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The biology of recovery

Bringing brain injury care around the globe.

A brain injury is often called the most complicated injury in the most complicated organ in the human body. The almost unlimited variations of the human mind can create huge barriers for caregivers and researchers on how to approach treating a brain injury. Having a robust team approach to manage both the biologic and psychologic factors is critical, as is having access to the latest research and scientific approaches. For patients at Spaulding Rehabilitation Hospital in Boston, that convergence of novel science and excellence in care is available each day.

As a world-recognised leader in research and innovative physical medicine and rehabilitation, Spaulding believes in fully integrating research into the care environment via the work of clinicians and therapists who work directly with patients and researchers in labs. Through its Spaulding Research Institute, there are over 100 active studies in a wide variety of diagnoses from stroke, brain injury, spinal cord injury, musculoskeletal injury, chronic pain and more, and the hospital’s clinicians and researchers are some the most prolific in the field.

New ideas and a passion for discovery are part of the daily work at Spaulding, the principal teaching hospital of the Harvard Medical School Department of Physical Medicine and Rehabilitation. This academic affiliation combined with its connections to world-renowned centres of healing such as Massachusetts General Hospital and leading innovators of science such as MIT, help Spaulding maintain a vigorous research agenda and operate ongoing clinical trials.

Spaulding’s work in brain injury, led by Dr. Ross D. Zafonte, the Earle P. and Ida S. Charlton Professor and Chairman of the Department of Physical Medicine and Rehabilitation at Harvard Medical School, can best highlight this forward thinking integrated approach to care. Dr. Zafonte also serves as Chief of Physical Medicine and Rehabilitation at Massachusetts General Hospital and Brigham and Women’s Hospital, as well as Senior Vice President of Medical Affairs, Research and Education at Spaulding Rehabilitation Network. His textbook is considered one of the standards in the field of brain injury care. The doctor brings a focus on looking at ways to discover new approaches to care that combine science and personalised medicine.

“What we see in so many of areas of healthcare now is the understanding that individuals are multifactorial, and we have to look at customised approaches to care and science to enable the best recoveries. This is more illustrative than ever when we look at the brain injury population, on why those methods can produce the greatest outcomes,” said Dr. Zafonte.

Often referred to by Dr. Zafonte as “The Biology of Recovery” is the acknowledgement that each person’s unique biological profile contributes to their type of injury and in turn what they may need to recover. The idea of personalised medicine is expanding in everything from wellness programmes to mental health. Applying it in rehabilitation medicine often requires the skill of clinicians to evaluate a patient on who they are and design a unique care plan based on their factors to achieve the greatest outcomes.

Spaulding’s Brain Injury Rehabilitation Programme provides cutting-edge rehabilitative care for adults and children recovering from an acquired brain injury as a result of trauma (such as an accident) or from non-traumatic causes.

An area that is informing brain injury research is sports. In the U.S., collision sports such as American Football and Ice Hockey have garnered attention for new advances and understanding of a type of brain injury – concussion.

Concussions are the sudden displacement of the fluid surrounding the brain causing impact of the brain against the inside of the skull. This damage can be immediately evident or cumulative over time, but often the lasting impacts are devastating resulting in memory loss, loss of function, mental health issues, and more. However, what is so challenging for clinicians is that there are many factors, some societal and unique to each person, that require individualised treatment.

The Harvard Health Football Players Study, which is the largest study of its kind, examines the long-term impacts on retired professional American football players in a multifactorial way. From examining everything right from mental health to biologic profiles of players, researchers hope to learn new methods and models that can help more accurately diagnose and support those with brain injuries from collision sports.

The study has already yielded high impact studies published in major journals including one that showed that mortality rates varied based on the collision rates in sports, and one published in JAMA in Neurology on the loss of sexual health function in men based on sports in which they participated.

Global awareness

The work of Spaulding and Dr. Zafonte has gained global notoriety on two fronts in the world of sports and entertainment in the past year. In the 2018 Champion’s Cup Final, Liverpool goalkeeper Loris Karius suffered a horrific collision on the field in the 3-1 loss to Real Madrid, in front of an audience of millions around the world. It was later learned that he had suffered a concussion and was able to get the support and treatment needed with a team from Spaulding and Mass General.

In the Spring of 2019, renowned actress Emilia Clarke, best known for her portrayal of Daenerys Targaryen on Game of Thrones, revealed to the world she was a brain injury survivor. As part of that broadcast, she announced the launch of her SAMEYOU Foundation to fund brain injury research and education. Clarke also announced that Spaulding would be the first U.S. based charity partner and immediately launched an online campaign to raise over US$1 Million for new studies into brain injury led by Dr. Zafonte.

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Actress Emilia Clarke, a brain injury survivor, partnered with Spaulding to launch the SAMEYOU Foundation to fund brain injury research and education.

As a U.S. News and World Report highly ranked Best Hospital (#3 in 2019), Spaulding recognised an ever-increasing global need for rehabilitative medicine and the opportunity to provide support and expertise in areas such as traumatic brain injury.

For Spaulding, that commitment to creating partnerships overseas began over six years ago with a consulting project with a group looking to create a new rehabilitation facility in the UAE. It became evident very quickly to the leadership at Spaulding that there was a dearth of rehabilitation medicine expertise and a significant growing need internationally. However, before diving in fully, Spaulding collaborated with other leading institutions to identify the best approach and locations where experts from Spaulding could make an impact.

Among the many pitfall’s healthcare organisations have found is trying to recreate or “set up shop” with an owner/operator model. This method becomes a labour and resource intensive exercise. Also, a classic traditional consulting model has a focus on the short-term and is generally project based. Rather, Spaulding leaders decided to take a collaborative model approach with an emphasis on long-term commitment, knowledge transfer and sustainable outcomes.

This approach serves to allow for local ownership, where organisations could tap specific expertise to apply it to the needs that best work within their culture and population. To lead these efforts to evaluate, create, and foster productive relationships internationally, Spaulding International, LLC was established.

“What we have found is a real desire to look for collaborators who can provide clinical expertise but also the openness and flexibility to understand that there is no one size fits all approach, and this is a different situation than in the U.S.,” said Bob McCall, Senior Vice President of Network Development. “What is rewarding is we feel that we have found emerging rehabilitation markets that can truly benefit from our clinical expertise and cutting-edge research to improve the lives of people. This also helps us create new revenues that support new pathways of research. We are just scratching the surface of the need across the globe.”

Services and approaches offered by Spaulding include hosting clinicians on-site for mentoring and training, virtual training via video conferences, tailored sharing of best practices, and more. In many areas internationally, there are massive acute care campuses of many thousands of beds; however, there are no formal home care services, limited outpatient programmes and a severe shortage of rehabilitation beds.

“For our team what has been very exciting is learning new ideas and best practices we take back to Spaulding. In many ways the technologies and processes for patient support, hospital wayfinding, and family response are outstanding,” said McCall. “Our goal is to build true collaborations that result in a productive sharing of ideas, culture and resources that ultimately enable all of us to better serve the populations entrusted to our care.”

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