Neurorehabilitation
Updates
Collaborative care, innovative approaches and research-driven therapies to help patients get back to their lives.
SUMMER 2017 | VOL. 5, ISSUE 1
Rehabilitation Specialty Programs at Kennedy Krieger Institute
A Word from the Director Frank S. Pidcock, MD, is the vice president of rehabilitation at Kennedy Krieger Institute and director of the Pediatric Rehabilitation Division in the Department of Physical Medicine and Rehabilitation at The Johns Hopkins Hospital.
We are delighted to welcome Shenandoah Robinson, MD, to the neurorehabilitation team at Kennedy Krieger Institute. Dr. Robinson is a professor of pediatric neurosurgery at the Johns Hopkins University School of Medicine. She brings a wealth of expertise in neurosurgical approaches to movement disorders in children. Her presence greatly enhances our ability to provide additional surgical options for patients with complex motor disorders. These interventions include selective dorsal rhizotomy, baclofen pump placement and deep brain stimulation. Also in this issue, we discuss the brain injury recovery measurement scales developed at Kennedy Krieger. These scales have been implemented in pediatric rehabilitation facilities throughout the country. They provide a much more detailed description of a young brain injury patient’s level of functional performance, particularly at very low levels of functioning, than do other scales. The information that the Kennedy Krieger Scales provide is critical for assessing patient progress, guiding treatment and formulating discharge plans. Read on to learn more about these exciting developments, and be sure to watch for future issues of “Neurorehabilitation Updates” for the latest in neurorehabilitation research and treatment options. If you have any questions or would like to learn more about our services, please call our Physician Referral Line at 443-923-9403.
Kennedy Krieger Institute has a wide variety of rehabilitation programs to meet the needs of patients at all levels. For a complete listing, please visit Rehabilitation.KennedyKrieger.org.
Pediatric Rehabilitation Unit • Brain injury • Medical rehabilitation • Pain rehabilitation • Post-orthopedic surgery • Spinal cord injury
Outpatient Rehabilitation Programs • Brachial Plexus Clinic • Center for Brain Injury Recovery: Concussion Clinic • Community Rehabilitation Program • Constraint-Induced and Bimanual Therapy Program • Cranial Cervical Clinic • Focused Interdisciplinary Therapy Program • International Center for Spinal Cord Injury • Limb Differences Clinic • Neurosurgical Services • Orthopedic Clinic • Pediatric Pain Rehabilitation Program • Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine • Philip A. Keelty Center for Spina Bifida and Related Conditions • Physical Medicine and Neurorehabilitation Clinic
Day Hospital • Specialized Transition Program
Related Services and Clinics • Aquatic Therapy Program • Assistive Technology Clinic • Audiology Clinic • Behavioral Psychology Outpatient Programs • Movement Disorders Program • Neuropsychology Outpatient Clinics • Nutrition Outpatient Program • Occupational Therapy Clinic • Pediatric Psychology Program • Physical Therapy Clinic • Seating Clinic • Speech and Language Clinic
Learn More. Get Involved. Stay Connected. Visit KennedyKrieger.org/Connect.
For more information, please call our Physician Referral Line at 443-923-9403 or visit Rehabilitation.KennedyKrieger.org.
Kennedy Krieger Scales Measures of functional independence, such as the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure for Children (WeeFIM), are typically used by pediatric rehabilitation facilities to track patient recovery and compare outcomes to those of similar facilities. These measures include short checklists to assess physical, self-care and cognitive functioning. In contrast, the Kennedy Krieger Scales were designed to supplement measures like the PEDI and WeeFIM by providing more detail about recovery in the pediatric inpatient rehabilitation setting. The additional details obtained via the Kennedy Krieger Scales are used to help treatment team members, families and insurance companies better understand a patient’s progress, and to fine-tune treatment programs and discharge plans. The scales, developed at Kennedy Krieger Institute, also provide information that can help improve quality of care on a programmatic level. There are four Kennedy Krieger Scales: the Physical Abilities and Mobility Scale (PAMS), designed to assess lower extremity movement and mobility; the Upper Extremity Motor Scale
(UEMS), which measures upper extremity movement; the Oral Motor Measurement Scale (OMMS), which assesses swallowing ability and oral motor skills; and the Cognitive and Linguistic Scale (CALS), which measures cognitive and language skills. Recent papers and posters have helped share information about the reliability and validity of the scales, which are gaining in popularity across the country and around the world. Several pediatric rehabilitation facilities in the U.S. are employing the scales, primarily the CALS and PAMS. (See “From Bench to Bedside” on page 3 to learn more.) The Kennedy Krieger Scales are more comprehensive than measures like the PEDI and the WeeFIM. And since they’re designed to measure very low levels of functioning and very small increments of change, they’re more sensitive to change in certain patients, particularly those with significant verbal, motor or cognitive impairments. For example, when patients are totally dependent on others for care, the Kennedy Krieger Scales will measure important, albeit subtle, changes that other measures like the WeeFIM and the PEDI won’t pick up. This gives doctors and family members clues to a patient’s otherwise unmeasurable progress toward recovery, even if the cause of the patient’s impairment is unknown. “When you don’t know what’s causing a patient’s impairment, all you have is your assessment tools,” says Dr. Beth Slomine, codirector of the Kennedy Krieger Center for Brain Injury Recovery and one of the scales’ primary developers. “Measuring function is possible, regardless of an individual’s cognitive ability, as long as you have the right tools.”
“Measuring function is possible, regardless of an individual’s cognitive ability, as long as you have the right tools.” –Dr. Beth Slomine The Cognitive and Linguistic Scale (CALS), developed at Kennedy Krieger Institute, can measure a pediatric patient’s recovery from a brain injury at very low levels of functioning, making the scale much more sensitive to small increments of recovery than other scales currently in use. Above is the first page of a CALS assessment form.
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Disorders of Consciousness Program Kennedy Krieger’s Disorders of Consciousness Program focuses on interventions to help patients with altered mental states due to brain injury, encephalitis, CNS tumor post-treatment, or any other type of chronic encephalopathy. Dr. Stacy Suskauer, the co-director of the Center for Brain Injury Recovery, directs this program. The program is also suitable for patients with chronic brain injury who may be “waking up” and need a boost of intensive inpatient therapy. For more information or to refer a patient, email FindASpecialist@KennedyKrieger.org.
Kennedy Krieger Welcomes New Physicians Kennedy Krieger Institute is pleased to announce the addition of the following new specialists to its physical medicine and rehabilitation team: Shenandoah Robinson, MD, is a neurosurgeon at The Johns Hopkins Hospital. She sees children at Kennedy Krieger who need baclofen pump, deep brain stimulation or dorsal rhizotomy procedures. As a nationally recognized expert in the treatment of epilepsy and spasticity, Dr. Robinson’s research focuses on clarifying how early damage to the developing brain leads to deficits, such as cerebral palsy and epilepsy, and how one may address these deficits with neurorestorative agents.
Mahim Jain, MD, is a faculty member of the Osteogenesis Imperfecta Clinic at Kennedy Krieger and an assistant professor of pediatric medicine at the Johns Hopkins University School of Medicine. Dr. Jain has strong clinical and research interests in treating and understanding disorders of low bone density.
With the addition of these new physicians, Kennedy Krieger is well-positioned to meet the growing demand for care for patients with advanced rehabilitation needs. To learn more about rehabilitation services at Kennedy Krieger, visit Rehabilitation.KennedyKrieger.org.
From Bench to Bedside Kennedy Krieger Institute’s clinicians and researchers are leaders in the worldwide effort to prevent and treat disorders of the brain, spinal cord and musculoskeletal system. Our investigators continue to break new ground by developing innovative imaging technology, investigating critical areas, and developing new treatment models and therapies. Below is a selection of research focused on the Kennedy Krieger Scales, which are used to measure recovery in patients with minimal consciousness: B.S. Slomine, J. Eikenberg, C.F. Salorio, H.W. Sesma and J.R. Christensen. The Cognitive and Linguistic Scale. Journal of Head Trauma Rehabilitation, 2006, 21:419. S.J. Suskauer, B.S. Slomine, C.F. Salorio, E. Bradley, L. Madigan, H.W. Sesma and J.R. Christensen. The Physical Abilities and Mobility Scale. Journal of Head Trauma Rehabilitation, 2006, 21:420. K. Dunkleberger, B.S. Slomine, C.F. Salorio, S.J. Suskauer, E. Salva and J.R. Christensen. The Upper Extremity Motor Scale. Journal of Head Trauma Rehabilitation, 2006, 21:420. M. Trovato, E. Bradley, C.F. Salorio, B.S. Slomine, J.R. Christensen and S.J. Suskauer. The Physical Abilities and Mobility Scale (PAMS): Reliability and validity in children receiving inpatient rehabilitation for acquired brain injury. Archives of Physical Medicine and Rehabilitation, 2013; 94(7), 1335-1341. DOI: 10.1016/j.apmr.2012.12.004.
B.S. Slomine, J. Eikenberg, C.F. Salorio, S.J. Suskauer, M. Trovato and J.R. Christensen. Preliminary evaluation of the cognitive linguistic scale: A measure to assess recovery in inpatient rehabilitation following pediatric brain injury. Journal of Head Trauma Rehabilitation, 2008; 23(5), 286-293. DOI:10.1097/01. HTR.0000336841.53338.2f. B.S. Slomine, P.H. Grasmick, S.J. Suskauer and C.F. Salorio. Psychometric properties of the Cognitive and Linguistic Scale: A follow-up study. Rehabilitation Psychology, 2016.
For more information about research studies and clinical trials at Kennedy Krieger Institute, please visit KennedyKrieger.org/Research. 3
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A New Name: The Center for Brain Injury Recovery
Neurosurgical Procedures for Spasticity
Kennedy Krieger Institute is changing the name of its brain injury program to the Center for Brain Injury Recovery. The new name better reflects the depth and breadth of its treatment services and research.
As a leader in the treatment of children with cerebral palsy, Kennedy Krieger Institute has partnered with the neurosurgery experts at The Johns Hopkins Hospital to provide important surgical options for chronic spasticity, including selective dorsal rhizotomy, baclofen pump placement and deep brain stimulation. These procedures are particularly useful for managing spasticity in patients with cerebral palsy and other complex motor disorders.
The Center for Brain Injury Recovery will continue to offer world-class medical care through its pioneering “continuum of care” model, providing coordinated care across inpatient, day hospital, outpatient, home and community settings. Stacy Suskauer, MD, and Beth Slomine, PhD, co-direct the center, which also houses a clinical research program focused on driving best practices in clinical care for patients with brain injuries, including concussion and disorders of consciousness. To learn more about the Center for Brain Injury Recovery, visit KennedyKrieger.org/BrainInjuryCenter. 4
Benefits of these procedures include: • Reduced spasticity • Improved gait patterns • Improved range of motion and functional mobility • Improvements in activities of daily living Referrals for neurosurgical evaluation at Kennedy Krieger may be made by calling 443-923-9403 or emailing FindASpecialist@KennedyKrieger.org.