Specialized Treatment Modalities
TIRR Memorial Hermann has numerous specialized treatment modalities. These specialized programs are offered for both inpatients and outpatients. Links to more information are also provided.
•Wheelchair Seating and Mobility Program
1. GAITRite: Changes in a person’s gait pattern can lead to an increased risk for accidental falls and fall-related injuries. A normal gait pattern helps to prevent injury and maintain independence. The GAITRite system records timing and distance parameters on a portable electronic walkway connected to a computer.
As a patient walks across the walkway, the system inputs data into the computer to document walking patterns, including both step time and step length. This captures abnormal walking patterns persons have adopted to compensate for muscle weakness, pain or limb shortening.
Patients using assistive devices and ambulatory aides such as crutches, walkers or canes, use these during their gait analysis. Therapists can use this data to assist with interventions and treatment designed to improve balance and gait. The data also helps to show progress.
2. Locomotion Training: Locomotion therapy supported by an automated gait orthosis on a robotic treadmill has established itself as an effective intervention for improving over-ground walking function impaired by neurological diseases and injuries.
Patients with neurological movement disorders are benefiting from intensive robotic rehabilitation therapy delivered at TIRR Outpatient Services Center at Kirby Glen, using the Lokomat®, the world’s first driven gait orthosis. The Lokomat assists walking movements of gait-impaired patients and is used to improve mobility in individuals following stroke, spinal cord injury, traumatic brain injury, multiple sclerosis or other neurological diseases and injuries.
The Lokomat is the first in Houston, the second in Texas, one of 30 in the United States and one of 100 in the entire world. It was provided for use at TIRR by a grant from the Medallion Foundation.
3. NeuroRecovery Network: TIRR is one of seven specialized member centers of the Christopher and Dana Reeve Foundation (CDRF) NeuroRecovery Network. The CDRF has launched the NeuroRecovery Network grant program to provide support for the translation of basic science and applied research into intensive, activity-based rehabilitation treatments.
It will also support the establishment of specialized centers to provide standardized care based on current scientific and clinical evidence. The program is funded by a joint agreement between the CDRF and the Centers for Disease Control and Prevention.
The therapy regimen includes highly specialized treatment strategies while using a body weight support system to optimize sensory cues to facilitate recovery of the nervous system. This treatment is provided daily during two-hour sessions and includes an hour of treatment on a treadmill followed by overground treatment time to increase carryover of the therapy session. Learn more about the NeuroRecovery Network.
Specialized Treatment Modalities
Wheelchair Seating and Mobility Program
The Wheelchair Seating and Mobility Program at TIRR provides assessments for inpatients and outpatients requiring the use of wheeled mobility in their home, work and community environments. The program enables the patient to try a wide variety of manual and power wheelchairs, seating and positioning accessories and environmental challenges. This allows the patient to trial the device and make accurate and informed decisions based on its performance.
The Seating and Mobility Program is designed to:
•Maximize independence and safety in the home and community
•Improve posture and function in the wheelchair
•Prevent secondary medical, orthopedic and skin problems caused by improper seating
•Provide demonstration equipment, simulation of the seating system and diagnostic tools, such as pressure mapping, to optimize comfort and function
With so many products in the market to choose from, information on the latest technology can be overwhelming.
TIRR keeps abreast of new and innovative technologies and monitors federal guidelines in the area of seating and mobility. We also work closely with local, certified and credentialed durable medical equipment providers and manufacturer representatives to provide comprehensive, patient-focused options.
For more information or to schedule an assessment, call 713-797-7386.
Specialized seating and mobility assessments include the projects below.
SMARTWheel® assessment – The SmartWheel is a clinical tool that assists clinicians with:
•Wheelchair Selection and Set-Up: The SmartWheel quantifies patient ease or difficulty in propelling different chairs or chair set-ups.
•Propulsion (momentum/propel) Training: Real-time visual feedback assists wheelchair users to reduce force and repetitive stress on their arms by using longer, less frequent strokes.
How a person propels a wheelchair is analyzed by a TIRR therapist specially qualified to perform the assessment by measuring every push on the hand rim. The SmartWheel then puts the data into easy-to-use automated summary reports to give clinicians better data to help manual wheelchair users improve quality of life.
The SmartWheel is for people with good hand function and has the following benefits:
•Eliminates pushing on the tire
•Gives a better grip for better performance with every push
•Eases pain in hands and wrists
•Provides greater control when braking
•Retrofits to your existing wheels
TIRR is one of 60 sites in the United States and the only site in Texas to have the SmartWheel clinical tool. It is offered on an inpatient and outpatient basis.
TIRR utilizes Caring Critters, a nonprofit, all-volunteer, Houston-area organization. Caring Critters enhances the lives of TIRR patients by providing them opportunities for interaction with animals in a positive, nurturing environment.
A music therapist’s role is to address the cognitive, speech/language, physical, and psychosocial needs of a patient, using Neurologic Music Therapy techniques. Music therapy is often requested to co-treat with other therapies, such as physical or speech therapy, and to facilitate functional movements and/or cognitive and speech behaviors.
•When co-treating with a physical therapist, music therapy may provide rhythmic stimulation to normalize a patient’s gait cadence, velocity and stride length.
•Music therapists address verbal expression in co-treating with speech therapists.
Music therapists also use song writing and lyric analysis activities to help address coping and adjusting issues. In addition, music is extremely helpful as a mnemonic cue in orientation and learning strategies for memory deficits.
Music Therapy is neurologically based and backed by more than 10 years of research at TIRR. Music therapists at TIRR:
•Hold a bachelor’s degree in music therapy
•Have passed the National Board Certification Exam for Music Therapists
•Are trained and certified in Neurologic Music Therapy (NMT)
The inpatient therapy pool offers aquatic therapy for patients with orthopedic and neurological disorders who experience symptoms such as pain, weakness, weight bearing restrictions after surgery, swelling, and/or changes in muscle tone. This therapy combines traditional exercise with the water’s buoyancy to enhance and accelerate the rehabilitation process. The pool is kept at a therapeutic 92 degrees and is accessible by stairs or chair lift.
Therapeutic recreation specialists use recreational modalities and experiences to:
•Improve functional abilities in therapy
•Provide education and training in recreational skills and attitudes for healthy recreation participation
•Promote social interaction and healthy living through group and community recreational and leisure experiences
Therapeutic recreation therapists at TIRR have the training and unique ability to combine a group of people with a wide range of disabilities and functional levels who share a common interest or focus. Therapeutic recreation:
•Promotes social interaction and appropriate recreational participation
•Helps with coping and adjustment while the patient works on enhancing functional abilities
TIRR therapeutic recreational therapists have four-year degrees and national certification training.
Spasticity is a form of muscle overactivity which can result in contractures, abnormal postures, and pain and stiffness in the muscles of the body due to damage to the central nervous system. Spasticity can result from traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, spinal cord injury and other diseases associated with the brain.
Spasticity frequently impairs one’s mobility, positioning, comfort, care and ability to perform activities of daily living. Commonly used management strategies for spasticity include oral medications, intrathecal baclofen, orthopedic procedures, bracing and splinting, and medications which are injected directly into the muscle. Successful management of spasticity in patients with central nervous system disorders requires the expertise of a well-integrated team of clinicians.
Traditional therapeutic approaches, such as muscle stretching, positioning and movement exercises, are basic components of a management program.
Research has proven the value of new treatment options in maximizing the benefits of therapy. These options include:
•Medications that are injected directly into the spastic muscle, such as phenol and botulinum toxin (Botox®), are used in conjunction with casting, splinting and orthotic management.
•The intrathecal baclofen pump, a mechanical device, is surgically implanted and delivers medication directly into the brain and spinal cord. This treatment targets the lower limbs and can affect the upper limbs as well. The pump is the first new treatment for spasticity of cerebral origin approved by the FDA since 1981. Patients who could potentially benefit from the pump undergo a trial to assess their response to the therapy. If there is a favorable response during the trial, patients are admitted for surgical implantation of the pump.
Oral medications may be beneficial for some patients, particularly those individuals with spinal cord injury.
Some patients may be candidates for orthopedic surgeries to correct deformities resulting from spasticity or to augment the effects of other anti-spasticity treatments.
Patients or families interested in spasticity management for inpatients and outpatients may call 713.797.5942 or toll-free 1.800.44.REHAB (73422).