Lower Extremity Orthotics Lab
The Lower Extremity Orthotic Lab provides multidisciplinary, comprehensive evaluations and treatment recommendations for patients with lower extremity impairments. All patients seen by the lab are currently enrolled in a clinical trial of an NIH institute or center. The orthopedic shoe technician with a pedorthotist, physical therapist or physiatrist provides orthotic shoe or bracing consultations as well as a detailed biomechanical-based musculoskeletal assessment. Interventions may include provisions of orthoses, prescription footwear, shoe modifications, therapeutic exercises, gait training, education, and more. The lab provides an opportunity for experienced clinicians from different disciplines to share ideas about evaluation and treatment strategies. The lab is staffed by the orthopedic shoe technician twice weekly and includes representatives from Physical Medicine and Rehabilitation, Physical Therapy, Biomechanics, and Pedorthotics.
The Neurology program emphasizes an interdisciplinary approach in the management of patients with neurological disorders such as: Syringomyelia, Von-Hippel Lindau, Parkinson's, and Gaucher's disease. The program responds to the needs of the National Institutes of Neurological Disorders and Stroke intramural research agenda. Services vary as the research protocols fluctuate and intramural patients require rehabilitation relative to the protocols. Additionally, the team responds to NINDS needs for outcome measurement relative to impairments, functional limitations, and disabilities.
The oncology program is designed to address the rehabilitation needs of cancer patients. Approximately 50 percent of the referrals to Physical Therapy are from the National Cancer Institute. Physicians and therapists treat patients involved in Phase 1 research studies, where scientists are determining the safety of medications and to Phase 4 research studies, where safety and efficacy of chemotherapeutic agents are established. Services are provided to reduce the impairments of cancer, improve patient function and minimize disability. These services improve quality of life as they relate to rehabilitation medicine and physical therapy.
The pediatric program emphasizes an interdisciplinary team approach in the management of children with disabilities and disease processes. The team evaluates patients with metabolic, neurological, rare genetic, infectious and oncologic diseases. The team assures proper contacts are made for home physical therapy, with the school systems and consults with the primary therapist. The team is involved with various NIH institutes or centers as collaborators on research studies. The main goal of the pediatric program is to minimize disability, and help the children get back to the activity they do best, play.
Pulmonary Rehabilitation Program
The Pulmonary Rehabilitation Program provides comprehensive, multi-disciplinary rehabilitation services for patients with all types of lung diseases. Physiatrists, nurses, physical therapists, recreation therapists, exercise physiologists and respiratory therapists collaborate to provide patients with medically-supervised exercise programs specific to each patient's unique needs. Patients learn how to safely monitor their response and adaptation to exercise and learn how to establish their own rehabilitation programs independently at home or in local community fitness centers. Patients learn how to optimize breathing techniques and how to manage shortness of breath during physical activities. Patients in the Pulmonary Rehabilitation Program also participate in educational lectures designed to teach basics of lung function, proper medication use, nutrition, ways to adapt their living environments, and how to access community resources in order optimize daily participation in preferred activities. The Pulmonary Rehabilitation Program also provides a 10 week outpatient program for individuals who live within traveling distance of the Clinical Center. Inpatient programs and single-visit consultative services are also available to patients with specific needs related to rehabilitation and advanced lung diseases.
Oral Motor and Swallowing Rehabilitation Program
State-of-the-art assessments are utilized to establish the differential diagnosis of an oral motor deficit or a swallowing disorder. This program uses an innovative approach with standard oral motor assessments, feeding evaluations and new instrumentation assessments documenting anatomic and physiologic aspects of the swallowing. Video-fluoroscopy is performed to provide a delineation of the swallowing dysfunction for assessments, treatment planning and intervention. Individual therapeutic programs are designed and conducted utilizing both standard therapeutic approaches along with biofeedback instrumentation. This program is offered to a variety of neurological, neuromuscular, otolaryngologic, and craniofacial disorders including: stroke, Parkinson's disease, Nieman Pick disease, Gauche disease, juvenile dermatomyosits, inclusion body myositis, cystinosis, head and neck cancers, Beckwith Wiedeman syndrome, and Smith Magenis syndrome.
Rheumatic Diseases Program
The rheumatic diseases program addresses the rehabilitation needs of patients with rheumatic diseases such as rheumatoid arthritis, polymyositis, systemic lupus erythematosus, and spondyloarthopathies. Interdisciplinary team members representing physiatry, physical therapy, occupational therapy, and speech language pathology evaluate and treat patients in order to prevent and or decrease impairments and disabilities. Patients may also need to be evaluated by other team members from recreation therapy, or a vocational rehabilitation counselor. Many of the patients seen in this program are referred from NIAMS; however, other NIH institutes that have patients with rheumatic diseases on protocols are also referred to rehabilitation medicine.
Traumatic Brain Injury (TBI) Phenotyping Core Program
The Phenotyping core is responsible for determining the phenotypic expression of the entire spectrum of TBI, including patients who display evidence of overlap symptoms related to both TBI and PTSD. The domains assessed depend on the details of the current protocols. Thus, the core retains staff with the capability to assess: depression, anxiety, anger, physical function, social role and participation, participation in leisure activities, fatigue, pain, sleep disturbance, weight disturbance, stigma, personality change, and cognitive function. In addition to providing Phenotyping support to investigators studying TBI, the Rehabilitation Medicine Department (RMD) also houses one arm of a pair of parallel natural history studies on TBI in coordination with the Walter Reed National Military Medical Center (WRNMMC) one focused on civilians and the other on the military. The natural history study at RMD follows a cohort of subjects with a clinical diagnosis of non-penetrating traumatic brain injury. Participants are enrolled within 1 year of their head injury. The patients are followed periodically for five years, with neuroimaging, including Magnetic Resonance Imaging (MRI) and Positron Emission Tomography – Magnetic Resonance (PET-MR), hematological (biomarkers), and extensive functional/cognitive phenotyping measures.