Burke Rehabilitation Hospital Helps Neurological Patients Achieve Their Highest Levels of Functioning

By Thomas Crocker
Thursday, August 6, 2015

Overcoming the myriad motor and cognitive deficits caused by stroke, brain injury and spinal cord injury requires flexible, tailored, multidisciplinary rehabilitation regimens led by clinicians who specialize in these conditions.

This brand of patient-centric care is the hallmark of the inpatient neurological programs at Burke Rehabilitation Hospital. One hundred years after Burke welcomed its first patients in 1915, its Stroke Rehabilitation, Brain Injury Rehabilitation and Spinal Cord Injury Rehabilitation programs embody the hospital’s spirit of innovation and commitment to helping every patient regain as much independence as possible.

Burke uses a framework of care that is rare in rehabilitation.

“Most rehabilitation facilities only follow a physiatry model of care; at Burke, we adhere to a combined medical/physiatry model, with exceptional strength in the medical aspect,” says Barry D. Jordan, MD, MPH, Assistant Medical Director, Director of Neurorehabilitation and Director of the Memory Evaluation and Treatment Service at Burke. “Many of our rehabilitation clinicians are also neurologists who specialize in treating particular disorders, such as stroke, brain and spinal cord injuries. Having clinicians with specialized knowledge of these conditions allows our team to make more accurate diagnoses and construct individualized treatment regimens based on the latest research trends.”

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(From left to right) Burke physicians Vincent Huang, MD, Director of the Spinal Cord Injury Rehabilitation Program; Barry Jordan, MD, MPH, Assistant Medical Director, Director of Neurorehabilitation and Director of the Memory Evaluation and Treatment Service; Justin Hill, MD, Director of the Brain Injury Rehabilitation Program; and Carolin Dohle, MD, Associate Director of the Stroke Rehabilitation Program

Stroke Rehabilitation Program

Nowhere is Burke’s dual medical and physiatry model more apparent than in the Stroke Rehabilitation Program, where physiatrist Mery Elashvili, MD, DO, and board-certified neurologist and Associate Director Carolin Dohle, MD, combine their expertise to lead a multispecialty team that’s not only equipped to treat primary deficits of stroke, but also to manage secondary complications that often arise during rehabilitation. Dr. Dohle leads Burke’s Neurorehabilitation Fellowship Program and is a member of the American Society for Neurorehabilitation, American Heart Association and American Academy of Neurology.

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Dr. Hill and staff physical therapist Amanda Censoprano, PT, working with a patient. At Burke, patients receive intensive physical, occupational and speech therapy as needed to reach their individual goals.

“Stroke patients may come to Burke with impairments in balance, gait, motor skills, language, vision and spatial perception,” Dr. Jordan says. “Having a multidisciplinary team that includes specialists in these areas is crucial to understanding the complex issues involved in each patient’s recovery.

“The overarching goal is to get these patients back home and reintegrated into the community,” Dr. Jordan continues. “To accomplish this, stroke patients, much like other inpatients, receive not only medical care and nursing services, but also physical, occupational and speech therapy, social services, nutrition services and neuropsychological care.”

The around-the-clock presence of medical clinicians allows Burke to address stroke-related complications, including dehydration, seizures, deep vein thrombosis, pulmonary embolism and cardiovascular disease.

“This capability is one of Burke’s primary advantages compared to sub-acute facilities,” Dr. Jordan says. “As an acute-rehab facility, we’re able to offer a higher level of medical care.”

Brain Injury Rehabilitation Program

Board-certified neurologist Justin Hill, MD, is Director of the Brain Injury Rehabilitation Program, which treats individuals with traumatic brain injury, brain infections, brain tumors, anoxic brain injury and other acquired brain injuries. Dr. Hill brings a robust research background to his role: After completing a neurology residency at the University of Pittsburgh Medical Center, he studied neural repair as a fellow at the Buck Institute for Research on Aging in Novato, California. Currently, he continues his investigations into brain injury at the Burke Medical Research Institute.

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Dr. Jordan discusses a patient’s neuroimaging results with Dr. Huang and Dr. Dohle.

Brain injury patients may display a variety of neurophysical impairments, such as seizures and headaches, as well as cognitive deficits, including diminished attention, memory, and visual and language skills. The Brain Injury Rehabilitation Program team possesses particular expertise in dealing with another common category of dysfunction that patients face: behavioral issues.

“When the brain is injured, one of the major difficulties of management and rehabilitation is dealing with behavioral problems, and this is why the presence of physicians, neuropsychologists, nurses and therapists who have training in coping with these issues is important,” Dr. Jordan says. “These patients may develop depression associated with their injuries, experience disinhibition or impulsivity or become agitated and combative. Addressing these issues is a fundamental aspect of the Brain Injury Rehabilitation Program, as is exploring the links between brain injury and late-life neurological consequences, such as dementia.”

Spinal Cord Injury Rehabilitation Program

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Dr. Dohle explains the importance of specialized therapy to a patient, who is working with physical therapy assistant Letha Varghese.

The Spinal Cord Injury Rehabilitation Program specializes in treating patients with traumatic spinal cord injuries, multiple sclerosis, myelitis, peripheral neuropathy, muscle disease, spinal cord tumors and spinal stenosis. Board-certified physiatrist, spinal cord injury medicine specialist and Program Director Vincent Huang, MD, joined Burke after holding appointments at SUNY Upstate Medical University and the Icahn School of Medicine at Mount Sinai.

“Spinal cord patients face mostly motor and sensory deficits; bowel and bladder dysfunction is often another major problem for them,” Dr. Jordan says. “At Burke, we treat specific dysfunctions that can occur, such as the bowel and bladder problems, as well as the more serious medical complications that can arise following a spinal cord injury.”

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Dr. Huang and staff physical therapist Laura Miranda, PT, program the ZeroG-Lite, which is used to treat gait impairments in individuals after stroke, traumatic brain injury and spinal cord injuries. Burke is one of the only rehab hospitals in the region with this piece of technology.

“Involvement of a varied group of providers is crucial for spinal cord injury patients,” Dr. Jordan continues. “Physical and occupational therapists spend significant time with them, and speech therapists may be called in if swallowing deficits are present. Behavioral problems are less of an issue for these patients; however, there is a significant emotional component to being paralyzed while remaining cognitively intact. Psychologists are important members of the care team for this reason.”

Helping patients and their families find the support they need to adjust to the circumstances of an injury is a major component of Burke’s mission. For certain patients, this support comes in the form of discovering new ways to get active in adaptive sports and fitness programs through the Therapeutic Recreation Department. For others, emotional healing occurs by spending time with other patients in the monthly Spinal Cord Injury Support Group, one of several disease-specific support groups Burke organizes.

Turning Tradition on Its Head

As Burke prepares to enter its second century, it’s helping lead a paradigm shift in the practice of rehabilitation.

“Traditionally, rehabilitation has focused on teaching individuals how to cope with disability,” says Richard Sgaglio, PhD, Director of Marketing and External Relations at Burke. “Here, whether through clinical programs or research conducted at the Burke Medical Research Institute, we’re striving to create treatments, and ultimately, cures for disability. Previously, if a patient needed a cane, rehabilitation taught him or her how to use it. Our work is focused on eliminating the need for it.”

Leveraging Leading-edge Technology and Driving Neurorehabilitation Research

At Burke Rehabilitation Hospital, the use of innovative therapeutic tools intersects with burgeoning investigations into technologies that could profoundly change the way patients receive rehabilitation.

Burke physicians and therapists have a diverse technological armamentarium from which to draw, particularly in the area of alleviating motor deficits. Examples of advanced technology in use at Burke include:

  • Bioness neuro-orthotic systems that use electrical nerve stimulation to help patients regain hand function and improve foot drop
  • Functional electrical stimulation bicycles that allow patients who have lost muscle control in the arms or legs to perform strength and conditioning cycling with the help of electrical nerve stimulation
  • InMotion ARM, a robotic arm and interactive platform that improves elbow and shoulder function
  • ZeroG-Lite, a gait and balance training tool custom-made for Burke that allows therapists to begin rigorous physical therapy with stroke, spinal cord and traumatic brain injury patients during the early stages of recovery

Burke clinicians conduct basic, translational and clinical research through the Burke Medical Research Institute, and patients have the opportunity to enroll in clinical studies that could shape the therapeutic modalities and methodologies of the future. Currently, robotics and remote care delivery are two areas of particular research focus at Burke.

“We’re heavily involved in researching the use of non-invasive brain stimulation such as transcranial magnetic stimulation in conjunction with robotic-assisted therapy for motor recovery,” says Barry D. Jordan, MD, MPH, Assistant Medical Director, Director of Neurorehabilitation and Director of the Memory Evaluation and Treatment Service at Burke. “We’re also beginning to study telemedicine and telerehabilitation, which I think will play a significant role in the future for improving outcomes following neurological injuries.”

To learn more about Burke’s inpatient and outpatient rehabilitation programs, research endeavors, and community education initiatives, visit burke.org.