access Vol.16 No.3 Fall 2009
the key to a full recovery from joint replacement surgery or fracture
“Most patients who have had joint replacement surgery, or
who are recovering from a fracture or other serious injury, need
assistance to help rebuild their strength, endurance, and their
ability to perform the tasks of daily living,” says Terry Berg, OTR/L,
Program Director of HHH’s Joint and Orthopedic Rehabilitation Program.
Physicians from hospitals throughout the metropolitan area refer pa-
tients to Helen Hayes Hospital for rehabilitation after single or bilateral knee
or hip replacement surgery or for treatment of hip and other lower extrem-
ity fractures. Patients receive a thorough evaluation and a treatment plan is
developed based on their individual abilities and needs.
HHH’s orthopedic rehabilitation team is directed by physicians with ex-
pertise in orthopedic rehab, and includes a nurse practitioner, nurses, physi-
cal and occupational therapists and case managers. The team works closely
with the referring physician to develop a treatment regimen based on the
physician’s protocols for weight bearing, medication and therapies. Team
members closely monitor each patient’s progress and work to help them
manage their pain and regain lost abilities.
Patients participate in both individual and group therapy. Using an ex-
tensive array of equipment, therapists help patients learn to walk again, how
HHH offers both acute and sub-acute to climb stairs, how to sit or bend properly and how to safely return to their
inpatient care for orthopedic patients, activities of daily living. For sports-minded individuals, the adapted sports
program can help them return to the athletic activities they enjoy.
as well as outpatient rehabilitation
“For many of our patients, pain management following surgery is a ma-
services. jor concern,” explains Berg. “Pain is closely monitored by all team members
and modalities and medications are continually adjusted so that the patient
is made as comfortable as possible. This enables them to participate in ther-
inside apy and make the most of their rehabilitation stay.”
Joint replacement surgery p.2 HHH offers both acute and sub-acute inpatient care for orthopedic
Hip fractures and osteoporosis p.3 patients, as well as outpatient rehabilitation services. Acute rehabilitation
TBI rehabilitation p.4 is designed for individuals who are able to participate in three hours a day
Snapshot views p.5 of intensive therapies. For those requiring a less intensive plan of care, sub-
acute rehabilitation provides a customized program to help them progress
Cardiac rehab saves lives p.6
at their own pace. continued on page 3
Massage therapy p.7
There have been numerous incremental improvements
in total joint replacement, including the use of small
Advances incisions. “For a few years, we were using tiny incisions,
but we have moved away from that because of their higher
complication rate,” states Dr. Bostrom. “Some surgeons are
in Joint using new approaches to total hip replacement rather than
the traditional posterior approach, but the advantages have
not been fully evaluated. New bearing surfaces, such as metal
on metal or ceramic on ceramic, may allow the prosthesis
to last longer, which is a significant advantage, especially for
Patients who are considering joint replacement surgery
should research the experience and complication rate of their
surgeon, specifically the surgeon’s experience doing the kind
R ecent advances in joint replacement surgery enable
patients to recover faster, reports Mathias Bostrom,
M.D., director of Orthopedic Services at HHH. Dr.
of surgery they are considering. The reputation, infection
and safety record of the hospital are also critical, says Dr.
Bostrom. Much of this information is available online.
Bostrom specializes in total hip and knee replacement, Patients who will be having their joint replacement
as well as complex reconstructions and the treatment surgery performed by Dr. Bostrom at Hospital for Special
of musculoskeletal infections. He is also an Attending Surgery can have their initial evaluation with him at HHH.
Orthopedic Surgeon at Hospital for Special Surgery in They need to make only one trip to HSS before surgery for
Manhattan, widely recognized as one of the nation’s medical clearance. All post-surgery follow-up exams can
leading hospitals for orthopedic surgery. be done at HHH, eliminating the need for multiple trips to
“The goal of total joint replacement is to improve an Manhattan.
individual’s quality of life, so they can get back to doing the The orthopedic rehabilitation team at HHH works
things they really enjoy,” explains Dr. Bostrom. “Patients closely with Dr. Bostrom and all other orthopedic surgeons
today are up and about quicker, and can participate in to design an individualized rehabilitation program for each
rehabilitation and weight-bearing activities sooner.” patient based on their surgeon’s recommendations.
Every year in the United States, more than one-third of adults 65 and Poor vision can increase your chance of falling, so have your
older fall. Many of these falls result in fractures and other serious vision checked.
injuries. Falls can also cause psychological trauma, as people Exercise Regularly
often become fearful of falling again. HHH physical therapist Jaime
Harwood recommends these helpful fall prevention techniques. Regular exercise helps improve balance and coordination. It doesn’t
have to be vigorous exercise; even going for a daily walk helps.
Eliminate Hazards in Your Home
Use Mobility Aids If You Need Them
Half of all falls happen at home, so check your home for safety
hazards. Tape loose wires and area rugs to the wall or floor, and If you feel unsteady, don’t be too proud to use a cane or a walker.
keep things off the floor. Don’t rely on an umbrella or a shopping cart for support.
Make sure your lighting is adequate. Use a nightlight if you get Finally, consider a Personal Emergency Response System, which
up during the night and make sure the path from your bed to the helps many people feel more secure.
bathroom is clear.
Install a grab bar in your bathtub or shower and next to your toilet. A
non-skid mat or a shower chair will also reduce your risk of falling.
Make sure stairs are well-lighted and there are sturdy railings.
Have a relative, neighbor or friend walk through your home for a
safety check as they may notice hazards you have overlooked.
Talk to Your Doctor
Many medical conditions or medications (including over-the-
counter medications) can contribute to dizziness or a loss of
balance. Get up slowly from your bed or from a seated position to
reduce your risk of getting dizzy.
Tell your doctor if you sometimes feel unsteady. Review your
medications to see if they may be contributing to the problem.
Hip Fracture & Osteoporosis
reducing the risk …
treating the cause
mineral density testing and follow-up treatment both before
and after the fracture liaison service is established. This data
will be presented at medical conferences and findings will be
prepared for publication.
“We believe that the only way that fracture patients can
be treated effectively is through an approach which begins
on the inpatient level and provides continuity of care to an
outpatient program that addresses the primary underlying
“Osteoporosis-related fractures represent disease of osteoporosis,” affirms Dr. Cosman. “We think
a growing public health problem in our aging this program can potentially have a huge positive impact
population,” states Felicia Cosman, M.D., endocrinologist, on patient care while also addressing the mounting costs of
osteoporosis expert and medical director of the hospital’s treating hip fractures and complications from fracture, which
Clinical Research Center. “Hip fracture is the most devastat- is expected to triple in the years ahead.”
ing type of fracture, yet most people who experience such a
fracture are unaware of the underlying cause, which in the vast
majority of instances is related to undiagnosed osteoporosis.” Orthopedic Rehab from p.1
Fewer than 25% of individuals with hip fracture are ul-
timately treated for the underlying fracture cause, and about The patient’s insurer makes a determination about the
20% of individuals die within a year of their fracture. The loss level of rehabilitation the patient receives and the length of
of independence and mobility and the increased risk for future time they will cover, based on the patient’s overall health,
fracture often lead to disability and nursing home placement. the extent of their injury and surgical status. In most cases,
To address this pressing health concern, Dr. Cosman and insurance companies will cover seven to ten days of inpatient
her colleagues have initiated a two-year outcomes research care. HHH admissions staff and case managers work closely
study being funded by Novartis, entitled Treatment of Osteo- with insurers so the patient receives the maximum benefit
porosis in Adults Hospitalized for Hip Fracture. “Our project possible.
represents a practical approach to improve outcomes in pa- After discharge, the team recommends that all patients
tients with osteoporosis-related hip fractures, and one that continue with outpatient therapy two or three times a week,
we believe will be cost effective and able to be replicated in either at Helen Hayes or at a facility near their home. In some
other facilities,” explains Dr. Cosman. cases, patients may receive therapy at home for a short time
The core of the study is the establishment of a fracture li- prior to going to an outpatient program.
aison service. A nurse practitioner will meet with all patients
50 years of age and older who have been admitted to HHH
for hip fracture. Along with obtaining a full medical history For information on
related to fractures, falls and osteoporosis risk factors, the NP orthopedic rehabilitation
will consult with the patient on fall prevention, calcium and services at HHH, call
vitamin D supplementation, write a prescription for bone 845-786-4535
mineral density testing to be done as soon as possible after
discharge and reach out to the patient’s primary care physi-
cian about the consultation findings.
An appointment will be made for the patient within
two months at the HHH Osteoporosis Center, or at a facility
convenient to their home. The patient will be apprised of all
laboratory test results and options for osteoporosis treat-
ment will be discussed. If warranted, treatment with an ap-
proved osteoporosis medication will be initiated within three
months of discharge after the fracture.
Data will be collected on patients’ calcium and vitamin
D usage, exercise, usage of fall prevention strategies, bone
Transitioning to a new life
a unique program helps those with
traumatic brain injury move on
or a survivor of setting and home, staff assist individuals in seeking to elimi-
traumatic brain nate unwanted behaviors.
injury (TBI), the An important focus of the Transitional Rehabilitation
transition to living in program is independent living skills training. Staff provides
the community can be one-on-one supervision and assistance with self-care, medi-
overwhelming, frustrat- cation management, money management, and future plan-
ing and downright scary. ning. They also accompany participants on trips out into the
The myriad of choices community, including the mall, drugstore or supermarket.
and demands of everyday
living are often more
than the individual can
confidently handle. Yet
most survivors strive to
regain some semblance
of a normal and produc-
A trip to the movies is part of the Transi- Enter the TBI Tran-
tional Rehabilitation program at HHH. sitional Rehabilitation
Program at Helen Hayes Hospital. Program director Barry
Dain and his dedicated team work under the motto WIT –
which stands for Whatever It Takes. “The goal of our program,”
explains Dain, “is to help each individual live a meaningful life
and get to the point where they no longer need the program.”
Following inpatient rehabilitation, most individuals with Participants use facilities at HHH such as the Therapeutic Pool.
TBI need ongoing supportive services to help them adjust to
There are fun trips, too, such as to the movies, to see a play or
their new limitations and become as independent as possible.
to go hiking, to encourage socialization and confidence. Trips
The Transitional Rehabilitation Program provides service
to a baseball game, City Island, Mohegan Sun and New York
coordination, counseling, life skills training, behavioral pro-
City help to re-orient survivors to “real life.” As they re-learn
gramming and social and recreational opportunities, along
and practice skills they once took for granted, participants
with Whatever It Takes, to help participants begin the next
become more confident about their ability to survive outside
phase of their life.
the protective hospital environment.
“We are also able to access resources within the rehabili-
Whatever it takes – that’s our motto as tation hospital,” says Dain. “Participants use the services of
we seek to help individuals with TBI lead a physical, occupational and speech therapy, vocational reha-
meaningful life. bilitation, and the Wellness Center and pool. Through daily
support meetings, they practice interpersonal communica-
Each participant has their own service coordinator, who tions and ways to reduce fear and anxiety. We also teach them
is charged with developing, securing and coordinating servic- about the brain, and how their brain was affected by their
es in the home and the community. The Coordinator collabo- injury.”
rates with the individual and family to ensure that all services With the support of the Transitional Rehabilitation Pro-
are being provided and received effectively. gram and the HHH medical, psychological and therapy staff,
Upon admission to the program, participants receive a survivors of traumatic brain injury receive the vital support
cognitive/behavior assessment that serves as the basis for the needed to reintegrate into the community. They learn that
individual and team members to develop a productive plan. they are not alone as they face the challenges ahead.
Through positive behavioral support, which takes place indi- For more information about the TBI Transitional
vidually, in group sessions, as well as in the community, work Rehabilitation Program, contact Barry Dain at (845) 786-4043.
Snapshot Views … personal outcomes
George Brunjes loves to dance, especially Celtic square dancing.
For the past several years, whenever he ventured out on the dance floor, he was in a lot of
pain. His ability to enjoy his hobby was seriously limited, so in May 2008, George had his right
hip replaced at the Hospital for Special Surgery.
Now, with the help of the HHH orthopedic rehabilitation staff, George is dancing again. He just
returned from a trip to Nova Scotia, where Celtic square dancing is very popular, and he was
able to enjoy learning new steps and making new friends.
“I love dancing, and now, for the first time in six years, I can dance again,” says George.
“I’m able to walk two miles and I’ve even climbed up a ladder to repair some loose shingles on
my roof. I’m back to my old self again, with no pain in my right hip.”
George spent one week at HHH after his hip replacement surgery. “My neighbor strongly
A new hip … urged me to come to Helen Hayes for rehab, based on her own experience. ‘Don’t think you
can do it yourself,’ she said, and she was right. I took her advice, and I am very happy that
a new dance I did.”
One of the most valuable aspects of rehab was the education he received, reports George. “The staff was great. They helped me
understand how my body was healing and how I could cope with my temporary limitations. Everyone was very friendly, helpful and
supportive. The therapists were very patient and showed me how to adjust to my new hip. They taught me how to walk again, how to
climb stairs, how to bend and how to get in and out of my car. They were with me, literally, every step of the way.” It’s been a little over
a year now, and George says he can do almost everything he wants to.
“I am so grateful to my neighbor for recommending Helen Hayes. For the first time in six years, I can dance again, and that means the
world to me.”
In the spring of 2005, Ed Morgan was enjoying his work as the director of fitness at a prestigious
college and relishing in his role of being a dad to his one year old twins. A certified and licensed
athletic trainer, he was running a road race when he suddenly had a stroke, leaving him in a
coma for 47 days. The resulting brain injury caused lasting communication impairments and
“Ed needed something else, including social contact with his peers,” explains his mother
Rosemary. Ed’s family researched the options and discovered the New York State Department
of Health’s TBI Waiver Program and the services it offers through the HHH Structured Day
A customized three-day a week regimen was developed for Ed and he has benefited from
vocational rehab, assistive technology services and occupational and speech therapy. His
physical conditioning has improved through use of the hospital’s pool and Wellness Center. He
Finding new ways has also participated in the GolfAbility program. Ed’s service coordinator closely monitors his
progress and re-evaluates his program every six months to keep pace with his goals.
Today, Ed is highly motivated, has improved his communication abilities and has developed
new interests and talents, including impressive photography skills. While he is still working toward regaining his athletic certification,
he has started exhibiting his landscape and architectural photographs. They showcase his amazing sense of composition and color,
his newly acquired digital photography skills and his ability to print, mount and frame his work. Ed finds that his photos help him to
communicate without words, allowing him to document and describe his family, travels and feelings.
“The Structured Day Program has really boosted Ed’s self-esteem and independence,” reports his Mom. “For him, it’s like going to work
and his job is to get better.” To which her son replies, “I’m trying!”
The Evidence is in
Rehabilitation saves lives
HHH. “Furthermore, the older or the sicker a patient is, the
more improvement they will experience. We are working
with the American Association of Cardiovascular and Pul-
monary Rehabilitation and other national organizations to
make doctors and hospitals more aware of the importance of
recommending cardiac rehab to all their eligible patients.”
“Many patients tell us that they were afraid to exercise,”
says Dr. Steven Lichtman, Director of Outpatient Cardiopul-
monary Services at HHH. “In our program, they feel more
confident because they know they are being closely monitored
by our medical, therapy and nursing staff.” continued on page 8
T Attending Physician appointed
here is now clear data showing that a comprehensive,
medically supervised outpatient cardiac rehabilitation
program, such as the one at Helen Hayes Hospital, de- Dr. Patricia Schnabel Ruppert
creases mortality, saves lives, reduces the risk of subsequent was recently appointed Attend-
complications and makes people live longer. The results of ing Physician on the Orthopedic
Rehabilitation Service at Helen
a study funded by the Centers for Medicare and Medicaid Hayes Hospital, where she over-
Services were recently published, highlighting these facts. sees the rehabilitation of patients
Of more than 601,000 Medicare beneficiaries who were with joint replacements and other
hospitalized for heart-related disease or surgery, there was orthopedic conditions on both the
acute and sub-acute level. Dr.
a 21-34% increase in the five-year survival rate among pa-
Ruppert has a strong background
tients who participated in cardiac rehabilitation programs. in geriatric care, orthopedics, the
The Outpatient Cardiac Rehab Program at HHH management of chronic illness
delivers on these outcomes by providing monitored and and post-operative care, which
supervised exercise, nutritional counseling and risk factor serve her well in her new position.
modification, including stress management and smoking “When consulting with and treating my patients, I take a very ho-
cessation techniques. At weekly educational groups, patients listic approach,” she explains. “Along with managing their post-op-
learn the importance of controlling their blood pressure, erative pain, I oversee and coordinate all aspects of their care and
cholesterol and weight, and benefit from sharing their ex- address any conditions that may have become exacerbated.”
periences and concerns with other patients. Dr. Ruppert received her medical degree from the New York Col-
However, studies have shown that many patients who lege of Osteopathic Medicine and completed a residency in Family
would benefit from cardiac rehab are not enrolling in pro- Medicine at St. Joseph’s Hospital and Medical Center in New Jer-
sey. She is board certified in Family Medicine.
grams. While the reasons for this are elusive, it is believed
that some patients may not be following through with their A strong proponent of the value of rehabilitative therapies, Dr. Rup-
physician’s recommendations, while other patients claim pert explains that orthopedic patients typically make significant
that their physician or surgeon did not discuss the option functional gains through participation in an inpatient rehab pro-
gram. “They improve much faster than if they had gone home im-
of cardiac rehab with them.
mediately following surgery,” she reports, “and in the end, it is more
“Women, minorities and the elderly are less likely to cost effective. It is gratifying to see that we can really make a dif-
get cardiac rehab, but do well once they are enrolled,” says ference in their lives.”
Dr. Marjorie King, Director of Cardiac Rehabilitation at
A Healing Touch
“So far, I have seen patients with stroke, cardiac disor-
ders, amputation and spinal cord injury,” she reports. “Mas-
sage increases tone and blood flow and decreases swelling
and pain, which enables patients to get more from their reha-
bilitation program. As many of our patients are stressed from
their injuries or illnesses, massage also helps them to relax,
which is a wonderful benefit.” Massage has also been shown
to be beneficial for individuals with chronic pain, Parkinson’s
Disease, multiple sclerosis and arthritis.
Prior to making an appointment for massage, patients
therapy must receive medical clearance from their HHH physician.
Maureen offers Swedish, Chair and Medical Massage on Friday
debuts afternoons and evenings, after a patient’s daily rehabilitation
regimen. She tailors each patient’s massage to meet his or her
medical and physical needs.
ith the goal of helping to restore a patient’s com- As time allows, Maureen also sees family members of
fort and well being and aiding in their recovery, patients. “Massage is a welcome relief for so many of them,”
Helen Hayes Hospital recently added massage she explains. “Often family members are highly stressed,
therapy to its repertoire of therapeutic offerings. Maureen tense and worried and a 30 or 60 minute session helps them
Foote, a physical therapy assistant on the hospital’s spinal to unwind and feel better. Ultimately, that helps them in car-
cord injury service, is also a licensed massage therapist and ing for their loved ones.”
initiated the Celtic Healing Massage Therapy service in re- For more information about the Celtic Healing Massage
sponse to patient requests. Therapy service, contact Maureen Foote at (845) 786-4240.
My mother, Josephine Marie
D’Andrea Vaught was a patient
in your hospital from June
1918 until 1926. Mom is now 94 oon after this message arrived via the HHH web site, a visit was arranged and Mrs.
years old. She has many fond
Vaught arrived at HHH with some of her own family, including her daughter, son-
memories of your hospital. She
was only three and a half years in-law and their two children. A large “Welcome Back Josephine” banner greeted her
old when she was admitted. at the front entrance and she was escorted to a luncheon with hospital staff, including the
Taken from her Italian family, Chief Executive Officer.
your hospital became her Over lunch, Josephine shared her many memories of growing up at what was then
family. She would like to visit called the New York State Orthopedic Hospital for Children. She recalled the hospital
the hospital. Is this possible? school, picnics on the beautiful campus and the names of many friends she made in the
She has many old pictures of girls’ ward. “After I went home, I attended reunions for many years,” she explained. To ev-
the hospital, staff, and good eryone’s amazement, Josephine took out an old and treasured photo album, chronicling
friends she met while there that her time at the hospital and her many friends, reunions and experiences.
I’m sure she would like to share
Following lunch, the group embarked on a tour and Josephine was thrilled to see the
… Please advise.
old buildings that still survive. The brick archways and palladium windows brought back
memories of long ago. A trip to Medical Records produced her original admission index card,
continued on page 8
Helen Hayes Hospital NONPROFIT
access ADDRESS SERVICE REQUESTED ORGANIZATION
Rt. 9W, West Haverstraw, NY 10993-1127 PAID
Helen Hayes Hospital is one of HUNTINGTON, IN
the nation’s leading specialty PERMIT NO. 832
hospitals offering innovative
care and treatment to people
with physical disabilities and
chronic disabling diseases.
Helen Hayes Hospital is affil-
iated with NewYork-Presbyte-
rian Healthcare System.
For further information re-
garding HHH programs and
services, please contact the
Admission Referral Center at
Please visit our web site:
Val S. Gray
Chief Executive Officer
Mary Marino Creagh
Cardiac Rehab from p.6 Visit from p.7 Calendar
Editor “We work with each which cataloged her diag- GolfAbility Outing
Lester Ferguson patient’s referring physician nosis and medical status, Mon. Sept. 14, 3:00 PM
Deborah Juarbe, O.T.R. to develop an individual- and a copy was made for her For information call
Bruce Marshall, D.D.S., M.P.A. ized program based on the photo album. 845-786-4200
Production patient’s needs and abilities,” Josephine also enjoyed
Copy: Mary Marino Creagh reports Dr. Lichtman. “Pa- spending some time in the with the United Spinal Mets
Design: Lester Ferguson tients should not hesitate to hospital’s Archive Center, Wed., Sept. 16, 4:30 PM
Photography: George Mattei ask their doctors for a refer- where she discovered pic- For information call
ral to cardiac rehabilitation.” tures of favorite teachers 845-786-4950
access is published by the The referring physician is and friends, as well as her
HHH Public Relations Office, kept up to date on their pa- favorite physician, Dr. John
845-786-4225. Arnold Goldman Center for
tient’s progress. Nutt, who performed her Assistive Technology
Most insurance com- surgeries. “I was so fasci- Wed., Sept. 16, 2:30-4:30 PM
panies, as well as Medicare, nated with him even at that For information call
cover the cost of outpatient young age that when I mar- 845-786-4225
cardiac rehabilitation, usu- ried and started a family, I Honors Assembly
Helen Hayes Hospital ally for a period of three named my first-born son Tues., Sept. 22, 1:30 PM
is operated by New York State months. Eligible diagnoses after him,” she exclaimed. For information call
Department of Health, Richard include open heart surgery, Josephine has a close- 845-786-4225
F. Daines, M.D., Commissioner
stent placement, heart attack knit family of four children,
& David A. Paterson, Governor Bone Health Seminars
and patients being medi- 10 grandchildren and 8
Wed., Sept. 30, 5:45 PM
cally managed for angina. great grandchildren. How Mon., Oct. 26, 9:45 AM
When patients complete gratifying it is to know that Tues., Nov. 17, 9:45 AM
their rehab program, they our hospital holds such For information call
are encouraged to join the special memories for this 845-786-4772
HHH Wellness Center or a healthy and spry nonage-
local gym to make their ex- narian and that the care she
The Power of Rehabilitation™ ercise program and lifestyle received here so long ago
changes permanent. has enabled her to enjoy a
1-888-70-REHAB full and rewarding life.