2013 MossRehab Activity Report

MossRehab_ActivityReport_FNL.crw1.indd 1 12/27/13 1:13 AM

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-of-

the-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.


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.


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

Our LEadErs kEEp pOinting thE Way tO Our suCCEss

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 leadershipChief Medical OfficerAlberto Esquenazi, MD


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these are just some of the

accolades We received in 2013

one of the nation’s best

hospitals, for the 20th year

In 2013, MossRehab was once again ranked #9 in the country

and #1 in Pennsylvania, by U.S.News & World Report.

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.

Philadelphia magazine also honored Dr. Esquenazi by naming

him a 2013 Health Hero finalist.

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.

our employees said it again this year

“mossrehab is a great place to Work”

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.

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.

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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dEvOtiOn tO Our patiEnts drivEs us tO bE first

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.

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.

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

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.

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.

The pablo® system

The tymo® system

The amadeo® system

The diego® system


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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 robot-

assisted 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


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

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.

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.


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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.

mossrehab leadershipChief Operating Officer

Ruth Lefton, FACHE

We knoW that policy impacts

patient care

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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.

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.

mossrehab leadershipDirector of Moss Rehabilitation Research Institute

John Whyte, MD, PhD


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 post-acute 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.

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.

nih grants suppOrt innOvativE rEsEarCh at MOssrEhab

topics of pioneering mossrehab

publications in 2013

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.


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.

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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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.

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.

We take training seriously, and it shoWs

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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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peer-revieWed publications

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.

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.

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.

mossrehab is greeting

the future With groWth

We’ll be unveiling a therapeutic greenhouse

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 piped-

in music. A dual-certified horticulturist and horticultural

therapist will oversee a range of therapeutic interventions.

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.

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1-800-CALL MOSSMossRehab.com


2013 MossRehab Activity Report

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Transcript of 2013 MossRehab Activity Report