With more than 50 patient visits a day, the Division of
NeuroRehabilitation is one of the busiest divisions within
the Department of Neurology. Neurorehabilitation serves a
vital role in the care of many patients with neurological
diseases including traumatic brain injury, stroke, and multiple
sclerosis.
Under the direction of Kester J. Nedd, D.O., the division’s
chief and an expert in the field of traumatic brain injury,
the program has become nationally recognized as a premier
center for the care of brain injured patients.
The division runs three inpatient services, a consult service,
numerous outpatient clinics, as well as private outpatient
clinical practices. In addition, the department is developing
a research program involving interventional treatments for
spasticity and pain.
All of the above programs are run by three faculty members,
four physician assistants, a fellow, and residents. Also
considered teaching programs, they are offered as elective
clinical rotations for medical students and neurology residents.
Neurorehabilitation Service at Ryder Trauma Center
The Neurorehabilitation Service at Ryder Trauma Center is
a CARF accredited, 30-bed rehabilitation unit dedicated
to the acute inpatient rehabilitation of neurologically
impaired patients at Jackson Memorial Hospital.
Kester J. Nedd, D.O. serves as the medical director for
this unit, which is staffed by a full-time comprehensive
rehabilitation
team. This team, which is specially trained to deal with
the needs of the neurologically impaired patient, includes
physical, occupational, speech, and recreational therapists,
neuropsychologists, rehabilitation nurses, and a full time
social worker and case manager.
Since the rehabilitation unit is part of a tertiary care
hospital, it often accepts lower level patients who have
significant medical needs. Furthermore, the unit regularly
accepts non-neurological patients with rehabilitation needs
such as post-transplant patients and patients with medical
deconditioning.
Neurorehabilitation Service at HealthSouth Rehabilitation
Hospital
The Neurorehabilitation Service at HealthSouth Rehabilitation
Hospital is also a CARF accredited rehabilitation program
that provides neurorehabilitation services to many private
patients in the southern part of Miami-Dade County. An
expert in the field of concussion and closed head injury,
David
Kushner, M.D. serves as the chief of the neurorehablitation
service at HealthSouth Rehabilitation Hospital in Cutler
Ridge.
He is also responsible for directing and managing the
neurorehabilitation and traumatic brain injury clinics
at Jackson Memorial Hospital.
Intermediate Head Injury Service
The Intermediate Head Injury Service is directed by Bruce
S. Rubin, M.D., an authority in the field of spasticity
management, and assisted by Kester J. Nedd, D.O. This
busy inpatient
service has close to 300 annual admissions.
Housed on the inpatient neurology ward, the service serves
two purposes at Jackson Memorial Hospital, it treats
patients with mild head injuries who require hospitalization
and cares for lower level brain injured patients who are
not yet able to tolerate an inpatient rehabilitation program.
All of the patients are screened and seen on a daily basis
by physical, occupational, and speech therapists, and a
neuropsychologist.
Neurorehabilitation Consult Service
The division offers consultation to patients at Jackson Memorial
hospital who may have neurological rehabilitation needs.
The consultant will give specific recommendations about
patient management and/or appropriate placement. The service
staff works very closely with members of the Neurosurgery
and Trauma Departments.
Neurorehabilitation and Traumatic Brain Injury Clinics
The Neurorehabilitation and Traumatic Brain Injury Clinics
run a weekly staff clinic, which offers follow-up care
for patients with traumatic brain injury and patients
discharged from the Neuorehabilitation Unit. In addition,
outpatients
who wish to be admitted for inpatient rehabilitation
are evaluated. The clinics are overseen by David Kushner,
M.D.
Spasticity Clinic
A recent addition to the division’s clinical offerings,
Bruce
S. Rubin, M.D. recently started this clinic at Jackson
Memorial Hospital. Patients who suffer with spasticity
are evaluated
by a team, led by Rubin, which includes a physical
therapist, an occupational therapist, and a physician
assistant who
are extremely knowledgeable about spasticity, its functional
impact, and potential treatments. Patients are routinely
videotaped prior to and after any type of intervention,
such as Botulinum Toxin injections or an intrathecal
Baclofen
trial. In addition, the physician assistant is available
to help patients when needed.
Due to direct involvement of critical structures of the
brain, spinal cord, and nerves, tumors of the nervous system
often cannot be cured or effectively managed by surgery alone.
Even benign tumors of the nervous system frequently cannot
be surgically cured and must be considered for adjuvant treatments
such as radiation therapy or chemotherapy. Surgical management
must be carefully integrated with radiotherapy and chemotherapy;
aggressive management may prolong life and improve functional
status and quality of life.
