Functional Specialists

UofL’s PM&R Division grows to better train residents and restore function to patients

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LOUISVILLE In its 41st year, the Physical Medicine & Rehabilitation Residency Training Program at the University of Louisville (UofL) was historically a private residency run by Frazier Rehab Institute, now a part of KentuckyOne Health. In 2011, UofL decided to create the Division of Physical Medicine & Rehabilitation and bring faculty on. The first three faculty members were part of the old Rehabilitation Associates group that Dr. Linda Gleis (this month’s cover story) was once a part of. In June 2011, Darryl L. Kaelin, MD, was recruited as the fourth faculty member and chief of that division.

Kaelin was a med student at UofL when Gleis was residency program director. He counts her as one of his mentors. In fact, Gleis gave Kaelin some advice. She said, “If you want to come back to Louisville to practice, you might want to train elsewhere.” That’s just what Kaelin did.

Leaps and Bounds

Kaelin returned to Louisville to not only take over a position that once belonged to his mentor but also to build a new legacy for the program. “We were fortunate enough to be able to negotiate a growth model with the university and have been able to expand over a two-year period to 10 physicians,” says Kaelin. “Now we have specialists in just about every area of rehabilitation including brain injury, spinal cord injury, cancer rehab, sports medicine, pain management, and pediatric rehab.” He adds, “This not only allows us to take care of all the people who need our services in the Kentuckiana area but also allows us to better train the residents who are coming through the residency program.”

The program currently has six residents, two per year in post-graduate years two, three and four. “We are looking to expand because we feel there is a need for more training in the field and maybe going to as many as 12 residents in the future, but that requires funding in order for that to happen,” says Kaelin.

The symbiotic relationship between the university and Frazier is evident in the organizations’ shared missions of education, clinical care, and research. “Frazier Rehab acts as the hub of our training program as well as all of our clinical and research programs,” says Kaelin. Frazier provides convenient inpatient units and outpatient clinics for residents to treat patients. Residents also see patients at physician offices at Southern Indiana Rehab Hospital, Baptist Health Louisville, and UofL.

Among the division’s rehab services, the spinal cord injury program may be the most well known. “We have what’s called a ‘Model System’ spinal cord program, which means that we’re recognized as among the top spinal cord programs in the country,” says Kaelin.

Two of the areas with the most growth right now are the brain injury program, which Kaelin leads, and pain management, led by Dr. Jonathan Pratt, a fellowship-trained pain specialist experienced in interventional treatments and medication therapy.

Generating Awareness

Because physical medicine and rehabilitation (physiatry) is a relatively small specialty, physiatrists spend a considerable amount of time educating patients and physicians about their services. “We comprise about only 1.1 percent of all physicians. However, almost everyone that develops an illness or injury that results in a loss of function could benefit from treatments that a physiatrist can provide,” offers Kaelin.

Physiatrists often have to differentiate themselves from physical therapists, orthopedic surgeons, and even neurologists. Says Kaelin, “We think of exercise as medicine. We are specialized in prescribing specific types of treatments, whether modalities like electrostimulation or ultrasound, or therapy prescriptions that work specifically for a person’s problem.” Kaelin calls physiatrists “functional specialists,” with expertise in non-surgical treatments and helping people regain function and independence.

Advancements in the field of PM&R include a growing area of technology and computerized equipment, such as electrostimulation, body vibration, and specialized treadmills that get patients better quicker.

At UofL, clinical trials further their mission to expand research and improve clinical care. Current areas being studied include: the effects of locomotor training and medications on spinal cord injuries, the effects of Nudexta on emotional dysregulation after brain injury and stroke, and the effects of botulinum toxin and intrathecal Baclofen on spasticity.

In addition to growth in specialized areas of clinical care, the PM&R program is also looking to expand its geographic reach into the state as part of UofL and the KentuckyOne network. One manifestation of that will be a telerehab program being developed over the next year to allow physicians to follow patients after a severe trauma or debilitating illness once they return home to more rural areas of the state.