A Look Inside Physical Medicine and Rehabilitation – MedStar Health Facebook Live Event

Have a good evening and welcome to MedStar
Health, physical medicine and rehabilitation webcast. You’re watching us on Facebook Live. I’m Jamie Costello from WMAR ABC News. I’ll be your host here tonight and we are
streaming live from the inpatient rehab unit here at Good Samaritan Hospital. Look what they’ve done for us. It looks like a hospital, look at this, we’ve
got crutches, we’ve got a walk, we’ve got everything needed to make you better and all
you have to do is watch from your own home here tonight. You can also submit questions. We’ve got a panel of great experts. What was the last time you’ve been calling
an expert, doc? That’s pretty good, -uh, just this morning.-
Listen, we’ve got a crowd full of people that have crammed in here to watch and listen and
to learn and we’re going to make you feel better over the next hour. And of course we want you to get on Facebook
Live. Put a little like on there. If you have a question, put it on there so
we can ask it right here. So if you have any questions at home, just
click a like and be sure to share the posts that your friends know that what we’re doing
here tonight, Facebook Live. We want to start with Dr. Scott Lepre, who
was the chair of the program here, as well as the associate medical director of regional
and the MedStar National Rehabilitation Network. So we’ll get right into it. Physical, what is this physical medicine and
the rehab, fill us in on this doctor- Physical medicine and rehabilitation is the
branch of medicine that focuses on improving quality of life by restoring function lost
to a variety of illnesses or injury that might have affected anywhere on the body from the
head down to the feet and as part of the MedStar National Rehabilitation Network, we are really
uniquely positioned to be able to draw on over 40 years of experience and expertise
in the field of rehab in order to accomplish our mission of adding life to years. How is this different from a skilled nursing
facility? Sure. So the main differences between what we do
here in acute inpatient rehab and what occurs in a skilled nursing facility has to do with
both the acuity of the medical issues that we are able to manage here and in the intensity
and the breadth of the therapy programs that we offer. Someone who is admitted to the inpatient rehab
program here can really expect to receive top of the line medical care and a truly comprehensive
therapy program. All right, doctor, thank you very much. We’ll be of course, spending more time with
the doctor here as we go along here in the next hour. Let’s bring in Carol Zeller. Carol is the patient care manager here on
the unit, but also a very personal insight in this inpatient rehab program. Tell us about that, Carol. Sure. Back in November of 2012, I as a parent received
a telephone call that no parent wants to receive. My oldest son, Adam, who at the time was 18
years old and was away at school in Virginia, suffered a near fatal brain aneurysm rupture. So basically one of the arteries in his brain
had ruptured and was bleeding. So he underwent about 10 hours of surgery
followed by two weeks or so in a neuro intensive care unit in Virginia. When Adam first came out of surgery he was
not breathing on his own. He was in a coma and within a few days did
regain consciousness but could not move his left arm, his left leg. Had cognitive issues wasn’t able to swallow
well and has lost about 50 percent of his vision as well as some memory issues, as you
know, as well. So after the two weeks in Virginia we had
to decide where to transfer out him and getting him closer to home for rehab and my husband
and I never had any question about where he would go. He came here and not because I work here,
but because I knew that what we would provide here would be the best care he could get. So one of his primary therapist is here with
us today, Jen, who we are so indebted to and they worked so intensely with him and as you
can imagine, we didn’t leave his side the first couple of weeks, but after we got here
we could go home and we could get some rest and we have a younger son, Noah, who we could
spend some time with. And we knew that he was in good hands when
we left. And so it was an incredible experience and
I have been fortunate to be a part of this MedStar Good Sam team for a long time but
never probably as fortunate as I was back then. So Adam continued after four weeks here in
inpatient rehab. He also attended our outpatient network through
NRH and also went through our adaptive driving program here at Good Sam and was able to drive
again, and in September of 2013 actually returned to college and he will be graduating this
May with his bachelor’s degree in civil engineering. And actually Adam is on spring break this
week. So he’s here with us today. Just kinda supporting mom and also demonstrating
what we’re able to accomplish here at Good Sam. How do you tell that story without crying? It’s really hard. I’m watching. Yeah, watching him, it’s hard, but it’s life. It’s what we’ve dealt with. And if I can share that and other people learn
from it then and they learn what’s possible, what’s out there and what’s available and
what can happen, you know, that’s all I wanted. — to raise your hand so we can catch on camera. You know what? I’m going to move this thing here. This is ridiculous. Since Adam, how old was he? 18. Look at you. That’s what Good Sam did. Unbelievable. What a job unbelievable. You’re doing great. You’re driving, going back. What are you majoring in? Civil engineering. Can you come on? Come on, come on. He’s going to kill me later. Yeah, hold on. Yeah. So, so do you consider yourself a miracle? I know you don’t have a mic. What the heck with it? Go ahead. Do you consider yourself —-to go ahead? Don’t be humble. Yes. I mean that’s what everybody says, but — I
mean, how bad was you had the brain aneurysm. I mean, you could barely function, right? — Yeah, it’s all a probably a week before
I could actually sit up, I had to learn how to walk, talk, smile. I mean, I couldn’t move the left side of my
face. Yeah. Yeah, it was rough, but without Good Sam,
none of this would’ve been possible. That’s for sure. I hear that. Mom, what are you saying to this place, the
place you work, I’m telling you that nothing happens by chance to tell you why I’m a rehab
nurse. That’s why we’re here. Right. And this place saved your son’s life, Adam,
way to go. Have you met Eve, yet? A few more months. All right, thank you. Carol. Maggie Lister has a doctorate in physical
therapy, has been part of the inpatient Rehab Unit for the last 12 years here. What is the objective, Maggie, of the physical
therapy and how can it help patients who have suffered like Adam from a stroke or even a
spinal cord injury. And so in this setting, our goal is basically
to restore function, increase their mobility, basically promote health and wellness. And we do this by just basic skills of learning
how to get in and out of bed, how to get in and out of a chair, get into a wheelchair. I’m learning how to use a wheelchair, being
proficient with the propulsion, parts management on the wheelchair and getting patients back
to walking again. And we do this by prescribing an exercise
program and in fact, in the patients that I’ve seen with spinal cord injuries and strokes,
if they’re very debilitated, have a lot of weakness. Our biggest thing that we start working on
is learning how to propel a wheelchair if they have pretty good upper body strength
and function. We learned basic wheelchair level skills propelling
the chair as you can see, Chris over here is demonstrating his ability to go up and
down a ramp and then doing a wheelie, which is a much more high level skill. It’s not something that we’re going to learn
right away, but is something that we will eventually get to. Chris also demonstrates in this video the
ability to jump off and on a curb. So that is not an easy skill to learn. He was a great patient for us. They’re a patient, is also very weak in their
upper body and they have difficulty with being able to propel a manual wheelchair. We also have a great variety of demo wheelchairs,
power wheelchairs. And again, Chris is demonstrating for us here
on this video hand control functions. So he does have hand control, if a patient
does not have good hand function strength, we have other options where they can control
the wheelchair with their head, they can control it using their chin right here is the chin
switch, Chris is driving the chair using his chin, and then there’s another system via
a straw which is called the sip and puff wheelchair. So this way patients can have independence
even if they can’t move their body by they’re able to get around their room, be able to
come and drive themselves to and from a therapy which is very important for our patients to
be able to control some part of their environment here while they’re in rehab. If they are able to do some standing and walking,
but yet they might not be stable and strong enough. We also offer bodyweight support system, which
is research based, has had a lot of research showing that it improves patients ability
to be able to stand and be able to walk at a normal pattern. Which is nice because a lot of patients are
unable to support themselves initially when they first are injured. And this way it allows the therapist to really
focus on getting their walking to be more normal as it’s supporting their body weight
so it makes it safe for the therapist and it makes it safe for the patient also. –So when you started out in this line of
work, did you see these advances this soon? All the wheelchair and the innovations that
we’ve seen? —
I’m telling you it’s an ongoing learning well in this environment and that’s why I love
being here in rehab. We have a lot of options and in fact our new
rehab that’s being built. We’re getting the zero G, which is overhead
track system that is going to allow us to do a lot more mobility with our patients,
be able to go up and down curbs, be able to go up and down stairs with it. So it’s just it’s an evolving thing and
it’s an awesome job to be able to continue learning and be able to promote this health
and wellness to your patients. Great job. Great job. Thank you Maggie. That’s great. It took us seven years. It took seven years of college. Yes. You’re still learning. Still learning. Still teachers
Getting people mobile. Of course could be walking, rolling or even
in a vehicle. Meredith Ofstead is the physical therapist
now. You can’t train patients are getting out of
the truck? Get a truck here. Kenny. Hi. Yes, we can. I’m glad you came over to join us with the
truck. The truck we use here to practice getting
in and out of as we’re going home because the biggest day really is the day you get
to go home, so we want to make sure you can get in and out of your car and be ready to
go home and continue your life. Jaime is going to demonstrate how to get up
and get into the truck for us, so Jaime’s gonna stand up. She’s going to use the walker and head over
to the seat backing all the way up so that she can feel her legs on the chair, on the
truck, and she’s going to reach back with her hands for the seat and possibly the dashboard,
depending on the car or the truck. We’re going to move the walker away from her
and she’s going to swing her legs in. Now, while we’re also here in the truck, Jamie
can practice putting on her seatbelt. That is something that is difficult at times
when you have an injured arm. And so we practice that as well. Jaime’s going to let go of that seatbelt and
she’s going to demonstrate how to get out of the truck. So swing your legs out, scoot to the edge
and push up from the seat or the dashboard. Never the car door, and she’s going to come
back on over to her wheelchair. We also have other things here at Good Sam
to practice with. We have our bathrooms and our ADL apartment
and that’s a place where folks can go and practice getting in and out of their tub or
the shower just like they have at home. We also have an apartment here that we have,
has a full kitchen. Let’s folks come and practice making meals. Practice getting in and out of a regular bed
and really practice all the skills necessary to go home. Thanks for joining us over here at the truck. We’re glad to have you. Incredible. Is it things we take for granted here? We have a practice we can practice getting
in and out of a car to get our lives back. That’s unbelievable. Hey Maggie. Let’s bring you back in here. I’ll show some of the. I see you’re going to have a video to show. Yes. So other options that we have for our patients
to really work on some strengthening their weakened muscles and electrical stimulation,
which is actually an electrical current going into these muscles and nerves. And Jen has a video that she demonstrated
with our Bioness L 300 Plus, which we are the only inpatient rehab in this state that
has it, so we can go to the video and you’ll be able to see. Jen is able to speak on it. So this is an example of a person with hemiparesis,
so that would be weakness on the right hand side of their body and how walking might look. With this example, Theresa has weakness in
her ankle, so she’s having difficulty and dragging her foot forward. And as she’s standing on her leg, she has
weakness in her quadriceps muscle where the muscle that straightens her knee and that’s
affecting her balance. It’s affecting her efficiency. And her gait speed. With our Bioness L 300 Plus unit were able
to both control the ankle and the quadriceps muscle. We’re the first unit in the state to have
this unit. So we’re now able to control both the ankle. Or the first unit and the state to have this
unit, so we’re now able to control both the ankle and the knee while she’s walking. Then we know from research that people that
walk in more normal gait speeds have less, less falls. There are more comfortable with getting out
in the community. They’re less likely to be home-bound. So it’s a really effective means for both,
for spinal cord population as well as our stroke population
That’s a computer generated, explain the machine. –Again, I’ll actually let Jen speak on that
because Jen actually is apretty good expert on the Bioness L 300 Plus. it has a computer
system in it and it has something called an actuator. So as your knees moving and your ankle is
moving, the computer already knows when to turn the muscle on to pick up your foot. And it also knows as your heel is landing
a to turn on the knee muscles as. So we can either do the quadriceps muscle
or the hamstring muscle depending on what is needed. And then we can also change how much, the
timing of it. And, and so it’s, it’s been a very effective
means for us. We’ve had other units before, and this is
an even better unit, was being able to control the ankle in the quad. Well, we’re the first in the state as an inpatient
rehab unit to happen on. Let’s go to Teresa Dolan, Teresa Senior Occupational
Therapist who has been here 20 years. And Teresa explain to me the difference between
PT and OT. I’m an occupational therapist and in occupational
therapy we work with individuals across the lifespan. Of course here at Good Samaritan, we work
with adults, so 18 and up and we use functional tasks or daily activities, which are what
we consider occupations, in order to have people recuperate and recover from injuries
and illnesses. So when we do in occupational, when we do
our evaluation, we look at multiple things. So we’re looking at a person and seeing how
they’re able to move their arms and legs. Do they have weakness there were looking at
their sensation. We’re looking at their cognitive or thinking
skills. We’re looking at their visual skills and their
perceptual skills. And we’re looking at how all of those things
impact their daily activities. So I like to tell our patients here that we
work on anything they do from the time they wake up until the time they go to bed. So in this setting, because we’re looking
at trying to get somebody to go home, we’re looking at patients being able to do their
bathing and dressing, their toileting, their toilet transfers and tub transfers, and then
depending on what they need to do when they go home, we may even be able to work on cooking
skills and and other tasks that they would have to do around the house that would continue
in outpatient that we might look at return to work and the skills that would be needed
for that. So let me give you an example of what we do
when we look at a task. Because even though somebody might have trouble
feeding themselves, that trouble could come from a variety of things. So one patient, when we observed them and
we do what’s called task analysis, we’re looking at why they’re having that problem. One person might have difficulty bringing
their hand to their mouth because they have arm weakness, so we might be working on that
with one patient, but another patient that might have trouble feeding themselves might
have trouble seeing where that plate is or seeing where their fork is. So we might work on changing the environment
by increasing contrast, so that they’re better able to see their environment and, and then
feed themselves. Another patient might have trouble figuring
out that maybe they’re trying to eat their soup with a fork and set up a spoon because
they have difficulty understanding the difference between the utensils and how to use objects
correctly. So as an occupational therapist, we’re looking
at all of those things, honing in on what that individual patient’s problem is and working
on it from that skill level. We’re all in time sensitive. So how long does it take? I know everybody’s different, but how long
does it take to learn how to walk again, to learn how to do a daily function, like wash
yourself again. That’s a great question and it’s a question
we often get from patients. How long is this going to be? Am I ever going to get back to where I was
before and for each individual patient, all of us on the therapy team and our physicians
and our nurses are are giving different kinds of different answers but similar answers because
we don’t have, we don’t have a magic wand and we don’t have the ability to exactly predict,
but we can give some general ideas of what patients are able to do when we give their
evaluation. We like to not just look at what’s wrong with
them, but what’s right because everybody has strengths and we can’t forget to really focus
on those strengths as well. What’s right with us instead of what’s wrong
with this already. If you have any questions, if you’re home
right now watching this on Facebook Live, you can hit us up right now. You can ask a question to one of our great
experts here. Where do you get this chance like right now,
so get online and send us a question in here. Try to stump the panel if you can. I don’t think the doctor will be stopped though. All right, which brings us to Nash. Jamie, Nash is not a therapy dog, but a facility
dog explain that for us. A therapy dog also serves an amazing purpose,
but they are typically superficially certified. Their handlers or owners are volunteers that
are going into facilities and visiting with patients in a more unstructured, emotional
way. –Alright, how old is Nash? — Nash is four and he is a graduate of Canine
Companions for Independence and he’s been with us here at Good Sam for about three years
and he’s a mix between a golden retriever and a lab. He’s devastatingly handsome to look at. –And he’s got a wet nose – And what
is so great about Nash is one of the most important things we need to do with our patients
is get them motivated and ready to participate in therapy even though they’re going through
something quite difficult right now. So without even working with Nash, just seeing
them, they come into the gym, their faces light up, you can see the stress go away and
they are primed and ready to get to work. So just his existence in the gym is a benefit,
but to give you a more structured example of what he does during the day. Theresa, why don’t you come over here and
you can act like my patient and work with me and Nash. So Theresa kind of described what task analysis
is she kind of broke it down in terms of what we would work on. So patients meet their goals. So let’s say one of Teresa’s goals is to be
able to put her pants on. In order to do that, she needs to have good
balance. So in this activity she’s going to work on
standing and bending and reaching to give Nash a toy or any kind of object. So that were challenging her balance. So she’s going to go ahead and reach. Yeah. Good boy. And now I’m going to take them a little bit
further back to challenge her a little bit more. Nash sit. Yes. Good boy. Yes. The job. So she’s working on standing unsupported. She’s reaching outside of her base of support. Those are all things that we need to do when
we’re trying to put our pants on and stand up. So another one of Teresa’s goals is to be
able to get to the grocery store because she’s the primary grocery shopper in our house,
so we know that when we’re grocery shopping we have to push the cart and the cart is heavy
so she needs to be able to have the endurance and the strength to walk with something and
push it so she can get through the grocery store. So in order to work on that we can go now. So we’re going to take Nashi for a little
joy ride. He loves this because he then gets to be king
of rehab and we’re just going to walk down here. So Teresa’s working on her endurance, her
balance. And this is going to get her back at home
so she can be the boss of the house getting the groceries. We’re just going to turn around here. Good boy. Yes. You’re being a good boy. I know you’ve been so good. And then as Theresa also explained to you,
um, OT is not just about motor and physical activities and sitting and standing. We also work on cognition and vision. Nashi, jump. One of those, one of the pieces of cognition
is being able to sequence and organize a task. So if we don’t do the steps are included in
putting on our shirt or getting dressed, then we’re not gonna be able to do it independently. So one of the things we can have a patient
work on with Nash is trying to get them dressed because here she’s trying to get somebody
else dressed and it might be a little bit easier for her to sequence that before she
attempts to do it on herself. So now she’s just going to sit here so patiently
while he gets dressed. As you can see by facial expressions. this is his fave. Nice job. Good boy Nash. So that’s a little taste of OT with Nash. I’m going to throw it back to you. Jamie. Jamie, she spells her name wrong. That is great. All you dog lovers. Anybody have a dog at home? No way can our dog do that. That is great. Nash as well. –He’s available for birthdays and weddings. — Get out of here. That’s great. I bet you catch the gardener. What really matters here is independence. Not everybody may have a highly trained dog
like that, but there are other technology advances that we’ve seen out there that can
really help us get to a level of independence. Let’s watch .
With a normal tremor, if my food starts to fly with LiftWare which is a technology that
you can purchase. When I have a tremor, I can come in, but the
spoon has a little micro computer in it that keeps the food on the spoon, allowing for
Parkinson’s patients to have better ability to feed themselves and more quality in their
life. Patients who have difficulty moving their
arms or their wrists or forearms sometimes have difficulty keeping the spoon level when
they come up to feed themselves the leveler will level the spoon for them so that they
can get the food to their mouth. So I’m going to just show you by coming up
and you’ll see that as I come up the spoon bends for patients who have or people who
have low vision or difficulty reading labels, this comes with this device and you can wear
it around your neck because it’s got a nice lanyard to it and then you can either use
these little magnetic clips or you could put on these little dots, stickers that come with
it, but then if you were on your own in your kitchen and you weren’t sure what that label
said. Chicken noodle soup. Basil. Sometimes even seeing what kind of money you
have in your hand is difficult. So this little device will do it for you and
all you do is slip the corner of your money in, press a button and it will tell you what
the bill is. There’s an app that you can download that
will do it for you. Sometimes people have difficulty standing
up. Obviously in occupational therapy and physical
therapy will work on people getting stronger so that they get better with those skills. But for some folks, they just have hard days,
sometimes everybody just needs a helping hand or a helping lift and that’s what this does. So you add this cushion to your chair, you
don’t have to buy a brand new chair and by the push of a button you get lift off. Sometimes people have memory problems and
it’s hard for them to remember to take their medications. Let’s say you’re supposed to take the medication
at 12:00 on an alarm can be set on this so that it will go off when you need to take
your medicine and then you simply flip it forward. The medication will come out and you go ahead
and take it. The alarm doesn’t go off until you flip it. So that is how you can remember to take that
medication, that medication box is locked. So you can’t go and take too much medication
at any one time during the day. Well that’s a great thing I’ve ever heard
because I had a father. My father was a, every time he went to sleep
and he woke up, he thought it was a new day. So he’d pop a pill, he was out of his mind
and we found that he was overdosing. That is a great invention. Great. Thank you. Hey listen, here’s the deal. When you’re here at Good Sam and then you
get the orders that you’re going home. That can be scary as hell. And I’ll tell you what, Teresa’s back with
us and we’re going to go over to Teresa’s apartment. That’s all going. How Teresa tell us about the apartment living. So the apartment is a great thing that we
have here at Good Samaritan hospital. And when we initially got the apartment we
had two kind of concepts in mind for. One was for the patient who had a traumatic
injury or illness and was going to need a lot of assistance at home and was going to
have caregivers or family members taking care of them. And while we do training individually during
our sessions and they may practice transfers and family members may get very good getting
them in and out of bed and doing all the things in isolated tasks by putting somebody in the
apartment overnight or for 24, 48 hours with their family member or caregiver, that caregiver
and the patient get an idea of what it’s going to be like to go home so we can set them up
with food in the apartments. So they still have to do whatever cooking
needs to be done. They get a really good picture of what it’s
going to take to do something for a full day. It’s a full working apartments so it’s got
a kitchen in it. It’s got a bathroom with a bathtub. We’ve really made things so that it wasn’t
a hundred percent accessible because our homes are not a hundred percent accessible. We have a regular bed in there. So, but we can also have the opportunity to
move the hospital bed in. If the patient is going to go in a home, in
a hospital bed, there’s a living room area with a sofa, so it really is a home setting
that patient and family member can be in that apartment and they still have the support
of us. So there, you know, the apartment is right
on our nursing unit, so they have care 24 hours. But they have, you know, the are really responsible
to kind of take care of their loved one. When you go home, do you find that some of
the patients get bed locked, like they’re just going to get in bed and stay there? That’s what we really try to avoid while they’re
here. We really reinforced that’s only going to
set them back. So the other patients that we put in the apartment
or patients that might be going home by themselves and while we might have confidence in their
ability to do things and they might not have confidence. So by putting them in the apartment, it’s
a way that they can kind of test themselves. So for example, they need to get up in the
morning, they need to be able to get themselves ready. Um, we’re not going to put them in there if
we don’t feel that they’re really independent with things, but it’s also kind of a test
so that, for example, they might, we might have it set up so they have to call in order
to get their medication. So are they remembering what they’re supposed
to take? And are they able to tell the nurse that,
they may have to do their bathing and dressing on their own. So sometimes the therapist will let them do
it on their own or we might come in just to observe and make sure that they’re not having
any difficulty but really kind of stay in the background so that they have to do it
on their own. So they’re doing everything they need to do
in order to be able to return to their home setting. But they get to, again, do it in a setting
where they feel like they have the support there to give them the confidence to take
that to next step. All right, well let’s bring Carol back. Carol. Now you’re not going to play the role of mom
here to play the role of nurse, which you’ve done admirably for 30 years here at MedStar
Good Sam. So can you explain that for a patient here? We all should look for the nurses, certified
inpatient registered nurse. Why is it so important? When you hear about other specialties, you
hear about an emergency room nurse, you hear about an ICU nurse, but I think a rehab nurses,
somebody you don’t hear about that often and really as has been said by some of my colleagues,
we’re are specialized in looking at patients who have maybe short term or progressive or
long-term disability and how can we help them to facilitate their highest level of functioning. So we may address things like skin, their
bowel issues, bladder, diet. I’m swallowing you kind of name it. Plus, we also will take what’s been going
on in therapy and will reinforce that information with the patients on the unit. As far as a certified rehab nurse, we have
been blessed that I have about 20 certified rehab nurses here in my program, which is
a large number in comparison to a lot of our competitors in the area. And what that requires is that you need to
have at least two years of experience in a specialty. You need to have recommendations from fellow
certified nurses and then you also must take a national computerized exam and it really
is a, I guess a testament to their knowledge base and their dedication to what they’re
doing and this practice. And I also just think it’s a way in which
we can allow and help our staff to grow because part of being a certified nurse, in order
to maintain that specialty, you must obtain as set number of continuing education hours. So that really keeps our staff abreast of
what’s going on up to date. You know, with the knowledge of what’s happening
in rehab nursing. And allowing them to be lifelong learners
and I’m been fortunate enough to work in this facility where we promote that we help to
support them getting the education, and they’re really proud of what they do and I’m proud
of what they do. And so I think that, this is one way in which
we can help to recognize that . –it’s almost like you’re a coach. –Absolutely. –You keep working on that. So bring them around. That’s great. We’re talking about speech therapy. You want to talk about this? — Absolutely. So as a rehab nurse, we collaborate a lot
with our, the other disciplines, PT, OT and speech, and oftentimes there are patients
in our program who may have dysphasia or swallowing issues and we often will collaborate with
speech language pathology and speech pathology will utilize a lot of different modalities
for how to deal with patients and work with patients who have swallowing issues. So we’re going to now see a video on one of
those modalities. We have a lot of different ways that we can
strengthen a swallow. And one of the ways that you’ll see here today
is we’re using Vital Stim therapy or electrical stimulation for swallowing muscles. So we know our muscles work off of electrical
impulses and this treatment will provide those electrical impulses to stimulate a swallow
art. Let’s bring in Stacy Wachter. She’s been here since 2010 and she has a master’s
in speech language pathology. You specialize in neurogenic communication
disorders. What, what does that. Well, those are, it’s an array of communication
disorders. They’re typically acquired disorders from
something such as a stroke. Um, it could be anything from dysarthria which
refers to slurred speech, muscle weakness, or incoordination of the muscles. Apraxia which is a motor planning disorder
where people have difficulty with voluntary movements to shape their sounds into words. Also it could be aphasia, which is a difficulty
with language. So finding the words we want to say. And aphasia actually also affects an individual’s
reading, writing comprehension of language, but oftentimes that person’s intellect is
intact. So you can imagine how frustrating that can
be about the speech language therapy and stroke recovery. So we just talked about some of the speech
disorders, but, as you can see from the video, we also treat swallowing as well. So many of our patients after a stroke might
have difficulty swallowing. They may need exercises or the modality that
you saw, Vital Stim being used in order to safely swallow so that the food or liquid
doesn’t enter their airway or their lungs. –Where do you start. You take a stroke victim, where do you start? — So, I mean, we go in and we do comprehensive
evaluations, so we look at their motor speech function, their swallow, their cognition because
that’s often a good indicator of how well they may do with their recovery if they’re
able to sequence and execute some of the strategies and exercises that we’re giving them. And we kind of start from there .
Listen, we’re on Facebook Live again if you have any questions, we just received a question
that you can put that back up there. Debra, it was a question from Brenda it was
a great question. How do you get the family involved when the
patient’s leaving to come home. Why don’t we start with you, doc. So obviously most of us have a extensive support
network and if a patient comes with that support network, it’s a critical part of what we do
to train them to be able to help the patient accomplish whatever goals they have. So we will certainly encourage family to come
in and participate with PT, OT, speech, nursing care, medication management and teach them
any skills that we feel they need in order to be successful. If the patient doesn’t have that family support,
then obviously we’re trying to get that patient to a different point, get them to be independent
and safe in doing so. OK, now we’re on Facebook Live. We have a poll question right now. A stroke can cause difficulties in remembering
and recognizing true or false. You can put your vote in right now, true or
false. And the Russians are not involved in this
one right there. They’re leaving us alone. Let me go to Dr Loren Connolly. There’s been a
lot of work. She is a licensed clinical psychologist and
there’s been a lot of work happening on this floor to help patients recover physically,
but there’s a psychological effect that we should not ignore, right? Doctor? Yes. Am I over here, Jamie again? I never take my eyes off the camera. Yeah. So there had been a multitude of studies that
look at the connection between the mind and the body and it’s very clear that somebody’s
mental state and psychological outlook will have a huge impact on their health and how
they recover from any of these major medical events. –So when do you come in? — So here on the inpatient rehab unit psychology
really play two major roles. Number one, we act as a consultant to the
whole rehab team. So I’ll get a consult because somebody has
noticed some symptoms that the patient may be exhibiting anxiety or, or stress or even
just a simple adjustment issues. And then we’ll evaluate. The patient will determine are they having
any adjustment issues, you know, with any sort of major medical event like a stroke
or an amputation is very common for patients to have adjustment and sometimes symptoms
of depression or anxiety will develop, which again can be even some my normal, a normal
reaction to a major stressor. How do you, when you feel the patients, I
just can’t do this. How do you turn that around? Well, that, that kind of plays to the sense
of resiliency, which I think someone was talking about too, which is a patient’s confidence
in being able to overcome adversity and having that sense of efficacy that I can get better. And so yeah, you’ll work with them, help them
develop coping strategies. If they’re anxious, you can teach them relaxation
strategies to help reducing anxiety, talk about previous challenges that they’ve been
able to overcome. What helped them then stuff like that. Treat depression. We worked really closely with the whole team. So if there’s something above and beyond a
normal adjustment reaction, something that warrants more of a clinical diagnosis, then
we’ll communicate very closely with the team and maybe medication will be recommended or
more ongoing counseling will be needed to just really help the patient overcome that. Or being personal. What’s it like to send somebody home successfully
and find out years down the road, man, they are living the life like Adam is right now. What is that like for you? I mean he’s a perfect example of a great success
story and his quality of life, you know, speaks for itself. I mean, he’s well adjusted, he’s smart, he’s
successful, he’s achieving all the goals that you know, any, any therapists or any mother
would be so proud of. I mean, it’s so rewarding and you couldn’t
ask for anything else, doctor. Thank you for that. All right. Carrie Wells has got a question. How do you deal with physical therapy patients
who have been through a traumatic event and have emotional challenges that might impede
their recovery, give it right back to the, they go, ah, son of a gun. That’s your question. How do you deal with, how do you do it? When somebody does go through a traumatic
event, like a, say, a car accident or something, they can have some anxiety and PTSD is an
anxiety disorder. So we’ll evaluate that again, will work to
see if any medication is needed. We’ll help them develop coping strategies. You utilize their support network. I they’re having trouble sleeping. Sometimes if you’re stressed, your sleep is
impacted, will work to help improve sleep, pain management. Pain can also have a big impact on patient’s
well-being and mood. Thank you. Let me go to Diane Jacobs now. Who is the senior admissions liaison here? She has been here over 30 years. Who’s who’s here first you or Carol? I beat you by a couple of days now. You started the first traumatic brain injury
program in Maryland back in 1983. You started it. –Well I was part of a team — Well, come
on. Don’t be humble. You started. All right. Just come out of it. What advice do you have for families looking
for quality with a therapy program like what we have here. One of the biggest things I see out there
when I’m talking to patients is a lot of times they are looking for a program and many times
they might choose convenience over quality and so I talked to them about, you know, this
person’s going through a major life altering event on it might take quite awhile to recover
and I would think that you would want what’s best instead of what’s convenient for the
family member. How do you get here? How do you get in here? It’s very easy actually, where whatever hospital
you happen to be in all they have to do is talk to everybody has a case manager or social
worker and all they have to do is just ask for referral to good Sam’s acute rehab and
uh, we take it from there. It’s pretty easy. We will check into the, uh, insurance, see
if it’s covered. We talk, we interface with the medical team
at the facility that they’re in a to see when they’re medically ready. We have interactions with the acute therapists,
they’re in the hospital, see what their function is like there and what their previous situation
was and see if we have goals and work to bring them in. I going to go back to Carol because you’ve
been on both sides of the fence here. Guide us through it as a mom first and then
as a nurse second, what they did here for your son as we saw earlier, but again, just
expounding on that a little bit more careful. I always knew what we had was special in working
with patients, seeing them as you talked earlier, you know, they may go home and then we’ll
see them come back later and we realize how much they’ve gained and you’re thinking, oh,
I had a piece to do with that. Being on the other side of it, you know, people
didn’t treat me as a nurse. They treated me as a mom. They treated Adam like they would treat any
patients, so it wasn’t as if he got any type of special care, it was just what they do
every day. Somebody asked him earlier if they thought
he was a miracle. I think you. You’ve asked to repeat though, and I do. I think that this institution, our extended
network of the NRH outpatient, our driving program. I mean all of them and Adam of course, resiliency
and his faith, I think has really been a testament to what you see today. –Can everybody be repaired?–
Everybody will be repaired so patients wouldn’t come here. If there wasn’t a capacity to improve, does
that mean they’re going to get back a hundred percent what they were prior to whatever happened
to them? No, but one thing that I think that we do
really well here is that we set people up for success, so for example, the person who
might be really anxious, we set it so that when they do something in therapy that they’re
successful with it and then we up the ante a little bit so that it continues to let them
have improvement and they’re not going to be perfect when they leave here. This we continue to consider and a continuum
of care. So when patients leave here, they might get
home help or they might go to our outpatient setting and that therapy is going to continue
and sometimes even after the therapy and for insurance purposes or whatever, there still
research things that people can participate in. So they continue to make improvements, particularly
for example, with stroke, the research has shown and we tell our patients this all the
time, you know, we used to say you have six months to recover, and then that was increased. You have a year to recover. Now we know that yours out, people can still
make recovery. It’s all about continuing to work. Maggie, what’s it like to see someone who
can’t walk, walk. I have had several patients that have come
back and visited after they’ve left here and they’ve come walking up to me and said, you
know what, I left it a wheelchair level and look at me now and I say, this is the reason
why I do what I do is to have that experience. In fact, Jamie and I just this week had a
patient that came back and visited and he, when he first got here, he couldn’t stand. He couldn’t walk and he left rehab and he
had to use a walker. And he just strolled in with his wife walking
just like you and I would. And that to me is the best feeling in the
world to be able to have a patient to come back and say, look at me now. Someone who mumbles all the sudden can speak
the word again. It’s wonderful, incredible. I mean, you can imagine that our communication
really connects us to people and also in these situations, you know, it’s important to be
able to communicate your wants and needs. Um, you know, and, and be a part of that decision
making process for your own health care and it’s really great that we can facilitate that. We also do a lot with, our patients education
and health literacy. You know, we do, stroke education courses
here. We also have a lot of support groups who have
a stroke support group. We have, um, an aphasia support group, um,
that we not only work with our patients but also their loved ones in teaching them, supporting
communication techniques and how to effectively manage that at home. We get a lot of questions online. Here’s one. My mother is not very active and forgets when
I visit her or calls, what can I do to help her get active and improve her memory? This is home care. Anybody wanna hit on that. You know, keeping a calendar or a daily planner
and writing things down. You know, it’s often helpful even to write
things down after they happen that you can go back to it. If you have a loved one who isn’t remembering
things and you go to visit them and you’re asking them questions, you know, what did
they do and the answer is constantly, I don’t know. It’s kind of a one sided conversation and
it’s not really a quality conversation. So if you do things like write things down
and have other visitors and other people also write things down, then you can refer back
to that information and it often helps the patient recall what happened in more specific
detail. Scott, I was fascinated how you got into this
line of work. What led you here? I can think back to a very specific day. When I was a medical student at Georgetown
and I was doing an orthopedic rotation and we had a lecture on gait analysis on walking
that was given by a physiatrist, by a doctor in, in this field. And the way that she thought about problems
in the way that she pursued the solution to the problem just really resonated with me. And as I learned more about it and learn about
how this field really does focus on improving quality of life, on restoring function, on
really having to work as part of a team and getting to work as part of a team and address
the whole patient, not just one small part of it, uh, from their illness to way out after
recovery. It’s, it’s really a tremendous opportunity
and privilege to be able to, you know, touch on so many different types of patients in,
in, in, in so many different ways. We have a couple minutes left. I’m fascinated by this too. I’m going to go down the line here. We’ll start with Stacey. The one you don’t have to mention, don’t mention
the names, but the one patient that sticks out the success story that sets the tone. Gosh, I’ve been doing this for a long time,
so I’ve had quite a few. We did just recently have a gentleman that
I had the privilege of working with. He was absolutely extraordinary. He was featured in the video earlier. He had a stroke that damaged the area of his
brain that control is swallowing and we were able to do a video swallow study on him. I think we have that video and he was actually
able to regain his swallow function so he went from not being able to eat anything at
all to being able to eat when he left us. And that was a wonderful accomplishment. I have another one and it was a lady who had
Guillain-Barre’ syndrome, which is delineating or takes away some of the surrounding areas
of your nerves and it causes, it can cause paralysis, it can cause you to not be able
to breathe. So she actually came to us on a ventilator. She needed a lift to get in and out of bed
and we couldn’t physically lift her because she was so dependent, she could not sit on
the edge of the bed and she progressed to being able to be weaned from the vent. She got her trach pulled while she was here. So she was able to go home without a trach. And she was able to walk with or without a
device by the time that she left rehab. So within just, I want to say three weeks
she made miraculous progress and it was just an amazing journey to be with her and her
family to be able to witness that in the care that the family brought to her and to be part
of that and felt like I was part of their family. And in fact I still keep in touch with her
to this day and she returned back to work. So very successful story. It’s really hard to pick one, you’re going
to lean on their minds. But I’ll say the one patient that I really
learned a lesson from, I had a patient when I was a young therapist who had a spinal cord
injury and he was paraplegic so he didn’t have use of his legs. And he was a tough nut. You, you go into the room, he wouldn’t look
at me. He would move deadly slow and he really was
tough to treat. But I persevered with him and he came back
two years later and came back and thanked me and said that this program changed his
life and he went from doing things that were taking him down the wrong path to completely
turning his life around and he was still in a wheelchair, but he was so appreciative and
I would’ve never ever thought that that patient would come back and say thank you. Well, I have my, I have my own story, but
mine too was from my younger years. It was an older gentlemen who had had an aortic
aneurism that ruptured and ended up impairing the blood flow to his spinal cord and he ended
up with an amputation as well as some other things. But just kind of the same thing. Watching the progress of the patient. He had such an extended family. So just kind of thinking about how that network
of people helps to reduce anxiety and incorporating families into it. And I had the luxury of being able to go to
his 50th wedding anniversary party after he left. And it just, you knew you made a difference,
but just also to see him back in his own element and thriving with his family. Nothing like it though. What are you going to school Adam? Where are you going to go? Where? George Mason. Oh, right there. And what are you going to major in? Civil Engineering. He graduates in May. May you graduate? Would you do us a hug? Can you come up here and have your mother? I know Jen too. Yes. It’s maybe a level of. All right, go hug Jen. I think we’ve seen the success of MedStar. Good Samaritan and what they’ve done. I think he’s going to leave us with memories
here tonight. We want to bring up. I don’t know how he follows his. Where’s Brad? Brad chambers. Who is the Pol present on the day of the hospital
group here and he’s gonna. Say a couple words. Looking at that to see you. Really, on behalf of everyone here at the
MedStar Good Samaritan, let’s give it up for a wonderful panel tonight and what a tremendous
job into all the wonderful staff that we have here at MedStar Good Samaritan. This is truly the heart of what we do for
nearly 50 years, providing excellent care to the community and at the core has been
our rehab program and I really hope all of you out there can join us next year when we
open up our brand new inpatient Rehab facility here at Good Samaritan. We’re very excited about that. We have a wonderful year-long celebration
celebrating our fiftieth anniversary here at Good Samaritan and at the center of this
is really our beautiful in-patient Rehab facility. As always, I want to thank Jamie and our wonderful
partners from a WMAR. We’ve been doing these webcast series now
across MedStar for five years and it seems like Jamie, every quarter you and I are together
wherever we are across MedStar, but on behalf of the entire MedStar family, to your family,
wonderful stories tonight. Thank you for being here with us at MedStar
Good Samaritan Hospital. And I hope everyone comes back and sees us
here next year. Thank you so much.

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