Remembering PM&R Founding Chair The Department of Physical Medicine & Rehabilitation at the University of Michigan would not be what it is today without the contributions of our founding chair James W. Rae, M.D., who passed away on January 7, 2013 at the age of 95. His experience as a U-M basketball team captain when he was an undergrad certainly informed his approach to team building, especially as he led the Universityâ€™s efforts to establish the PM&R department in 1950. In addition to his leadership role in the growth and development of rehabilitation services at U-M, he also contributed extensively to the training of medical students, physical therapy students and residents. He believed strongly in the role of outreach in the community, establishing many clinics throughout the state served by U-M faculty and staff until his retirement in 1975. He will long be remembered for his vision and numerous contributions to the field of rehabilitation medicine, most especially at the University of Michigan.
Leadership Dear Colleagues: The field of Physical Medicine and Rehabilitation is undergoing great change, with new technologies and demands for new models of care driven by changes in how health care will be delivered in the future. However, our values remain the same. Physiatrists and other rehabilitation professionals are dedicated to improving the function and quality of life to individuals with disability due to pain, biomechanical dysfunction and neurologic deficit. As Department Chair of PM&R at the University of Michigan, I am privileged to work with international leaders in clinical care and rehabilitation research who are helping to define these changes. We have exciting new programs in robotics and other technologies as well as cutting-edge research in the improvement of spine care delivery and spinal cord management. We also have many faculty who are well-recognized for their clinical and academic contributions to the field and for their excellence as educators. All of this combines to produce what we like to call â€œthe Michigan Difference.â€? It makes Michigan the first choice for rehabilitation care, from the most common sports injury to the most complex ventilator dependent post-trauma case. I am proud of this department, and the great work that it does every day to increase the knowledge in our field and to train new rehabilitation professionals. However, I am most proud of the outstanding rehabilitation care that patients receive from an outstanding multidisciplinary team of professionals every day. I am pleased to present this brochure that highlights our latest activities, and I hope you will enjoy reading about the exciting developments in our department.
Dr. Hurvitz with the Lokomat ÂŽ. Expansion of robotics and other high-tech innovations is a major goal for U-M Physical Medicine & Rehabilitation.
Edward A. Hurvitz, M.D. Chair, Department of Physical Medicine and Rehabilitation
PM&R overview The University of Michigan PM&R multidisciplinary team includes:
• Physicians • Psychologists • Physical therapists • Occupational therapists • Orthotists & prosthetics • Rehabilitation engineers • Physician’s Assistants &
Clinical Nurse Specialists
National Leadership in Physical Medicine & Rehabilitation The Department of Physical Medicine and Rehabilitation at the University of Michigan provides expertise and a breadth and depth of services across all aspects of physical medicine and rehabilitation. We are dedicated to improving function and mobility whether through patient care, research into new modalities and treatments, and educating tomorrow’s providers.
Faculty Highlights Our department features outstanding faculty producing the highest quality work. Two of our colleagues were recognized this past year for their efforts in advancing the field of physical medicine and rehabilitation. 2012 Walter J. Zeiter Lectureship: Anthony Chiodo, M.D. The American Academy of Physical Medicine and Rehabilitation selected Dr. Chiodo to receive the Walter J. Zeiter Lectureship for 2012. This award honors members of the Academy who have demonstrated statesmanship, scholarship, executive leadership, and warm friendship to their
colleagues through their accomplishments and contributions to PM&R. The Zeiter lecture is presented during the American Academy of Physical Medicine & Rehabilitation Annual Assembly. Dr. Chiodo is co-director for U-M Spinal Cord Injury Model Systems and has been the clinical director of Spinal Cord Injury Medicine at the University of Michigan since 2002. Dr. Chiodo is the primary attending physician for Spinal Cord Injury services in the U-M Adult Rehabilitation Unit and coordinates all clinical services there. He is an active Spinal Cord Injury researcher and has published several manuscripts. He was also honored with the Distinguished Clinician Award from the American Academy of Physical Medicine and Rehabilitation in 2011. 2012 Distinguished Clinician Award: M. Catherine Spires, M.D. Dr. Spires is the fifth faculty member at the University of Michigan to be awarded the Distinguished Clinician Award by the American Academy of Physical Medicine and www.med.umich.edu/umhs/health-providers
Rehabilitation. This award is presented to individual physiatrists who have achieved distinction on the basis of their scholarly level of teaching and their outstanding performance in patient care activities. Dr. Spires exemplifies these qualities through her clinical and research efforts in children born with Brachial Plexopathy, lower extremity amputation, burn injury and education.
Technology and Clinical Care At the University of Michigan, we provide the highest quality rehabilitation therapies for patients with functional mobility challenges. Our in-depth expertise combined with innovative robotic and other high-tech therapies offer referring physicians and their patients the most comprehensive options available to encourage functional recovery, improvements in mobility and coordination, and advances in all areas of function. PM&R therapy services are available in several locations, including Ann Arbor, Canton and Brighton. Our occupational therapists work with children and adults, with specialized programs in neurorehabilitation. For pediatric patients, we offer specialized programs for cerebral palsy, spina bifida, injuries, developmental delays, and many others. M-LINE 800-962-3555
We also treat spine and musculoskeletal disorders as part of our Musculoskeletal Services at U-M (see page 10). Our services include robotic interventions such as the Lokomat®, a robot-assisted walking therapy device that gives patients consistent, repetitive practice of movement to help develop or retrain neurologic pathways. Other devices such as the ReWalk™, a wearable bionic suit, and the Bioness® rehabilitation systems help replace lost function and allow for increased mobility. Virtual reality devices, including those commercially available like the Nintendo ® Wii™ system, work to improve coordination patterns. There are several programs our patients use to increase cognitive skills as well. The University of Michigan Health System is planning to develop a robotic and high-tech rehabilitation center that will expand our capacity to offer these services. The Lokomat is currently located in our MedRehab facility. The other technologies listed above are also available in MedRehab, in addition to the Milestones pediatric outpatient facility, and at the University Hospital for inpatient use.
PM&R Department Highlights
Faculty • Staff •
NIH Funding National Ranking •
Spinal Cord Injury Model System • 27
Patient Care Volumes Inpatient Discharges • Outpatient Visits (including therapy) •
uring the last few years we have D witnessed unprecedented growth in biotechnology and related high-tech devices designed to improve the health and function of those who live with physical limitations at every level. These advances provide solutions to the many challenges faced by those with disabilities, chronic illnesses, injuries and other conditions.”
Research Highlights Technology Aids in Advancing Rehabilitation Research and Clinical Care PM&R at the University of Michigan has a long history as a leader in rehabilitation research. We focus on maximizing technological advances to improve the lives of patients throughout the community and around the world. This research is enhanced by our Rehabilitation Outcomes and
Advancing Robotic Rehabilitation through Research
— Denise G. Tate, Ph.D., ABBP, FACRM Associate Chair for Research and co-director of the Spinal Cord Injury Model Systems
Robotic therapies provide innovative methods of improving mobility in cerebral palsy, spinal cord injury, stroke and many other diagnoses.
Assessment Research Center, directed by David Tulsky, Ph.D., which has contributed to the development of the PROMIS, SCI-Quol, and other measures that are critical in understanding the effects of new technology for our patients. We continue to succeed in leveraging our talents to advance physical medicine and rehabilitation research at our institution and beyond.
Our Rehabilitation Robotics core includes 11 faculty from Physical Medicine & Rehabilitation, Engineering and Kinesiology. Chandramouli Krishnan, Ph.D., M.A., P.T. is part of this core, and he has focused his research on the use of novel control algorithms for the gait rehabilitation robot Lokomat ®. The control algorithm provides the ability to tune the robot’s interaction with the subject based on their capacity to initiate movements. The developed control algorithm has been implemented on the Lokomat housed at U-M’s Medical Rehabilitation Facility, making the University of Michigan one of the few centers in the world to have such an advanced robot.
Sports Concussion Dr. Krishnan’s research provides new methods to encourage active patient participation during robotic rehabilitation, which is a key component in motor learning and recovery after a neurological injury such as stroke. Recent papers from Dr. Krishnan’s lab provide preliminary evidence on the benefits of active robotic training in facilitating gait recovery after stroke. Dr. Krishnan also researches the use of noninvasive brain stimulation as a potential therapeutic adjuvant for facilitating functional recovery after an injury or insult to the neuromusculoskeletal system. He is currently looking at the best ways to combine noninvasive brain stimulation with robotic rehabilitation to facilitate therapeutic outcomes. In collaboration with engineering faculty at the University, Dr. Krishnan is also working to develop a new class of wearable robots that have the potential to improve the quality of life for millions of individuals suffering from mobility and movement disorders.
Pioneering Brain-Computer Interface Research at U-M Jane Huggins, Ph.D., is one of the co-founders of the Direct Brain Interface (DBI) project that investigates brain-computer interface (BCI) using EEG signals to control computers and other devices. The DBI project is closely connected to, with assistive technology service delivery through, the Rehabilitation Engineering Program’s clinical service. The goal of this project is to improve BCI technology and clinical availability for people with physical impairments. U-M DBI has been funded in part by the National Institute on Disability and Rehabilitation Research and the National Institutes of Health. For more information on the Direct Brain Interface project, visit www.umich.edu/~umdbi
Sports-related concussions are a common occurrence. James T. Eckner, M.D., M.S. is one of several researchers at the University of Michigan who are investigating this serious and often underreported injury. As a resident, Dr. Eckner worked with mentor James Richardson, M.D. to examine a clinical assessment tool of reaction time called the RTclin, which led to an article about the effect of concussion published in the British Journal of Sports Medicine. Currently, Dr. Eckner is working with other researchers and the Biomechanics Research Lab to analyze the relationship between neck girth and the head’s response to external forces. Dr. Eckner is also a co-investigator on two studies: an industry-sponsored review of a novel EEG-based tool and a longitudinal, multi-site study that is currently recruiting high school and college athletes with the ultimate goal of determining the effect of concussions later in life.
Using a brain-computer interface to operate assistive technology. M-LINE 800-962-3555
Research Highlights Technology Aids in Advancing Rehabilitation Research and Clinical Care
Research Highlights Grant Awards
$3.1 million 23 grants NIH Department Ranking
Video Game Aims to Teach Teens How to Manage Spinal Cord Injury Traumatic spinal cord injury (SCI) affects about 259,000 individuals in the U.S., with nearly 12,000 new injuries each year. About half of these new injuries occur in mostly men between the ages of 16 and 29 years old, and their SCI is often the first time they have experienced the need for serious medical care. These individuals are told that they have to perform many new behaviors to adequately manage their SCI, including shifting their weight, and planning and implementing a schedule to empty their bowels and bladder. Michelle Meade, Ph.D., is a PM&R researcher whose primary interest is the self-management of health among individuals with disabilities. She had developed a program called Health Mechanics, but soon realized that the audience who most needed it were unlikely to learn about it through reading a manual or attending in-person sessions. She began looking into video games and other technology-based interventions as a way to tailor Health Mechanics for the high-risk population of adolescents and young adults
with SCI, and eventually teamed up with programmers and artists at U-Mâ€™s 3D Lab. They were awarded a grant from the National Institute on Disability and Rehabilitation Research and the U.S. Department of Education to study the use of video game technology to promote key skills for managing SCI to teens. By meeting this target group where they are and leveraging their high degree of technical sophistication, Dr. Meade and her team created SCI Hard, a health video game that is designed around SCI self-management skills. Games such as SCI Hard are one way to teach patients the importance of engaging in these behaviors (and see the consequences
SCI Hard video game screen capture along with the gameâ€™s
of not performing them) in a non-threatening environment. While there is currently not enough data to support that playing a game will change behavior, SCI Hard is designed to improve knowledge and confidence, normalize and promote self-management behaviors, and reduce secondary conditions and health care costs associated with SCI. Dr. Meade expects to begin recruiting research participants in April 2013. Participants will be asked to play the game at home over a two-week period and then provide their feedback about it. Ultimately, her goal is to help patients optimize their health in a format that works best for them.
Department of Defense Funds U-M PM&R Research Project on Spinal Cord Injury Denise G. Tate, Ph.D. is the principal investigator for a DOD-sponsored research initiative to explore the psychosocial and behavioral factors associated with bowel and bladder management after spinal cord injury (SCI). Loss of function associated with bladder and bowel are rated at the top of the list of problems that influence quality of life for persons with SCI, their families and caregivers. These issues can be especially difficult for the men and women in the military. Used to very active lifestyles and need for quick action, loss of physical function along with independence with bladder and bowel can cause a severe blow to oneâ€™s already fragile selfesteem. In order to better understand these issues, Dr. Tate proposes to examine factors related to bladder and bowel complications, and to study the impact of these on quality of life through individual and focus group interviews.
Study findings will not only identify clinical care priorities for persons with SCI, they will also contribute to current clinical practice guidelines for bladder and bowel management by highlighting the role of behaviors and other factors in successful management.
Education Highlights Excellent Educators in PM&R by the Numbers PM&R in Training Residents • 22 Fellows & Post-doctorates •
PM&R Training Programs Residents • 2 Fellows & Post-doctorate •
Notable Graduates Dan Barry, M.D., Ph.D. (Residency 1985) Robotics Inventor, Astronaut, Survivor Contestant
Michael Boninger, M.D. (Residency 1993) Chair PM&R and Assistant Dean, UPMC
James Leonard, M.D. (Residency 1975) Former Chair PM&R, U-M Medical School
Kate Stolp-Smith, M.D. (Residency 1986) Former Chair, PM&R, Mayo Clinic
On January 23, 2013, the University of Michigan Medical School inducted its initial members of the League of Educational Excellence. The League recognizes outstanding achievement in medical education in the faculty, honoring those who exemplify one of our most cherished values: educating the next generation of physicians and care providers. These faculty members have demonstrated their commitment to this mission through their innovative and tireless efforts to continuously improve curriculum content and delivery, advocate for their specialty, develop their role within the greater community and effectively mentor students to their highest potential.
Joseph Hornyak, M.D., Ph.D. Associate Professor Dr. Hornyak has developed an impressive record of teaching and research mentorship among the resident physicians. Dr. Hornyak has received the coveted Silver Crutch Award for resident teaching four times. His name is frequently mentioned as a mentor on Ted Cole Day, when residents present their research. Dr. Hornyak also interacts with undergraduate and graduate students in Kinesiology and in the Health Sciences Scholar program.
The Department of PM&R was proud to celebrate the induction of three of our faculty members into the League:
James R. Richardson, M.D. Professor Dr. Richardson has won the Silver Crutch Award so many times that the residents have retired his name and awarded him a Platinum Crutch as permanent recognition of his teaching skills. Dr. Richardson also gives highly appreciated lectures to medical students during their
pre-clinical years. He is known for his poetry, humor, and an outstanding ability to make difficult concepts interesting and fun. He is a sought-after research mentor and requested speaker nationally as well. M. Catherine Spires, M.D. Professor Dr. Spires has served as director or associate director of the residency program for more than 20 years. She recently graduated her 100th resident. Along with being a valued clinical teacher, she is a highly respected career mentor for residents and junior faculty. She is a leader in PM&R education on a national basis, chairing committees and serving as an editor for the American Academy of Physical Medicine and Rehabilitation Knowledge NOW program.
U-M PM&R Resident Participates on Expert Review Panel for The Centers for Medicare & Medicaid Services Michael Wheaton, M.D., PM&R chief resident, recently participated on an expert review panel to evaluate bundled payment proposals for the Center for Medicare and Medicaid Innovation (CMMI) and the Centers for Medicare & Medicaid Services (CMS). This panel is part of an effort by CMMI and CMS to work in partnership with providers to redesign the delivery of healthcare and develop innovative models of bundling payments for these services. Dr. Wheaton, along with other healthcare professionals including physicians, nurses, hospital and healthcare administrators, health policy experts and public policy professors, served on the committee to review pilot proposals under Model 4, which includes all services furnished during an inpatient hospital stay. The
proposals were assessed based on overall feasibility, cost savings to Medicare and care redesign strategies that health care providers would make to improve the quality of care and the patient care experience. Each member of the panel took the lead role as primary reviewer on several proposals, secondary reviewer on several and then they voted as a group to recommend changes or to reject an individual proposal. Dr. Wheaton said, â€œMy goal in participating in this review process was to learn as much as I could about the future of healthcare redesign for Medicare and Medicaid, and effectively advocate for the importance of this continuum in healthcare and in the rehabilitation process. I also wanted to deepen my knowledge of these expected changes in healthcare delivery that will hopefully place the University of Michigan ahead of the curve.â€?
Clinical highlights Musculoskeletal Services at U-M University of Michigan Health System offers a complete spectrum of medical, surgical and rehabilitative services for musculoskeletal conditions, addressing everything from disease prevention to the treatment of complex disorders.
• Back, Pain and Spine Services
• Bone and Joint Services • Geriatric Services • Radiology Services • Rehabilitation and Therapy Services
• Sports Medicine Services
Musculoskeletal Services at the University of Michigan provides comprehensive services for patients seeking care for conditions affecting bones, joints, muscles and connective tissue, including back and spine. We believe that an interdisciplinary approach to musculoskeletal health, where specialists with different backgrounds work together, provides the optimal care for each individual patient. Our experienced teams include more than 110 physicians who provide more than 300,000 outpatient visits a year along with thousands of surgeries and medical procedures. Our experts treat a wide range of conditions from sports-related trauma to rheumatic diseases, bone fracture to pain management and prosthetic care, total joint replacement to repetitive stress syndromes. In addition, extensive and effective rehabilitation services are available and include physical, occupational and sports medicine therapies. Patients are also provided with some of the most advanced diagnostic imagining technology available.
Collaboration for Patients Better Patient Care and Cost Savings When Physiatrists and Surgeons Work Together Andrew Haig, M.D, founding director of the University of Michigan’s internationally known Spine Program, published an article in the February 2013 issue of Spine that provides details about a recent study he completed in conjunction with Priority Health, a Michigan-based insurance company. While it is widely known that Americans undergo more back surgery than any other country, it was not known how patients who have been referred for non-emergency back surgery would benefit from a pre-surgical consultation from a physiatrist. For the purposes of this study, Priority Health developed a program that would require patients referred for non-emergency back surgery to see a physical medicine and rehabilitation spine specialist first, however
they did not have to follow any of the PM&R doctorâ€™s advice. It turned out that consultations with the PM&R doctors decreased back surgery rates in that region by a third, and a survey of these patients showed that they remained very satisfied with care. Most spine surgeons work in isolation from PM&R specialists. However many programs around the country, including some at the University of Michigan, have both physiatrists and surgeons working together. This collaboration makes the surgeonâ€™s life more efficient, and provides patients with a balanced perspective on their treatment choices. The results of this study demonstrate that a mandatory physiatrist consultation prior to surgical consultation resulted in decreased surgical rates and continued patient satisfaction across a large region. Interestingly, although it might be assumed that physiatrists who worked for surgeons would be biased towards surgery, it turned out that surgical rates dropped equally in people who went to those joint clinics.
Overall, this study reinforces the idea of collaboration for better patient satisfaction: by working together, specialists in surgery and PM&R can provide optimal solutions for people with spine pain.
To make a referral or speak with one of our specialists, contact M-LINE 24 hours a day, 7 days a week.
M-LINE 800-962-3555 For additional referral information see the UMHS Health Provider website. www.med.umich.edu/umhs/health-providers
Executive Officers of the University of Michigan Health System Ora Hirsch Pescovitz, M.D., Executive Vice President for Medical Affairs; James O. Woolliscroft, M.D., Dean, U-M Medical School; Douglas Strong, Chief Executive Officer, U-M Hospitals and Health Centers; Kathleen Potempa, Dean, School of Nursing. The Regents of the University of Michigan Mark J. Bernstein, Julia Donovan Darlow, Laurence B. Deitch, Shauna Ryder Diggs, Denise Ilitch, Andrea Fischer Newman, Andrew C. Richner, Katherine E. White, Mary Sue Coleman (ex officio). The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 48109-1432, 734-763-0235, TTY 734-647-1388. For other University of Michigan information call 734-764-1817. ÂŠ 2013, The Regents of the University of Michigan.
Physical Medicine & Rehabilitation 325 E. Eisenhower Parkway Ann Arbor, MI 48108 734-615-6722
M-LINE 800-962-3555 www.med.umich.edu/umhs/health-providers
Published on Apr 1, 2013