The laTesT rehabiliTaTion news and advances from Carolinas rehabilitation

summer/fall 2012

Comprehensive rehabilitation for transplant patientsBuilding strength before and after surgerypage 4

a first in stroke

CareNew stroke

rehabilitation database will

benefit patients and physicians

page 6

2 • carolinasrehabilitation.org

as part of Carolinas healthCare system’s (Chs) commitment to bring care to the community, a new adult inpatient rehabilitation hospital, called Carolinas rehabilitation-pineville, is being built on the campus of Carolinas medical Center-pineville. The 29-bed, 86,500-square-foot facility, scheduled to open in august 2013, will occupy the first floor of a four-story building it will share with a 40-bed, long-term, acute-care hospital.

easier aCCess to Care

“The decision to build Carolinas Rehabilitation-pineville is part of CHS’s five-year plan to reallocate inpatient beds where they’re needed most,” says John Roberts, vice president of Carolinas Rehabilitation.

people living in the south Charlotte area, close to the South Carolina border, will have convenient access to the new hospital. “We’ll offer the highest level of care for those who need medical rehabilitation for stroke, neurological diseases, traumatic injury, orthopedic conditions and general medical rehabilitation to improve strength, stamina or balance,” says Roberts.

The most critically ill patients, including those suffering from spinal cord injuries or traumatic brain injury, will continue to be cared for at Carolinas Rehabilitation’s hospital located in center city Charlotte.

Created for learning and enjoying

patients can take advantage of a rehab gym with state-of-the-art equipment. In addition, patients and their families can practice daily living skills in a transitional apartment, complete with residential furniture, a fully functioning bathroom and kitchen with working appliances.

another special feature that’s planned is an outdoor therapy garden, filled with beautiful plants and a variety of ground cover to simulate mobility challenges patients may encounter when outdoors.

“We’re proud to bring our rehabilitation services to the communities we serve,” says CMC-pineville president Chris Hummer. “The partnership with Carolinas Rehabilitation, which is nationally recognized, is another example of how, at CMC-pineville, advanced care has never felt so personal.”

What’s neW @ Carolinas rehabilitation

expandIng ouR SeRvICeS

viki adornato, ma, CCC-slp, was recently accepted into the american Speech-Language- Hearing

association’s Leadership program. This yearlong program encourages participants to develop leadership skills and give back by volunteering.

five Carolinas rehabilitation outpatient therapists recently passed the american physical Therapy association orthopedic Specialist Certification exam, including our first two orthopedic physical therapy residents. • David Aiken • Andrew Ball• Matthew Johnson• Gary C. Of • Shubhra Tyagi

Currently, seven therapists at Carolinas Rehabilitation have an orthopedic clinical specialist (oCS) certification.

on the Cover: Liver transplant patient Diane Scheuer works with occupational therapist Brittany Lorden during post-surgical rehabilitation at Carolinas Rehabilitation.

stay informedTo see pictures of CR-Pineville’s ground-breaking and construction progress, find us on Facebook at www.facebook.com/carolinasrehabilitation or follow us on twitter @Carolinasrehab

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to refer a patient to Carolinas rehabilitation, call 1-877-rehab51 (734-2251) • 3

“i promise to bring it every day. never surrender. never give up. there is no choice.” These are the words that pushed Brian Muscarella to bike 180 miles to the Carolina coast this past April and the words that motivate him every day. Brian is one of 40 riders who participated in this year’s 13th annual Cycle to the Sea (CTTS).

Every year, disabled and able-bodied athletes from the Adaptive Sports and Adventures Program (ASAP) at Carolinas Rehabilitation cycle from Monroe, NC, to North Myrtle Beach, SC. They averaged 60 miles per day for the three-day, rain-or-shine bike ride. The hand cyclists have a couple of key goals: to show how “abled” the disabled can be and to raise money for ASAP to

on the road again

Carolinas rehabilitation patient brian

muscarella races toward the finish line at the Cycle to the sea event.

ContinueD on page 8 >>

outpatient serviCes

raising awareness and funds for the community

brian muscarella was an avid skier before a spinal stroke left him paralyzed from the chest down.

Lofton, MD. During his first week of rehabilitation, Brian met ASAP athlete Greg Taylor at a mentor support group. Greg talked about the different sports offered through ASAP, and Brian was immediately sold. Before the spinal stroke, Brian was very active, competing in four New York City marathons. Brian’s main goals were to remain active through ASAP, eventually walk without assistance and ski out West on his favorite

brian and the asap cycling

team take a break during the

event.

support ongoing community programs such as power soccer, rugby, golf, snow skiing and more.

overComing Challenges

For Brian and other ASAP athletes, this ride is personal. On March 23, 2011, Brian was working from his home office when he started experiencing right arm numbness and chest pains. He went to the emergency room and within 24 hours he was void of feeling and movement from his neck down. “I couldn’t sit up or move my legs,” says Brian.

What was initially thought to be angina turned out to be a C5–C7 spinal stroke. After days in the neurological intensive care unit at Carolinas Medical Center, he was transferred to Carolinas Rehabilitation under the care of LaTanya

4 • carolinasrehabilitation.org

suCCess stories

transplant surgery felt like it was years away for diane (nancy) scheuer, after she learned she had liver failure. She was on the transplant list for about 10 years at the Hospital of the University of Pennsylvania in Philadelphia, but when her condition became life threatening, her physician suggested they look into another hospital that had a shorter waiting list.

Her physician contacted his colleague, Mark W. Russo, MD, with the Transplant Center at Carolinas Medical Center (CMC), part of Carolinas HealthCare System, in Charlotte. He felt the CHS transplant team would give Diane the comprehensive services and personalized attention she needed.

Diane and her family traveled to Charlotte for evaluation. In February, her health took a turn for the worse and Diane was quickly admitted to Carolinas Medical Center.

keeping faith, gaining

strength

Diane’s road to recovery was an extreme team effort and began even before she received a new liver. Her family, physicians, nurses and rehabilitation professionals worked to help her be strong enough for the transplant surgery—“it was fabulous

teamwork,” says her daughter, Kristian.

Before the transplant, Diane’s quality of life was poor. Her legs were so swollen with fluid she was

unable to bend them. She was also having trouble speaking

and completing daily tasks. On March 18, Diane received

her new liver; soon after, she began rehabilitation at Carolinas Rehabilitation. The rehab care team focused on exercises to help Diane regain her strength. Initially, walking up stairs was difficult; she could walk with a walker but couldn’t get up unassisted and had little strength in her gluteus

muscles. Joanna Edeker, PT, would say, “It’s mind over matter, and I know you can do it, but you have to see you can do it.” This encouragement helped boost Diane’s morale and drive. “Everyone was so sweet to her; I never had to worry whether she was being cared for. The therapists were excellent, they gave her confidence,” says Kristian.

Celebrating life

Kristian, who’s a recreational therapist in Pennsylvania, has seen many other rehab facilities, and says that Carolinas Rehabilitation helped her mother feel better both emotionally and physically. In addition to her supportive rehab team, Diane’s positive attitude and will to succeed helped in her recovery.

“Diane was walking independently by the time she left,” says Vishwa Raj, MD, associate medical director at Carolinas Rehabilitation. “She was able to get in and out of a bed and a

Hope for the future

transplant patient diane scheuer and

her daughter, kristian are grateful

for the care she received at Carolinas

rehabilitation.

vishwa raj, md, checks diane scheuer’s

progress while at Carolinas rehabilitation.

therapy helped her regain stamina and

strength after surgery.

matthew shall, md, received his undergraduate degree from miami university in ohio and his medical degree from the medical College of ohio. he completed his internship in internal medicine at eastern virginia medical school and his residency in physical medicine and rehabilitation at carolinas rehabilitation, where he was also chief resident. following his residency, dr. shall joined a private practice in seattle. he returned to charlotte to become medical director of carolinas rehabilitation-mount holly.

he is certified by the american board of Physical medicine and rehabilitation. dr. shall has received several honors and awards; he also participates in numerous volunteer activities and community service projects.

he is an active member in the american academy of Physical medicine and rehabilitation, the american association of academic Physiatrists and the american medical association.

dr. shall has been on staff at carolinas rehabilitation since 2007. his clinical interests are stroke and general rehabilitation. he’s currently involved in a research project titled “Preventing hospital readmission after inpatient rehabilitation.”

“dr. shall excels in patient satisfaction and helps to lead his facility in the same way,” says william bockenek, md, medical director at carolinas rehabilitation. “he’s an excellent physiatrist, patient advocate and friend. he provides great mentorship and leadership to the staff and physicians at mount holly in his role as facility medical director. it’s truly an honor to have dr. shall as one of our team members, and i look forward to many years of further collaboration.”

MaTTHeW SHaLL, Md

physiCian foCus

meet our dediCated staff

Visit carolinasrehabilitation.org for more information about our physicians and other medical staff members.

chair unaided, and she participated in long periods of activity without any significant breaks. We anticipate that Diane will return to a very normal life.”

Diane returned to her family in Pennsylvania in time for her 34th wedding anniversary in June. She says she feels like she was given a rebirth and resurrection. “I just have such high regard for the hospital and the rehabilitation—it’s an entire package. You can move departments or to a different building for rehabilitation but you’re still part of the same family.

“I now have hope for the future—to do things with my husband, my family and my friends that I couldn’t do before,” says Diane. “I almost didn’t have a future, and now I do!”

vishwa raj, mdassociate

medical director

to refer a patient to Carolinas rehabilitation, call 1-877-rehab51 (734-2251) • 5

6 • carolinasrehabilitation.org

a groundbreaking stroke rehabilitation database, which will include information on thousands of Carolinas rehabilitation stroke patients, is about to begin collecting crucial information. Principal

investigator Vu Q. C. Nguyen, MD, director of the stroke rehabilitation program, expects that the information compiled in the database will benefit both stroke patients and their physicians.

“It will be the first stroke rehabilitation database established in the country,” he says. “If we’re successful, other institutions will copy the format that we have instituted.”

Dr. Nguyen was awarded a Cannon Grant to create the database. He has partnered with researchers at Duke University to collect and analyze data from about 4,000 Carolinas Rehabilitation stroke patients. The

project will incorporate information from current stroke patients at the hospital and former patients dating back to 2007 or 2008. Dr. Nguyen estimates that it will take one to two years to collect, input and analyze all of the data.

identifying trends

Dr. Nguyen and his partners hope that the database will help physicians learn the most effective ways to treat each stroke patient, based on his or her particular symptoms or disabilities. For example, patterns may emerge from the data regarding the most effective treatments for patients with double vision, bladder problems or muscle weakness. Physicians may be able to determine which patients will benefit most from inpatient rehabilitation or what characteristics will make patients most likely to maintain the benefits they gain during therapy.

“If we collect all this data on function and outcome and we learn that there is a trend, that one drug is better than another, it’s going to change the

pioneering stroke database

vu Q. C. nguyen, md, director, stroke

rehabilitation program

way we practice,” Dr. Nguyen says. “I know what drugs I give to my patients, but I don’t know what my colleagues do. With the database, everybody can review everybody else’s data.”

Creating Care models

Dr. Nguyen expects to publish studies in peer-reviewed journals detailing patterns that are discovered among stroke patients and the effectiveness of streamlining medication and treatments for people with particular symptoms or disabilities. He also hopes to impact the federal government’s Model Systems of Care program, which follows patients with traumatic brain injury, spinal cord injury and other serious conditions from their initial injury until they are able to participate fully in their lives again. Currently, there is no such system established for stroke patients.

“If we are successful, we could go to the government and argue for funding to establish stroke model systems across the country,” Dr. Nguyen adds.

researCh

to refer a patient to Carolinas rehabilitation, call 1-877-rehab51 (734-2251) • 7

Carolinas rehabilitation is participating in two new clinical trials with hopes of creating better, more effective treatments for patients.

biomarkers

for mild brain

injury

Researchers from the brain injury department recently began recruiting patients with mild traumatic brain injury, such

as concussion, through the hospital’s Emergency Department. They plan to enroll 400 patients who initially experience headache, nausea, dizziness, balance problems or even brief loss of consciousness.

Each subject will be followed from his or her initial injury for a one-year period, so that researchers may track their recovery. At regular intervals, researchers will evaluate patients’ cognitive, emotional and sleep symptoms. They’ll also test patients’ balance and analyze blood samples to search for biomarkers that may indicate patterns of recovery among certain patients.

“It’s unclear right now why some people recover completely and others do not,” says Lori Grafton, MD, director of the brain injury rehabilitation program and one of the study’s principal investigators. “We hope to identify different biomarkers so that at the time of head injury, we’ll be able to better predict outcomes.”

BRaIn InJuRy and SpInaL CoRd InJuRy STudIeS undeRWay

mediCation for aCute spinal

Cord injury

Earlier this year, Carolinas Rehabilitation became one of 60 acute trauma centers throughout the United States and Canada that’s participating in a clinical trial to test the safety and effectiveness of a new investigational drug for patients with acute spinal cord injury (ASCI). Researchers hope that the drug, called SUN13837, will help patients with ASCI to improve neurological function. If successful, it will be the first drug to treat paralysis and sensory loss, the hallmarks of ASCI.

Patients will be enrolled in the study based on the severity of their

help for patients

For information about these or other research programs at Carolinas Rehabilitation, call Tami Guerrier at 704-355-9713.

spinal cord injuries. Each of the 164 study subjects will be given either SUN13837 or a placebo within 12 hours of sustaining the injury. They’ll continue to receive the drug (or placebo) daily for 28 days. Researchers hope that ASCI patients will respond well to the drug, so they may live more independently and be more likely to eat, bathe and care for themselves with minimal assistance.

lori grafton, mddirector, brain

injury rehabilitation program

medical director William bockenek, md,

reviews emg studies with pgy-4, physical medicine & rehabilitation resident

jessica mowry, do.

PRSRT STDU.S. POSTAGE

PAIDLebanon Junction, KY

Permit No. 19

Carolinas Rehabilitation1100 Blythe Blvd.Charlotte, nC 28203

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hoW to reaCh usCarolinas rehabilitation 1100 Blythe Blvd., Charlotte, NC 28203

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mountain. He began with rugby and paratriathlon clinic training, and then took up handcycle training for CTTS.

a grateful heart

“A freak act of nature changed my life dramatically in a few hours,” says Brian. “My life went from working as a managing director for New York Life and enjoying a busy family life in Charlotte to fighting every day to do tasks we take for granted.” With an amazing support group called Team Freak, comprising Brian’s family, friends and colleagues, he was able to complete the 180-mile trek and raise almost

$20,000 (that amount is still climbing). “I can’t thank the dedicated

professionals at Carolinas Rehabilitation and ASAP enough. We can make a difference and change a person’s life through ASAP,” Brian says. When asked what motivates him to continue, he says, “For me, it’s never been a choice. It has only been when I will walk again, not if. My family and dear friends have selflessly given their time and energy to my cause: I bring it every day to honor them.”

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participants at this year’s Cycle to the sea event, sponsored by Carolinas

rehabilitation’s adaptive sports and adventures

program. riders traveled 180 miles to raise

awareness and money for adaptive athletes.

on the RoaD again i ContinueD fRom page 3 >>

Want to donate to Ctts?

Your donations help ASAP purchase new equipment and continue to offer activities at no or minimal charge to the community. Visit www.cycletothesea.org or contact us at asap@carolinas.org or call 704-355-1062.