The neurorehabilitation program at St. Louis Children’s Hospital is designed to address the needs of children and adolescents who have suffered severe injury or illness. In-patient rehabilitation is available for children age 6 months and older whose illness or injury has resulted in impaired physical, cognitive or communication skills.
Michael Noetzel, MD, Washington University pediatric neurologist at St. Louis Children’s Hospital, joins the show to discuss how the neurorehabilitation program strives to maximize physical, psychological, cognitive, social and educational outcomes for children with a variety of neurologic conditions.
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Neurorehabilitation Program at St. Louis Children’s Hospital
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Learn more about Michael Noetzel, MD
Michael Noetzel, MD
Michael Noetzel, MD is a Washington University pediatric neurologist at St. Louis Children's Hospital.Learn more about Michael Noetzel, MD
Transcription:
Melanie Cole, MS (Host): The neurorehabilitation program at St. Louis Children’s Hospital is designed to address the needs of children and adolescents who have suffered severe injury or illness. My guest today is Dr. Michael Noetzel. He’s a Washington University pediatric neurologist at St. Louis Children’s Hospital. Dr. Noetzel, it’s a pleasure to have you join us today. Tell us a little bit about the conditions that are treated by the neuro rehab program at St. Louis Children’s Hospital.
Michael Noetzel MD (Guest): Well, it’s a very broadly applied kind of net that we set out to get the children that have had usually acute injury or medical conditions that really have impacted on their ability to be functional as children. So the most common diagnosis that we see in these children is going to be an acquired brain injury, often traumatic in nature as a result of an automobile accident. We also see other children that have had strokes, injury to the spinal cord, infections involving the central nervous system. Then a lot of patients who have just been acutely ill and have been in our intensive care unit for a number of weeks or months and have gotten terribly out of shape or deconditioned and require the intensive therapy that we supply in our neurorehabilitation program.
Host: So then describe for us some of the program highlights and features.
Dr. Noetzel: Well, I think the most impressive aspect of the program that the parents tell us about is how fully integrated it is to the total needs of the children as they're starting to recover. So we begin with children, perhaps, even when they're in the intensive care unit setting making certain that there aren’t any sort of complication or issues that are gonna prevent them from making gains as they recover out on the floor. We have what we call a transdisciplinary model. Transdisciplinary means that it’s not just occupational and physical therapists and speech language pathologists working on separate issues, but they combine a lot of their activities along with nursing and music therapy so that within a single session we’re probably addressing multiple different needs that a child might have.
The other very important aspect is because this takes place at St. Louis Children’s Hospital up on our neuroscience floor, we’re able to deliver these services to children that still may require other acute medical interventions. For example, children that have had a traumatic brain injury that are still having seizures. We work very closely with the epileptologist to maximize treatment for those problems. We have a very close relationship with neurosurgeons. So we will have children that at some stage of their recovery while they're getting therapy may have to go back to the operating room for their procedure. Children with brain tumors can continue to get their radiation and chemotherapy treatments and still get the intensive therapy. That’s a big key because you don’t want to slow down the child’s recovery unnecessarily because of the need for acute medical interventions.
Then as the child continues to progress and get more gains, we have the ability to ramp up the intensity and the frequency of therapy. By the time the child is midway through their therapy treatment with us, typically they're gonna be receiving an hour of physical therapy morning and afternoon, an hour of occupational therapy morning and afternoon, and the same for speech therapy. They get that six days out of the week and one session for each on Sunday. So that’s 13 sessions, for example, of physical therapy that really allows the child and the family to see maximum gains during the stage at which their brains and nerves or muscles are making the greatest effort to regain function.
Host: What a comprehensive program. You have a national accreditation by the Commission on Accreditation of Rehabilitation Facilities. Tell us what that means and why it’s important.
Dr. Noetzel: Well, I think the most important aspect of it is that it tells not only parents and their children, but also the medical providers and the insurance companies that we work with. We’re a program that is accredited the highest standards of providing up to date intensive and very knowledgeable rehabilitation strategies to our patients. It also assures that we’re on the cutting edge of changes that take place on a yearly basis in terms of neurorehabilitation treatment with children. In working with CARF, they let us know what sort of possibilities are going to be existing down the road. It allows us to take advantage of that in conjunction with all of the wonderful neuroscience that takes place at Washington University School of Medicine.
Host: Dr. Noetzel, tell us about the facility itself. How many beds? Tell us about the physical nature of it.
Dr. Noetzel: Well, we have nine accredited beds through the CARF process, but we exist fully if you want embedded in the neuroscience unit on the 12th floor at Children’s Hospital. In that unit we have access to about 46 or so different beds. We have our own therapy gym up on the 12th floor. Several rooms that we use for more, I'm gonna say, fun recreational therapeutic interventions. Then also we have a modern up to date fully advanced therapy gym on the fourth floor of Children’s. Again, once our older patients—by that I mean late teenagers and young adults—are ready, for example, for treadmill or exercise bikes or other sorts of high level activities, we can transition them down to that marvelous part of Children’s Hospital.
We also take advantage of other aspects of Children’s. For example, we do outings. We call them early on when we get the children into one of the garden settings where they can get outside. Then we also use the teen lounge to engage in, again, therapeutic social interactions for our patients. Then finally we do what we call functional trial visits and therapeutic community outings where we actually take the patients once they’ve achieved a level of stability into the community, into an environment where they’re going to have to demonstrate some of the gains that they’ve made. For example, going to the science center here in St. Louis, the zoo. That way we can, if you want, in a real life sort of situation gauge what sort of gains they’ve made. Also try it and figure out, okay. Is this child going to have certain issues when he or she is reintegrated into the community both going to home and going back to school?
Host: It’s all so important, especially for children. Since the main point of entry is typically through the emergency department or pediatric ICU, reinforce for us the importance of EMS providers and local hospital providers to know that especially in the cases of trauma involving neurological consequences that Children’s is the place to go.
Dr. Noetzel: Well, I can't emphasize that enough. We had a study that we published about I want to say probably five or six years in concert with our intensivists and our neurosurgeons working in the ICU demonstrating that what takes place there and immediately preceding it in the field with the care being rendered by the EMS providers is so key in putting the child on a proper path to allow us to begin our interventions in the best possible situation to ensure the child’s neurologic recovery. So, again, we get patients transferred to us from other hospitals. We love that. We think that that’s very important, but if we can start working with the child doing everything that’s going to be appropriate to ensure maximal neurological recovery from the moment a provider put his or her hands on the patient in the field. That’s where we really see the best outcome. So we just feel it’s very important that the neurorehabilitation program be considered as a continuum that really starts in the very early stages of a child’s injury or illness.
Host: As we wrap up, Dr. Noetzel, what else do you feel that a pediatrician or provider would want to know about the multidisciplinary aspect of the neurorehabilitation program at Children’s?
Dr. Noetzel: Well, I would say probably the final thing I’d like to leave our listeners with is the concept of outcomes. What are the goals of the neurorehabilitation program. One of the things that we do on a consistent basis with our patients is a scoring system called the functional improvement measure designed specifically to look at recovery of function in young children even down through infancy. We use that as a key to determine A, are we delivering the right therapy to the child? What are the areas we need to work on? We constantly reassess how the child’s doing at our twice weekly conferences and meeting with the family and adjust what we’re attempting to do for the child. We also repeat this analysis to see how the child is functioning after we've discharged them from the hospital, and they’ve returned home, they’ve returned to school, they're getting outpatient therapy. One of the things that our program is most proud about is when these children come back they clearly have demonstrated ongoing improvement.
That tells us a couple of things. Number one, we have put them on the right trajectory to continue improving even with the reduction and the frequency and intensity of services. Number two, we have given the providers in the community, the schoolteachers that are going to be working with them, and most importantly the family the critical knowledge and ability to continue helping their child as they recover and get better and better at doing the things they're supposed to be doing as a child. Playing sports, going to school, and having friends.
Host: Wow. Dr. Noetzel, thank you so much for coming on and explaining to us why this continuum of care is so important for the success of these children. Thank you again for joining us. That wraps up this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or learn more about services and resources available at St. Louis Children’s Hospital, please call the Children’s direct physician access line at 1-800-678-HELP. You can also head on over to our website as stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with other providers. Share on your social media that way we can all learn about these services from the experts at St. Louis Children’s Hospital together. Don’t miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.
Melanie Cole, MS (Host): The neurorehabilitation program at St. Louis Children’s Hospital is designed to address the needs of children and adolescents who have suffered severe injury or illness. My guest today is Dr. Michael Noetzel. He’s a Washington University pediatric neurologist at St. Louis Children’s Hospital. Dr. Noetzel, it’s a pleasure to have you join us today. Tell us a little bit about the conditions that are treated by the neuro rehab program at St. Louis Children’s Hospital.
Michael Noetzel MD (Guest): Well, it’s a very broadly applied kind of net that we set out to get the children that have had usually acute injury or medical conditions that really have impacted on their ability to be functional as children. So the most common diagnosis that we see in these children is going to be an acquired brain injury, often traumatic in nature as a result of an automobile accident. We also see other children that have had strokes, injury to the spinal cord, infections involving the central nervous system. Then a lot of patients who have just been acutely ill and have been in our intensive care unit for a number of weeks or months and have gotten terribly out of shape or deconditioned and require the intensive therapy that we supply in our neurorehabilitation program.
Host: So then describe for us some of the program highlights and features.
Dr. Noetzel: Well, I think the most impressive aspect of the program that the parents tell us about is how fully integrated it is to the total needs of the children as they're starting to recover. So we begin with children, perhaps, even when they're in the intensive care unit setting making certain that there aren’t any sort of complication or issues that are gonna prevent them from making gains as they recover out on the floor. We have what we call a transdisciplinary model. Transdisciplinary means that it’s not just occupational and physical therapists and speech language pathologists working on separate issues, but they combine a lot of their activities along with nursing and music therapy so that within a single session we’re probably addressing multiple different needs that a child might have.
The other very important aspect is because this takes place at St. Louis Children’s Hospital up on our neuroscience floor, we’re able to deliver these services to children that still may require other acute medical interventions. For example, children that have had a traumatic brain injury that are still having seizures. We work very closely with the epileptologist to maximize treatment for those problems. We have a very close relationship with neurosurgeons. So we will have children that at some stage of their recovery while they're getting therapy may have to go back to the operating room for their procedure. Children with brain tumors can continue to get their radiation and chemotherapy treatments and still get the intensive therapy. That’s a big key because you don’t want to slow down the child’s recovery unnecessarily because of the need for acute medical interventions.
Then as the child continues to progress and get more gains, we have the ability to ramp up the intensity and the frequency of therapy. By the time the child is midway through their therapy treatment with us, typically they're gonna be receiving an hour of physical therapy morning and afternoon, an hour of occupational therapy morning and afternoon, and the same for speech therapy. They get that six days out of the week and one session for each on Sunday. So that’s 13 sessions, for example, of physical therapy that really allows the child and the family to see maximum gains during the stage at which their brains and nerves or muscles are making the greatest effort to regain function.
Host: What a comprehensive program. You have a national accreditation by the Commission on Accreditation of Rehabilitation Facilities. Tell us what that means and why it’s important.
Dr. Noetzel: Well, I think the most important aspect of it is that it tells not only parents and their children, but also the medical providers and the insurance companies that we work with. We’re a program that is accredited the highest standards of providing up to date intensive and very knowledgeable rehabilitation strategies to our patients. It also assures that we’re on the cutting edge of changes that take place on a yearly basis in terms of neurorehabilitation treatment with children. In working with CARF, they let us know what sort of possibilities are going to be existing down the road. It allows us to take advantage of that in conjunction with all of the wonderful neuroscience that takes place at Washington University School of Medicine.
Host: Dr. Noetzel, tell us about the facility itself. How many beds? Tell us about the physical nature of it.
Dr. Noetzel: Well, we have nine accredited beds through the CARF process, but we exist fully if you want embedded in the neuroscience unit on the 12th floor at Children’s Hospital. In that unit we have access to about 46 or so different beds. We have our own therapy gym up on the 12th floor. Several rooms that we use for more, I'm gonna say, fun recreational therapeutic interventions. Then also we have a modern up to date fully advanced therapy gym on the fourth floor of Children’s. Again, once our older patients—by that I mean late teenagers and young adults—are ready, for example, for treadmill or exercise bikes or other sorts of high level activities, we can transition them down to that marvelous part of Children’s Hospital.
We also take advantage of other aspects of Children’s. For example, we do outings. We call them early on when we get the children into one of the garden settings where they can get outside. Then we also use the teen lounge to engage in, again, therapeutic social interactions for our patients. Then finally we do what we call functional trial visits and therapeutic community outings where we actually take the patients once they’ve achieved a level of stability into the community, into an environment where they’re going to have to demonstrate some of the gains that they’ve made. For example, going to the science center here in St. Louis, the zoo. That way we can, if you want, in a real life sort of situation gauge what sort of gains they’ve made. Also try it and figure out, okay. Is this child going to have certain issues when he or she is reintegrated into the community both going to home and going back to school?
Host: It’s all so important, especially for children. Since the main point of entry is typically through the emergency department or pediatric ICU, reinforce for us the importance of EMS providers and local hospital providers to know that especially in the cases of trauma involving neurological consequences that Children’s is the place to go.
Dr. Noetzel: Well, I can't emphasize that enough. We had a study that we published about I want to say probably five or six years in concert with our intensivists and our neurosurgeons working in the ICU demonstrating that what takes place there and immediately preceding it in the field with the care being rendered by the EMS providers is so key in putting the child on a proper path to allow us to begin our interventions in the best possible situation to ensure the child’s neurologic recovery. So, again, we get patients transferred to us from other hospitals. We love that. We think that that’s very important, but if we can start working with the child doing everything that’s going to be appropriate to ensure maximal neurological recovery from the moment a provider put his or her hands on the patient in the field. That’s where we really see the best outcome. So we just feel it’s very important that the neurorehabilitation program be considered as a continuum that really starts in the very early stages of a child’s injury or illness.
Host: As we wrap up, Dr. Noetzel, what else do you feel that a pediatrician or provider would want to know about the multidisciplinary aspect of the neurorehabilitation program at Children’s?
Dr. Noetzel: Well, I would say probably the final thing I’d like to leave our listeners with is the concept of outcomes. What are the goals of the neurorehabilitation program. One of the things that we do on a consistent basis with our patients is a scoring system called the functional improvement measure designed specifically to look at recovery of function in young children even down through infancy. We use that as a key to determine A, are we delivering the right therapy to the child? What are the areas we need to work on? We constantly reassess how the child’s doing at our twice weekly conferences and meeting with the family and adjust what we’re attempting to do for the child. We also repeat this analysis to see how the child is functioning after we've discharged them from the hospital, and they’ve returned home, they’ve returned to school, they're getting outpatient therapy. One of the things that our program is most proud about is when these children come back they clearly have demonstrated ongoing improvement.
That tells us a couple of things. Number one, we have put them on the right trajectory to continue improving even with the reduction and the frequency and intensity of services. Number two, we have given the providers in the community, the schoolteachers that are going to be working with them, and most importantly the family the critical knowledge and ability to continue helping their child as they recover and get better and better at doing the things they're supposed to be doing as a child. Playing sports, going to school, and having friends.
Host: Wow. Dr. Noetzel, thank you so much for coming on and explaining to us why this continuum of care is so important for the success of these children. Thank you again for joining us. That wraps up this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or learn more about services and resources available at St. Louis Children’s Hospital, please call the Children’s direct physician access line at 1-800-678-HELP. You can also head on over to our website as stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with other providers. Share on your social media that way we can all learn about these services from the experts at St. Louis Children’s Hospital together. Don’t miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.