What is Rehabilitation Therapy? Expert Q&A

Not all therapeutic rehabilitation programs are the same or located close to home. If you've had an injury or illness, find out what services are provided during inpatient and outpatient rehabilitation, and how rehabilitation can improve your quality of life. We'll have two of our doctors on to answer your questions on-air, coming up right now on At the Forefront Live.

And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's start off with having our two doctors introduce themselves to our audience and tell us a little bit about what you do. And Dr. Weiss, you are immediately to my, I always get this wrong, it's backwards, to my left. Let's start with you, Dr. Weiss.

Hi. Thanks for having us. My name is Dr. David Weiss, and I am the Medical Director of Rehab Services at the University of Chicago. And I am an associate professor at the University of Chicago, based at Ingalls Memorial Hospital.

Great. And Dr. Doyel.

Hi. My name is Ryan Doyel. I want to thank you all for inviting me to this, as well. I am also working here at Ingalls Memorial Hospital. Dr. Weiss, myself, and a few other rehab physicians also have a presence at the University Hospital in Hyde Park campus too, so thank you for having us today.

Happy to have you on. So let's start off with just kind of some general questions. And Dr. Weiss, I want to start with you on this one. What types of conditions or injuries require rehabilitation? So I think in looking at the questions, we kind of took a look forward and we were going to kind of split this up into inpatient and outpatient. And I think Ryan is going to take the first part of this as inpatient.

Yeah.

And then I'll take a second.

[INAUDIBLE]

Go right ahead.

Yeah. Sorry for jumping in. I can go ahead and talk about inpatient rehab. So injuries, essentially what we're looking at is any kind of significant medical condition that would cause a significant change in someone's physical function. Some of the more obvious conditions are things like stroke, an injury to the spinal cord or other type of brain or neurologic injury, orthopedic injury such as hip fracture, or sometimes it's a multiple orthopedic injury like after a car accident. But I also want to point out that other types of illnesses or conditions can cause this, too. Sometimes it's just that somebody's heart failure is acting up, and that can really knock you back. Anything that would lead you to have advanced level of care and therapy to get back on your feet again.

Dr. Weiss, anything you want to add to that [INAUDIBLE]?

Sure. So in the outpatient world, and the inpatient world, think of us as when the experiment has gone wrong you go to the primary care doctor or other specialists, but when the experiment has gone wrong it's a person, and it affects their function, your function. And we are the ones that look at how that disease process, that trauma, has affected your life, and then put in place a plan, with the help of therapists and our expertise in those disease processes, to get you back to your functional best. In terms of outpatient, that is a [INAUDIBLE] world.

So if you've had a stroke, and you've gone through inpatient, then you go home. But that's just the start of everything. Then you'll start outpatient, and that's where you'll pick up the world in the outpatient.

But we also look at-- we are considered the musculoskeletal primary care doctors for patients. So anyone with low back pain, neck pain, knee pain, hip pain, headache sometimes. We cover quite a broad spectrum of disease processes and complaints. We also go into gait abnormality. So if a person is just not walking right, we're going to be able to help with those conditions and really try to help in reversing that process.

Great. And we do want to remind our viewers that we will take questions. So if you have a question that you want to one of our experts to answer, just type it in the comments section. We'll try to get to as many as possible over the course of the program.

And I was pretty fortunate. I got to come by just a couple of weeks ago and actually see the facility. We shot some video there, and John, if you want to run that. And either one of you can kind of jump in and tell us a little bit about maybe what we're seeing in the video. And we can kind of talk about the program and the actual facility there at Ingalls Memorial, which is quite nice.

So Dr. Weiss or Dr. Doyel, if you want to kind of explain to us a little bit about the facility there at Ingalls, and talk to us about what we're seeing here.

My screen is frozen, but I'm pretty sure based on-- An upstairs gym? Is that what we're looking at?

Well, right now we're--

We've had physical therapy.

Yeah, right now we're actually looking at some therapy. This involves a gentleman that's doing some therapy walking.

So yeah. So he is being helped with physical therapists and trying to get him to walk in the most natural and appropriate possible way. And we know that the more steps you take the more your brain recovers after injury, and so that's kind of the mode that we take.

So the more steps, the better off you are. It's kind of-- Many people have heard of the 10,000-hour rule. Well, this is kind of the 10,000-step rule. So the more steps you take, the better you are.

Perfect. And Dr. Weiss, one of the things that I was just really impressed with when I was there was the staff that you have working there, they seem to be extremely caring. They worked really well with the patients that were there, and some of the patients even made comments to that effect, just how wonderful the people are there. So you've got a good bunch there.

You know it's-- We're very lucky. Very blessed. Every day that I come to work I have-- it gives you a smile. It gives me a smile, and it's a very uplifting, very positive place to go to work. And you're right, the patients comment on that. People are nice here. And in today's world, that's really important.

Yeah, it's just great to see. We are getting some questions from viewers already. The first one is, do you get pain with osteoporosis, and does rehab therapy help? And I don't know. Either one of you can take that one.

So osteoporosis by itself, if you haven't had any problems as a result of osteoporosis, by itself will not cause pain. Now unfortunately when you have osteoporosis that sometimes connotates that you've had a fracture in your back, or in your hip, and thus you have pain, which can be quite debilitating.

Great. And can you talk to us a little bit about rehab in general when it comes to osteoporosis? Are there things that you all do, or is that an area where you can help?

So, yeah. Osteoporosis, we definitely have a program for osteoporosis. And it's something that it has to be weight-bearing. And we would probably include an endocrinology consult, a doctor that helps with bone absorption, and certain medications to help with the osteoporosis. But there are therapy programs in terms of strengthening muscles, and it should be weight-bearing, so walking and other things where your feet are hitting the ground can be quite helpful in preventing this, the problems from having osteoporosis.

Great. Another question from a viewer. Are you seeing an increase in any specific injuries attributable to COVID and just so much time spent in quarantine? I don't know if that's happening, and Dr. Doyel, I don't know if you want to take this one?

Yeah. Yeah, I can vouch to that. So it's a great question. And actually, we are seeing an increase of patients coming on the inpatient side. Strictly, they came in, COVID was the main diagnosis that they had. We have found, and I'm sure you've seen in the news, that unfortunately the virus, which we're still learning more and more about each day, it can affect pretty much any system.

We have seen patients who have delirium or confusion based on just from a process going on from this virus. There's hyper-coagulability, or increased blood clots with the virus. And with a lot of patients, it's just a matter of their breathing status has been off for so long. If you can imagine being in bed for a few weeks while you're convalescing from something like this, not breathing as well while you're in bed, there's going to be weakness.

There's going to be trouble with function. And there's certainly going to be a decline in one's endurance. So actually, Dr. Weiss and myself, last year starting maybe a few weeks from this time last year, we started seeing our first patients, which we brought over here. And we did see some very remarkable gains in people who were having trouble even getting out of bed, getting to a point where they were walking with the appropriate assistive device. So it was great to see that.

And I would imagine you're probably seeing more of this with elderly patients? Would that be accurate, or are you seeing it with the younger patients, as well?

So it is actually both. And I can leave the-- Dr. Weiss, he actually took care of a patient here, who I had seen over at the University Hospital, who is a younger patient and had unfortunate run-in with this and really, I think, did quite well over here in rehab.

That's great. Dr. Weiss, is there anything you want to add?

Sorry.

Oh, I'm sorry. Go ahead, Dr. Weiss. Is there anything you want to add?

Yeah, so COVID is obviously a-- we want to stay as far away from it as possible, but when people do get it it can manifest in so many different ways, and affect us in so many different ways, whether that's the inpatient, which Dr. Doyel just alluded to, and the seriousness. And you can be healthy. You can be sick. And it doesn't care. It's going to-- it really does take its toll.

And we also do have both the inpatient programs here at Ingalls, but we also have a robust outpatient program for-- We've all heard of the long-haulers and how it-- COVID can affect our ability to think. It can cause all kinds of pain. And we have developed, in our downtown campus, an expertise in taking care of this in the outpatient world, in addition to what we do in the inpatient world for those that are then hospitalized, and really had their functional status, their pulmonary status, all kinds of organ systems negatively affected. We can help in that recovery.

Great. Another question from a viewer. Can therapy delay the need for joint replacement surgery from osteoarthritis, and can it even remove the need for that type of surgery?

And I can answer this one if that's all right.

Yeah.

So absolutely, absolutely. And in fact, I think if you came even to most orthopedic surgeons, a lot will really want to do what we call these kind of conservative measures first. And that would include getting into therapy. Some intensive therapy, a lot of times it's a matter of strengthening muscles that you haven't been working as much. And surprisingly, these are not always muscles that are around the knee.

Sometimes, and a lot of times, they're muscles that are around the hips and the buttocks. Strengthening those muscles so that your own mechanics and your [INAUDIBLE] will be optimized to try to offload those knees and really try to stave off the need for surgery. Because as we know, and not saying that surgery is a bad option, but as we know that is a more advanced option, and we want to try and do what we can to help you before going toward that.

So--

And in addition, even if you eventually go for that surgery, by doing what Dr. Doyel has just suggested in terms of strengthening, working on gait, can only help in the recovery following that surgery.

I was just going to ask that. And I'm glad you brought that up, Dr. Weiss. That makes perfect sense because there would be some rehabilitation, actually, after that surgical procedure, I would imagine, to help get better more quickly and really have the best effects and impact of the surgery. So that makes perfect sense.

I do have a question about Shirley Ryan AbilityLabs in general, because I know, I think, when we look at Shirley Ryan AbilityLab, we know that that is just a premier area for rehabilitation. And now UChicago Medicine is working with Shirley Ryan AbilityLab, which is obviously what you all do. What does that partnership, or that connection, do for patients, and can you tell us how that works?

So it's a blossoming relationship, I would categorize it. In November of 2019, the relationship was started. And we are now growing from inpatient and getting started in outpatient and we'll continue in both inpatient at Ingalls Memorial Hospital and in the Hyde Park campus.

And we are starting to really see the way that we believe is a benefit-- the most beneficial way to help patients during their inpatient and outpatient journeys. And so we have a totally integrated-- anything with that has to do with rehab, Shirley Ryan is now leading that charge at the University. So you get that exposure to what we think is the best possible clinicians and an experience that is available to you as a patient in the University of Chicago system.

That's fantastic. And I'm sure just the ability to bring that expertise, your expertise, to the Southland area, because that's a section of the Chicagoland area that I think we could agree is probably underserved in a lot of ways medically, that's a huge benefit. And I don't know if you care to comment about that, but I think that's a huge, huge positive.

Yeah, I will go ahead with that. I think it is a positive. When Dr. Weiss and myself started here, I think I speak for both of us, that I was excited. We were excited about this opportunity because Shirley Ryan has quite a history from before.

People might recognize the name Rehabilitation Institute of Chicago, or RIC. It's the same thing. The name was changed only a few years ago. In fact, it was four years ago yesterday when that change was made, and there was a move from the original RIC in downtown to the Shirley Ryan AbilityLab.

What's exciting about the Shirley Ryan AbilityLab is kind of in the name. Ability is very important. It takes kind of a forefront there. And there are some really, really interesting and quite innovative things that are going on. In what they call the ability labs, which are the gyms at Shirley Ryan, there is translational research kind of going on at the same time that the patient is getting his or her therapy at the same time that the medical team is caring for the patient.

If you can imagine it, that it is researchers, patients, and medical providers, as well as therapists, all together, working as a team side by side. Now that is what is going on at that hospital downtown, so Shirley Ryan AbilityLab. And all of that information that is taken from that, all of the evidence-based practice that comes from that, all of that is then kind of sanctioned out and given to us so that we can use that for best practice in the other locations within our system, Ingalls Memorial Hospital being one of them, as well as the UCMC campus and Hyde Park.

And it's actually really been great having been at both Ingalls and at UC in Hyde Park. It's been great to be able to utilize that knowledge, that I have learned at least personally, and bring that to the fore when I'm helping out a team, whether it be at Hyde Park like for a patient who has just come in with what we call multi-trauma after maybe a bad car accident, or if it's at the Ingalls campus where a patient is coming in with some kind of functional gains to be had because of some kind of illness or condition. It's great to be able to bring this all together, and having that kind of at our fingertips is very helpful.

That's fantastic. And Dr. Weiss, Dr. Doyel touched on this a little bit in his answer just a moment ago, but I wanted to know if you could kind of talk about this team approach that happens when somebody comes to rehab? And we had that video, and maybe we can roll the video again, that showed that entire team that works with the patients that come in, and it's really impressive. Who all works with patients, and how do you personalize the programs for those patients?

Sure. So a typical team will include the nurse, obviously, who's an expert in taking care of patients on the rehab unit. And nursing in a rehab unit is much different than in a regular unit. There are different expectations of the nurse and expectations of the patient.

There's also the nurse assistants that, obviously, become the first line of, what we call, defense. In other words, they are the ones that a lot of times the patients will open up to most. They have-- they see them a lot of the time. They're helping them quite a bit.

And then we have our therapists. From the physical therapists that deal with gross movements such as bed mobility, and getting up from a chair, and walking, stair climbing, to wheelchair mobility. We have occupational therapists that do-- the best way to think about it, it's what occupies your day.

And so that's eating, that is personal hygiene, that is going to the bathroom, and that is transferring, that is dressing, both the-- And then we also, in our rehab hospital, have simulations of homes. So we have a kitchen, a full kitchen that where people make meals. We have a bedroom, so they'll simulate how a person will be doing-- what a person will be doing at home.

We have speech therapists, and people think of speech therapist is only how we speak, but they do much, much more than that. They are intimately involved in helping in the rehab when a person has cognitive deficits and swallowing deficits, in addition to speaking deficits. We also have psychologists, neuropsychologists, that are invaluable in getting at what's going on from a psychological standpoint, and also a higher cognitive standpoint. We also have our clinical liaisons, who are the people that help with the discharge planning. We have dietitians, and we have pharmacists.

And so I tell a lot of people that, through that video that we saw earlier, that it's almost as if we have a pseudo-spa when you come to rehab. Because you're going to try different things. You're going to eat different foods. You're going to be around really happy people. You're going to exercise throughout the whole day. And if you think about what a spa is, it's very similar to what I've just said, and we try to give it that same feel. And when you're done, you will have learned something and-- hopefully be able to [INAUDIBLE] and be in a better place as a result.

Yeah, I love your analogy there. And it's interesting because I think a lot of times people, when they are in a situation where maybe they need rehab, it's challenging for them. And I have a family member who went through some fairly significant medical issues recently, and he was told that he needed to go to rehab and didn't want to do it initially. But once he was talked into it and did it, the benefit was fantastic. And it was-- It was amazing how much better he was coming out of rehab than when he went in.

So I think you're 100% spot on. I mean that's just, it's a great way to put it. And if people will listen to the physician or the folks that they're talking to, you guys can work miracles. It's pretty amazing to see what you do.

Tell us a little bit about if a family member needs rehabilitation, do they need to provide a referral? How does that work? How do they get into the system and work with a team like yours?

So there's a couple of different things we're talking about. In the inpatient world, there has to be a referral made to us. And then we have to see if the person is appropriate for inpatient acute rehabilitation.

In the outpatient world, there are two different things that we're talking about. One is for to see the physician, and obviously if you don't need a referral through your insurance, you can come see one of our colleagues at any of our many locations. In terms of therapies, if your primary care doctor has given a referral, then you do not need to see one of the rehab physicians before [INAUDIBLE] the inpatient/outpatient process to see one of us comes about.

Right. And can we talk a little bit about average length of stay for both inpatient and outpatient? And Dr. Doyel, I don't know if you want to start us off on that one, and then we can go to with Dr. Weiss after that.

Yeah, absolutely. Thanks. So for on the inpatient side of things, kind of an average length of stay is going to be right around two weeks, or 14 days, but that is an average, and things change based on the level, really, of functional capacity and level of functional decline that there's been. I have seen, and Dr. Weiss has maybe seen even longer, but I've seen patients here for five, six weeks, sometimes. It will vary based on the degree of help that is needed at the time they come over.

There is a major difference between someone who maybe just, unfortunately, had a fall with a hip fracture and needs a little bit of a tuneup, versus someone who might have a, unfortunately, a new spinal cord injury and now really needs to be able to work on how do I function without the full use of my legs right now. How do I get around? So two weeks is kind of the average. It can be shorter than that. And it certainly can be longer than that.

Great. And Dr. Weiss?

Sure. So as I mentioned before, to think of our specialties is two specialties within one. There's the physical medicine, which is more of the musculoskeletal sports medicine where those average length of stays is, in terms of therapy, is it varies vastly based on the patient, and also how well a person is responding to the various treatment protocols that have been put in place. So what we try to do is if things are working, we will continue along that line. If not, then we're going to use evidence-based treatments and change things around because it's not working. If it's broken, we better fix it.

But then there's the second part, which is the rehabilitation. And as Dr. Doyel alluded to, we start out, and I alluded to it, we start out with the inpatient world. But that's just the start of your recovery following certain injuries or diseases.

And then after the inpatient, you might go to an outpatient world where if you've had an amputation, we start to fit you with the prosthesis, we teach you how to use the prosthesis, and then get you so good that, hopefully, you don't need any assistive device, and you're able to walk without an assistive device in a way that gives you a lot of confidence. But then also, downtown at our mothership, we have a full gym that allows you to continue to feel even more confident by exercising on a regular basis. And again, it's a whole continuum when it comes to both inpatient and outpatient.

Fantastic. Gentlemen, we are out of time. Special thanks to our physicians for being with us today. And a big thank you to those of us who, or those of you who watched and participated in the program today. Please remember to check out our Facebook page for our schedule of programs that are coming up in the future. And to make an appointment, go online to uchicagomedicine.org or call 888-824-0200. Thanks again for being with us today, and hope everyone has a great weekend.