Spring 2014 Edition

William H. Donovan, MD, is widely known for his expertise in treating people with spinal cord injury and amputations. After joining the TIRR Memorial Hermann medical staff in 1980, he served as director and principal investigator of the Texas Model Spinal Cord Injury System grant, awarded by the National Institute on Disability and Rehabilitation Research (NIDRR). Moving TIRR Memorial Hermann forward in the pursuit of excellence in spinal cord injury care is Matthew E. Davis, MD, clinical director of the Spinal Cord Injury (SCI) Program at the rehabilitation hospital. The two physiatrists share their insights about the past, present and future of SCI treatment.

TIRR Memorial Hermann takes an active role at the local, state, national and international level in advocating for people with activity limitations and participation restrictions. We accomplish our objectives through programs like Independent Living Research Utilization, which has a long history of advocating for independent living; the Americans with Disabilities Act; home- and community-based services; and health issues for people with disabilities. Our 29-year-old Challenge Program helps people recovering from brain injury gain community reentry skills critical for the transition to independent living, school, work or volunteer activities.

State-of-the-art therapy equipment, private rooms, a visually stunning environment and a “neighborhood” design characterize TIRR Memorial Hermann-The Woodland’s new 18-bed inpatient unit. The new unit was designed with self-contained “neighborhoods,” each with community dining and gym space, to reflect the character of The Woodlands community. Artwork includes photos of community activities, local restaurants, outdoor cafes and neighborhood parks. The light-filled unit offers big-picture views of the area, and interior materials were chosen to create a home-like environment.

TIRR Memorial Hermann’s new 15-bed patient care unit is allowing the rehabilitation hospital to further advance its unit-based team care model. In addition to private rooms, the new unit includes a therapy gym, community dining room, family lounge, private consultation rooms and offices for nursing, therapy, neuropsychology, social work and case management. “People across all disciplines interact throughout the day and coordinate patient care together,” says chief nursing officer/chief operating officer Mary Ann Euliarte, RN, CRRN. “It’s a beautiful unit and a great model for furthering co-treatment and collaboration.”

TIRR Memorial Hermann continues to expand its international outreach by providing multidisciplinary evaluations in other countries, including a recent trip to Italy by Dr. Joseph and a physical therapist, occupational therapist and speech/language pathologist. The hospital has also extended its international influence to China, where hospital CEO Carl Josehart is consulting on the development of a rehabilitation hospital. In addition, the international rehabilitation team has plans to build relationships with South American countries working through their embassies. “When patients experience the services we provide firsthand, many are overwhelmed by the experience.

Cullen Gibbs, PhD, was an undergraduate majoring in journalism at the University of Houston when an elective psychology course sparked an interest that led him down a different path. Today, he works as a clinical and rehabilitation neuropsychologist in TIRR Memorial Hermann’s Challenge Program, which has a long track record of success in helping brain injury survivors develop community reentry skills critical to the transition to independent living, school or work. “My psychology instructor was a graduate student – an amazing human being who made psychology fascinating,” Dr. Gibbs says.

Five teams at are engaged in quality improvement projects that will benefit patients by streamlining processes for improving the quality of care. Among them is an ongoing project focused on improving resident sign-out and patient handoff using a secure online system. “Handoff among health care providers has been recognized as a source of medical errors,” says Sunny Dhah, DO, who leads the project in collaboration with Marie Frando, MD. “Last year we addressed issues involved in a standardized handoff system that meets Joint Commission requirements for passing patient-specific information from one caregiver to another to ensure continuity and safety of patient care."

As the winner of the 2014 Leonard Diller Award for excellence in the field of brain injury and neurorehabilitation, Mark Sherer, Ph.D., ABPP, FACRM, was keynote speaker at the 16th annual conference of the American Psychological Association’s Division of Rehabilitation Psychology, held in February in San Antonio. Dr. Sherer presented early results of a new investigation intended to determine clusters of measures that can be used to predict outcomes after traumatic brain injury (TBI). The project’s ultimate goal is the creation of a website, accessible to rehabilitation professionals, that can be used to guide treatment for persons with TBI.

Women’s issues have historically been ignored in spinal cord injury (SCI) research, and limited attention has been given to exploring gender differences in physical and psychological health following SCI. With women composing about 19% of people with SCI, most research understandably has been based predominantly on samples of men. Existing literature documents high rates of depression and psychological morbidity following SCI, with one recent study finding the rate of probable major depression three times higher in people with SCI than in the general population. Rates of depression are consistently higher among women than men in the general literature.

Neuromuscular impairment following stroke can severely impact functional independence and quality of life. Postural instability and impaired balance after stroke increases the risk of fall and fall-related injuries, including fracture and traumatic brain injury. Although intensive rehabilitation aids in motor recovery, the outcome is often limited. Research has shown that one of the most effective modulators of cortical structure and function is repeated sensory input, and that the direct manipulation of sensory input can modulate brain plasticity and enhance the effects of motor training in individuals with stroke.

“Half of the spinal cord injury-specific positions in this country come from the VA system of care, which provides a unique practicing environment,” Dr. Davis says. “Most of the other SCI fellowships available in the United States are more heavily weighted either to VA or non-VA programs. We have a good balance, offering postgraduate students the opportunity to spend six months at a distinguished rehabilitation hospital adjacent to Memorial Hermann-Texas Medical Center’s Level l trauma center and six months at the VA.” Dr. Davis’ counterpart at the VA Medical Center is Sally Holmes, MD.

TIRR Memorial Hermann opened its doors in 1959 as the Texas Institute for Rehabilitation and Research (TIRR), one of the country’s first rehabilitation hospitals. Over the span of 55 years, the institution has grown into a national leader in interdisciplinary rehabilitation, clinical care, education and research. Last fall, the hospital celebrated another milestone when the TIRR Memorial Hermann Research Center was completed and diverse research programs came together under one roof for the first time, creating new synergy between researchers, disciplines and programs.

Carl E. Josehart, Chief Executive Officer of TIRR Memorial Hermann, shares a message for the Spring 2014 edition of the TIRR Memorial Hermann Journal.