Spring 2017 Edition

The Texas Model Spinal Cord Injury System (TMSCIS) at TIRR Memorial Hermann has been funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) from 2016 through 2021. NIDILRR awards SCI Model System Center grants to institutions that are national leaders in medical research and patient care and provide the highest level of comprehensive specialty services from the point of injury through rehabilitation and reentry into full community life.

Five lower-extremity robotic exoskeletons are now in use at TIRR Memorial Hermann, thanks to the generosity of donors, our researchers at the Center for Wearable Exoskeletons, and their collaborators here and abroad. Four are dedicated to research on gait and mobility in patients with spinal cord injury and stroke, and one is in use at TIRR Memorial Hermann Outpatient Rehabilitation-Kirby Glen to facilitate recovery and community reintegration in various patient populations.

Accomplished artist and former TIRR Memorial Hermann patient, Jared Dunten, is determined to paint himself out of his electric wheelchair. In April 2000, while on a camping trip in Big Bend National Park, Dunten dove into the Rio Grande, hit a sandbar and broke his neck, severely injuring his spinal cord. Saved from drowning by a friend, he woke up in an intensive care unit in Lubbock, Texas, paralyzed from the neck down and breathing with the help of a ventilator. A month and a half later he was flown by air ambulance to TIRR Memorial Hermann.

As a Medicare Accountable Care Organization (ACO), Memorial Hermann has improved information sharing among providers and made changes that allow the system to deliver seamless service across the continuum of each patient’s care. Among the changes was the appointment of Carl Josehart, CEO of TIRR Memorial Hermann, as system executive for post-acute care services in 2015. What began as the Memorial Hermann Rehabilitation Network – an effort to coordinate rehabilitation care at multiple facilities across Houston – has expanded to include skilled nursing, home health, hospice, durable medical equipment and other services in a broader Post-Acute Care Network.

A month after delivering her third child in October 2015, Dionni De La Cruz developed a cough and numbness in her feet and fingers that continued to progress. By early December, her condition was severe, and she was admitted to Memorial Hermann Memorial City Medical Center where neurologists diagnosed her with Guillain-Barré syndrome.

The Southwest ADA Center, a program of Independent Living Research Utilization at TIRR Memorial Hermann, has received funding from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) to continue its work as the Southwest’s leading resource on the Americans with Disabilities Act and related disability rights laws. Funded since 1991, the Center will receive more than $1 million annually for the next five years, supporting its programs through September 2021.

Dr. Chang is currently conducting a study on the use of a lower-extremity exoskeleton to promote walking in patients with multiple sclerosis (MS). “Impairment of the ability to walk independently is a significant consequence for people with MS,” he says. “Limitations in mobility mean restrictions in these patients’ ability to perform routine activities at home, at work and in the community. It requires a greater expenditure of energy for people with MS to walk, which contributes to fatigue and promotes a sedentary lifestyle. Both of these factors are associated with secondary health deterioration and compromised quality of life.”

Weight management can be one of the most frustrating and challenging conditions facing women with mobility impairments (MI). Rates of obesity are higher among people with disabilities than those without and women with disabilities have higher rates of obesity than men with disabilities. Many factors contribute to obesity among people with disabilities, including physiological factors, biochemical mechanisms, medications that affect metabolism and satiety, and an array of complex barriers to effective weight management. Exercise can be limited by the disability itself as well as by disability-related fatigue, weakness and pain.

Two new community-based clinics operated by TIRR Memorial Hermann are now serving cancer survivors and patients who have lost a limb. “Several factors have converged to create a need for cancer prehabilitation and rehabilitation,” says physiatrist Carolina Gutiérrez, MD, who focuses her practice on cancer rehabilitation at TIRR Memorial Hermann. “First, we have a growing population of cancer patients. Because of education, screening programs and advances in cancer treatment, more patients live longer and many have multiple functional deficits, ranging from cognitive issues in brain tumor patients, to swallowing and eating in head and neck cancer patients.”

Cindy B. Ivanhoe, MD, received the Distinguished Clinical Award last October at the meeting of the American Academy of Physical Medicine and Rehabilitation held in New Orleans. She was named Alumnus of the Year at the Baylor/UTHealth Physical Medicine and Rehabilitation Alliance in June 2016.

Research done at TIRR Memorial Hermann has the same underlying objective: empower people to be their own health care advocates. With funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), our investigators collaborated with other researchers across the country and a community advisory board of women with mobility impairments to create GoWoman. A new study funded as part of our Texas Model Spinal Cord Injury System supported by NIDILRR, called “Zest: Promoting the Psychological Health of Women with SCI,” is the first-ever group intervention to address the specific psychological needs of women with SCI.