Transcription:
Spinal Cord Injury and Psychology Integration at Marianjoy Rehabilitation Hospital

Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm your host, Melanie Cole, MS, and we have a panel for you today with Dr. Leslie Rogers. She's the Spinal Cord Program, clinical coordinator and staff psychologist at Northwestern Medicines Marianjoy Rehabilitation Hospital.

And Dr. Anita Co. She is a spinal cord injury fellowship trained physiatrist and the medical director of the spinal cord injury program at Northwestern Medicines. Marion Joy Rehabilitation Hospital, and they're here to highlight today spinal cord injury and psychology. Thank you both so much for being with us and Dr.

Rogers. I'd like to start with you. Tell us a little bit about your role at Northwestern Medicines. Marion Joy Rehabilitation Hospital, and how does it fit within spinal cord injury and psychology.

Dr Leslie Rogers: Sure. So, I am an inpatient psychologist and I am the only psychologist in the spinal cord program. So, I see all of the spinal cord patients who come here and I provide individual psychotherapy support to them and their families, work on cognitive skills if that's an issue. And then, I am also, as you said, the clinical coordinator. So, I'm responsible for quality assurance with the program and program development and team meetings and things like that.

Melanie Cole, MS (Host): It's an interesting topic. And Dr. Rogers, tell us a little bit about this topic. How can psychology help patients who've experienced a spinal cord injury or another life-altering injury or sickness? How does it help with that psychosocial and emotional aspect of spinal cord injury, which really can be devastating to patients and their families?

Dr Leslie Rogers: So, life changes in an instant when something like that happens. And it's also because it's a neurological injury, there is a lot of uncertainty. With a lot of our patients, we are not sure. How much better they're going to get or how quickly they're going to get better. And the uncertainty is extremely difficult for people. And then, just the loss, the loss of whatever abilities they don't have anymore, whether it is permanent or temporary. So, trying to help people understand what is going on with their bodies and process their feelings about what's happened to them and helping their families work through it, dealing with how this is going to change their lives and how they can cope with that.

Melanie Cole, MS (Host): Dr. Kou, you've been in this field quite a while. Tell us a little bit. When Dr. Rogers mentions life-altering disabilities, the things that really change, as you see SCI patients, what are some of those? Because as we're looking at those psychosocial and emotional and psychological aspects, they're all tied together with the physical limitations the patients are dealing with.

Dr Anita Kou: Just agreeing with Dr. Rogers there, just that immediate kind of loss of ability or strength and function is very difficult for patients to adjust immediately. So, it's really important, as I collaborate with Dr. Rogers, that we're screening immediately for depression, for any symptoms of anxiety or also a lot of questions about prognosis that I'm able with Dr. Rogers to address early on and also including our families for patients to be involved in that discussion.

Melanie Cole, MS (Host): That's an important point you make about prognosis, because it certainly is a question on so many minds. Now, Dr. Rogers, tell us a little bit how you incorporate psychological working into the clinical program at Marianjoy Rehabilitation Hospital. Tell us a little bit about the process itself.

Dr Leslie Rogers: So, the first time I meet with a patient, and this would be true for any patient, whether it's in the spinal cord injury program or not, I'm doing a clinical interview. So, I'm trying to get to know them, what do they understand about what happened to them? Do they remember what happened to them to cause whatever the injury was that brought them into the hospital or the illness? And then, just basically trying to find out how are they feeling physically, how are they feeling emotionally. And then, I go through a whole history so I can get to know them pretty well. It's interesting because some people don't really understand why I'm asking all those questions, why do you need to know if I have siblings or things like that. Because I'm really trying to get to know them as a person because they bring things from their history to this situation, which is going to influence how they deal with it. And then, based on that clinical interview, if they are having any cognitive problems, I may do some testing to see how they're doing with their thinking skills. If they don't seem to have any issues like that, then I wouldn't necessarily do that. But after the initial evaluation, I basically would come up with a treatment plan, what does this person need to focus on, how often do I need to see them, how involved is their family, do I need to reach out to them really soon or can I wait a little bit, things like that.

Melanie Cole, MS (Host): Well, thank you for that. And Dr. Kou. As Dr. Rogers was just mentioning and we've briefly touched on, spinal cord injury affects the entire family, not just the injured person, and that support of the family system plays such a significant role in recovery. Give us some strategies that you offer for families to help cope with these long-term effects, and Northwestern Medicine's Marianjoy Rehabilitation Hospital's process for treating spinal cord injury patients with psychological issues, how the family is involved, tell us how you all work together.

Dr Anita Kou: I think it's really important to have a good working relationship with the patient and their families, along with the SCI team. And kind of like what Dr. Rogers hinted at is that getting them in for the family care meetings, getting some family care training during their inpatient stay helps give opportunity for families to ask those questions and practice hands-on on caring for a loved one who is now living with a spinal cord injury. And just going forward, after they leave the rehab unit, what I would recommend is that the families and the patients still continue to follow up with myself and our outpatient spinal cord injury team, so that way we can help them have the right resources, that they continue their therapies, that they get connected with the spinal cord injury support group. And that also as, for some who live with a chronic spinal cord injury, that they have opportunity to know how to get respite care too for caregivers. It can be very tiring and burdensome over time. And so, we want to make sure that families feel that they have that support, even after they leave us for their inpatient program.

Melanie Cole, MS (Host): Dr. Rogers, what advice do you have for physicians that are working in spinal cord injury rehabilitation and the psychological aspect of this particular injury? When you speak to them, what would you like them to know about the whole situation?

Dr Leslie Rogers: Well, I think they need to know that people bring their history and their style of coping to the situation. So, you're going to see a pretty wide gamut of reactions in terms of how people cope, the level of acceptance, also just ability to understand medical terminology and medical issues. So, you're not going to necessarily see like a textbook these stages of adjustment people are going to go through because everyone is different.

Dr. Kou made the point that the treatment team needs to work together. And I think our team does work very closely together. We communicate a lot with each other, so that we are all aware of how people are doing various aspects of the program. And, I may be able to communicate things that people are telling me that they might not be telling other people, but also vice versa. Sometimes people will tell their physical therapist or their occupational therapist something that they didn't necessarily tell me. And I think people also have different levels of comfort in terms of opening up with the physician about how things are going or being assertive about their concerns.

Melanie Cole, MS (Host): Such an important topic and not one that we discuss very often. And I'd like for each of you to have a final thought. Dr. Kou, why don't you speak to other providers about why you feel it's so important that they refer to Northwestern Medicine's Marianjoy Rehabilitation Hospital for their patients with spinal cord injury.

Dr Anita Kou: I agree with, Dr. Rogers, I think we have a great spinal cord injury team and program where staff communicate very well with each other and voice concerns that patients maybe sometimes might feel uncomfortable bringing to one staff member versus another. And I think just having a place where a patient feels comfortable doing that is important.

And I can't speak highly enough that Dr. Rogers, she's a wonderful asset to her team. She always wants to make sure that our patients after they leave our program have good followup, even in the outpatient setting. And so, she helps really remind our team to always think about that psychological aspect and how even though physically patients are healing, there's still that psychological, healing aspect too to address.

Melanie Cole, MS (Host): Dr. Rogers, last word to you. What would you like providers to take away, the key message about this unique topic we're discussing here today, spinal cord injury and psychology together?

Dr Leslie Rogers: Well, I would say that this hospital has always been about the people and about returning people as much as possible to their lives. And I think that's where psychology fits in. I had an acquaintance years ago who was a physician in a certain specialty. And at that time, I was actually working on the brain injury unit. And that physician said, "Why would someone who has a brain injury need a psychologist?" And that really shocked me. Why would you think they wouldn't need a psychologist? And again, sometimes patients aren't going to open up to a physician right away about how they're feeling. So, if they can put their trust in us as psychologists to get to know the patient and then communicate to the team how that person is doing, I think we can work together really well.

And then, I also want to say that a shout out to Dr. Kou here, she really helped us develop that whole part of the program even more, and really promoted having these patient and family care conferences that are so valuable to the patients, the families, and us as a treatment team.

Melanie Cole, MS (Host): Well, as we've said, this is a really important topic and such an important part of the recovery for patients with brain injury or spinal cord injury. Thank you both so much for joining us today. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole, MS. Thanks so much for joining us today.