The Mount Sinai Spinal Cord Injury Program offers specialty clinical programs to assist in the treatment of individuals with spinal cord injury (SCI). Patients with varying degrees of SCI can receive the rehabilitation support they need to navigate daily life.
Specialty Clinical Programs
The 25-bed inpatient SCI Rehabilitation Unit at The Mount Sinai Hospital has been under the medical direction of Thomas N. Bryce, MD, since 2001. It is a self-contained unit with all inpatient rehabilitation services for inpatients located in close proximity to one another on the same floor. As the unit is located within The Mount Sinai Hospital, there is immediate access to all its diagnostic and interventional services of this world renowned medical institution.
Innovative and coordinated therapy programs are delivered by a highly trained and experienced group of professionals, who work together as an interdisciplinary team to develop, implement and coordinate every patient’s individualized program of care. To maximize functional recovery, each patient receives a minimum of three hours per day of therapy. In addition, all persons with spinal cord injury (SCI) have the opportunity to use a full range of advanced rehabilitative technologies, including:
- Myoelectric biofeedback directed electrical stimulation using Zynex NeuroMove systems.
- Functional Electrical Stimulation (FES) cycle ergometry for both the upper and lower limbs using Restorative Therapy RT300 units.
- Motorized cycle ergometry systems for both the upper and lower limbs using Reck Motomed units.
- Body weight-supported ambulation over ground using LiteGait® systems or ceiling-mounted gantry lifts with walking harness (Guldmann Inc.). Ceiling tracks cover 290’ of hallways on the SCI Rehabilitation Unit allowing for uninterrupted suspended locomotor training.
- Robotic exoskeleton training systems for the upper limbs using Hocoma Armeo units.
- Video gaming systems including Wii and Kinect videogames chosen to facilitate motor control, balance, hand-eye coordination, strength and well-being.
- Powered exoskeletons for the lower limbs including two Ekso exoskeletons and one ReWalk exoskeleton.
One of the many strengths of the inpatient program is its dedication to the primary team model. Upon admission, each patient is assigned a primary team of professionals: an SCI physiatrist, nurse, occupational therapist (OT), physical therapist (PT), rehabilitation psychologist, social worker (SW), SCI outreach coordinator, recreational therapist, registered dietician, and case manager comprise the core team, and an speech and language pathologist (SLP), respiratory therapist, and vocational rehabilitation specialist are involved as indicated.
Upon admission, all patients are evaluated by the attending SCI physiatrist, who prescribes a comprehensive rehabilitation program that includes the recommendations of the team members, instructions for nursing care, and orders for medications and special diagnostic tests. Continuity of care is assured through daily rounds by the SCI physiatrists. These rounds are made with the Physical Medicine and Rehabilitation (PM&R) residents, the SCI fellow, the SCI nurse manager, and the SCI therapy manager, during which the patient’s rehabilitation, medical, and emotional needs are continually assessed.
All team members complete their comprehensive initial evaluations within 24 hours. A team conference is held within a week of admission, at which time the patient’s medical, neurological, functional, psychological, vocational and social status, and potential are discussed. The team in collaboration with patients and families sets rehabilitation goals, project equipment needs, home modifications, and personal assistance needs upon return home, and set a tentative discharge date. The SCI outreach coordinator in collaboration with the team identifies an appropriate peer mentor at this time as well. A family meeting is also scheduled which is attended by the patient, family members and the entire treatment team as well as the SCI outreach coordinator during which the injury, prognosis, therapy progress and goals, and future plans are all discussed. Re-evaluation team conferences are held weekly, to review progress and make changes in the patient’s program based on reassessment of progress and goals. From the time of admission, the patient and the family are encouraged to actively participate in the development and implementation of the program, ask questions, and contribute to decision making. The patient and family meet with the SCI physiatrist weekly to review progress and make plans for the future.
All patients participate in one-on-one sessions with various team members. Individuals with SCI who are no longer inpatients and may be outpatients and have transitioned to the community come to the SCI Rehabilitation Unit regularly to participate in support groups with the inpatients. These individuals function as role models, and their participation offers opportunities to develop mentoring relationships. Inpatients can participate in a weekly luncheon organized by the Do It! Outpatient Program, where open discussion about community living issues takes place under the guidance of the SCI outreach coordinator and the rehabilitation psychologist.
On admission, each patient is given a binder which contains and accumulates information about the therapy program, discharge and community reintegration, health promotion, vocational resources, prescribed medical supplies and medications, transportation options, other community resources, and maintenance of their specific wheelchair and durable medical equipment.
As part of the transition from the SCI Rehabilitation Unit to outpatient care, inpatients tour the therapy area for the Outpatient Programs prior to discharge and receive an orientation to the various therapies offered and to special programs, like the Do It! Program.
Each person discharged from the SCI Rehabilitation Unit is scheduled for follow-up appointments with a SCI physiatrist (typically the one who treated them as an inpatient), primary care physician, spine surgeon, neuro-urologist (if there are urologic issues), and other specialists as appropriate. Verbal handoffs are made from the SCI physiatrists to the other outpatient caregivers, which are supplemented by written discharge summary information. Typically after discharge a person will initially receive physical and occupational therapy at home for a short period followed by an individualized outpatient therapy program either at The Mount Sinai Hospital or closer to their home if they reside at a distance.
The SCI Rehabilitation Unit is equipped to treat persons with ventilator dependency. When possible, we wean these patients from the ventilator through the cooperative efforts of our SCI physiatrists, pulmonologists, rehabilitation nurses, occupational therapists, physical therapists, speech language therapists, and respiratory therapists.
During the weaning process, we provide our comprehensive rehabilitation program. Historically, approximately 60 percent of those admitted to our program who initially required ventilator support have been completely weaned from the ventilator during the course of their rehabilitation stay.
For those who are unable to be weaned, we offer a diaphragmatic pacing system. Dong-Seok Lee, MD, a thoracic surgeon at The Mount Sinai Hospital, has performed implantations of Synapse diaphragmatic pacing systems in several persons with high level of SCI and permanent respiratory insufficiency.
These surgeries give patients freedom from a ventilator for many hours. Several patients have become entirely independent of mechanical ventilation. Our SCI physiatrists are trained to interrogate and reprogram the pacing systems to maximize stimulation efficiency.
As a significant percentage of Individuals who have sustained a traumatic SCI concurrently have sustained a traumatic brain injury (TBI), we screen and monitor all patients.
At The Mount Sinai Hospital’s Department of Rehabilitation Medicine we serve as aTBI model system of care and are nationally recognized for our expertise in rehabilitating persons with TBI. Through the Mount Sinai Injury Control Research Center we provide quality care to persons with comorbid SCI and TBI.
We usually admit patients with SCI and TBI to the SCI Rehabilitation Unit and they attend cognitive remediation classes in the Acute TBI Inpatient Rehabilitation Unit (TBI Rehabilitation Unit).
If a person has significant cognitive deficits that interfere with learning, we admit that person to the TBI Rehabilitation unit for more intensive cognitive rehabilitation. We provide other relevant therapies on the SCI Rehabilitation unit.
The evaluation for proper seating and positioning is a multi-step process. At the initial meeting, our therapists perform a physical assessment/mat evaluation to determine your level of sensation, skin integrity, pressure relief capabilities, pelvic and spinal alignment, and range of motion of your upper and lower extremity joints. We also document any safety precautions needed. If needed, the assessment will include evaluation of posture on a seating simulator to ascertain accurate measurements.
We will transfer you to a wheelchair so that your therapist can test different types of seating systems/angles/postures, cushions, and back components. We will do computerized mapping before we order your wheelchair and cushion so that we can arrange for the best possible seating interface pressures, in order to minimize the risk of skin breakdown. We offer pressure mapping systems in the SCI Rehabilitation unit and in the outpatient program. After testing different chairs, you will choose a wheelchair with the help of a SCI physiatrist and occupational therapist (OT) who alongside a licensed vendor, will perform a wheelchair “spec out” and generate a prescription for the wheelchair.
After you receive your wheelchair, you will visit an outpatient OT seating specialist who will evaluate your seating and function in the new chair, make any needed adjustments, and confirms that it meets your requirements and specifications.
If you have skin integrity problems, we will repeat the pressure mapping to ensure that seating pressures are well distributed and minimize the risk for skin breakdown. We will instruct you in the use, care, and maintenance of your wheelchair. If you have a power chair, we will train you for safety and maximum independence in indoor and outdoor mobility. If you have a manual wheelchair, we offer both basic and advanced wheelchair mobility skill training as an inpatient and later as an outpatient.
Along with one-on-one training with a therapist, we provide wheelchair mobility group classes to inpatients and outpatients.
For men with SCI, infertility is a common problem. Poor sperm quality, coupled with erectile and ejaculatory dysfunction, presents significant obstacles to fathering children. Advances in reproductive rehabilitation, including oral and injectable drugs to facilitate penile erection, electroejaculation, and assisted reproductive techniques have improved the prognosis for men suffering from neurogenic infertility.
We offer the most advanced methods available under the director of urologist Natan Bar-Charma, MD.
We provide obstetrical management of women with SCI in collaboration with SCI physiatrists, neuro-urologists, obstetricians/gynecologists, and primary care providers. Our faculty provides care to women with SCI through wheelchair-accessible offices and adjustable (high/low) examination tables. Pregnancy and delivery after SCI poses special risks, particularly in women with neurological levels of injury at or above T6. Several members of our faculty are committed to providing quality care to women with SCI.
Our doctors thoroughly assess the impact of spasticity on a variety of areas including comfort, positioning, and function. We also develop wide-ranging interdisciplinary treatment plans, which may include oral or intrathecal medication, chemodenervation with neurotoxins, peripheral nerve blocks using alcohol injections guided by electromyography or electrical stimulation, bracing and splinting, seating and positioning, and individually designed physical (and/or occupational) therapy programs.
The management of intrathecal pumps for administration of anti-spasticity medication is an essential component of the program. Within the last five years, we have implanted 58 intrathecal pumps for baclofen in people with spinal cord disorders, and nearly all of these cases are managed by SCI physiatrists.
Our nerve and tendon transfer surgery program offers persons with tetraplegia the opportunity for improved hand and arm function by mean of surgical reconstruction. Michael Hausman, MD, Professor of Orthopedics and Chief of Hand and Upper Extremity Surgery, performs about two or three reconstructive nerve and tendon transfer surgeries for persons with SCI each month.
The outpatient Functional Electrical Stimulation (FES) Program has been operating since 1988. FES cycle ergometry for the upper limbs with arm cranks and the lower limbs with leg cranks is performed using Restorative Therapy RT300 units. These devices allow individuals with SCI an opportunity to exercise both impaired upper and lower limbs and the cardiovascular system using computer-controlled electrical stimulation which they ordinarily would not be able to do. Upper extremity FES rehabilitation systems myoelectric biofeedback using Zynex NeuroMove systems which are designed to increase functional use of the hands are also available for use.
All these devices are integrated into physical and occupational therapy and are also available for use by persons who wish to self-pay to use them after receiving a referral from a physician and have been found to be an appropriate candidate by the screening therapist.