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Dr. Vogel and Dr. Mukherjee explain Shriners Children's Chicago's research-based approach to spinal cord injury rehabilitation which features the latest technology.

Spinal Cord Injury Rehabilitation

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Melanie Cole (Host): Each year, 12,000 new cases of spinal cord injury are reported throughout the US. Approximately 10% affect children under the age 16. In the mid 1980’s, Shriner’s Hospital for Children established the nation’s first SCI rehabilitation program specifically designed for children and teenagers. The groundbreaking research at Shriner’s Hospital for Children has led to innovative treatment techniques providing care that helps children lead a full, active, and healthy life. Here to speak with us today is Dr. Lawrence Vogel. He’s an internationally renowned expert in pediatric spinal cord injury, Chief of Pediatrics at Shriner's Hospital for Children – Chicago and the outgoing Medical Director of the Spinal Cord Injury Program, and Dr. Sue Mukherjee. She’s a board certified physical medicine and rehabilitation physician and the new Medical Director of Rehabilitation, Shriner's Hospital for Children – Chicago. Welcome to the show, doctors. Dr. Mukherjee, I’d like to start with you. What is the major cause of spinal cord injuries to children that we’re seeing now?

Dr. Sue Mukherjee, M.D., FRCPC (Guest): The major cause for spinal cord injuries, at this time, are motor vehicle accidents. About half of them are caused by motor vehicle accidents or injuries. As we get into the teenage years, about 40% can be due to a combination of violence or sports accidents.

Melanie: And where are you seeing – is it full spinal cord injury? Are you seeing specific types?

Dr. Mukherjee: In younger children, younger children are more at risk of quadriplegic type injuries. So, injuries to the cervical spinal cord and that’s just related to the physiology of young children with a large head and lax ligaments. Older children tend to have spinal injuries in the lower part of the spine and the thoracolumbar areas, and so, they are more commonly to have paraplegia.

Melanie: So, Dr. Vogel, tell us about pediatric rehabilitation for spinal cord injury using the latest high-tech equipment and innovative therapies offered at Shriner’s Hospital for Children – Chicago. What kinds of things are you doing there for children?

Dr. Lawrence C. Vogel, M.D. (Guest): Well, actually, I’d say probably the highest tech stuff we do is probably the lowest tech stuff, in that I guess I should start with what our goal is and that is that we want our children and adolescents to get back home and participate fully in their community, school, etcetera, and, so, you know, it’s our goal obviously. There’s a huge variety of different interventions that we utilize and a variety of – it’s obviously a team effort with a variety of therapists, physical therapists, occupational therapists, rec therapists, child life specialists, speech therapists. You know, we have, obviously, the physicians, nurses, social workers, dieticians, and psychologists. So, it really is a huge team effort in that the most critical part is the child themselves and their family because they're really the core of the treatment team. So, we use a variety of both high-tech and low-tech activities. Our key, again, is to make sure that they become as independent as they can in all their self-care activities and are as mobile as possible. Whether it be the ability to walk or to use the wheelchair that we certainly have some very advanced techniques such as our robotic walking using, right now we have a Lokomat®, but we also have treadmills called like AlterG, which is kind of like walking underwater. There are kids that have some motor activity. We use aqua therapy, too, which is, again, kids who have some motor function are able to take advantage of aqua therapy. We also use a lot of functional electrical stimulation. So, we have bicycles that even individuals who are completely paralyzed, we can stimulate the muscles to move in a cycling type of pattern which is good for their physiology, and may also if kids are going to show some return, this will help hasten that return. So, those are just a few of the things. We also have an exoskeleton, which is kind of a robotic ability to walk, kind of like a thing that goes from the waist down to the feet, and kind of for somebody who’s, you know, completely paralyzed, as long as they're five foot or taller, can utilize and are able to walk independently. So, that’s just a variety of techniques, again, from the low-tech to the high-tech, but the most important is the team approach.

Melanie: Dr. Mukherjee, what’s the most important thing for parents to know or to do after a child is diagnosed with a spinal cord injury because that can be so scary for a parent to hear? What would you like them to do if they get that devastating news?

Dr. Mukherjee: One of the most important things is to remember that the child with the neurologic injury is still, after all a child, and has a lot of social and developmental aspects of their life that they also need to build on and develop on, and despite the fact that they may have a neurologically impairing condition, we want them to continue to engage in all sorts of activities that help them develop a personality and interests and social skills. So, to participate in the community in different groups, clubs, sports, in an organized manner so that they can fulfill all the things they may wish to do when they become fully-fledged teens and young adults.

Melanie: Dr. Mukherjee, sticking with you for just a minute, how can a parent find a facility that specializes in pediatric spinal cord injury rehabilitation? What would you like them to be looking for?

Dr. Mukherjee: We would say the setting in which they feel that they are getting attention from all the different types of therapists as well as one that fits with their values and their personality and can support school-related goals as well as that fits with the child’s learning style or just being a pediatric patient in general. So, some of the settings can be more adult-focused and so especially for a younger child or a child who is planning to return to school, having a setting that supports their pediatric development, social skills, and play as well as their school development will be important for the younger children, especially.

Melanie: Dr. Vogel, tell us about some of your research on helping patients as children becoming teenagers and adults reintegrate into their communities. Why is that reintegration and transition helpful for your patients?

Dr. Vogel: Sure. Well, one of the things that we did many years ago, well almost a quarter century ago is I realized that the way to measure our success in respect to things like you mentioned, their community reintegration, socialization, etcetera, was to know how they do as adults. So, we had a long-term outcome, we found over 500 patients. Now, some of them are over 15 years of age to see how they're doing in all respects – health problems to socialization, marriage, complications, you know, are they working? Most importantly, what's their quality of life? So, that was probably one of the most important ways to look at how people have done to then say how can we do better when we’re taking care of these children as adolescents? We’ve also, over the years, have had several major studies looking at the psychosocial adjustment of the kids as well as their parents, and you know, it helps us understand as far as, you know, things such as anxiety and depression and what are issues that caregivers like parents face which I think are very important. And the last thing that I think that we're looking at that Dr. Mukherjee, as well as Dr. Zebracki, who we with, have been looking at is that transition. So, the transition from adolescence into adulthood, which is probably, short of being born, was probably the most traumatic period of time that one can go through is those teenage years to become adults. Dr. Zebracki right now has a grant looking at that transition phase and how we can improve it. So, we have a variety of things that span the life span as it were, but, again, my goal is I want my patients to be productive adults. So, it's important for us to understand how the natural history and how they do as adults.

Melanie: And Dr. Vogel, what have you learned after four decades at Shriner’s Hospital for Children – Chicago which began as one of the nation’s first pediatric spinal cord injury rehab programs?

Dr. Vogel: Well, yes, it’s kind of interesting as I look back, I think probably the thing I’ve learned the most is that seriously how resilient and really courageous our patients and their families are. You know, they're obviously, they’re faced with an incredibly dramatic and traumatic situation, and it just impresses me so much how resilient people are and that you need to have expectations to make sure that you provide the patients and their parents with the expectations that their kids are still kids. As Dr. Mukherjee already stated, I think establishing those expectations that you know, we expect our patients to grow up and get a job and, as I would way, move out and stay out of the house is what our goals are, and I think once we, you know, after all these years, again, I'm just very, very impressed and humbled by how well our patients and families have done.

Melanie: Dr. Mukherjee, what are your goals for Shriner’s as the new Medical Director of Rehabilitation Services at Shriner’s Hospital for Children – Chicago?

Dr. Mukherjee: Well, we have a very good wrap-around medical team approach in the sense that, in addition to physiatry, we have orthopedics and now urology as well as we’ll have plastic surgery so we have the full-complementive medical personnel that may be involved in pediatric spinal cord injury care, which is nice to have as something in the onset of the condition and for long-term follow up. So, one of the things I’m interested in is looking at the long-term medical outcomes for kidney function, etcetera, as the children get older, and then in terms of rehabilitative care, I think we have done very well serving the children with regards to returning to functional activities, and then I would like to see a greater focus in the communities with regards to sports participation and other types of community participation to really maximize the outcomes as children get older and reintegrate into their societies.

Melanie: So, Dr. Vogel, last word to you. What's the most important thing that you would like parents of children with spinal cord injuries to know, and why they should look at Shriner’s Hospital for Children – Chicago?

Dr. Vogel: Well, I think too, just really hit that point in that, you know, we really have a very comprehensive approach to how we care for a patient, and we also have a long history of taking care of children and adolescents with spinal cord injury so our experience is very broad, but I do think that having a comprehensive team approach with the involvement of the patients and their families as a part of that team. In fact the most important part of the team, I think is what makes the Shrine system optimal, and I think that, you know, it's always been very family-centered. We’re very culturally sensitive, and, you know, it’s a very nice environment to be honest with you. Most people walk in here – it doesn’t feel like a hospital. It doesn’t smell like a hospital. It’s really a place of very positive vibes, and it’s a lot of fun, as much fun as one can have in a hospital.

Melanie: Thank you so much, both of you, for being with us today. What a wonderful program. This is Pediatric Specialty Care Spotlight with Shriner's Hospital for Children – Chicago. For more information, please visit shrinerschicago.org. That's shrinerschicago.org. This is Melanie Cole. Thanks so much for listening.

About the Speakers

Lawrence C. Vogel, M.D., and Sue Mukherjee, M.D., FRCPC

Lawrence C. Vogel, M.D., is an internationally known expert in pediatric spinal cord injury, chief of pediatrics emeritus at Shriners Children's Chicago. Additionally, he is the medical director of the spinal cord injury program emeritus.

Learn more about Dr. Vogel.

Sue Mukherjee, M.D., FRCPC, is a board-certified physical medicine and rehabilitation physician and medical director of rehabilitation at Shriners Children's Chicago. She leads the hospital’s specialty rehabilitation care for children with spinal cord injuries, spina bifida and other rehabilitation needs.

Learn more about Dr. Mukherjee.

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