RESEARCH-BASED INTERVENTIONS

Trauma patients with high BMI may struggle with depression and returning to work

3 An antidote to physician burnout

Residency at Baylor University Medical Center at Dallas, helped design the analysis to determine the impact of obesity on health and social outcomes following traumatic injury.

“Americans have the longest workweek and longest workdays compared to the rest of the world. Consequently, we choose quicker food options, not necessarily healthy ones. Living in Texas, where there is an even greater demographic of diabetes and obesity, I wanted to see if there was an association between obesity and trauma outcomes,” says Patel, a fourth-year resident.

The group studied by Dr. Patel was part of the Baylor University Medical Center Trauma Outcome Project (BTOP), and was comprised of patients

Baylor Institute for Rehabilitation’s research into a demographic and injury-related data set on trauma patients is reveal-ing potential outcomes

that may aid patient intervention and recovery. The latest example: An analysis of injury-related data on those treated at Baylor University Medical Center affi rmed that trauma patients

who are obese or overweight experi-ence a higher rate of depression and are less likely to return to work. The preliminary fi ndings could lead the way to earlier interventions to identify and treat depression among trauma patients who are obese or overweight.

MethodsSonesh Patel, DO, chief resident of the Physical Medicine and Rehabilitation

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Injury-related data revealed that overweight trauma patients experience a higher rate of depression, information that can help guide future care.

4 Katherine Froehlich-Grobe, PhD, now associate research director 6 Residents want feedback

in a clinical environment

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with TBI, SCI and other traumatic injuries. Initially, 455 patients were consented and enrolled. Of those, 343 completed a three-month post-traumatic injury follow-up. The group was comprised of 127 obese patients, 105 overweight patients and 104 normal weight patients. Seven of the original 343 were disqualifi ed because they were considered underweight.

Demographic and injury-related data were collected retrospectively from the medical record as well as the hospital’s trauma registry. Screened health outcomes included depres-sion, post-traumatic stress disorder (PTSD), pain and whether patients had returned to work three months post-injury. Patients who were not working prior to the traumatic injury were not included in the return-to-work variable.

ResultsRelative to controls, obese trauma patients were 2.36 times more likely to screen positive for depression at a three-month follow-up. Additionally, overweight trauma patients had lower odds of returning to work compared to the normal weight control group. No signifi cant diff erences were found in rates of PTSD or pain outcomes among BMI groups.

With 34 out of the 62 Hispanic participants having a Body Mass Index (BMI) qualifying for obesity, that ethnic group had the highest rate of obesity (55 percent). Thirty-eight per-cent of white participants were obese (88 of 231), and 35 percent of African-American patients (27 of 78).

Patel says the depression and return-to-work fi ndings put a diff er-ent face on obesity than the atten-tion given to typical adverse health outcomes. “A lot of attention is given to how obesity drives higher rates of diabetes, heart disease, high blood pressure and high cholesterol, and rightly so,” Patel says. “However, our preliminary fi ndings establish that obesity can aff ect mental health and

return-to-work, too. This has very big implications for family breadwinners. It extends beyond the patient’s health to his or her family members.”

ImplicationsThese and other fi ndings may help guide early treatment of trauma patients, especially obese patients. “The fi ndings help us identify compli-cations for which patients are most at-risk. With this study specifi cally, knowing that a trauma patient with a high BMI is at more risk for depression and failure to return-to-work, we can now make the case for screening those patients for depression early on and fol-lowing them,” says Ann Marie Warren,

PhD, ABPP, associate investigator of trauma research for the Division of Trauma, Critical Care and Acute Care Surgery at Baylor University Medical Center at Dallas. “We should be pay-ing a lot more attention to screening for depression, and this data supports that idea.”

Warren is the principal investigator for BTOP and says the data set could open doors for program interventions across many diff erent kinds of trau-matic injuries. “Every trauma center has data on how people were hurt. What is more unique to BTOP is that we have data on hundreds of trauma patients on alcohol use, PTSD, mental health, pain, quality-of-life and other

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RESULTSObese trauma patients were

2.36 times more likely to screen

positive for depression at

a three-month follow-up

Overweight trauma patients

had lower odds of returning to work compared to the

normal weight control group

“The goal was to see what’s really going on with trauma patients. What are the problems? What patients are most at-risk? What can we do while patients are in the hospital to predict problems later on? If we can answer these questions, we can make eff orts to provide earlier interventions.” —Ann Marie Warren, PhD, ABPP

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positive psychological factors like resil-ience,” she says. “The data opens doors and supports the idea of thinking about programmatic interventions.”

The research takes a comprehensive view of trauma, which can improve treatment.

“The goal was to see what’s really going on with trauma patients. What are the problems? What patients are most at-risk? What can we do while patients are in the hospital to predict problems later on? If we can answer these ques-tions, we can make eff orts to provide earlier interventions,” Warren says.

Patel says the fi ndings of his obesity and trauma outcomes study pave the way for specifi c interventions such as early involvement from psychol-ogy (which could lead to depression screening, medication, intervention therapy and other treatments), dietary consultations to foster healthier eat-ing plans, education on how to adopt healthier behaviors, and connections to social support services that can help the patient transition to home and work. “This research is really all about learning how to better support our trauma patients,” he says.

While the fi ndings should be con-sidered preliminary and are limited to one health care system, Warren says the results could likely be generalized to other trauma centers.

Funding support for BTOP was provided by the Stanley Seeger Surgical Fund of the Baylor Health Care System Foundation. �

Sonesh Patel, DO, is Chief Resident of the Physical Medicine and Rehabilitation Residency at Baylor University Medical Center at Dallas. He can be reached at 3 Sonesh.Patel@BSWHealth.org.

Ann Marie Warren, PhD, ABPP, is Associate Investigator of Trauma Research for the Division of Trauma, Critical Care and Acute Care Surgery at Baylor University Medical Center at Dallas. She can be reached at 3 AnnMarie.Warren@BSWHealth.org.CO

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A t a time when dissatisfaction in working as a physician is at an all-time high and the term “burnout” is regularly used in our fi eld, it is sometimes diffi cult to fi nd the silver lining. I regularly contemplate the many factors that play into these emotions, such as increased regulatory constraints and the ever-annoying

electronic health record, and how my organization can implement measures to help physicians stay interested and healthy.

Out of the blue, a recent patient encounter served as a message to me.

The patient I am referencing is a physically strong, muscled man who works protecting the public. My fi rst impression indicated he was capable of handling the stress of his current situation, but I reconsidered when he choked up while talking with me. He asked if one of my physician partners that he saw in consultation was at work that day, as he needed to tell him something. He relayed the story of a leg injury gone very bad, resulting in numerous surgeries without guarantee of a satisfactory and functional end point. He had met my partner in the acute care setting to discuss amputation as an option in his care plan.

As the patient continued with his story, he revealed that my partner had not necessarily made the decision to select amputation (which the patient ultimately had). The patient instead was impressed that my partner carefully outlined his anticipated functional outcome with amputation (as only a physiatrist can do) and, more importantly, my partner listened to him. This big, burly man was moved to tears by the honesty and time given to him by my partner, and this intervention reassured him about his decision to proceed with surgery.

While this story falls short of being a solution to the complex issues of physician dissatisfaction and burnout, it does serve as a simple reminder of what inspired many to enter medicine in the fi rst place: helping others. I hope we can all remember that mission while we seek and implement meaningful solutions for challenges that face us today.

Keeping sight of why we’re here

Dr. Wilson can be reached at: 3Amy.Wilson@BSWHealth.org 3 AMWilson@BIR-Rehab.com

A MESSAGE FROM

The Medical DirectorAmy J. Wilson, MDMedical Director, Baylor Institute for RehabilitationChief, Department of Physical Medicine and Rehabilitation, Baylor University Medical Center

At a time when dissatisfaction in working as a physician is at an all-time high and the term “burnout” is regularly used in our fi eld, it is sometimes diffi cult to fi nd the silver lining.

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The goal is to examine the effi cacy of the intervention in another for-mat. “Can we move this intervention to deliver it on an online platform and use it to promote health? We are hypothesizing that 75 percent of peo-ple will adopt the exercise program, and we will be able to detect changes in fi tness by measuring aerobic capac-ity during performance on a maximal graded aerobic test, also referred to as a stress test,” she says.

A focus group will begin soon, followed by a small feasibility trial that will enroll patients who are at least one-year post-SCI. The trial will be underway by late spring 2017.

Froehlich-Grobe says she’s pleased to join Baylor Institute for Rehabilitation. “The research we are conducting here, combined with clinical knowledge and skill that helps patients to resume the highest level of function possible, positions Baylor Institute for Rehabilitation as a hos-pital on the forefront of rehabilitation and community health,” she says. �

activity,” she says. That yearlong randomized, controlled trial looked at one group that got maximal phone sup-port to encourage physical activity and a control group that

got minimal support via mailed information

about becoming physically active. Unsurprisingly, the group with maxi-mal phone support did signifi cantly more exercise over the year.

“We have transitioned the support content to a website, and now we’re testing to see if we can deliver this inter-vention in a virtual, group-based set-ting,” Froehlich-Grobe says.

A facilitator will lead group online video meetings with SCI patients to help them sustain increased physical activity. “We’ll have set meeting times where people will connect virtually on a tablet or phone into the meeting so they can see the facilitator and one another,” she says.

K atherine Froehlich-Grobe, PhD, has joined Baylor Institute for Rehabilitation as associate director of research.

Froehlich-Grobe was trained as a behavioral psychologist and has devoted 20 years to examin-ing, developing and testing healthy behavior interventions for people who live with stroke, multiple sclerosis and spinal cord injury. “My research is predominantly focused on getting people started on exercise, but has also begun to address weight loss,” Froehlich-Grobe says.

Froehlich-Grobe served more than fi ve years on the faculty of the University of Texas School of Public Health. Previously, she was a researcher at the Kansas University Life Span Institute and on the faculty of the occupational therapy depart-ment at KU Medical Center.

Web-based InterventionsFroehlich-Grobe brings with her two grants on which Director of Research Simon Driver was already collaborating. One is a yearlong weight loss interven-tion for people living with mobility impairment, funded by the Centers for Disease Control and Prevention.

The other project is a NIDILRR-funded study she is leading with Baylor Institute for Rehabilitation and the UT School of Public Health. Called Workout on Wheels Intent Intervention (WOWii), the project aims to deliver a web-based physical activity intervention directly to SCI patients, overcoming the transportation barrier often faced by this community.

“It builds off of a previous one-on-one phone-based intervention designed to get people to adopt more physical

RESEARCH STAFF GROWTH

Katherine Froehlich-Grobe, PhD

New associate director joins expanding research offi ce

Froehlich-Grobe is working on a

project that uses a web-based

physical activity intervention ,

via online group meetings, to

encourage people with SCI to

exercise.

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families are much more motivated to take part in recovery. This is a fi nding we weren’t necessarily expecting,” Trammell says. “And if patients are more empowered when they leave, hopefully they will be more engaged in eff orts at stroke prevention and health maintenance as well.”

Kapoor says the patient-directed program is a win-win model that she envisions other rehabilitation hospitals replicating in the future. “Our patients’ lives are so aff ected by stroke. They rely on us to lead them to recovery,” she says. “Therapists want to maximize our stroke patients’ potential in the time allowed. This project puts our resources and space to innovative use.” �

The program has eight diff erent stations where patients carry out customized activities in 30-minute segments. The activities are specifi c for each patient’s needs and initiated by the treating therapist. The patients perform self-directed activities in a dedicated space of the gym where they are in the direct line of sight of the therapist and can notify the therapist if they need help.

The stations give patients an opportunity to practice what they learn during inpatient therapy sessions. “Their activities are very task-specifi c based on their abilities and the goals they want to achieve,” Trammell says. Additionally, the stations provide ther-apy time above and beyond the typical three hours per day.

“What we are fi nding is that the patients randomized to be in that extra intervention group are really motivated to take more ownership of their own recovery,” Kapoor says.

Early PromiseBy implementing the protocol dur-ing the inpatient rehabilitation stay, increased emphasis is placed on neuro-recovery in the earliest days following stroke. “We are often treating patients within the fi rst week after stroke. We intervene early in the rehabilitation process, thus putting us at an advan-tage,” Kapoor says.

Although data collection is ongo-ing, Kapoor and Trammell see promise and progress already. “Objectively, we are encouraged with the results thus far. We are fi nding patients and their

T herapists at Baylor Institute for Rehabilitation have developed a program that shows early poten-tial for empowering

stroke patients to participate more fully in their own recoveries, which is critical in times of increased insurance pressures and decreased inpatient length of stays. Preliminary results indicate that the program could have broad implications for improving patient participation and care.

Underway for just over a year, this feasibility study already shows a 20 point increase in patients’ STREAM (Stroke Rehabilitation Assessment of Movement) outcome mobility mea-sures. “When we look at admission to discharge, patients who are participat-ing in self-directed activities are getting 20 points better than the patients who receive only traditional three-hour-a-day therapy,” says Molly Trammell, PT, clinical specialist for Baylor Institute for Rehabilitation.

Program Specifi csFollowing a stroke, the typical inpa-tient rehabilitation patient gets three hours of therapy per day, including physical, occupational and speech therapies. With pressure to produce improved outcomes in shorter peri-ods of time, Trammell and colleague Priyanka Kapoor, OTR, senior therapist at Baylor Institute for Rehabilitation, developed a system of self-directed stretching and task-specifi c activity stations for stroke patients.

MAXIMIZING STROKE RECOVERY

Molly Trammell, PT, is a clinical specialist for Baylor Institute for Rehabilitation. She can be reached at 3 MTrammell@BIR-Rehab.com.

Priyanka Kapoor, OTR, is a senior thera-pist at Baylor Institute for Rehabilitation. She can be reached at 3 PKapoor@BIR-Rehab.com.

Therapists test patient-directed program to enhance post-stroke rehabilitation

Patients are motivated to take more ownership of their own recovery.

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RESIDENT EDUCATION

or punctuality, which are undoubt-edly important. Delve deeper into key performance metrics that a resident or medical student needs to master, such as reading and presenting an article for journal club or mastering the brachial plexus by the end of the rotation,” Hamilton says.

Today’s learner responds to imme-diate, rather than delayed, feedback. This means that faculty physicians should not wait until the end of the rotation to discuss defi ciencies or to off er praise for performance. Dr. Cox reveals that even negative feedback is viewed positively if it is connected back to the original expectations.

Finally, recognize that the teachers are also still learners in this process of setting expectations and providing feedback. “People tend to fall back into old habits of what they felt worked in the past,” Dr. Cox says. “We have to help the teacher to understand that they can-not rely on this anymore.” Both Dr. Cox and Dr. Hamilton agree that with the teachers, one has to set expectations on setting expectations that in turn have to be reinforced—ingraining in them more relevant teaching methods. �

then providing feedback at critical junc-tures along the way.

Interestingly, resident physicians have been shown to evaluate fac-

ulty fi rst on the faculty’s clinical competency followed closely by how well the faculty member

sets expectations and provides feedback, proving just how important these concepts are. By examining the exit interviews of hundreds of resident physicians, Tom Cox, PsyD, director of faculty development and research, Baylor Scott and White Health – North Division, has found that failures in the teaching process consistently occur when the expectations of the educa-tional endeavor were poorly defi ned and feedback was not provided.

Rita Hamilton, DO, physical medicine and rehabilitation residency director at Baylor University Medical Center, agrees. “One of the oversights I see repeatedly is that the attend-ing physician often assumes that the learner can read their minds in terms of expectations. And furthermore, the attending physician feels that the learner should have to do what was done to them during their training years ago,” she says.

“One of the most important things in the role as a teacher is the gift of time,” says Dr. Cox. And often the time involved does not have to be long in order to be impactful, Dr. Hamilton adds. “Give the learner that extra 10 minutes before starting a rotation to set expectations. This one brief crucial conversation dur-ing morning coff ee can save heartache at the end of the rotation.”

Seasoned educators advise teachers to be very explicit with the expecta-tions. “Go beyond the more obvious suggestions around professionalism

Each summer, those of us involved in medical edu-cation participate in the tradition of welcoming a new batch of learners into our institutions. With this

yearly transition comes the responsi-bility of keeping pace with the latest techniques to optimize engagement and learning. Although the mantra, “See one, do one, teach one,” may still have some application in a medical learning environment, generational diff erences in learners command the need for per-sonalization and customization to the educational approach. The teacher has to set the tone for the journey by care-fully outlining expectations at the start

Tom Cox, PsyD, is Director of Faculty Development and Research Education at Baylor Scott and White Health. 3 Thomas.Cox@BSWHealth.org.

Rita Hamilton, DO, is Director of Spinal Cord Injury Medicine at Baylor Institute for Rehabilitation and Residency Program Director of Physical Medicine and Rehabilitation at Baylor University Medical Center. 3 Rita.Hamilton@BSWHealth.org

Part one of a two-part series on key tools for faculty development from Medical Director Amy J. Wilson, MD

Setting expectations and providing feedback in the clinical environment

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MEETING COMMUNITY NEEDS

Growing Services, Saving JobsThe clinic plans to secure funding to purchase an Arobella Qoustic Total Contact Ultrasound, a device used in advanced wound care. “This device may keep some patients off of anti-biotics and help with debridement, which will also save clinic resources,” Orphey says.

Access to expert care also saves patients money and time.

“Many of these patients are working but simply don’t have insurance ben-efi ts,” Orphey says. “We are able to help them keep their jobs by getting their wounds healed up without being admit-ted to the hospital and missing work.” �

Expert Wound CareThe wound clinic is staff ed with a rotation of three certifi ed wound spe-cialists, three half days per week. All three are physical therapists trained to off er advanced wound care, education in wound treatment and prevention, and training in exercises for strength and mobility.

The clinic has used the donated funding to purchase offl oading shoes, total contact casts, compression stockings and advanced products such as enzymatic ointments and foam dressings. The clinic set up an agree-ment with a local podiatrist to supply orthotics and diabetic shoes for the patients after they have healed. The patients pay a small percentage of the cost, the clinic pays the rest from the funding, and the hospital donates the wound care staff ’s time to the clinic.

“Our patients are really getting two-in-one. They receive wound care, but they are also receiving essential rehabilitation,” Orphey says.

In 2015, the clinic saw a total of 38 wound patients, the majority of whom had diabetic wounds. While Orphey and her team are still assembling outcome data, anecdot-ally she knows of patients who have ceased regular ED visits due to clinic wound care.

“We had one patient who would go to the ED with persistent wound infections. They would see him, admit him, and discharge him but his wound would not heal, and they would repeat the whole cycle many times per year. We healed his wound at the clinic, and he has not been back to the ED in over a year,” Orphey says.

When a group of physicians from Baylor Scott & White Medical Center at

Irving started a clinic to address basic medical and dental needs among Irving’s underserved population in 2013, they did not anticipate the large number of patients with wound care needs. These patients’ circumstances were serious: many had slow-healing diabetic wounds, and most had jobs at risk because their wound complica-tions prevented them from attending work consistently.

“We cared for them strictly with donated wound care supplies at fi rst, but quickly realized we needed advanced wound care products and personnel,” says Sharon Orphey, PT, DPT, CWS, FACCWS, CLT, advanced clinical specialist for Baylor Institute for Rehabilitation at Baylor Scott & White – Irving.

Orphey reached out to Irving Healthcare Foundation, which raises money for Baylor Scott & White – Irving. The foundation sought dona-tions and awarded $50,000 to the clinic for essential wound care supplies for this population.

The wound clinic doesn’t just help people with few to no resources; it saves money for the entire system. “Many of these wound patients were telling us they routinely sought care in the emergency department,” Orphey says. “We knew we could keep them out of the ED and help them heal faster, resulting in savings to the hospital in the long run.”

Sharon Orphey, PT, DPT, CWS, FACCWS, CLT is an Advanced Clinical Specialist in the Physical Medicine Department of Baylor Scott & White – Irving. She can be reached at3Sharon.Orphey@BSWHealth.org

Orphey (pictured left) says the clinic now averages almost a dozen patients a month and has started a waitlist.

Wound care for underserved helps patients heal faster and stay out of ED

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Grants• Group Lifestyle Balance: Funded by the Centers for Disease Control and Prevention and led by Katherine Froehlich-Grobe, PhD, this project tests the effectiveness of adapting an evidence-based weight loss program for individuals with mobility impair-ment. In this trial, 68 individuals were randomized to either an experimental or wait-list control group. In August 2016, the experimental group will complete the one-year lifestyle intervention, and the wait-list control group will complete the first six months of the intervention. The study is funded through 2017.• Workout on Wheels Internet Intervention (WOWii): Funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), WOWii utilizes a novel, web-based platform to deliver a physical activity intervention to individuals who have experienced SCI. This community-based participatory research project incorporates elements from research previously conducted by Dr. Froehlich-Grobe.

This project aims to overcome transportation barriers faced by the SCI community by delivering the inter-vention through the internet. Phase 1, which will convene focus groups to review and provide the team with input and guidance on changes to the website, was completed in April 2016.• Traumatic Brain Injury Model System:

Shahid Shafi, MD, MPH, FACS, and his team of investigators continue to work on the TBI Model Systems grant sup-ported by NIDILRR. In its fourth year of support, the project is focused on comparative effectiveness research in TBI treatment.

Publications/Presentations • Warren, A.M., Reynolds, M., Driver, S.J., Bennett, M., Sikka, S. (2016). Posttraumatic Stress Symptoms Among Spinal Cord Injury Patients in Trauma: A Brief Report. Topics in Spinal Cord Injury Rehabilitation, 21(4):356-361.• Pickens, N.D., Long, T. (2016). Occupational therapy practitioners working with caregivers in adult pal-liative care and end-of-life care. OT Practice, 21(3).• Froehlich-Grobe, K., Driver, S.J., Sanches, K.D. (2016). Self-Management Interventions to Prevent the Secondary Condition of Pain in People with Disability Due to Mobility Limitations. Rehabilitation Process and Outcome, 5:1–24• Dixon-Ibarra, A., Driver, S.J., Vanderbom, K., Humphries, K. (2016). Understanding Physical Activity in the Group Home Setting: A qualitative inquiry. Epub ahead of print. Disability and Rehabilitation. PMID:27007887• Driver, S.J., Rachal, L., Sikka, S., Woolsey, A. (2016). Health Literacy: Building a System of Support to Improve Patient Safety and Quality. 4th Annual National Summit on Safety and Quality

for Rehabilitation Hospitals, April 18-20, 2016; Baltimore, MD.• Rachal, L. (2016). Implementation of Dual-Task Performance Assessment Prior to Discharge from Inpatient Rehabilitation. 4th Annual National Summit on Safety and Quality for Rehabilitation Hospitals, April 18-20; Baltimore, MD.• Driver, S.J., & Sikka, S. (2016). Healthcare Utilization following SCI-Regional Registry Data. 4th Annual National Summit on Safety and Quality for Rehabilitation Hospitals, April 18-20; Baltimore, MD.• Carrol, S., Sturdivant, C., Reynolds, J. (2016). Using Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to Assess Infant Feeding in the Neonatal Intensive Care Unit. Pediatric Academic Societies (PAS) 2016 Meeting, April 30-May 3; Baltimore, MD.• Carey, S., Driver, S.J., Reynolds, M., Ko, J., Roberts, W., Lima, B., Hall, S. (2016). Heart-to-Heart: Using Patients’ Native Hearts to Promote Lifestyle Change Post-Transplant. The International Society for Heart and Lung Transplantation Annual Meeting, April 27-30; Washington, DC.• Rachal, L., Driver, S.J., Swank, C. (2016). Intensity and duration of physi-cal activity during acute rehabilitation for traumatic brain injury. American Physical Therapy Association Combined Sections Meeting; February 17-20; Anaheim, CA.

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AURORA, ILPERMIT NO. 500

The material in Rehabilitation Quarterly is not intended for diagnosing or prescribing. Consult your physician before undertaking any form of medical treatment. Physicians are members of the medical staff of Baylor Institute for Rehabilitation and are neither employees nor agents of Baylor Institute for Rehabilitation, Baylor Scott & White Health, Select Medical or any of their subsidiaries or affiliates. Baylor Institute for Rehabilitation is part of a comprehensive inpatient and outpatient rehabilitation network formed through a partnership between Baylor Institute for Rehabilitation and a wholly owned subsidiary of Select Medical. If you are receiving multiple copies, need to change your mailing address or do not wish to receive this publication, please send your mailing label(s) and the updated information to Robin Vogel, Baylor Scott & White Health, 2001 Bryan St., Suite 750, Dallas, TX 75201, or email the information to Robin.Vogel@BSWHealth.org.

RESEARCH UPDATES

The latest news in grants, publications and research

Baylor Institute for Rehabilitation hospitals in Dallas

and Frisco are certified for stroke

rehabilitation by The Joint Commission.

Baylor Institute for Rehabilitation at Dallas is one of only 16 facilities

nationwide designated as a

model system of care for patients with traumatic

brain injuries by the National Institute

on Disability, Independent Living, and Rehabilitation

Research.

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