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WELCOME to the world of MossRehab, where we transform lives while inspiring others We invite you to discover why we rank among the best rehabilitation and research facilities in the nation. Each year we challenge ourselves to go further in our dedication to meeting the rehabilitation needs of our patients, and our success is reflected in everything we do. From providing state-ofthe-art rehabilitation technology to making significant strides each year in the realms of research, education and advocacy, our pursuit of excellence is our promise to our patients, our partners, and our colleagues. In our 2013 Activity Report, you’ll discover an extraordinary culture of committed researchers and clinicians who have generated a remarkable momentum in addressing some of the most pressing problems in our field. MossRehab is a place where new ideas take root and are cultivated in a continual effort to solve complex problems and bring them to clinical care. We keep re-imagining the future, posing the practical and conceptual questions that we believe will make a real-world difference.

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We are eager to share with you our achievements, our knowledge, and our pride in being a longstanding national leader in physical medicine and rehabilitation. It is our hope that you will reach out to us if we can be of service on any front. We believe that engaging other leaders, forging new relationships, and integrating the best ideas is the way to transform the world of rehabilitation. We’re making an impact here and around the globe. We invite you to turn the page to see why.

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Our leaders keep pointing the way to our success In these pages you’ll meet several of the remarkable leaders at MossRehab. At the helm is our Chief Medical Officer, Alberto Esquenazi, MD, who is recognized around the world for his leadership in the field of physiatry. With a deep commitment to patients and colleagues and a steadfast determination to improve public understanding of the role of physical medicine and rehabilitation, he has assumed prominent positions of leadership in this country and abroad, while providing superior guidance at MossRehab. In 2013 Dr. Esquenazi led the American Academy of Physical Medicine and Rehabilitation (AAPM&R) as president during the celebration of the organization’s 75th year. He worked tirelessly during his tenure to ensure that physiatrists have a voice in a wide range of current issues. During this era of health care reform, he brought attention to the pressing need for change in health care delivery and financing, setting an example with model initiatives at MossRehab. Among these was a remarkable patient safety project by MossRehab and Einstein Healthcare Network, which resulted in reducing catheter-associated urinary tract infections by more than 50% in one year and eliminating other types of infections, and concluded with the development of effective training and competency guidelines applied to the six inpatient locations MossRehab serves. During his presidency, Dr. Esquenazi forged strong international relationships, representing nearly 8,000 members of the AAPM&R in the International Society of Physical and Rehabilitation Medicine (ISPRM), and bringing

the voice of the AAPM&R to important global issues. During the recent disaster in the Philippines he promoted U.S. efforts to provide financial support and rehabilitation assistance to facilities in the region that were destroyed by the storm, and scheduled a follow-up visit to the Philippines in 2014. Throughout his career, Dr. Esquenazi has participated in notable national and international dialogues on rehabilitation, such as the roundtable discussion on military issues hosted last year by First Lady Michelle Obama. In 2013, he began the final year of his six years of service as a member of the NIH subcommittee on Function, Integration, and Rehabilitation Sciences (FIRS). Outside the U.S., he is a member of the executive committee of the ISPRM, and the author of numerous international peer-reviewed articles. At MossRehab, Dr. Esquenazi is the first John Otto Haas Chair in Physical Medicine and Rehabilitation, a role made possible by a generous grant from former patient John Otto Haas and his wife Janet, a former MossRehab physiatrist. Dr. Esquenazi is responsible for overseeing the endowment, which has been allocated exclusively for education and development of rehabilitation.

MOSSREHAB LEADERSHIP Chief Medical Officer Alberto Esquenazi, MD

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These are just some of the accolades we received in 2013 One of the nation’s best

Our employees said it again this year

hospitals, for the 20th year

“MossRehab is a great place to work”

In 2013, MossRehab was once again ranked #9 in the country and #1 in Pennsylvania, by U.S.News & World Report.

MossRehab was ranked for the third consecutive year as one of Philadelphia’s Best Workplaces by the The Philadelphia Inquirer and the Philadelphia Daily News.

Top Doctors in Philadelphia Four of MossRehab’s physiatrists were ranked among Philadelphia magazine’s Top Docs in 2013 — Alberto Esquenazi, MD; Nathaniel Mayer, MD; C.R. Sridhara, MD; and Thomas Watanabe, MD.

Better Patient Outcomes Patient outcomes continue to be an important measure of MossRehab’s success, and ours consistently register better compared with regional and national averages for most groups we treat.

Philadelphia magazine also honored Dr. Esquenazi by naming him a 2013 Health Hero finalist.

Indicator/Metric

MossRehab Outcome

Benchmark

Discharge to Home

73.35 %

72.36 %

Funtional Independence Measure (FIM®) Change

27.82 points

24.59 points

Average Length of Stay

15.73 days

15.0 days

FIM® Efficiency

2.4 points per day

2.08 points per day

Unplanned Transfer to Acute

11.5 %

10.81 %

Case Mix Index

1.3906

1.2914

Source: eRehabData® NationalComparison

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Leadership & Recognition

MossRehab is honored to be recognized on so many fronts for excellence in physical medicine and rehabilitation. Recognition is a tribute to our outstanding staff and the ongoing commitment to advances in research, rehabilitative technology, and patient outcomes.


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devotion to our patients drives us to be first Among high-ranking rehabilitation facilities, we have a reputation for residing at the forefront of technology. We’re known for eagerly adopting leading-edge equipment that has proven its value in sophisticated new clinical applications. Several leading manufacturers have come to regard us as a partner in technological advancement and clinical integration, and as a showcase for innovative rehabilitation equipment. In November 2013, MossRehab became the first rehabilitation facility in the U.S. to offer the TYROMOTION ROBOT collection We’re excited to be able to offer these devices to our patients who may benefit from robotic interventions that target the upper extremities. The four versatile robots that comprise this collection, named after four famous artists, enable patients to undergo a series of robot-assisted exercises that deftly address different segments of the upper body. At MossRehab we deploy these robots in our clinics, which are dedicated to specific diagnostic groups. After training on the Tyromotion systems, our therapists across all neurological groups (stroke, spinal cord injury and brain injury) collaborated to determine how these robots would best fit the needs of our patients. We use Diego® to assist our patients in arm exercises that are difficult for patients with neurologic or orthopedic problems. Equipped with easily adjustable arm slings, this robot trains and tracks their movements in three-dimensional space.

® The Pablo system allows our patients to engage in a greater variety of advanced movements, depending on their level of function and activity.

The Diego® system

With the Tymo® system we help our patients improve balance and postural control, and active exertion in the upper extremities. Our patients especially enjoy the therapy modules in the form of games. The Pablo® system

We use Amadeo® for our patients with motor dysfunctions of the hand and wrist. Our therapists select from different modules based on progress made during therapy and are able to program passive, assistive or active movements.

MossRehab robots help our therapists help our patients

The Tymo® system

Our robots function as therapeutic aids but are not intended to reduce the human involvement that is so critical to the rehabilitative process. At MossRehab robots help our clinicians deliver more precise and repetitive treatment. With these advanced systems we can proudly offer unique benefits to both patients and their therapists. The Amadeo® system

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Technology

MossRehab is the first rehabilitation facility in the U.S. to offer the G-EO System Evolution Clinical care at MossRehab rose to a new level with the installation of the G-EO System Evolution, a new robotassisted gait rehabilitation tool. Our patients benefit enormously from this robot, which is capable of simulating three kinds of movement — walking, step climbing and descent. The G-EO Evolution provides enhanced feedback, giving training at MossRehab a level of sophistication that helps to set us apart from other rehabilitation facilities. The robot actively responds in real time to patient capabilities and the patient gradually gains the ability to walk with increasing independence, eventually allowing G-EO-independent motion.

In 2013, we enhanced our patients’ experience by installing the G-EO System Virtual Scenario This new addition allows our patients to enjoy virtual visual environments while engaging in repetitive walking. Patients experience simulated scenery that evokes pleasurable activities such as long walks along winding wooded trails or a city plaza. Our patients tell us that these virtual scenarios help to lighten the arduous journey to recovery, making the challenge of rehabilitation just a little more enjoyable. We encourage you to view more of our rehabilitation robots at MossRehab.com.

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Our patients inspire us

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That’s why we consider them our partners. We walk alongside them on their journeys and watch in awe as they navigate extraordinary situations with courage and endurance. Their confidence in our treatments keeps refueling our commitment. Their passion to give back by encouraging other patients is humbling. For these reasons we are honored to partner with them in a range of unique therapeutic programs and events. This year we received the Outstanding Special Event Award® for partnering with the Philadelphia Museum of Art This annual award, bestowed by the Pennsylvania Therapeutic Recreation Society, recognizes organizations that sponsor therapeutic events of exceptional benefit to the community. In MossRehab’s Outpatient Art Therapy Program, our special collaboration with the Philadelphia Museum of Art provides a powerful creative outlet for our patients. Specially trained guides lead participants through a selection of the museum’s collection for encounters with inspiring and renowned works of art. In follow-up art therapy sessions, MossRehab patients give artistic form to their own challenges and changing sense of identity as they cope with physical and cognitive limitations. Displays of our patients’ artwork at the Philadelphia Museum of Art and at MossRehab reflect the transformational journeys we are privileged to facilitate.

Our focus is always on our patients’ potential So we support unique therapeutic programs that help our patients realize new dreams. For the second year, MossRehab partnered with the Life Rolls On organization for their annual “They Will Surf Again” program, giving veteran and novice surfers with spinal cord injury the opportunity to surf on modified boards. In June 2013, 45 MossRehab therapists

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volunteered as part of this boundary-pushing program that gives persons with spinal cord injury a rare opportunity to transcend their limitations. See more at MossRehab.com. Our extraordinary Camp Independence, an overnight camp for adults with physical disabilities, fills a vital need for patients who have no other opportunity to interact with peers outside of an institutional setting. This week-long camp dramatically expands our patients’ worlds with daytime activities such as swimming, hiking, basketball, archery, decathlon competition, fishing, arts and crafts, and creative writing, and evening events such as a talent show, drama skits, movies, and dancing. Camp Independence benefits patients with a range of physical abilities. Activities are tailored to accommodate a wide spectrum of physical involvement, and our staff is trained to keep campers safe as they stretch their limits. Some campers have been returning for more than 20 years, and most look forward all year long to this unique opportunity to enjoy nature and develop new friendships. Our one-of-a-kind All About Art audio tour features ten artists from the MossRehab permanent art collection, whose work in a diverse range of mediums provides vibrant and inspiring examples of fine art within the context of rehabilitation. Open to all patients and visitors of our main MossRehab campus, the audio tour guides viewers through selected artwork with handheld audio equipment or with our new cell phone app. Our collaboration with Q-Media on this superb audio tour of the lives and work of artists with disabilities has culminated in a rich interactive experience that deepens the visitor’s appreciation of the artwork and the artist’s ability.

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patient care At MossRehab we are leaders among state and national provider organizations when it comes to meeting with members of Congress and the Senate to discuss improving patient care, designing future rehabilitative programs, and ensuring proper access to and payment for rehabilitative services. On behalf of all individuals requiring rehabilitation, we work diligently to influence policy-making that affects our patients’ lives. MossRehab’s Chief Operating Officer, Ruth Lefton, FACHE, frequently shares her invaluable perspective with legislative decision-makers. She has dedicated herself to ensuring that individuals with disabilities are able to receive care in their community settings whenever possible. In honor of her outstanding leadership and advocacy endeavors, Lefton was recognized by the American Medical Rehabilitation Providers Association (AMRPA) with the Leadership Excellence Award at their annual meeting in September 2013. This prestigious award is bestowed on individuals with lifelong service in the field of physical medicine and rehabilitation who implement transformative leadership initiatives, advocate locally and nationally, mentor future leaders while encouraging research and education, and are dedicated to improving patient outcomes.

Patient Partnership & Advocacy

We know that policy impacts

MOSSREHAB LEADERSHIP Chief Operating Officer Ruth Lefton, FACHE

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Outstanding research informs our success MossRehab’s renowned research is expertly guided by John Whyte, MD, PhD, director of the Moss Rehabilitation Research Institute (MRRI). The recipient of numerous national awards for his exceptional work in research and education, he steers groundbreaking research that places an emphasis on advances in the field of traumatic brain injury. MRRI operates one of only 16 Traumatic Brain Injury Model Systems (TBIMS) in the U.S. Directed by Tessa Hart, PhD and co-directed by Dr. Whyte, the TBIMS at MossRehab uses a rich network of collaborations to achieve ambitious goals in research and dissemination, with the ultimate aim of providing advanced treatments for individuals with TBI. With three level-one trauma centers and the nationally recognized Drucker Brain Injury Center, the TBIMS at MossRehab offers a full spectrum of high-quality treatment, including superior emergency, acute trauma, and neurosurgical care. MOSSREHAB LEADERSHIP Director of Moss Rehabilitation Research Institute John Whyte, MD, PhD

In 2013, we launched several exciting new TBIMS national module studies that focus on a wide range of topics, including: The effect of statin drugs on TBI recovery — Lead investigator, Dr. Whyte. To date, neuroprotective drugs have not demonstrated an improvement on outcomes after brain injury. This study will expand on findings from several animal studies and small human trials that suggest statins may have a beneficial effect on recovery after brain injury. This study seeks biological evidence that statins offer neuroprotection, with the hope that subsequent prospective studies may help determine the impact of early introduction and withdrawal of statins, and the overall effect of statins on patient outcomes. The development of a unique tool to gauge hidden gradations of brain injury and recovery — Co–lead investigators, Dr. Whyte and Joseph Giacino, PhD (Spaulding). Inspired in part by implications of their impressive 2012 NEJM publication on the effects of emerging treatments on neuroplasticity and functional recovery, the co-investigators of this study are examining the complexity with which the pace of rehabilitative recovery can and must be described. This critical study examines the inadequacy of current measures of rehabilitative progress by confronting floor and ceiling effects to develop an indispensible new yardstick.

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Topics of pioneering MossRehab publications in 2013

NIH grants support innovative research at MossRehab Our dedication to our patients and to advanced research has been rewarded by numerous NIH grants, which allow us to explore unique solutions to persistent problems in rehabilitation. In just one of our current clinical trials, lead investigator Tessa Hart, PhD is examining an innovative treatment for anger among patients with postacute traumatic brain injury (TBI). Problematic anger and irritability are common after TBI, and exist across the spectrum of injury severity. Our multi-center clinical trial is designed to test a novel treatment approach called Anger Self-Management Training (ASMT). The ASMT is a promising individual, psycho-educational intervention based on principles of self-monitoring and problem-solving.

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We’re elevating the visibility of rehabilitation psychology In 2013, Tessa Hart, PhD ably represented MossRehab as President of the Division of Rehabilitation Psychology (Division 22) within the American Psychological Association. A leader at home and abroad, Hart was also invited to deliver a keynote address at the 2013 Brain Injury Rehabilitation Trust (BIRT) conference in the United Kingdom. At BIRT’s 5th international conference in London, she joined world-renowned speakers on research and strategies for the treatment and rehabilitation of acquired brain injury, delivering a keynote address entitled Outcome Measures in Brain Injury Rehabilitation: Challenges and Solutions.

Disorders of consciousness. Dr. Whyte and colleague Risa Nakase-Richardson, PhD edited a special collection of articles on disorders of consciousness, published in the October 2013 issue of Archives of Physical Medicine and Rehabilitation. This collection brings awareness to the discovery that meaningful recovery proceeds for longer intervals than previously appreciated, and that many complex comorbidities require expert management. Together, these findings suggest the need to redesign the care system for this population. Treatment taxonomy. John Whyte, MD, PhD, Tessa Hart, PhD and other MossRehab researchers, along with colleagues from Mt. Sinai collaborated on a special issue of Archives of Physical Medicine and Rehabilitation that addresses the critical need for a detailed taxonomy to classify treatments for improved interdisciplinary communication in research, practice, and training. This collection, which examines one of the most pressing conceptual and practical issues in rehabilitation, is scheduled for publication in 2014.


Research

We foster excellence in others through education

At MossRehab, we don’t stop with groundbreaking research, we transmit paradigm-changing ideas to others through our unparalleled educational programs. We have a deep appreciation for education, and take seriously our calling to share knowledge with professionals and members of the rehabilitation community around the world. MossRehab takes pride in thought leadership In 2013, we joined colleagues in establishing a new educational vehicle for sharing expertise in the management of complex conditions. At the 75th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation, MossRehab physiatrists Thomas Watanabe, MD, Clinical Director of the MossRehab Drucker Brain Injury Center and Michael Marino, MD, Attending Physician at the Center, participated in the inaugural Thought Leader Presentations. They presented on managing behavioral problems after acute traumatic brain injury.

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At MossRehab, we value innovative forms of communication In 2013, we proudly launched Medcast, the educational podcast series for professionals. These podcasts offer clinical information in key areas, including emerging diagnostics, treatment interventions, and rehabilitation research. This library of presentations by renowned physiatrists and scientists is available on the MossRehab website. We invite our colleagues to download the podcasts for free on iTunes. Among the most popular of these has been the Medcast session entitled Ulnar Nerve Electrodiagnostic Techniques to Localize Entrapment Site. We’ve also developed podcasts for patients and caregivers. Our Living Beyond Disabilities podcasts demonstrate how we partner with our patients to tackle challenges in their lives. Current topics include Understanding the Psychology of Recovery, Returning to an Active Lifestyle, and Rescuing Digital Outcasts.

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and it shows

The Temple/MossRehab Residency Training Program, our long standing collaboration with Temple University, is fertile ground for residents to develop critical thinking and become leaders in clinical rehabilitation, research, and education. In this program, residents have the opportunity to learn from mentors who are publishing seminal works and use revolutionary equipment. The program gives residents the confidence to manage complicated situations and become future leaders in rehabilitation. Dr. Esquenazi and eight other MossRehab resident and staff alumni have served as presidents of the AAPM&R or provided leadership to the Association of Academic Physiatrists. Our residents gain invaluable experience by translating training into practical, high-impact protocols. In 2013, MossRehab developed new catheter-associated urinary tract infections (CAUTI) prevention protocols for medical staff and residents, which led to a marked reduction in hospital-acquired CAUTI rates. In 2013, one of our recent residency program alumni, Daniel Moon, MD, began his 12-month fellowship in neurorehabilitation with an emphasis on spasticity, gait analysis, and movement analysis. After rotating through the two functional assessment laboratories (Sheerr Gait and Motion Analysis Laboratory and Motor Control Analysis Laboratory) and the intrathecal pharmacology program, he will complete a clinical research project and draft a paper to publish his findings.

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Education

We take training seriously,

We host visionary professional conferences MossRehab has a rich history of sharing its expertise with rehabilitation professionals at large through educational programs and conferences. We gather audiences every month to explore topics such as clinical care advances, rehabilitative technology, and research in spinal cord injury, stroke, TBI, and amputation. In 2013, we hosted two major conferences on spinal cord injury and brain injury rehabilitation. Information on upcoming educational programs is available at MossRehabConference.com.

MossRehab is proud to be an international model for education and training Each year, our pioneering training and education program attracts many international visitors. In 2013, 20 professionals from 14 different countries traveled to MossRehab to glean ideas and acquire clinical training to share with their colleagues. Two groups from Korea and China spent several days studying our methods, systems, and processes to develop new private and governmental programs of rehabilitation. Funds from the John Otto Haas grant allow MossRehab professionals to engage in learning abroad as well as host national and international programs at home.

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We keep defining what it means to move forward

Indeed, we’re hosting a conversation about the future. We’ve been asking experts around the country to share their perspectives on what the future holds for the field of physical medicine and rehabilitation, by posing the following question:

Looking ahead 10 years, what do you think will be the most exciting changes to impact physical medicine and rehabilitation? Some fascinating videotaped responses are already available at MossRehab.com. We invite our colleagues to visit this unique forum for experts and join in the conversation by creating and uploading their own one-minute video response. For details and easy instructions, please visit MossRehab.com/ conversation-about-the-future.

Our thought leadership will continue in 2014 and beyond In February of 2014, John Whyte, MD, PhD and Tessa Hart, PhD will conduct a continuing education workshop, Clinical Trials in Neuropsychological Rehabilitation: Challenges and Solutions, at the 42nd annual meeting of the International Neuropsychological Society in Seattle. Alberto Esquenazi, MD will lecture at the 40th anniversary of the Philippines Society of Physical Medicine and Rehabilitation. Dr. Whyte will provide the keynote address at the 2014 International Brain Injury Association Tenth World Congress in San Francisco, and co-chair a symposium with colleague Joseph Giacino, PhD. Dr. Whyte has been invited to serve on a committee of the American Speech-Language-Hearing Association to develop treatment taxonomy in speech-language pathology. In early June 2014, as Chair of the Program Committee, Dr. Esquenazi will also host the meeting of International Society of Physical and Rehabilitation Medicine in Cancun, Mexico.

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MossRehab is greeting

peer-reviewed publications

the future with growth

Our first scheduled publication, already available on PubMed, is an inspiring article by Dr. Esquenazi on gait analysis, with methods for selecting interventions and prosthetic components to optimize gait.

We’ll be unveiling a therapeutic greenhouse

Esquenazi A. Gait analysis in lower-limb amputation and prosthetic rehabilitation. Phys Med Rehabil Clin N Am. 2014 Feb;25(1):153-67.

We’re asking new questions in 2014 Can Cell Phones and Text Messaging Enhance Patient Outcomes? We’ve launched some thought-provoking new studies to find out. Tessa Hart, PhD is examining how widely available technology can be used to help patients recover from a variety of emotional disorders related to brain injury. We expect to share our progress in the 2014 issues of Inside MossRehab, our quarterly newsletter.

In early 2014, we will open the Sachs Therapeutic Conservatory, funded by a generous donation from Herb and Alice Sachs. The spectacular indoor-outdoor four-season glass structure will be used for relaxation, reflection, and therapy. The conservatory design will showcase several distinct areas with a variety of beautiful plants, water, and calming pipedin music. A dual-certified horticulturist and horticultural therapist will oversee a range of therapeutic interventions.

Looking Forward

We’ve prepared exciting 2014

And we’ll continue to expand in 2014 and beyond A new outpatient site scheduled to open in Collegeville, Pennsylvania this spring will bring the total number of MossRehab inpatient and outpatient locations to 26. Our expansion is just one sign of success that we are happy to share with our guests. We invite you to visit our facilities.

We’re looking forward to engaging our local community In the fall 2014, the MossRehab Traumatic Brain Injury Model System will offer an education and networking conference in center city Philadelphia for people with brain injury and their families. Professionals and individuals affected by brain injury will take an active role in many of the workshop offerings.

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MossRehab.com

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1-800-CALL MOSS

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2013 MossRehab Activity Report