The Santa Clara Valley Medical Center's (SCVMC) Rehabilitation Research Center (RRC) is dedicated to improving patient care by investigating innovative treatments, identifying and promoting factors associated with prevention and resilience, and understanding the continuum of care from acute care through community reintegration. Recently published research led by the Chair of the Physical Medicine and Rehabilitation Department (Dr. Crew) and Chief of the Respiratory Rehabilitation Unit (Dr. McKenna) has provided evidence for the benefits of specialized respiratory management, which include the use of high-volume ventilation, mechanical insufflation-exsufflation, and consideration for the use of theophylline in individuals with high cervical spinal cord injury (SCI). Clinical trials conducted at SCVMC should further inform future clinical practice by investigating the efficacy of stem cell treatment through the Asterias SCI study, acute administration of Riluzole in individuals with SCI through the RISCIS study, and repetitive transcranial magnetic stimulation in individuals with severe traumatic brain injury (TBI).
Beyond investigating innovated treatments, research led by the Chief of Outpatient PM&R (Dr. Shem) illustrates the feasibility, quality of care, and consumer satisfaction of telemedicine treatment of individuals with SCI using Apple's FaceTime. This telemedicine program may reduce the barriers to specialized care by reaching individuals in the comfort of their own home; by doing so increasing patients' independence to reach treatment. Furthermore, research investigating preventative care, such as the use of Vitamin D treatment for individuals with SCI, has shown to the reduced odds of developing venous thromboembolism. Work led by both the Chair (Dr. Crew) and Vice Chair (Dr. Duong) of the PM&R Department are investigating the seasonal and demographic effects of Vitamin D deficiency, which could inform treatment strategies for under-represented groups in research.
The RRC at SCVMC has a unique ability to investigate outcomes from acute care through initial inpatient rehabilitation onto discharge back into community. Additionally, the RRC continues to be a part of a national database that includes 25 years of longitudinal data for patients with TBI and SCI. Research from these databases elucidates the importance of care, and subsequently may reduce secondary complications that are commonly experienced when individuals reintegrate into the community. This unique commitment from a public hospital allows SCVMC to be a leader in providing care for individuals with spinal cord and brain injury.
Research led by Dr. Kazuko Shem, the Chief of Outpatient Physical Medicine and Rehabilitation (PM & R) at Santa Clara Valley Medical Center (SCVMC), illustrates the feasibility, quality of care, and consumer satisfaction of telemedicine treatment in individuals with spinal cord injury (SCI) using Apple's FaceTime. Dr. Shem has received three grant awards over the last 6 years to investigate general telemedicine consultations, tele-nutrition counseling, and tele-psychology-based Cognitive Behavioral Therapy (CBT). The initial telemedicine study, funded through the Craig H. Neilsen Foundation, tested the efficacy of a FaceTime-delivered medical consultation for individuals with SCI. The aim of this study was to decrease resource utilization and secondary complications and increase participants’ quality of life. From 2015 to 2018, this study provided 213 consultations for 83 participants and received a 90% program satisfaction rating by the participants across 3 categories (perceived health, satisfaction with telemedicine equipment, and program satisfaction).
With a goal to provide care for individuals with SCI specialized care that meets their needs, Dr. Shem collaborated with Registered Dietician Nutritionist, Shelley Wood, to develop a tele-nutrition counseling protocol, which was funded by the Christopher and Dana Reeve Foundation. This project saw significant improvements in eating behaviors as well as 97-100% participant satisfaction. Similarly, Dr. Shem along with Dr. Mark Held, a rehabilitation psychologist, developed a CBT protocol that can be administered via FaceTime, resulting in the first Department of Defense Grant SCVMC has received. Currently in the second year of the project, the hope is that this study will receive similar satisfaction ratings as previous telemedicine research at SCVMC.
These telemedicine programs may reduce barriers to specialized care by reaching individuals in the comfort of their own home and increasing participants’ independence and quality of life.