Transcription:
Providing Additional Levels of Care with Comprehensive Rehabilitation

Melanie Cole (Host): Our topic today is the Comprehensive Rehabilitation Unit at Shepherd Center, and my guest is Dr. Wes Chay. He's a physiatrist with the Comprehensive Rehabilitation Unit at Shepherd Center. Dr. Chay, I'd like to start by asking you what is a physiatrist?

Dr. Wes Chay, MD (Guest): A physiatrist is a physician who's gone through medical school and a residency training in physical medicine and rehabilitation. The way I kind of describe it to people is we're kind of a cross of neurology and orthopedic and neurosurgery, except we are a non-surgical specialist. We specialize in working with individuals who have experienced the loss of function or impairment in some kind of I guess either movement, or ability to communicate, or swallow, and as a result of either a neurological deficit or a physical kind of deficit or a medical condition, kind of been dealing with problems.

And so what we do is we work in a team- on the inpatient side of things, we work in an interdisciplinary team with therapists, physical therapy, occupational therapy, speech therapy, with psychologists, neuropsychologists, with chaplain services, with case managers, with rehabilitation nurses that help to put things back together hopefully for the patient and the family to be able to get back to life and have a high quality of life and return to function, return to work, return to school. So here specifically at Shepherd Center, we see a lot of neurological injuries or diseases that result in impairment in function, and so a lot of our patients, probably the vast majority of our patients here fall in that category.

But physiatrists by and large across the country can be treating people for all sorts of different disfunction in many different areas of life from pain being debilitating, to kind of a sports injury, or helping kind of to even help with some diagnostic studies that some of the neurologists may be known for with EMGs and nerve conduction studies to help figure out what's causing some problems and how to help fix these problems, or how to improve symptoms to be able to get people back to their life.

Melanie: As far as the Comprehensive Rehabilitation Unit at Shepherd Center, what kinds of patients is it designed for?

Dr. Chay: So the Comprehensive Rehabilitation Unit at Shepherd is a little special in that all the other units here at Shepherd are kind of catered to an individual diagnosis. So we have brain injury units and spinal cord injury units specifically, and there's good reason for that. There are a lot of specific kind of complications or approaches that one wants to be familiar with, and the team should be familiar with in approaching treatment for individuals with spinal cord injury or brain injury. But the interesting thing about the Comprehensive Rehabilitation Unit, or CRU as we call it, is that CRU was kind of created out of a need, and we're thankful for the opportunity to be able to help more patients, more people, more families, because unfortunately in the years past, Shepherd only had so many beds dedicated for rehabilitation, and that meant like hundreds of people, hundreds of families were turned away because we didn't have the bed space.

So thankfully I think in kind of alignment with the vision of Shepherd trying to help as many people as possible with these kind of catastrophic injuries, this CRU unit was created. So we actually take care of individuals with spinal cord injury, with brain injury, with amputations, with sometimes transverse myelitis, or Guillain-Barre syndrome, or a variety of other things primarily neurological in nature, but some even beyond that. So in a sense, this is a special unit because we have to be really good at everything.

Melanie: So are there different levels of care in a rehabilitation unit?

Dr. Chay: To a certain extent, there are different levels of rehabilitation care and different units. Now here at Shepherd, we have the ability to deliver acute rehab level care and that's kind of the most intense level of care is three hours of rehab a day split up between PT and OT and speech therapy as needed, and then having the support from rehabilitation nurses, and everyone else here. That's what we can deliver here, that's what we can offer, and then there are other levels of care that may not be quite as intense with three hours a day with inpatient rehab, it might just be an hour a day, or half an hour a day. So that's more the sub-acute level, and then there's outpatient therapies where people can be at home or another kind of location where they're going to a kind of facility, an outpatient facility where they can continue with therapy. And then there's home therapies where somebody in kind of the comfort of their home can have therapists come to their house to work with them.

Melanie: What kinds of modalities are involved in these types of therapy?

Dr. Chay: Yeah, so depending on what patients' need are, there may be a lot of opportunities for technology and different modalities. Some of the kind of tried and true things that people have used for a long time are heat and cold, and then there's electrical stimulation that many people use to try to help wake up the muscles, and the nerve connections, and try to get things firing and stronger.

But there are also a lot of kind of robotics and kind of fancier technologies that are available to help with maximizing the function that people may be able to demonstrate to lessen the kind of level of- the number of hands, and the intensity of kind of the burden of therapy for therapists with some of the other higher level robotic gait training systems. There are some different things that the therapists can also do with ultrasound techniques, or sometimes there's some myofascial pain or issues, then we can do some dry needling, or we can do some trigger point injections. So there's kind of a big spectrum of treatment options depending on what patients need.

Melanie: What about secondary medical complications? Can you help with that?

Dr. Chay: Sure. Yeah, we tend to see a certain pattern of secondary medical complications after spinal cord injury. We have a much better understanding of how systems get affected after an injury to the spinal cord, and the effect of other- like respiratory system, GI system, bladder, and kind of temperature regulation, and skin preservation.

Those are all- at this point we've definitely learned a lot from experience, and studies, and research, and a lot of things are much more understandable, and kind of predictable and preventable. On the brain injury side certainly as well there are a lot of secondary complications that we run into, and behavioral complications we run into, and so thankfully with a big team of support here, not just with the psychologists, neuropsychologists, and therapists and nurses, but also with medical clinicians and consultants available that we have here, we're able to provide the necessary support for our patients.

Melanie: And Dr. Chay, since rehab is so comprehensive, as is the name of your rehabilitation unit, and it's so multidisciplinary, how does rehab medicine integrate with and enhance other specialties in your department?

Dr. Chay: Yeah, so I think that rehabilitation medicine is kind of a special field in that part of how we approach things may be a little bit different than how traditional kind of- the traditional medicine approaches. I feel like one of the things that I noticed going through medical school was that oftentimes patients were classified by their diagnosis, and then they kind of- that's how people were referred to or seen, and I think that I feel fortunate in that in our field here, although obviously diagnoses are important, I think that we don't lose sight of the whole person, the holistic approach.

And so that's something that with a big team, I think that's important to maintain, a big picture perspective on the person, that although they may have a catastrophic injury that has changed the course of their life, that they have a new diagnosis that has taken away a lot of their function, or a lot of their abilities, and potentially changed things not just for them, but their family. But with what we can offer here, sometimes we do see a tremendous amount of neurological recovery, and we celebrate that with patients and families, but even if we don't see a tremendous amount of recovery per se, I think that as a team, one of the special things that we can do is really help provide education, and training, and help set patients and families up with resources locally in their community that then allow them to then enter back into their lives, into their communities, into their homes successfully, safely, and maximize the quality of life that they can have there.

And this is just a kind of short period of time in this journey that patients and families usually experience, whether it's a brain injury, amputation, or spinal cord injury, or what brings them through these doors, but there's a long road ahead and our role in this picture is in a sense I think getting them on the right path so that they can achieve a high quality of life, and optimize what they can do back in their home, and hopefully back in family, and back in work, back in school.

Melanie: Dr. Chay, wrap it up for us with your best information about your team at the Comprehensive Rehabilitation Unit at Shepherd Center, and how it offers treatment to stabilize conditions and help secure better health for the patients there.

Dr. Chay: So I think that we're fortunate here at Shepherd. I think that the teams are incredible. The nurses, the therapists, the techs here, the aides, the consultants that come here, the case managers. Everyone top down to leadership, everyone down up. Like you know, you can tell that the pulse of Shepherd is for the patients and families that come through these doors. I think that's something that everyone who comes through, whether just observing or visiting patients, visiting friends, or patients and families themselves, I think they identify very quickly that this is a really special place. The team is really special, and it really kind of takes a family to help oftentimes with these catastrophic injuries. The patients couldn't pull through on their own. They wouldn't be able to do everything on their own early on especially, and it takes a family surrounding them to help, and that's the way it is here too, you know? It's like the teams are our family. We all have special kind of gifts and talents and a certain role in this team, but together our passion and our purpose is unified, and that's how I think we can deliver such a high quality of care.

Melanie: Thank you so much, Dr. Chay, for all the great work that you're doing at Shepherd Center, and for being on with us today. For more information on additional levels of care with the Comprehensive Rehabilitation Unit at Shepherd Center, please go to www.Shepherd.org. That's www.Shepherd.org. You're listening to Shepherd Center Radio. I'm Melanie Cole, thanks so much for tuning in.