Spaulding Rehabilitation Hospital Network, Framingham

Wednesday 21 May 2008


Liz kindly collected us this morning for our 9:00am meeting with Dr Darren Rosenberg, Medical Director at Spaulding Framingham. His specialty is Physical Medicine and Rehabilitation, also incorporating Osteopathic Manipulative Medicine. Dr Rosenberg took over as Medical Director from Dr Julie Silver last year and is committed to carrying on the International Rehabilitation Center for Polio (IRCP) that she started in 2001, believing that there will still be a need to provide services for post-polio patients through to his retirement. Whereas Dr Silver learned much about treating patients with PPS through Dr Lauro Halstead (see Washington NRH), Dr Rosenberg has honed a full range of skills and treatment options from the established team of therapists and the patients themselves. An interesting emphasis for all staff working with PPS patients is prescribed reading from a variety of books that provide a framework for the experience of a polio survivor and, of course, Dr Silver’s book is one of them.

He is currently seeking opportunities to do research in areas such as: sleep apnea in polio survivors; and the effect of osteoporosis in the polio affected limb – especially in training technicians to do bone density scans on the polio affected side, not just the area indicated by standard protocol. Because of his specialty knowledge, Dr Rosenberg believes manipulation has assisted his post polio patients with freeing up motion and ambulation, helping with breathing problems, providing pain relief, and increasing tolerance for bracing. He also believes that there is scope to incorporate people with other neurological conditions into the polio program such as Parkinsons Disease, MS, etc., which may be the future direction for the IRCP.

Dr Rosenberg is justifiably proud of the range of specialists he has working in the Center, and we were later treated to an in depth team case study / information session with PT’s, Kristeen Blossfeld and Beth Grill, and OT’s, Maria Cole and Laura Ryan, as well as Assistant Site Manager and PT, Terry Sutherland, and Liz McKenney, IRCP Co-ordinator. The case study was an excellent way to present the range of treatment options offered to a post-polio patient who attends the IRCP.

A key to the examination and resulting suggestions for management strategies is based on what goals the patient wants to achieve. In this case study, the patient wanted to gain an understanding of what to expect in the future with PPS and learn ways to reduce fatigue and pain. Of course, a thorough background is taken including medication used; home environment/support system; sleep/fatigue issues; trip/fall history; pain; posture; muscle strength; range of motion; leg length; and functional mobility. After working with the range of therapists available at IRCP, the expected outcomes for this patient included: decrease falls to zero; reduce pain in feet for walking greater than 1 hour; incorporating energy conservation techniques into daily activities; exercise appropriately using PPS exercise parameters; reducing progression of weakness, and improving quality of life. Just as an aside, we were interested in the importance placed on the need for safe footwear in the snow, and the much more severe emphasis on cold sensitivity. At lease this is not such a significant issue to contend with in Australia.

A range of tools are used to gain knowledge of the patients’ issues, both for the therapist and the patient themselves. One that is not unique, but definitely revealing, is the ‘Daily Activity Log’ that is used by the OT. This is a simple sheet with 3 columns: Time (6.00am – 12.00am) / Activity / How did you feel? Filled out in hourly increments throughout the day, it gives a clear indication of where their ‘hot spots’ are and how this can impact on that all important ‘energy bank’.

Following an initial assessment, all the therapists involved meet together with the patient and any ‘significant other’ to discuss the process and to go over any points that need clarification. This is especially important when the patient has come from out of state or overseas as they will need to take information back to their own physicians.

It was made quite clear by all the therapists we spoke to at the IRCP that their sole objective was to assist the patient to achieve their own goals, backed up by the philosophical belief that although they may be ‘experts’ in their field, the patient is the ‘expert’ on their own body. This level of respect is a great adjunct to the patient’s therapeutic experience.

One of the most promising things about the IRCP is that the team is young, motivated, stable, and committed to ensuring their post polio patients have access skilled clinical services into the future.

To finish off our visit, we were introduced to Lynn Fraser, a local polio survivor and a speaker with the “In My Shoes” 2 day school disability awareness program run by Spaulding Framingham. Lynn and Maria Cole (OT) joined Jill and me for lunch and a good old fashioned chin wag. This was a lovely way to finish of a very successful and well organised visit.

Tomorrow we leave the USA and fly to Toronto in Canada to meet up with Sheila Casemore from Polio Canada. More soon.