rehab quarterly summer

Results and ReseaRch

Challenging the unknowns behind West Nile virus, one patient at a time

3 An announcement on certification from The Joint Commission

Although scientists know in which sea-sons it is likely to occur, determining geographic location (see sidebar “By the Numbers”) and who is likely to con-tract the disease has remained elusive. In 2012, Dallas County was the epicen-ter for the nation’s WNV outbreak; yet the following year saw a dramatic drop in the region’s cases.

Experts are uncertain how to explain this trend. Weather patterns character-ized by unusually warm winters likely play a role, as well as public health pre-vention efforts such as public education and targeted spraying. Some scientists, including those at the University of North Texas, are examining whether animal migration patterns are a key to further understanding the seemingly unpredictable outbreaks. ›West Nile virus

(WNV) has been one of the most puz-zling endemics to strike the

United States since it was introduced in North America in 1999. The upsurge in clinical cases in 2012 has generated

an equally robust increase in research on WNV, prompting scientists and clinicians to focus on unlocking the secrets of how and where this disease will strike next.

Battling the unknownA particularly challenging characteristic of WNV is its stubborn unpredictability.

VOL. 1, NO. 2, SUMMER 2014

Baylorhealth.com/BIR

Structure of West Nile virus (PDB 3IYW). WNV is a virus of the family Flaviviridae and mainly infects birds but is known to also infect humans. The main route of human infection is through the bite of an infected mosquito.

4 Two patients with West Nile virus offer their perspectives 6 A new gait-training

device for patients with neurological injuries

quarTerlYan educational Journal of Baylor Institute for Rehabilitation

R E h a b i L i t a t i O NtM

FdBMSU14007_Rehab_v2.indd 1 7/23/14 1:22 PM

(cover story continued )

Unfortunately, even when research-ers are able to pinpoint a future hotspot, prevention and intervention remain diffi cult. The incidence of WNV is low, resulting in small studies that make gen-eralizing results challenging. Each year scientists learn more about the virus, but without larger samples, it is hard to build consensus on which symptoms, treatment response and other patient outcomes refl ect typical patterns of the illness. Clinically, this adds to the uncertainty when discussing pattern of recovery and prognosis with patients.

Nonetheless, many individuals with WNV are still being told upon diagnosis that their symptoms and functioning should return to baseline within three to six months, and certainly within a year. Unfortunately, the research to date does not support such patterns of recovery among all subtypes of WNV. This variability in outcome is compli-cated by small studies tracking people over time, an overreliance upon patient

self-report, and inconsistent outcome measurement tools. More long-term studies are needed to clarify why and how the disease manifests over time and in diff erent individuals. Baylor Institute for Rehabilitation is address-ing this knowledge gap by systemati-cally following patients with WNV from inpatient hospitalization through the course of recovery.

Looking at Long-Term CluesPatients at Baylor who have WNV initially are tracked at admission to acute inpatient rehabilitation and then followed as outpatients. This tracking includes participation in the outpatient Day Neurorehabilitation Program, and then outpatient follow-up at three months, 12 months and even 24 months after diagnosis. Consistent with the scientifi c literature, these patients have generally demonstrated lingering fatigue and fi ne motor impairments six months after diagnosis. While not fully resolved, complications such as balance and gait

problems appear to improve in the fi rst three to six months post-diagnosis in those patients diagnosed with West Nile encephalopathy. Residual cognitive changes have typically included atten-tional defi cits, mental slowing and exec-utive function diffi culties (for example, problems with planning, fl exibility and organizing). The varying nature of defi cits and recovery has ranged from examples of one patient who returned to work with recommended modifi ca-tions in six months to another patient who suff ered from chronic headaches, fatigue, balance diffi culties and visual problems two years post-diagnosis.

These preliminary trends based on a paucity of patients do not yet allow us to better predict individual patient outcomes.

Shared LearningThe challenges surrounding WNV extend to treatment options. The virus has a variety of subtypes (for example, uncomplicated West Nile fever, West Nile meningitis, West Nile encephalitis, acute fl accid paralysis), and presenta-tions are not uniform even within sub-types. Hence, some infected with WNV may be virtually asymptomatic and not require treatment or rehabilitative interventions, or patients may present with profound physical and cognitive changes as detailed above. Furthermore, a small percentage of cases will develop potentially fatal neuroinvasive disease.

In general, treatment is supportive and based on targeting symptoms. The research base lacks enough carefully controlled clinical trials to support a human vaccine at this time. The limited medical treatment options and range of residual diffi culties experienced by patients with WNV support the need for a comprehensive approach in rehabilita-tion programs. Similar to the multidis-ciplinary approaches that are standard with stroke and traumatic brain injury, a subset of WNV patients will likely benefi t from programs that integrate interventions targeting physical and cognitive recovery. Physical therapy can address basic motor abilities, including gait training, balance, strength and stam-ina. Occupational therapy can address PH

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Sources • cdc.gov/westnile/statsMaps/preliminaryMapsData/index.html • diseasemaps.usgs.gov/2013/wnv_tx_human.html (redirected from ArboNET County-level Data Presented on the

U.S. Geologic Survey (USGS) hyperlink on cdc.gov/westnile/statsMaps/preliminaryMapsData/index.html)• cdc.gov/westnile/statsMaps/cumMapsData.html

5,674 in 2012 2,469 in 2013

29 in 2014*

BY THE NUMBERS

No WNV activityWNV human infectionsNon-human WNV activity*as of July 15, 2014

2014 WNV ACTIVITY BY STATE*

Dramatic Drop in Cases

Percentage of 2013 cases coming from Texas, including 16 in Dallas County, 10 in Collin County, 9 in Denton County and 8 in Tarrant County8%

*as of July 15

2 | BaylorHealth.com/BIR BaylorHealth.com/BIR | 3


upper extremity motor coordination or visual defi cits that can impact functional independence in activities of daily living, including self-care, preparing a meal, folding laundry or returning to work.

Mental and physical energy conser-vation techniques can be highly useful in combating fatigue in home and vocational environments. Cognitively, learning compensatory strategies to minimize the impact of reduced effi ciency in atten-tion, memory and mental speed changes are frequently benefi cial in facilitating independence and minimizing frustra-tion and adjustment-related symptoms. This holistic assessment and treatment approach across the continuum of care needs to include patient/family education throughout the process with an individual focus on guiding recommendations to maximize level of functional activity.

Putting Attention on PreventionThe abundance of unanswered questions makes WNV an exciting fi eld of research, and one of the most active areas of study concerns WNV prevention. Current tech-niques involve public education about risk reduction—avoiding standing water and staying indoors at dusk and dawn, when mosquitoes are most active—as well as use of aerial and ground pesticide sprays in areas where mosquitoes have tested positive for WNV. With clini-cal trials ongoing, the current focus in rehabilitation is tracking the recovery process and targeting rehabilitation eff orts to maximize return to indepen-dence and functional recovery. And in doing so, experts at Baylor Institute for Rehabilitation and health care facilities nationwide continue their mission to enhance the research and knowledge base of WNV literature with a focus on rehabilitative eff orts across the contin-uum of care and recovery. �

Nicole Fromm, PsyD, is a clinical neuropsychologist in the Baylor Institute for Rehabilitation’s Department of Neuropsychology Services. 3 [email protected] or [email protected] PH

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As a nationwide symbol of commitment to quality patient service and performance standards, The Joint Commission provides accreditation and certifi cation—known as its Gold Seal of Approval™—to more than 20,000 health care organizations in the United States. Such a designation is not

to be taken lightly; it refl ects an organization’s dedication and willingness to uphold the highest standards in clinical care and is an overall hallmark of excellence.

In June 2014, Baylor Institute for Rehabilitation was bestowed The Joint Commission Disease-Specifi c Care Certifi cation in Stroke Rehabilitation. This certifi cation is only a small part of our numerous eff orts to bolster the provision of continuous quality improvement aimed at enhancing our clinical programming. Continuous quality improvement initiatives have been shown to eff ectively target key patient and performance outcomes, including improving patient safety and delivery of consistent care across the organization. This certifi ca-tion signifi es to others the quality of our institution and helps guide our day-to-day eff orts.

Several acute care settings within the Baylor Health Care System have achieved Joint Commission Primary Stroke Center Certifi cation. Through our collaboration with these acute care settings, a true contin-uum of care for the stroke patient exists from the emergency department through return to community and provides patients a rigorous approach to the treatment of stroke. As noted by Beth Hudson, chief nursing offi -cer of Baylor Institute for Rehabilitation, “One of the most exciting parts of The Joint Commission Disease-Specifi c Care Certifi cation in Stroke Rehabilitation for our facility is a built-in network of support for patients and families that extends into the community setting.”

We plan to use this latest designation as an operational improvement tool through the adoption of clinical practice guidelines along with con-tinuing our research eff orts in stroke rehabilitation. And although this is our fi rst disease-specifi c certifi cation in rehabilitation, we certainly do not intend for it to be our last as our goals are fi rmly set on pursuit of such certifi cation for Traumatic Brain Injury and Spinal Cord Injury. Through this notable achievement, patients and providers at Baylor Institute for Rehabilitation can be confi dent that we are committed to a health care culture that emphasizes teamwork, research, comprehen-sive and collaborative treatments, and patient satisfaction.

Dr. Wilson can be reached at: 3 [email protected] 3 [email protected]

A MESSAGE FROM

The Medical DirectorAmy J. Wilson, MDMedical Director, Baylor Institute for RehabilitationChief, Department of Physical Medicine and Rehabilitation, Baylor University Medical Center

BaylorHealth.com/BIR | 3


which led to therapy with intravenous immunoglobulin. After two months of treatment, he was admitted to Baylor Institute for Rehabilitation.

Until February 2010, Lemoine—initially still fully ventilated and using an electric wheelchair—began physical therapy to relearn basic and functional skills, including supporting his own body weight, sitting, standing, ambula-tion and activities of daily living (like dressing himself). By March, he gradu-ated to the Baylor Rehab Day Neuro Program, where his therapy intensified in complexity, including six hours of daily speech therapy, physical therapy and cognitive training, five days per week. Outpatient rehabilitation began in August, as Lemoine progressed from full wheelchair dependence to partially ambulating with a walker. On the UpswingThe next few years brought a series of successes and regressions. By 2012, Lemoine was able to forgo the wheel-chair altogether and began walking with a cane, but even today, he has difficulty standing, walking on uneven surfaces, and climbing stairs. In 2014, he was able to stop using the cane full time, and his lung capacity improved to 70 percent.

“But I still struggle with balance and coordination, and I’m still highly susceptible to falls,” he adds.

Lemoine has returned to full-time work as a trial attorney, and while he values being at nearly full speed (putting in a mere 50 hours per week instead of his typical 60–70 hours), the anxiety and stress that are an expected part of his profession can exacerbate his symptoms.

“If I put in three or four 16-hour days, my system starts to collapse from stress and lack of sleep,” he notes. “I’ve wound up back in the ER a couple of times from pushing my body too hard.”

Although his illness has been puni-tive in producing such physical setbacks, it has been charitable in other ways.

“This gave me more empathy for people who have been hurt and injured and also a lot of respect for the people who work with them,” Lemoine says. “Having someone do things for you

A spinal tap soon confirmed the cause: WNV with encephalitis and meningitis. Lemoine was placed into a medically induced coma to mitigate any further deterioration and after three weeks was transferred to short-term acute care at Baylor University Medical Center.

Unfortunately, his condition con-tinued on a downward trajectory.

“I was getting weaker because the virus was stripping the myelina-tion off of my nerves,” he explains,

Sean Lemoine A Steady DeclineWhat seemed to start as a routine case of the flu for Sean Lemoine, 36 at the time, quickly evolved into a dangerous constellation of neurological symptoms that led him to the emergency depart-ment one evening in August 2009.

“I was blacking out, having cognitive difficulties. … My mind pretty much shut down by the time I went through the first round of testing at the ER,” he recalls.

CliniCAl ViewpOint

Most people are familiar with platitudes that remind us to search for the silver lining in every rain cloud. But when faced with a sig-nificant crisis, it can be difficult to actually embrace the meaning of such words.

For two Dallas residents, the battle against West Nile virus (WNV) has been long and accompanied by unique challenges to everyday living. Yet despite their ongoing difficulties, both patients serve as a reminder of what it means to live with a positive mindset.

Over several years, Sean Lemoine’s

rehabilitation recovery gradually

progressed from relearning basic

and functional skills to participating in

speech therapy and walking with

a cane.

Two patients with West Nile virus find new perspectives on life

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that you can no longer do for your-self is extremely humbling, so, in my opinion, [West Nile virus] made me a better person and gave me a better perspective on life.”

Claire McCall A Slow Climb BackLike Lemoine, Claire McCall, 56 at the time, initially believed her fever and fatigue were nothing to be alarmed about, but her partner, Lenora Moffa, then 54, suspected otherwise.

“Claire was really weak and unsteady,” says Moffa. “I’d never seen her so exceptionally lethargic, even with a bad flu.”

With McCall’s temperature at 103.4 degrees, Moffa decided to take her to the Baylor Emergency Department, at which point neurological symptoms of spasticity, immobility and respira-tory paralysis began to set in. After undergoing a spinal tap, McCall was diagnosed with neuroinvasive WNV and placed into a medically induced coma for six weeks. She was moved to Baylor’s specialty hospital until she could be weaned off a respirator.

It was then that she was referred to Baylor Institute for Rehabilitation to prepare her for the upcoming journey through rehabilitation.

“I remember the first time I sat up for 45 seconds. I cried and cried because it hurt so,” says McCall. “But my physician at Baylor Institute for Rehabilitation was encouraging from the beginning. It was like, ‘We can do this. We can help you,’ even though I couldn’t lift a finger—literally.”

Shortly thereafter, McCall began physical and aquatic therapy to regain movement and strength. For cogni-tive therapy, rather than focus on the typical tasks Baylor Institute for Rehabilitation clinicians use, “I told them I’d rather study to be a nurse practitioner again. So I studied for my boards,” she says. “I ended up making the 99th percentile.”

After two months of inpatient reha-bilitation, McCall was discharged home but still faced numerous functional challenges. Occupational and physical therapists made home visits to teach

accommodations, such as teaching Moffa how to wash McCall’s hair in the sink, and strategies for McCall to sit up, stand and sustain her body weight. Intensive outpatient therapy followed for nine more months to address lin-gering symptoms of imbalance, inco-ordination, chronic pain, fatigue and cognitive dysfunction (such as memory deficits), which remain today.

An Attitude of GratitudeAlthough fatigue, pain and other neu-rological symptoms have made it dif-ficult for McCall to resume working and function at previous levels, she now volunteers at a clinic for medically underserved patients.

But the impact of the virus extends beyond McCall herself. Moffa carries a majority of the household responsibili-ties and is on the constant lookout for unexpected falls.

“And emotionally, I feel like I have PTSD because I’m constantly hyper-alert,” she says. “I’m just anxious all the time, and so is our daughter.”

Each woman has experienced her share of difficulties, but they are quick to recognize the surprising ways in which WNV changed their lives for the better—such as the ability to bet-ter distinguish between what’s trivial

in life versus what’s truly important. And for McCall, WNV presented an unexpected opportunity to return to an old love.

“I was a global human resource director at a large corporation for 16 years before I got sick, and I had always wanted to go back into medi-cine,” says McCall. “What this has done for me is help me get back into health care. And no matter how much I go through, I know I could be much worse. That truly helps me appreciate life. I tell people that Baylor [Institute for Rehabilitation] saved my life and volunteering at the clinic gave me back my soul.” n

Claire McCall’s experience with WNV led her to a career change, returning to

medicine as a volunteer in a clinic for underserved patients.

Questions about WNV?For additional information about WNV, contact Nicole Fromm, PsyD, at 214.820.9503, or email her at [email protected] or [email protected].

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Despite an appearance and name that sounds less like science and more like science fi c-tion, robotic assistive devices have already carved a place for themselves in rehabilitation medicine. Their growing use can be attrib-uted to signifi cant advancements in utility and complexity over the past two decades. While empirical evidence has provided initial

compelling support for the clinical application of these exciting machines, there continues to be a strong need for further research on functional outcomes and longitudinal eff ects, particularly as more commercially available equipment comes to market. In an eff ort to address this research necessity, Baylor Institute for Rehabilitation has teamed with Texas Woman’s University (TWU) to become the fi rst hospital in North Texas to begin using one such innovative gait training device and, in the process, improve the care of patients with neurological injuries.

One Step at a TimeThe Ekso™ bionic suit is a fully operational, wearable exoskeleton that uses mechanical leg braces and a backpack-computer to help patients who have experienced complete or incomplete spinal cord injury, stroke or other neurological injury (for example, Guillain-Barré syndrome) regain the ability to ambulate. Motor controls are placed at the hip and knee joints to facilitate leg movement, while leg braces off er stability through the thigh, knee, foot and ankle. Additional accessories provide trunk support.

Powered by lithium batteries mounted at the shoulders, the suit gradually guides patients through three modes to accommo-date stand training, balance, weight shift training, and ambulation. In FirstStep™ mode, the device is mechanically controlled by a physical therapist while the patient uses crutches or a walker to relearn basic skills in weight shifting and muscle control. During ActiveStep™, the patient now controls the device and can advance through the same skills as in the previous mode but more autono-mously. In the advanced ProStep™ phase, the suit’s computerized programming facilitates actual walking by automatically responding to and anticipating the wearer’s weight shift and initiation of leg movement, while the therapist can serve as a “spotter.”

Crucial Distinctions Robotic walking assistive devices are themselves not new, but the Ekso suit separates itself from previous technol-ogy in important ways. It uses both mechanical and electronic assistance to induce gait training that is functional, weight bearing and based over ground.

Many other electromechanical ambulatory devices, such as the Lokomat® and LiteGait®, have the wearer working on a treadmill with their bodyweight suspended rather than fully self-supported. This cer-tainly provides important training for ambulating in the therapy setting, par-ticularly for individuals whose injuries prevent them from sustaining their own body weight. But patients who use such devices aren’t necessarily able to continue their newly learned walking pattern at home or outside the rehabilitation clinic.

Body-weight supported treadmill equipment is also physically demanding on therapists, making fatigue a poten-tial therapeutic limitation. But by using full-ground reactions, the Ekso suit can allow patients to transition to more functional and independent locomotion quickly and effi ciently—and with less physical burden on the clinician.

The longer a person is unable to walk normally and properly, the more

INNOVATION

Joanna Weakley, MSPT, right, supervises as Elizabeth Daane uses the Ekso bionic suit. Daane says the brief experience brought improvement in pain and edema, and in her mood.

New robotic gait trainer means one small step for patients, one giant leap for rehabilitation medicine

6 | BaylorHealth.com/BIR BaylorHealth.com/BIR | 7


Despite an appearance and name that sounds less like science and more like science fic-tion, robotic assistive devices have already carved a place for themselves in rehabilitation medicine. Their growing use can be attrib-uted to significant advancements in utility and complexity over the past two decades. While empirical evidence has provided initial

compelling support for the clinical application of these exciting machines, there continues to be a strong need for further research on functional outcomes and longitudinal effects, particularly as more commercially available equipment comes to market. In an effort to address this research necessity, Baylor Institute for Rehabilitation has teamed with Texas Woman’s University (TWU) to become the first hospital in North Texas to begin using one such innovative gait training device and, in the process, improve the care of patients with neurological injuries.

One Step at a TimeThe Ekso™ bionic suit is a fully operational, wearable exoskeleton that uses mechanical leg braces and a backpack-computer to help patients who have experienced complete or incomplete spinal cord injury, stroke or other neurological injury (for example, Guillain-Barré syndrome) regain the ability to ambulate. Motor controls are placed at the hip and knee joints to facilitate leg movement, while leg braces offer stability through the thigh, knee, foot and ankle. Additional accessories provide trunk support.

Powered by lithium batteries mounted at the shoulders, the suit gradually guides patients through three modes to accommo-date stand training, balance, weight shift training, and ambulation. In FirstStep™ mode, the device is mechanically controlled by a physical therapist while the patient uses crutches or a walker to relearn basic skills in weight shifting and muscle control. During ActiveStep™, the patient now controls the device and can advance through the same skills as in the previous mode but more autono-mously. In the advanced ProStep™ phase, the suit’s computerized programming facilitates actual walking by automatically responding to and anticipating the wearer’s weight shift and initiation of leg movement, while the therapist can serve as a “spotter.”

Crucial Distinctions Robotic walking assistive devices are themselves not new, but the Ekso suit separates itself from previous technol-ogy in important ways. It uses both mechanical and electronic assistance to induce gait training that is functional, weight bearing and based over ground.

Many other electromechanical ambulatory devices, such as the Lokomat® and LiteGait®, have the wearer working on a treadmill with their bodyweight suspended rather than fully self-supported. This cer-tainly provides important training for ambulating in the therapy setting, par-ticularly for individuals whose injuries prevent them from sustaining their own body weight. But patients who use such devices aren’t necessarily able to continue their newly learned walking pattern at home or outside the rehabilitation clinic.

Body-weight supported treadmill equipment is also physically demanding on therapists, making fatigue a poten-tial therapeutic limitation. But by using full-ground reactions, the Ekso suit can allow patients to transition to more functional and independent locomotion quickly and efficiently—and with less physical burden on the clinician.

The longer a person is unable to walk normally and properly, the more

Joanna Weakley, MSPT, is a physical therapist at Baylor Institute for Rehabilitation. She specializes in outpatient rehabilitation with a concentration on SCI treatment and functional recovery. 3 [email protected]

likely he or she is to manifest devia-tions in gait pattern or use compensa-tory strategies. By mimicking more natural movements, the Ekso technol-ogy mitigates some of those issues while still inducing neuromuscular re-education of the nervous system.

And because the bionic suit is out-fitted with graduated learning modules and a variety of motor placements, even someone with no movement whatsoever from the chest or waist down (up to a C7 complete spinal cord injury) can benefit. Anecdotally, per-sons who have used the suit for as little as half an hour have demonstrated improvements in their gait pattern and a significant decrease in neuropathic pain after a single use.

Looking Further into the FutureEkso has been in the stages of research and development since 2005, and the Food and Drug Administration approved the commercialization of the Ekso suit in 2012—underscoring the importance of clarifying its util-ity and efficacy for its now-expanding audience. There is existing research on computer-controlled orthoses in general to confirm the device’s initial safety and clinical usefulness, par-ticularly for basic medical outcomes

like decreasing spasticity and improv-ing bowel functioning. But further questions remain about the Ekso suit specifically as well as the degree to which it and similar technology affect patients’ functional recovery and activities of daily living.

In November 2013, Baylor Institute for Rehabilitation began discussing joining with TWU to try to answer these and other questions about out-comes associated with the Ekso, such as whether or not improvements exceed those gained from traditional, manual physical therapy; which pop-ulation is most likely to benefit (for example, acute stroke versus chronic stroke patients); and understanding how the equipment affects patient-related factors relevant to clinical out-comes, like engagement and motivation. The device will be the only Ekso suit currently available in North Texas and only the third in the state (the other two are at facilities in Houston and San Antonio). Clinicians at Baylor Institute for Rehabilitation and TWU have undergone training to learn how the device functions and is controlled, and the next phases in planning for implementation of study protocols will be underway shortly.

The arrival of Ekso to Baylor Institute for Rehabilitation and TWU signals a critical progression in rehabilitation research and practice, as the potential to improve gait rehabilitation means more opportunities—and more hope—for a greater number of patients. n

New robotic gait trainer means one small step for patients, one giant leap for rehabilitation medicine

Discover MoreTo learn more about research at Baylor Institute for Rehabilitation, see page 8 and visitBaylorHealth.com/research.

A SeCOnD CHAnCeThis year, Elizabeth Daane of Dallas was asked to assist in demonstrating use of the Ekso bionic suit at Baylor Institute for Rehabilitation. “I was really excited to get to use it,” says Daane, who sustained a T11 complete spinal cord injury in 2010. “I know the device can help people regain some functionality. People with spinal cord injuries should be up and moving, and this device is a great way to do that.”

For the week that clinicians at Baylor Institute for Rehabilitation were trained, Daane spent two hours a day in the suit, standing, walking the halls and feeling a bit more like her former self.

“Being upright, I can’t tell you how significant it is just to stand up and be at eye level with others,” she says, noting that, even with such brief use, she experienced improvement in pain and edema, and in her mood. “My husband came with me, and when I was in the Ekso suit, that was the first time we could have a ‘real’ hug in three and a half years.

“I’m very grateful to Baylor Institute for Rehabilitation for this oppor-tunity, and I can’t wait to use it again.”

BaylorHealth.com/BIR | 7


From January through April of this year, investiga-tors at Baylor Institute for Rehabilitation have been engaging in a wide range of research activities in

support of the scientific and clinical mission of Baylor Health Care System. This includes the development and sub-mission of several grant applications; publication of manuscripts in peer-reviewed journals; and dissemination of research findings at professional medical society gatherings. Here is a current listing of select grants, publica-tions and presentations.

GrantsApplications for proposed projects to address the health and rehabilitation needs of individuals with mobility and neurological impairments are currently under consideration at:

• The Centers for Disease Control and Prevention

• The National Institute for Disability and Rehabilitation Research

• Patient-Centered Outcomes Research Institute

• The Neilsen Foundation

Publications• Dixon-Ibarra, A., Driver, S.,

& Dugula, A. (2014). Systematic framework to evaluate the status of physical activity research for persons with multiple sclerosis. Disability and Health Journal, 7, 151-156, doi: 10.1016/ j.dhjo.2013.10.004.

Research Updates• Vanderbom, K., Driver, S., &

Nery-Hurwit, M. (2014). The current status of physical activity research for individuals with spina bifida. Disability and Health Journal, 7, 36-41, doi:10.1016/j.dhjo.2013.09.002.

• Monden, K., Trost, Z., Catalano, D., Garner, A.N., Symcox, J., Driver, S., Hamilton, R., & Warren, A.M. (2014). Resilience following spinal cord injury: A phenomenologi-cal view. Spinal Cord, 1-5, doi:10.1038/sc.2013.159.

• Harris, C.L., & Shahid, S. (2014). Physical therapy-driven quality improvement to promote early mobil-ity in the intensive care unit. Proc (Bayl Univ Med Cent), 2014;27(3):1–5.

Presentations• Dahdah, M., Schmidt, K., Buros,

A., Barnes, S., Dubiel, R., Dunklin, C., Callender, L., & Shafi, S. (February 2014). The impact of preexisting illness on functional outcomes and neuro-psychological performance in patients with TBI. Rehabilitation Psychology Conference; San Antonio, Texas.

Baylor Health Care System Marketing Department 2001 Bryan Street, Suite 750 Dallas, TX 75201

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PERMIT NO. 500

The material in Rehabilitation Quarterly is not intended for diagnosing or prescribing. Consult your physician before undertaking any form of medical treatment. Physicians are members of the medical staff of Baylor Institute for Rehabilitation and are neither employees nor agents of Baylor Institute for Rehabilitation, Baylor Health Care System, Select Medical or any of their subsidiaries or affiliates. Baylor Institute for Rehabilitation is part of a comprehensive inpatient and outpatient rehabilitation network formed through a partnership between Baylor Institute for Rehabilitation and a wholly owned subsidiary of Select Medical. If you are receiving multiple copies, need to change your mailing address or do not wish to receive this publication, please send your mailing label(s) and the updated information to Robin Vogel, Baylor Health Care System, 2001 Bryan St., Suite 750, Dallas, TX 75201, or email the information to [email protected]. U.S. News badge, all rights reserved, U.S. News & World Report.

CeRtifiCation annoUnCedIn June, the Baylor Institute for Rehabilitation hospitals in Dallas and Frisco both received their first disease-specific certification—for stroke rehabilitation—from The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 20,000 health care organizations and programs in the U.S. The certification is based on an orga-nization’s commit-ment to meeting certain performance standards. Other Baylor Institute for Rehabilitation facilities also expect to receive certification in the near future.

Christy L. Harris, PT, is a physical therapist in the Physical Medicine and Rehabilitation Unit at Baylor All Saints Medical Center.

• Vance, J., & Reynolds, J. (April 2014). Implementing oral care and free water protocol studies in acute care. Texas Speech Language Hearing Association Convention; Houston, Texas.

• Baker, S., & Brady, L. (April 2014). Rehabilitation of the Stroke Patient. Dallas Fort Worth Case Managers Society of America Conference; Irving, Texas.

Baylor Institute for Rehabilitation is the only hospital recognized for rehabilitation in a 54-county area in North and Central Texas.


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