On the road but not alone

Man on treadmill receives therapy assistance in open, spacious clinic

MUSC Health Neurologic Rehabilitation Institute and NExT Wellness Research Center provide dedicated spaces for recovery journey to those living with neurological disease or injury

by Shawn Oberrath

For thousands of South Carolinians every year, surviving a stroke or traumatic brain injury or receiving a diagnosis of Parkinson’s disease is just the beginning of a lifelong journey to reclaim wellness and quality of life. After the dust has settled from hospital stays or rounds of testing, the patient’s work truly begins.

And according to Eric Monsch, PT, DPT, an assistant professor in the MUSC College of Health Professions, people want to recover. They just need access to the right tools and services in a way that works for them.

To this end, MUSC is quietly revolutionizing neurological rehabilitation, research and recovery with a collaborative venture between the MUSC College of Health Professions and MUSC Health. With an easily accessible West Ashley location in Charleston, the MUSC Health Neurologic Rehabilitation Institute (NRI) and the NExT (Neurological Exercise and Training) Wellness Research Center gather state-of-the-art equipment and specialized expertise under one roof, providing a roadmap for recovery, healing and ongoing fitness for patients with various neurological conditions.

The NRI is a specialized clinic where every patient shares a common thread – a neurological diagnosis or disease. The therapy team is comprised of recognized clinical specialists in neurology and includes physical therapists (PTs), occupational therapists (OTs), and speech therapists, ensuring that patients receive expert care tailored to their unique needs.

The clinic boasts cutting-edge technologies that may not be available in other therapy settings, such as an overhead bodyweight support system and functional electrical stimulation equipment, as well as access to a dedicated facility for advanced seating and positioning for patients who use power wheelchairs or ultralightweight wheelchairs.

Monsch highlights the importance of the NRI’s comprehensive approach. "Before we opened, many patients were receiving piecemeal rehab at two or three destinations,” he said. “Now they can get all their PT, OT, and speech therapy services under one roof. And as clinicians we love that we can coordinate their care very easily by being in the same place."

Occupational therapist Genevieve Lagonera, who leads the clinical team at the NRI, echoed the advantages of collaboration for both clinicians and patients. “At the NRI we can get three specialized perspectives on one person,” said Lagonera. “Then we can layer our approaches to treatment for the best possible outcome, knowing that we’re moving in a direction that's supported by all these disciplines.”

Patients have been pleased with the convenience of one location and the specialized services that help them make progress, and the groundbreaking collaboration between the college and the health system has unlocked opportunities both clinically and academically. The NRI provides access to state-of-the-art technologies and a wealth of expertise within the clinical setting. And students benefit from virtual patient interactions and hands-on examples of various patient presentations, bridging the gap between theory and practice.

Furthermore, MUSC's commitment to community service is exemplified by a weekly “neuro night” at the NRI run by the MUSC CARES pro bono clinic. With this opportunity, students run the clinic under faculty supervision, and patients who might not have access otherwise can receive specialized holistic care.

Situated adjacent to the NRI, the NExT Wellness Research Center is a dedicated fitness and research center for individuals living with neurological conditions. It addresses a critical need for these individuals to access a supportive environment for regular exercise while providing researchers with valuable data for future research studies.

Chris Gregory, Ph.D., PT, a professor in the College of Health Professions who originally pioneered the concept of a gym geared toward stroke survivors, expanded the center's focus to include people with other neurological diagnoses, such as multiple sclerosis, Parkinson's disease, spinal cord injuries and traumatic brain injuries.

A self-proclaimed big believer in exercise, he emphasizes the value of a welcoming atmosphere for clients who may feel uncomfortable in a conventional fitness center.

"It's intimidating for any newcomer to walk into a typical gym,” said Gregory. “But if someone's using a walker or a cane or sitting in a wheelchair, it's even tougher to feel at ease. We give them that space to belong."

Open, airy gym with weights and other fitness equipment
The NEXT Wellness Center looks like an ordinary gym but provides specialized training opportunities and a welcoming environment for clients with neurological diagnoses. Credit: Shawn Oberrath

The NExT Wellness Research Center's facilities are designed to accommodate all levels of ability, offering a safe and familiar gym environment. With a wide range of standard equipment and an overhead harness system for safety during specialized training in tasks like walking sideways or moving really quickly, individuals can focus on improving their strength, balance and overall well-being.

Christina Miyares, PT, DPT, is the Center’s resident director but also a trained physical therapist with a specialty in neurology. Nowadays she leans on her exercise and sports training background to create tailored workout programs for her clients, but her clinical experience helps her understand each person's needs and challenges.

“When people come in, they see other people exercising who are just like them, with some of the same struggles,” said Miyares. “It’s been very gratifying to hear them say, ‘You don’t treat me like I have a disability, and you push me hard to succeed just like you would anyone else.’”

Miyares and Gregory have witnessed an encouraging shift in mindset among many clients who realize that they can do more than they expected and can start to rejoin their communities, even working out alongside a partner or friend.

“After illness or injury, people have to figure out how they fit into the community again, whether it's getting comfortable going out to restaurants or shopping or the gym,” said Gregory. “And I think it's just fantastic to see them do that.”

For both facilities, research plays an integral role as well. The NRI is currently piloting tele-rehab and tele-OT services to address the needs of those who might not have access to specialized care due to their location. They are also partnering with MUSC neurosurgeons and researchers to open the door to future opportunities, including investigations into vagal nerve stimulation.

At the NExT Wellness Research Center, two NIH-funded trials are already under way, with one focusing on heart failure and the other looking at poststroke exercise and weight loss. The fitness center is also a shared research space with Department of Veterans Affairs backing, so it can cater to veterans with neurological needs, and a new VA trial is on the horizon.

The NRI and the NExT Wellness Center are invaluable resources for individuals facing neurological challenges. Lagonera sums up the impact of this innovative partnership by looking to the value for patients.

“With our dedicated rehab space and the gym facility right next door, we are cementing the importance of exercise for neural recovery in our patients,” she said. “We’re offering a welcoming hub for skilled therapy, exercise and community involvement for the rest of their lives.”