMSW; and Dr. Jordan work together on a case.
For optimal treatment, patients should be referred anytime there is documentation of memory impairment and functional deficit — some declines can be nuanced, and providers should make note if patients complain of troubles such as balancing checkbooks or keeping appointments.
Upon referral, patients undergo comprehensive neurological and physical exams conducted by neurologists. Neuropsychological testing and neuroimaging studies are conducted in concert with blood work to identify the underlying cause of the symptomatology, and if possible, diagnose reversible causes of dementia.
“For patients to recover from neurological disease, it’s important they have an intense, multidisciplinary approach to restore their function, and acute rehabilitation is critical to that end. Our patients have better outcomes in our acute rehabilitation program than they would if they were sent directly to home care or a subacute facility.”
— Barry D. Jordan, MD, MPH, Assistant Medical Director and attending neurologist, Burke Rehabilitation Hospital; Director, Brain Injury Program; Director, Memory Evaluation and Treatment Service
When physicians arrive at a diagnosis, the comprehensive resources available at Burke Rehabilitation Hospital provide ample options for constructing an individualized care plan. They may incorporate FDA-approved medications for Alzheimer’s disease, aspirin or anticoagulant regimens for vascular dementias, or clinical trials involving experimental medication use.
Patients with mild impairment learn strategies to regain cognitive function through cognitive remediation programs, and patients and their families also benefit from a broad offering of condition-specific support groups.
For more information about Burke Rehabilitation Hospital’s neurological rehabilitation services, visit www.burke.org.