Our “clinician-researchers” working in physical medicine and rehabilitation across the continuum of care are focused on improving outcomes for all patients and families. Below are brief descriptions of select projects that are currently ongoing.
West Nile Virus
Studies evaluating neuropsychological and functional outcomes in patients who have been diagnosed with neuroinvasive subtypes of West Nile Virus have been emerging in the relatively young course of the virus since the first outbreak in New York in 1999. Generally subsequent and retrospective data review has had limitations associated with the unpredictability of the virus including single points of contact, limited sample size, and/or self-report measures. Texas was at the center of 2012 outbreak, which initiated a protocol for neuropsychological data collection across the continuum of care, from inpatient hospital admission, day neurorehabilitation, and return to the outpatient clinic. As a result, Dr. Nicole Fromm, is to evaluating trends in cognitive, physical, and functional recovery during rehabilitation and recovery process. Her goal is to add to the literature on best clinical practices to educate patients and families on cognitive and functional patterns of recovery, as well as evaluating the use of neuropsychological assessment across the continuum of care to target recommendations and interventions during the course of recovery.
Fiberoptic Endoscopic Evaluation of Swallowing in the NICU
The standard procedure to assess an infant in the NICU who is suspected of aspirating on oral bottle feedings is to conduct a modified barium swallow study, also known as a Videofluoroscopic Swallowing Study (VFSS). There are challenges and barriers with this procedure for assessment of swallowing including cost, transport team, exposure to barium. Based on the challenges with VFSS for infants in the NICU, the Baylor NICU team discussed the possibility of utilizing FEES (Fiberoptic Endoscopic Evaluation of Swallowing) as an alternative assessment. A multi-disciplinary team was formed and created and implemented a FEES program for the NICU. The Baylor University Medical Center’s neonatal therapy team has performed over fifty FEES in the NICU, including ten FEES during breastfeeding. The therapy team and physicians have successfully collaborated based on the FEES results to determine feeding plans and recommendations for further plan of care for the patient. Currently, the team are working on a randomized control trial with the primary objective to determine sensitivity and specificity values for laryngeal penetration (liquid within the larynx) and tracheal aspiration (liquid below the level of the vocal folds) using both VFSS and FEES. The secondary objective is to evaluate FEES while breastfeeding as a method to observe the presence or absence of laryngeal penetration and/or tracheal aspiration during breastfeeding.
Improving Health Literacy Awareness among Staff and Patient Populations
The purpose of this research series is to develop awareness of how health literacy impacts the hospital environment and quality of patient care. Through this research we plan to enhance modes of patient delivery to accommodate all patient learning preferences across all disease processes.
Patient Activation Measure
Individuals requiring inpatient rehabilitation have to self-manage diverse aspects of their health and healthcare. As a result, clinicians are challenged to identify individuals who are at greater-risk for being unable to self-manage health and health care. The purpose of this research series is to determine “activation” level as it is critical to self-management of health and is considered to be significant to an individual’s knowledge, skills, and motivational attributes.