“Out to the side.”
“Turn this off,” occupational therapist Genevieve Lagonera instructs, gently touching patient Eric Kinard’s pectoral muscle. “And turn this on,” she says, touching the muscles around his shoulder blade. Kinard concentrates on his reflection in the mirror, working to move his right arm out and in, out and in, and then forward and back, forward and back, to Lagonera’s calm encouragement.
Kinard suffered a stroke in August 2020. As with many stroke patients, he’s been left with a muscular imbalance around his right shoulder – one set of muscles is tight and stiff while the other is loose and weak. This in turn has led to a painful partial dislocation in his shoulder joint. Lagonera aims to loosen the pectoral muscles and build strength in the scapular muscles to reduce instability and regain some function of the right arm.
But first, the pain must be dealt with. Lagonera began the session by working on the pectoral muscles to get them to relax.
“I always try to address pain first because no one wants to move if it’s painful,” Lagonera explains.
Kinard has gone through multiple therapies since the stroke, his daughter, Sarah, says. Recently, the family began coming here, to the MUSC Health Neurologic Rehabilitation Institute in West Ashley.
The institute, a partnership between MUSC Health and the MUSC College of Health Professions, quietly opened in the fall. Leaders who have been working to develop the institute for the past three years say it fills a niche in the region by offering comprehensive therapy services geared toward neurological conditions, all under one roof.
“Our Comprehensive Stroke Center is one of the best in the country. So then, what we need to be able to do is offer that care long term, ”said David Comeau, DPT, director of Therapeutic and Rehab Services at MUSC Health.
“We thought about this a whole lot. If we ever had a chance to run a clinic, what would it look like? … This is an opportunity to do something very different that MUSC does not currently have. ”
Mark Bowden, PT, Ph.D.
College of Health Professions
Until now, physicians have been limited in their ability to refer patients to a single facility that offers comprehensive neurological rehabilitation from a multi-disciplinary team approach, said Mark Bowden, PT, Ph.D., director of the Division of Physical Therapy, Department of Rehabilitation Sciences, in the College of Health Professions.
Bowden has been gathering ideas for this clinic for some time. As part of a distance-learning physical therapy residency for neurological conditions, overseen by CHP, his team has conducted three to four site visits per year for the last eight years in 13 facilities across seven states.
“We thought about this a whole lot. If we ever had a chance to run a clinic, what would it look like? ” Bowden said. “So, when the opportunity presented itself, that was how we pitched it to MUSC Health – that this is an opportunity to do something very different that MUSC does not currently have.”
The institute includes physical, occupational and speech therapy as well as a seating and positioning clinic. Another goal is to add a specialized wellness center for those who have gone through their therapies and increased their mobility.
“Some of these folks can’t just go to Planet Fitness and Exercise because they still have limitations and safety concerns in a traditional gym environment,” Comeau explained.
Although stroke is one of the most common conditions for patients in the program, the institute can also assist people with spinal cord and brain injury, Parkinson’s disease, multiple sclerosis, balance problems due to inner ear issues or adults with congenital issues like spina bifida or cerebral palsy.
And because of the partnership between the college and the health system, the institute includes opportunities for research and student training.
“I think the thing that makes it really special is not just that it’s comprehensive outpatient therapy, but it really does represent the true tripartite mission of an academic health center of being able to do clinical care, education and research all in the same facility, Bowden said.
The facility includes a classroom, private rooms for speech therapy and specialized equipment to assist patients in relearning to walk. A body weight-supported treadmill system is in place and a weight-supported walking track, which will allow patients to walk around the room while in a safety harness to prevent falls, is due to be installed.
After the session working on his shoulder mobility, Kinard tries out the body weight-supported treadmill. Although he’s pretty active around the house and the neighborhood – he clocked 12,000 steps the day before this therapy session, and he does laundry, dishes and other housework – his gait is off. His right leg turns outward, partially due to muscle tightness. When a therapist tries to get his toes pointing forward, he does not have the range of motion to allow for a full step. That’s something they’re going to work on, says Eric Monsch, PT, DPT, a board certified neurologic clinical specialist.
Kinard goes home with an assignment, too. Lagonera wants him to prop a pillow under his arm when he’s sitting and watching TV, to keep his arm out to his side, instead of letting it drift back to the center of his body as it wants to do. Keeping it in a more open position will stretch the pectoral muscles, which will help with the immobility.
Kinard looks skeptical but promises to try it and report back.
“We’ll see,” Lagonera says. “Sarah and you can try it out, and you and your wife can tell me on Thursday if it worked. OK?
“I’m proud of you today,” she adds. “You’ve got some stuff in there that we can work on. I can not wait to see what else comes through. ”