Core Inpatient Rehabilitation rotations are located exclusively at The Rehabilitation Institute of St. Louis (TRISL). TRISL is a free standing 96-bed comprehensive rehabilitation facility located a few blocks from the medical campus of the Washington University School of Medicine. A multitude of inpatient and outpatient programs are available at TRISL. These programs form a solid teaching base for the training of residents and medical students. Patient referral sources to TRISL are mainly from Barnes-Jewish Hospital and other community and regional hospitals of BJC Health Care System. Comprehensive Rehabilitation Services are structured programmatically and comprise the following programs: Stroke Rehabilitation, Traumatic Brain Injury, Spine and Spinal Cord Injury, Amputee and General Rehabilitation.
Stroke Rehabilitation and Brain Injury (BI) Training
Residents are involved in the management of all aspects of the medical and rehabilitation care of stroke patients of various etiologies, and brain injury patients both traumatic and non-traumatic in the inpatient setting. Residents are actively involved in rehabilitation team including rehabilitation nurses, case management, respiratory therapy, speech therapy, physical therapy, and occupational therapy. Residents are exposed to neuro-psychological testing and evidence-based aphasia programs.
Spinal Cord Injury (SCI) Training
Residents have an opportunity to be involved in the management of a wide range of traumatic and non-traumatic spinal cord patients in inpatient setting to include multiple sclerosis, transverse myelitis, tumors, post surgical degenerative spine diseases, scoliosis, failed back syndrome etc. Residents acquire clinical skills in providing primary care to spinal cord patients along with specific medical and rehabilitative care and complications as related to spinal cord injury.
General Rehabilitation (GR) Training
Residents are involved in the management of patients in their transition from the acute care hospital to the home environment. Most common diagnoses on this unit include general deconditioning secondary to multiple medical co-morbidities, complicated knee and hip joint replacements, fractures, polytrauma, LVADs, and transplants (kidney, heart, liver). Residents are involved in the management of all aspects of the patient’s medical and rehabilitation care and participate in weekly conferences with the rehabilitation team.
This rotation includes exposure to patients with amputations and co-existing medical conditions. This rotation covers the entire continuum of care for amputee population to include: pre-prosthetic acute inpatient program and prosthetic gait training rehabilitation. Residents are involved in management of all aspects of the patient’s medical and rehabilitation care. They acquire clinical skills in wound care, pain management, gait analysis, prosthetic prescription and management.
Specialty Rehabilitation Clinics Rotation
Specialty Rehabilitation Clinics are held at the Center for Advanced Medicine on the Washington University Medical Campus. Residents participate in Stroke, Brain Injury, Spinal Cord, Spasticity and Amputee Clinics. These are all continuity clinics where residents acquire clinical skills and knowledge in long-term rehabilitation management of wide range of neurological conditions, pain management, amputee care, evaluation and management of spasticity to include Botulinum toxin therapy and Intrathecal Pump management.
Musculoskeletal (MSK) Rotation
Residents have an extensive exposure to acute and chronic musculoskeletal conditions and pain syndromes through a variety of clinics in the outpatient setting. During this rotation, residents work with physiatric faculty in the Department of Orthopedics. Residents acquire skills in various interventional spine procedures, MSK ultrasound, joint and trigger point injections, as well as EMGs. Residents may also rotate with private practice musculoskeletal/sports medicine physicans where they are exposed to Independent Medical Evaluations (IME) and worker’s compensation.
Pain Management Rotation
Residents rotate in the Pain Management Center within the Department of Anesthesiology. This clinic offers diverse training in both medical management and interventional procedures as well as working in a multidisciplinary team. Residents will be exposed to fluoroscopic and ultrasound guided interventional pain techniques including various nerve blocks, neuraxial blocks, joint injections, neurolytic procedures, radiofrequency lesioning, and placement of spinal cord stimulators.
Residents are involved in the rehabilitation consults at Barnes-Jewish Hospital. Emphasis of the consult is to provide parallel and ongoing rehabilitative assessment and recommendations for patients with neurological, musculoskeletal and medical conditions and disorders and associated disabilities. Residents actively engage with acute medical and surgical teams and well as rehabilitation team to discuss and initiate rehabilitation therapies and recommendations and facilitate transfer to TRISL or provide other recommendations for another level of rehabilitative care. Resident works closely with the Rehabilitation Liaisons and under the supervision of the attending physician.
Orthotic and Prosthetic (O&P) Rotation
Residents attend clinics and production labs at the local orthotic & prosthetic companies: Prosthetic & Orthotic Design and Hanger. They have an opportunity to work with very experienced practitioners and do hands-on evaluation, casting and fitting of orthotics and prosthetics.
Electrodiagnostic (EDX) Rotation
Residents rotate through the Electrodiagnostic Lab of the Department of Neurology where approximately 3,000 studies are performed each year. Residents receive the extensive training in performing NCSs and EMG and attend weekly clinical neuroscience lecture series that cover mechanisms of neuromuscular diseases, nerve and muscle pathology and electrodiagnostic testing and interpretation. Additional EDX training takes place during MSK rotations and at the VA under the guidance of physiatric faculty. Over the course of the residency program, residents perform over 200 EDX studies under the direct guidance and supervision of AANEM Board certified neurologists and physiatrists.
Residents rotate at the Ranken Jordan (RJ) Pediatric Specialty Hospital, which provides a continuum of care and the intensive transitional care and living support and for medically complicated children and their families. Residents are involved in inpatient and outpatient care of children of all ages and are supervised by two experienced pediatric physiatrists.
Residents also rotate on a pediatric neuro-rehabilitation inpatient unit and attend outpatient clinics at St. Louis Children’s hospital and participate in several pediatric specialty clinics including neuro-rehabilitation, Muscular Dystrophy Clinic, and orthopedics. During these rotations residents gain clinical skills and knowledge in diagnosis and rehabilitation management of a variety of pediatric conditions to include spinal cord and brain injury, cerebral palsy, spina bifida, scoliosis, hip dysplasia, and numerous other neuromuscular and musculoskeletal diseases.
Residents rotate on the Extended Care Rehabilitation Service at the Jefferson Barracks division of the St. Louis VA System. They work under the guidance of three physiatrists and are involved in the evaluation and management of vide range of patients with neurological, polytrauma and MSK conditions in inpatient and outpatient settings. They learn about state, federal and community resources for long term care and support for veterans and their families.