LEADING THE WAY GLOBALLY IN NEUROREHAB

INTERVIEW

Craig Hospitalsetting global standards in neurorehabilitation

With a global reputation for its work in brain and spinal cord injury rehabilitation, Craig Hospital has delivered life-changing outcomes for thousands of patients for 65 years. Deborah Johnson meets Dr. Jandel Allen-Davis, CEO of the pioneering US hospital, to learn more about its work

With an unrelenting focus on rehabilitation, underpinned by world-leading technology and led by a team who pride themselves on being by their patients’ sides every step of the way, Craig Hospital has built a global reputation for its work. Having offered neurorehabilitation since 1956, supporting over 34,500 brain and spinal cord injury patients during that time, Craig is known the world over for its pioneering and brave programmes which empower patients and maximise their independence. From its base in Denver, Colorado, Craig attracts patients from across the United States - and often internationally, too - with its ‘Craig graduates’ routinely building a lifelong affection with the hospital and its team, forever indebted to the life-changing impact they have made. Led by Dr Jandel Allen-Davis, who became CEO of Craig in 2018, Craig’s reputation for pushing the boundaries of possibility for its patients through intensive rehabilitation is one she is committed to taking forward even further. “We work hard, we’re healing bodies, minds and spirits,” Jandel tells NR Times. “The people we care for woke up with one reality and went to bed with a very different one - but there is life after brain injury or spinal cord injury, and we will show them that is possible. “The interesting thing about Craig is that typically in United States acute rehab, you’ll get two or three hours a day (of rehabilitation). Here at Craig, it’s between four and six, and it’s usually six. “The day generally starts at 9 and ends at 4, and that hard work could be physical for brain injury and spinal cord injury patients, or cognitive for brain injury patients. “We only have 93 beds, so it’s a precious resource and there is way more demand than we have beds. “They have got to come here ready to work. On the first day here, we’ll get them fitted for a wheelchair if that’s needed, we start work on day one and work hard from there.” But the concept of hard work is something welcomed by Craig patients, with the outcomes of countless Craig graduates showing what can be possible for those living with brain and spinal cord injury. “We achieve stellar outcomes,” says Jandel.

INTERVIEW

“In 2020, 82 per cent of our patients were discharged to their homes, and about 48 per cent of our SCI and BI patients returned to work or school within one year after discharge. “Our patients require significantly fewer hours of daily attendant care than those who don’t come here - we strive for independence. “I love it when I hear patients say ‘I do what I used to do, but now I do it differently’. Often they say they wouldn’t go back to their life before their injury - and often that’s because they have discovered new resilience and determination in themselves they had no idea existed. “It’s pretty remarkable and shows us every day there is life on the other side of spinal cord injury and brain injury, a good life.” With therapy programmes devised around the exact needs of each patient, Craig’s use of technology and equipment - partly funded by the “magical generosity” of donors through its associated Craig Foundation - is genuinely world-leading. Its work in transcutaneous electrical stimulation for spinal cord patients in particular is globally significant, having begun in pilot in 2019, and is now helping people to regain the power of movement. “We are helping people to get their function and movement back, even years after injury, it is really amazing,” says Jandel. “But the physician in me totally believes and knows that technology is like a scalpel and pills, they are tools, enablers, not the be all and end all. “We start with the basics and then look at how technology can advance their rehab. It’s a holistic approach, of which technology is a part.” But the part technology plays is without doubt a key component in Craig’s offering - from exoskeletons to EyeGaze, VR to robotics, as well as gaming which proves especially popular in its Teen Rehab groups. And through its work in research and paving the way for new innovation, the potential for its patients - both current and future - is increasing all the time. “We have the most amazing equipment, there are some really cool things,” says Jandel. “It starts here at Craig where we have the most highlyskilled therapists who understand neuroscience and body mechanics, we’re learning more about neuroplasticity and the ability to regenerate. We have things being created on 3D printers by our therapists which can support people in living independently. “Human ingenuity and the quest for innovation will never be complete, and that thirst will never be quenched, thank God. “Neurorecovery is a big frontier in an exciting way, in the way that brain plasticity can recover, and neuroregeneration through spinal cord injury transplant

INTERVIEW

I LOVE IT WHEN I HEAR PATIENTS SAY ‘I DO WHAT I USED TO DO, BUT NOW I DO IT DIFFERENTLY’. OFTEN THEY SAY THEY WOULDN’T GO BACK TO THEIR LIFE BEFORE THEIR INJURY - AND OFTEN THAT’S BECAUSE THEY HAVE DISCOVERED NEW RESILIENCE AND DETERMINATION IN THEMSELVES THEY HAD NO IDEA EXISTED.

of tissue - these things are super new, the data is not yet solid, but the cool thing is that as we have a research unit at Craig, we stay in the game all the way.” But for Jandel, while technology and therapy are of course fundamental in Craig’s offering, the factor that underpins its reputation, outcomes and work is the dedication of its team. “This place is so unique. I’ve never worked in a place which lives and breathes patient and family-centred care like this. A lot of places talk about it, but this is truly standout - and I can say this with 40-plus years in healthcare,” says Jandel, whose background is in obstetrics and gynaecology, and admits a move into neurorehabilitation was “completely off the beaten path”. “It’s team-based care. We have psychologists, PT, OT, speech and language and the ‘angels’ who are the clinical care managers. “I’ll have been at Craig for three years in October and it still feels new. I think that speaks volumes about what a difference it makes to bring your whole self to work, with team mates who bring their whole selves to work. It is a privilege and an honour to serve at Craig. “From the folks in the environmental services team, through to the frontline caregivers, everyone gives their all. Some of the leadership team have been here for 30plus years, they are Craig veterans, and everyone plays their role.” Leading from the front, Jandel is often to be found walking the floors at Craig, getting to know patients and their families and discovering the impact her team’s work is having on their lives. “I love walking the floors and talking to patients, they gush about this place and the relief that washes over them when they come here,” says Jandel. “We hear from families what a wonderful place this is,

INTERVIEW

and I say ‘It was like this when I got here’. “It’s not just about the patient; as with brain injury and spinal cord injury, they are probably going to need an attendant to help them. So we deliver family-centred care. “The patient and family are at the centre of a myriad of services and people that surround that patient, and we customise a care delivery programme. “When I’m walking around, I joke to patients ‘Did we beat you up today?’ They say we have and I say ‘Well, our work is done’. “Craig graduates always come back, many come to get their ‘tune ups’, get their wheelchair checked, and so on. But we offer lifelong care and support for patients and their families, so we do hope they will come back.” As a hospital working at the forefront of neurorehabilitation, but with only 93 beds, Craig is a great believer in the power of empowering people in their own homes and communities, with the COVID-19 pandemic highlighting the importance of enabling that. “I’m interested in what potential lies ahead for distanced medicine,” says Jandel. “With people living longer, we have to think about delivering care for everyone, it’s less about the ages and stages. As an example, spinal cord injury patients do age more quickly, and there are parts that telehealth can enable. “Home health needs a huge lift, people live in tiny communities - how do they access the support and neurorehabilitation they need? This is where their life happens so it’s more natural for people if they can do this where they live. “If we can figure out how that works, then do we need to add a whole ton of new beds? We have to think about these sorts of things. The economics of it would enable us to lessen the burden on resources, while enabling people to be more independent. “Rehab is always going to be part of the deal, so we need to do the right things.” While Craig’s work continues to develop, with ongoing innovation and progress for its patients made by the day, it will continue to hold its place as one of the world’s leading neurorehab centres. But for Jandel, the ultimate dream is that no patients would need to access such a place, and that prevention could get to such a stage that such intensive neurorehabilitation would not be needed. “The big dream is that we wouldn’t need a place like this,” she says. “Nobody wakes up in a morning and says ‘I want to go to Craig’. “We’re in a space now where we’re thinking more about prevention, how to prevent sports injuries, workplace injuries. I think it’s so important to use our voice in the prevention space, alongside the work we’re doing now in treating.”