The specialists and subspecialists in the CARF-accredited Spinal Cord Injury Rehabilitation Program at Helen Hayes Hospital leverage comprehensive, personalized therapies, advanced technologies, and wide-ranging psychological and other support services to generate excellent outcomes.
Victoria Lent, MD, Director of Spinal Cord Injury Rehabilitation at Helen Hayes Hospital, and Matthew Castelluccio, Coordinator of the hospital’s Adapted Sports & Recreation and Peer Mentoring programs, discuss available options for adapted kayaking. The hospital’s indoor warm-water aquatic facility is available for inpatient and outpatient therapies as well as wellness programs, including kayak stability evaluations for the Adapted Sports & Recreation Program.
As a large specialty physical rehabilitation hospital for over 117 years, Helen Hayes Hospital recognizes that patients who have sustained spinal cord injuries benefit from being able to access a full continuum of care in one location. It is among few facilities that follow SCI patients from acute rehab care to home and beyond, enabling these individuals to regain maximum mobility and functioning and return to home, school and work, leading productive and independent lives.
Crafting a Care Plan
In addition to causing life-altering conditions such as quadriplegia or paraplegia, spinal cord injuries may affect the respiratory, digestive, excretory, cardiovascular and other systems. Some patients require ventilator management and wound care as well. When inpatients arrive at Helen Hayes Hospital’s 24-bed specialty unit dedicated to patients with spinal cord injuries, they undergo a thorough evaluation. Once patients’ needs are assessed, clinicians begin their therapy regimens immediately.
Maria Boiano, DO, a physiatrist specializing in multi-trauma and spinal cord injury, and Dr. Lent meet at the nursing station on the spinal cord injury unit to confer on the progress of the service’s inpatients.
“Lying in bed is not what the body is meant to do,” says Victoria Lent, MD, Director of Spinal Cord Injury Rehabilitation at Helen Hayes Hospital. “Patients can become deconditioned very quickly. Muscles weaken, the bowels and bladder can stop functioning normally, and other issues may arise. Ideally, therapy should begin during acute care.”
To individually tailor therapies for patients, the Spinal Cord Injury Rehabilitation Program has brought together a collaborative team of subspecialists, including a multidisciplinary roster of physicians, along with rehabilitation nurses, therapists, psychologists, nutritionists, case managers and more.
“Everyone plays a crucial role — from pulmonologists and respiratory therapists who address ventilator weaning to assistive technology specialists who can devise environmental controls and computer access options,” Dr. Lent explains. “With an extensive, interdisciplinary team, we’re able to make a patient’s transition from hospital to home a smooth one.”
Courses of treatment include intensive physical, speech and occupational therapy. Inpatients undergo at least three hours of combined therapy, though the sessions are broken up to ensure patients have time to rest and recuperate.
Physicians are available around the clock, and providers respond nimbly to anything that may impede treatment.
“For example, if a patient is having certain skin issues, it can be difficult for him or her to focus on physical therapy, so we may send in our wound care specialist,” Dr. Lent explains. “Maybe a recent surgery is limiting movement in some way. We gather these facts from the team and adjust care as needed.”
Occupational therapists work one-on-one with patients on activities of daily living, while recreational therapists may reintroduce patients to activities they enjoyed before their injury or expose them to new activities. The hospital’s hugely successful Adapted Sports & Recreation Program utilizes adapted equipment so patients can learn to fish, ski, play video games, sail and more. Vocational rehabilitation is also available for patients who plan to resume or pursue employment.
Therapists at Helen Hayes Hospital are well-versed in a range of advanced technologies and equipment that enhance therapy. Among those technologies is ReWalk, a motorized robotic exoskeleton that manipulates limbs into a walking pattern. Only a few rehabilitation facilities in the United States offer this technology.
Dr. Lent and Tammy Goedken, DPT, ATP, Assistive Technology Specialist with the Center for Rehabilitation Technology (CRT), review the custom and other extensive options available for power wheelchair mobility. The CRT showroom showcases a wide-ranging selection of wheelchairs.
“In addition to walking, there are psychological benefits of the ReWalk as well as positive effects on the bowel and bladder and improvements in spasticity from being upright,” Dr. Lent says.
Other technologies, such as the TheraStride system, which is used for body weight-supported gait training, retrain neural pathways to help restore mobility. A harness holds patients upright while physical therapists move patients’ legs in a walking motion. Software monitors patients’ progress.
The Armeo device, though typically used for stroke patients, can also help patients with spinal cord injuries regain hand and arm function. Armeo targets multiple muscle groups in the arm and hand, including the shoulder, elbow, wrist and fingers. Patients’ arms are placed in an adjustable, spring-loaded support while they participate in virtual reality simulations of real-world activities, such as grocery shopping.
Other key technologies include Functional Electrical Stimulation (FES), which uses electrodes to stimulate muscle groups in specific patterns to aid neural pathway recovery. Dysphagia, a swallowing disorder, can be treated with a form of neuromuscular electrical stimulation called VitalStim Therapy. Speech-language pathologists with specialized training in breathing, swallowing and cognition oversee this therapy and can also use a variety of speaking valves to help patients communicate.
A Wealth of Resources
Spinal cord injury patients have access to an abundance of additional resources at Helen Hayes Hospital as well. A warm-water pool is available for inpatients and outpatients who can benefit from aquatic therapy or are interested in aquatic exercise programs.
Francesca DeSimone, DPT, lead physical therapist, guides a patient through a session on the Functional Electrical Stimulation (FES) bike. FES helps patients with spinal cord injury improve their strength and cardiovascular endurance for both upper and lower extremities.
The screen on the FES bike provides the therapist and patient with information on the resistance, speed, distance and time expended during the therapy session. The parameters can be adjusted by the therapist to accommodate a wide range of patients with spinal cord injuries.
“Not many hospitals have pools now because of space and staffing requirements,” Dr. Lent says. “However, it’s a great tool for working through muscle control, and it can be motivating for patients who enjoy the water.”
Aquatic therapy is valuable for patients who have weak muscles or experience significant pain during other types of physical therapy. The temperature and buoyancy increase circulation, flexibility and balance. The pool at Helen Hayes Hospital has hydraulic lifts that can attach to special chairs and equipment to allow patients of any ability access to the water.
Patients who want to regain the ability to drive after a spinal cord injury can take part in the Adapted Driving Program at Helen Hayes Hospital. Adaptive devices can be used to transform vehicles to meet their needs.
“Our Adapted Driving Program is yet another service that sets us apart,” says colleague Maria Boiano, DO, a physiatrist specializing in multi-trauma and spinal cord injury. “We first evaluate patients with a simulator and then introduce them to different hand controls and other adaptations for steering, braking and starting the vehicle.”
After a pre-driving assessment and an on-the-road evaluation in the hospital’s special adaptive driving van, patients with driver’s licenses can be referred to the Department of Motor Vehicles to receive final approval to drive.
Center for Rehabilitation Technology
Providing patients the means to be more independent is a central goal of the Spinal Cord Injury Rehabilitation Program. An essential component of that is the hospital’s Center for Rehabilitation Technology (CRT), staffed by assistive technology experts who specialize in wheelchair seating, computer access and job accommodations.
Dr. Lent and Dr. Boiano confer with a driving program participant on the range of accommodations in the adapted driving van. The van features a power lift for access, power seating, variable hand controls, a left foot gas pedal, a standard right directional for single-arm driving and other evaluation tools.
The new Helen Hayes Hospital adapted van is available for outpatient driving evaluations and inpatient education for patients with power or manual wheelchair mobility. The Adapted Driving Program at Helen Hayes Hospital is a unique service in the New York metro region and a resource for individuals with physical or cognitive disorders that may impact their ability to drive.
“There aren’t many hospitals that have the capabilities for patients to turn on the TV or call a nurse if they don’t have use of their hands,” Dr. Lent says. “The CRT staff regularly meet with patients in their rooms to adapt the space so patients can be as independent as possible. They can also help people access their technology and devices with services such as eye tracking and help wheelchair users identify the best chairs and cushions via pressure mapping.”
Staff members of the CRT are trained in electronics and engineering and can fabricate custom solutions, such as cell phone mounts for electronic wheelchairs, often eliminating the need for patients to have someone by their side at all times.
Another service of the CRT is the Smart Apartment, which features an array of Electronic Aids to Daily Living (EADLs) in an apartment setting for patients to determine what they may need in their own homes. From controlling entertainment systems, mobile devices and bed positioning to automating door and window operations, the Smart Apartment lets patients and family members try out both low- and high-tech options to find solutions to the challenges of everyday living.
Systems of Support
Spinal cord injuries can present momentous life adjustments to patients. For that reason, Helen Hayes Hospital offers extensive resources as patients move through care, including access to psychological and psychiatric care, as well as complementary medicine such as massage, acupuncture and yoga. In addition, a spinal cord injury and amputee support group meets monthly and is open to patients, family members and friends.
Peer mentors may also be assigned to help patients navigate treatment and transition to life outside the hospital. Peer mentors have experienced spinal cord injuries and therefore can provide the perspective of someone who more fully comprehends patients’ concerns or anxieties.
“Peer mentors help patients understand that it’s a different, individual process for everyone and that it’s possible to have a productive, enjoyable life,” Dr. Boiano says. “They help patients realize they are not alone.”
Helen Hayes Hospital also recognizes the vital role families can play in improving outcomes. The Spinal Cord Injury Rehabilitation Program encourages family members to work alongside patients and learn from therapists during rehabilitation in order to empower them to provide care and support after patients return home. For example, family members may need to know how to assist with wheelchair transfers so that the patient can transition out of the hospital smoothly.
“We are dedicated to personalizing every patient’s care. The staff takes time to learn about and accommodate our patients in order to provide special touches, such as incorporating a favorite sport or music into therapy. If someone really enjoys a certain food, our nurses and nutritionists bend over backward to provide it. These are ways to aid recovery and make a challenging process more manageable. We treat our patients like family.”
— Victoria Lent, MD, Director of Spinal Cord Injury Rehabilitation at Helen Hayes Hospital
For patients and families who want to experience what life at home will be like after the completion of inpatient care, Helen Hayes Hospital offers an overnight transitional living apartment service.
“The transitional living apartment doesn’t look like a hospital room,” Dr. Lent explains. “It is set up so the family can do a test run with the proper equipment a few weeks before the patient goes home. There’s a nurse bell just in case, but the transitional apartment gives family members and patients a safe space to practice and build their confidence with regard to successfully functioning in the home environment.”
Because Helen Hayes Hospital attracts patients from a catchment area well beyond the metropolitan New York region, dorm rooms are available to accommodate family members while their loved ones receive treatment.
The program also promotes a soothing, comfortable environment for patients and their families by offering a variety of amenities and services, such as pastoral care and weekend performing arts events. Patients and families enjoy paved walkways throughout the 155-acre campus and dining rooms and parks with magnificent views of the Hudson River.
Discharge and Outpatient Services
As inpatients prepare for discharge, the staff at Helen Hayes Hospital communicates with primary care physicians and family members so that continuity of care is maintained and future needs are addressed. Outpatient services such as a variety of clinics and therapies are available.
Pictured on the TheraStride system, which provides body weight-supported gait training, are leaders of the Helen Hayes Hospital Spinal Cord Injury Rehabilitation team: Mejo Kallamthanam, LMSW, case manager; Francesca DeSimone, DPT; Kamila Wysocki, OTR/L; Victoria Lent, MD, Director of Spinal Cord Injury Rehabilitation; Kimberly Flanagan, MS, CCC/SLP; and John Ficucello, PT, Program Director SCI, Amputee and Stroke Rehabilitation Service. Body weight-supported treadmill training helps to improve upright mobility and ambulation, with the goal of retraining neural pathways.
“We even have dentistry,” Dr. Lent says. “If patients need dental services after their initial stay, our dentistry program is wheelchair-accessible and can provide sedation. Our goal is to have the full spectrum of general medical services so that patients can return for care if they need it.”
The constellation of services extends to recreational activities through the Adapted Sports & Recreation Program, with activities including everything from basketball and golf to handcycling and rock climbing. Helen Hayes Hospital is also home to a Wellness Center that houses exercise equipment customized for people with spinal cord injuries. Certified recreational therapy specialists supervise the center and can provide training on the use of wheelchair-accessible equipment and devices.
“A typical gym isn’t very accessible to someone with a spinal cord injury,” Dr. Lent says. “Additionally, some patients do not have access to adaptive equipment at home. Many of them return here to use the Wellness Center in the same way that others may go to the gym down the street.”
The Spinal Cord Injury Rehabilitation Program prioritizes ongoing communication with patients and acknowledgment of the challenges they have overcome.
“We like to keep in touch with our patients to see how we can continue to help them,” Dr. Lent says. “Each September, we invite the community to celebrate our patients’ achievements during National Rehabilitation Week, when we host our annual Honors Assembly, which recognizes patients’ hard work in their recovery.”
Helen Hayes Hospital values civic engagement as well. It serves as the location for the Hudson Valley Chapter of the United Spinal Association, an organization for those interested in events and outreach focused on bettering the lives of people with spinal conditions. The hospital is also home to a Paralympic Sport Club chapter.
“Because of our high-quality care, comprehensive services, caring staff and access to high-tech equipment, our patients make remarkable recoveries and have excellent outcomes,” Dr. Lent says.
Visit helenhayeshospital.org/spinal-cord-rehabilitation to learn more.