By Frank Long, MS, Editorial Director
Healthcare organizations don’t find their way to the head of the pack by accident. Earning that distinction requires talent, technology, and an institutional curiosity to ask how healing can be done better. Those characteristics are woven into the DNA of the top three rehabilitation hospitals chosen by U.S. News & World Report as the best in the United States in 2019. Their common thread is a commitment to use technologies that permit therapists to enter the narrowest paths of their patient’s treatment and provide interventions with maximum impact. Each organization uses that thread to weave success in its own way.
Shirley Ryan AbilityLab
If it can be said that a rehab facility has established a dynasty of success then that sentiment surely describes the grip on excellence achieved by the Shirley Ryan AbilityLab (SRA). The Chicago-headquartered facility, previously known as the Rehabilitation Institute of Chicago, has claimed the number one position in the U.S. News ranking each year since 1991.
This success has not made the leadership at SRA complacent. In fact, what seems to propel the managers and executives of this facility forward is a strategic and sustained effort to assure that its integration of research and clinical treatment remains focused and on track.
“We are honored and thrilled to have this ranking, but from our perspective it’s yesterday’s news,” says Glenn Paustian, MSLP, Director of Inpatient Therapies at Shirley Ryan AbilityLab.
“There is no other place I am aware of that integrates research science and clinical care like we have,” Paustian says. “We have been able to work on translational knowledge that reflects the ability of our organization to get our cutting-edge research into our practice within a few months to a year to validate what we are doing,” he adds.
According to Paustian that process traditionally has taken 10, 12, 14, or more years.
“Improving that integration is what we need to work toward every day,” he adds.
Paustian explains that one of the factors he feels sets SRA apart is that the physicians, therapists, nurses, and research scientists all share the same physical space and all see the same patients. Under SRA’s model inpatients who are undergoing treatment are located on inpatient floors and grouped essentially by similar diagnoses.
Also, he notes, when patients are treated by the lab therapists, the lab therapists are treating those patients cross-diagnoses. Because of this, Paustian says, the therapists become focused and experienced as well as uniquely qualified to treat a specific impairment; ranging from vision, ambulation, gait, swallowing, or a cognitive communicative disorder.
Many people who are patients at SRA have had an interruption in their ambulation, which is oftentimes a condition for which they are seeking help, Paustian says. Sometimes helping them reach their goals means enlisting the use of advanced rehab technologies.
“These patients want to be able to walk and move through the environment easily, and the instrumentation we have here to help them do that is amazing,” Paustian says. “We have a Lokomat, which is a robotic device that helps patients practice ambulation over a treadmill when they have minimal function in their legs. This is important in the early stages of being able to ambulate when it is critical to give patients a lot of practice.”
For patients who are progressing in their program, body weight supported treadmill training might be the next level of technology they will use.
“For this, the patient is in a harness that both will keep them safe from falling but it will also be able to off-weight some of their weight,” Paustian explains. “So it will be an ability to take some of their weight off of their legs so they might be able to move their legs more easily.”
The next level, Paustian says, is training over ground while wearing the harnesses, which allows the therapist to make sure the patient is safe, but also challenges the patient physically.
For individuals who are learning to walk again as the result of an accident or disease process, Paustian adds, the people helping them would be very concerned about the patient falling or getting hurt. With the technology SRA has for the over ground therapy patients can walk up and down the hallways all around the ability labs.
“Even where we practice daily functions in our activities of daily living area—which is almost like a small apartment; there’s a bathroom and a kitchen and a bed—things of that sort where you would practice cooking a meal or transferring to and from bed, or using the bathroom facilities,” Paustian says. “Even in those areas we have this track system to support them, so people can move around safely and really take advantage of learning these tasks,” he adds
Technology that meets patients at the furthest level of progression is a track system unique to SRA that allows patients to safely attempt to regain their skills walking the stairs. Via the system, which was designed specifically for SRA therapists to use in the building where they work, clinicians can walk an entire flight of stairs safely with patients; with the patients aware that the harness will keep them from falling and becoming injured.
Paustian explains that the track system also allows patients to access an obstacle course in one of the ability labs where the patient can use a balance beam or walk on textures such as grass or pebbles—all of which, Paustian says, are challenging, yet safe to perform.
Kessler Institute for Rehabilitation
Kessler Institute for Rehabilitation, based in West Orange, NJ, is no stranger to U.S. News’ elite group of rehab providers. This year marks the 27th consecutive year the facility has been selected by U.S. News as one of the nation’s best. One aspect of Kessler’s operations that has kept them on this distinguished short list is making sure it puts the best tools in the hands of the best people. And, Lauren McDonagh, PT, Director of Inpatient Rehabilitation Services for Kessler Institute, Saddlebrook Campus, says it boils down to this: “If we have all the tools that are out there, then there’s no stopping us: we can provide the hands-on, we can provide the technology if it’s appropriate for them and they’re interested in it, and we can give them the best package.”
McDonagh says the technologies allow the therapists to progress patients and improve outcomes. They also technologies create helpful synergies.
“Being innovative and having the education and knowledge to use all these new innovations and technologies makes the staff excited and interested and want to learn more. It makes them a better advocate for their patients and enables us to provide the best quality care that we can,” McDonagh says.
In making purchase decisions for the facility’s rehab equipment, McDonagh notes, one important criteria any new technology must meet is that is must support any hands-on interventions. “We look at what will be an adjunct to our basic clinical interventions,” she says.
One of the equipment categories McDonagh says is available to therapists are electrical stimulation and robotics. “For the upper and lower extremities we have the Bioness H200 and L300 which we can use with standard therapeutic interventions to act as an adjunct,” McDonagh says.
Related technologies include the Excite which McDonagh explains is for motor recovery and helps therapists focus on function. RTI bikes, she says, are also useful for the upper and lower extremities while electrical stimulation is helpful for motor recovery.
A recent technology at Kessler is the Sychrony unit, which McDonagh describes as “e-stim for swallowing.” She says the facility’s speech therapists have been using the device for several months, and its effects are profound. “Things that would normally take many sessions to achieve are happening now in one to two sessions with the assist of this e-stim technology,” McDonagh says.
Rising with Robotics
Robotics are another technology category that has been taken on by Kessler with the appearance of the ReWalk exoskeleton. McDonagh says the device is used with brain injury, spinal cord, and stroke patients. Likewise, she says, the Kessler’s research division—Kessler Foundation—has a considerable amount of collaboration occurring between researchers and our clinicians using these robotic tools.
Clinicians and researchers are not the only ones who are impressed by robotic devices.
“You’re putting someone in an exoskeleton, which excites many but scares some,” McDonagh says. “It’s this big black unit that they have to be fitted for. But oftentimes once they’re in it and they see that they’re standing upright, their feelings begin to change. It can be scary at first but exciting when they’re moving in a way they hadn’t in a long time.”
Manual Still Matters
Scary or not, and regardless of whether it’s old school or new school, McDonagh says any of the technologies used at Kessler must be supported by standard clinical interventions. She emphasizes that the “hands-on” component of therapy is essential and that the role of technology is to provide an assist or an adjunct to what therapists do clinically.
“You can’t just slap a device on someone,” McDonagh says. “You have to have the hands-on facilitation to really put the body in appropriate movement patterns.”
Spaulding Rehabilitation Hospital
At number three in the U.S. News ranking is Spaulding Rehabilitation Hospital, headquartered in Boston, Mass, which is also the teaching hospital for Harvard Medical School’s Department of Physical Medicine and Rehabilitation. Any relationship with Harvard Medical school tends to confer a sense of excellence, and Spaulding understands the importance of this dynamic. With its reputation pinned so closely to the success of its therapists, Spaulding also understands the value of connecting its clinicians to technologies that fuel their success, according to Robert McCall, PT, MSPT, Sr. Vice President of Network Development and Inpatient Rehabilitation Services, Spaulding Rehab Network.
“Probably the most important role technology played in boosting Spaulding to this high rank is the opportunity our therapists have to collaborate with Spaulding’s own researchers as well as physicians and external technology vendors,” McCall says. “That means not only trialing the technologies we use but also giving feedback and recommending improvement,” he adds.
It is all strengthened by connecting Spaulding’s clinicians to researchers who are innovating both in and out of the hospital and in laboratories and working with local talent at MIT, Harvard and similar types of institutions, McCall explains. “It also engages our students in these pilot projects to trial and get feedback and test what some of these things do,” he says.
Technology Helps Spread the Word
That interconnectivity, McCall says, helps expand Spaulding’s reputation not only through its use of technologies such as wearable devices and apps that stretch out to hundreds of patients, but also through technologies that are narrowly specialized and have tremendous impact on highly individualized cases.
Devices such as exoskeletons and unweighting treadmills do not have an application for thousands of people, McCall observes, but do have a reputation for making a strong individual impact. The strength of that reputation helps spread an important message to potential patients, according to McCall: “If you have not been able to accomplish your rehab goals in any other format, come to Spaulding and they’ve got this tremendous connection and network, or this specific device, that will get you over the hump and take you to your final goal.”
McCall breaks down Spaulding’s rehabilitation technologies into several categories: body weight support, treadmill-based, augmentative technologies, and balance technologies. Each fulfills a specific need for Spaulding’s diverse patient population.”
Body weight support devices range from the most intensive and restrictive, like the Hocoma Lokomat, which operates in a stationary and tethered manner, to help patients who really aren’t able to mobilize effectively independently,” McCall explains.
As patients move across the spectrum that transition to technologies that still support body weight by slings and supportive robotics. These devices still provide substantial support but allow a patient to do some walking and mobilizing without being held in one place.
At the higher end of the spectrum are devices that integrate a treadmill and, in essence, eliminate the sense of gravity. McCall says such devices offer utility for patients affected by less severe injuries or are mostly recovered and now working through an injury. The unweighting capability, he explains, protects the injury while allowing the patient to walk leisurely or walk quickly, or even run or sprint while being unweighted.
Augmentative and Balance Technologies
Part of the technology mix that helped Spaulding to rise among the U.S. News rankings are what McCall defines as “augmentative” or assistive devices, such as exoskeletons. These devices, he explains, are for patients affected by some degree of paralysis. McCall describes the devices as metal-framed battery-powered electronic suits that worn by the patient and allow the person to walk untethered across a terrain or mostly level surface.
Also under the umbrella of augmentative technologies, McCall says, is a wide range of electrical stimulation devices that can be used to treat upper or lower extremities. “These devices look like braces but they have electronic components or battery components that allow individuals to more effectively contract their muscles,” he explains.
McCall counts devices that improve balance among technologies that can help optimize outcomes. “This type of device ranges include force places that allow the therapist to adjust the amount of effort required by the patient, or create an unsteady surface,” he says. They may also involve a visual challenge provided by an images on a screen or through virtual reality. Whether they are devices that have force plates that can change the amount of a patient’s effort, or unsteady the surface, or involve visual challenge on a screen or through virtual reality, these devices help round out the types of treatment options needed to address a wide scope of needs.
Revving up Recovery
Being recognized among the best of the best is desirable in any sector of healthcare, and what these three facilities have achieved by leveraging talent, technology, and strategic relationships, is noteworthy for rehab managers and clinicians everywhere. And while there may be room at the top for only a few, there is a wide open space for the hundreds of rehab facilities that dot the nation to follow similar examples and models to improve what they are able to accomplish. That is an especially important fact when one considers that almost all healthcare is regional, if not local. And the operational practices that lift a rehab hospital to prominence on a national scale can be scaled and tailored to fit healthcare consumers wherever injured patients strive to recover their best lives possible. RM