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The Brain Trainers
A new outpatient neurorehab program helps patients rebuild their lives

“First of all, I need to congratulate myself for successfully recovering from a severe traumatic brain injury I had suffered from a couple of years ago. It has taken me loads of self-discipline and determination to do so. However, I must add that without the help of several therapists, I really don’t know where I would be. My speech therapists, occupational therapists, physical therapist, neurologist and so many more have all proven to be so beneficial to me physically, mentally and psychologically. I can’t forget to include the receptionists.They have all made Hopkins a fun place to go. Last but certainly not least, I would like to thank my mom dearly for all the care and support she has given me. I honestly can’t imagine how anyone in a similar situation as me would be doing without someone like my mom.”


Joey Lombardo shows his appreciation. Flanking him, from left: speech pathologist Judy Haynos, neuropsychologist Kate Kortte and occupational therapist Annette Lavezza.

Joey Lombardo typed these words of gratitude on the computer keyboard. It wasn’t easy. He had lost the use of his right hand. Now his therapists, trying to strengthen it, were encouraging him to use it as he typed. Still, typing was a lot easier than speaking. Joey’s words come out haltingly. And yet, he’s come a long way.

***

Back in 2003, Joey Lombardo, of Arnold, Md., was a wide receiver on Broadneck High’s varsity football team. He spent his summers as a lifeguard at Sandy Point Beach. Handsome and laid back, Joey was a good student and looked forward to attending Salisbury University that fall.

But on June 21, he was riding in the back seat of an SUV when it was broadsided by a large van. All five passengers suffered injuries, but Joey fared worst. He lay comatose for 54 days. When he finally emerged from the coma, he could neither speak nor walk. He had to relearn everything.

Six months of inpatient therapy at two local hospitals didn’t help as much as everyone had hoped. Joey was still communicating with hand signals and notes. He wobbled a few steps and couldn’t propel himself in his wheelchair. He was frustrated because he wanted to be his old self. Then, his mother, Terry, enrolled Joey in the Department of Physical Medicine & Rehabilitation’s new outpatient neurorehab program.

The program is the only one of its kind in Baltimore. Medical director Pablo Celnik, a neurologist and physiatrist, oversees a 12-member team consisting of physiatrists, neuropsychologists, OTs, PTs, speech pathologists and a social worker. They meet weekly to review each patient’s progress. The goal is to restore function as much as possible while improving quality of life.


Striking a pose with program director Pablo Celnik.
The PM&R program responds to the acute need for outpatient brain-injury rehab. After a lengthy hospital stay, patients with brain injury typically undergo outpatient physical therapy, occupational therapy and speech therapy. These services are usually offered at different venues. It’s inconvenient and hard to coordinate. “That’s why we started this team-approach program two years ago,” says Celnik. “We wanted to respond to a lack of organized, coordinated outpatient rehab services in one place.”

Currently, the program has about 50 active patients. Many are patients who have had strokes. Others might have neurological deficits after, say, surgery, brain tumors or aneurysms. Then, there are patients with traumatic brain injury (TBI), patients like Joey.

Now that Joey’s been in the program for more than a year and a half, he no longer uses his wheelchair and speaks more clearly. “Speaking,” he says, “has been the hardest part for me.” Corrective surgery to his palate and pharynx shortened the amount of time it took for Joey’s voice to start, but it’s still quite slow.

Judy Haynos, Joey’s speech pathologist, recalls when his speech was only 20 percent intelligible. “Now,” she says, “for the untrained person, he’s 60 percent intelligible, and for those who know him, he’s up to about 80 percent.” Most patients with TBI don’t progress as quickly, Haynos adds.

On this day, in Meyer 1, Joey stands squarely over a kitchen counter mixing chocolate chunk brownies with his left hand. It’s a balancing act. He holds the bowl with his right hand, still shaky with lingering tremors. He steadies his legs and starts to mouth words, taking a deep breath, just as Haynos taught him to do.

“Thee-ee-ese are for you,” he says to occupational therapist Annette Lavezza, pointing to the brownie batter.

“You’re doing great, Joey,” replies Lavezza, smiling in appreciation.

“You too,” he says, gesturing with a thumbs-up sign and flashing a high-wattage smile.

“One thing hasn’t changed about Joey,” says his mother, who is standing by. “He enjoys being sociable.”

***

Neuropsychologist Kate Kortte is one of the first points of contact for outpatient neurorehab patients. In an exhaustive evaluation lasting up to six hours, Kortte assesses the cognitive-behavioral skills needed to perform everyday tasks, like driving, paying bills and going to work. She finds out if the person needs supervision to complete daily activities. Then she helps patients and caregivers adapt to changes in their lives.

It’s not easy. Take the case of a stroke patient who, for many years, was an executive assistant at a big firm. She was known for being organized and efficient. But the stroke impaired her memory and organizational skills. After leaving the hospital, she returned to work but couldn’t complete her tasks and almost lost her job. She consulted the outpatient program and embarked on a rehab plan to improve her cognitive skills. She spent several weeks working on organizational strategies, her memory and the tasks her job required. Today, even though she’s not the same executive assistant as before the stroke, she has been able to keep her job and continues to progress in her path to recovery.

The brain needs a lot of practice, and challenges abound. Patients typically spend an hour a day in the Meyer gym practicing walking and balancing on treadmills or bikes. A partial body weight harness called a Lite-Gait supports them from above. Physical therapy plays a big role in neurorehab, and it’s quite different from rehab for an orthopedic injury.

“We can’t grow nervous tissue,” says Laurie Sweet, the program’s primary PT, “so we have to get to different parts of the brain to take over functions that were not there.” It’s what Sweet calls “movement reeducation,” which requires lots of hands-on guidance with manual cues. When a stroke patient leans to the side, for example, the PT will point to it and show the patient how to shift weight.

***


Joey says his mom, Terry, keeps him on track.

Joey’s backpack is bursting. He carries a notebook for all his sessions. Inside are papers outlining the tongue and voice exercises he has to practice at home. Lately, he’s been reviewing a handout on breathing. Pointing to the notebook, he says, “This is my second brain. I study the hell out of it.”

Now that Joey’s becoming more independent, the PM&R team is conferring about his future. Though he’s had to take a detour from Salisbury University, Joey, who loves animals, hopes eventually to work in veterinary medicine. As the opening passage shows, Joey likely has what it takes. His sentiments, intellect and insight are intact; he simply has difficulty expressing himself—for now, at least. Joey’s family hopes he’ll be self-sufficient one day soon. But neither they nor anyone on the neurorehab team can predict how well he, or any patient, will do in the long term. In the meantime, every therapist involved will work in synch to strengthen the odds.

—Judy Minkove

 

 

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