Patient in wheelchair holding a weight, receiving rehabilitation from a therapist.

Physical Medicine and Rehabilitation - Neuro Rehabilitation

 

Our Neurorehabilitation physicians, both physiatrists (PM&R) and neurologists, lead a comprehensive, multidisciplinary team to improve function for people with diverse medical conditions including spinal cord injury, limb-loss, concussion and brain injury, multi trauma, stroke and complex medical issues including transplants and cardiopulmonary deconditioning. The goal of the program is to enable the best possible quality of life for patients with these challenging issues.

Patient Care Services  

Our continuum-of-rehabilitation care services include:

  • PM&R consultation at Barnes Jewish Hospital
  • Inpatient rehabilitation care at The Rehabilitation Institute of St Louis 
  • Outpatient rehabilitation clinics at the Center for Advanced Medicine 

Our physicians are board-certified by American Board of Physical Medicine and Rehabilitation and American Board of Psychiatry and Neurology. Several physicians hold additional subspecialty certifications in spinal cord injury and brain injury medicine. Others have special interests in post-limb loss rehabilitation, transplant and oncologic rehabilitation, spasticity management (including Botulinum toxin and Baclofen pump management), concussion management, and community transition rehabilitation care. 

Treatment Approach

Neurorehabilitation physicians approach care by evaluating and managing a patient's medical conditions, including related anatomic and physiologic impairments, limitations in daily activities, mobility, cognition, and restrictions in work and recreation. A more in-depth assessment of specific tasks, such as driving, can be performed as it relates to access, transport, support, home and personal factors. Our focus is not the medical condition in isolation, but the person with the medical condition, and we take each individual's differences into consideration to develop a comprehensive, personalized rehabilitation plan.

The primary goal is to help facilitate a patient's journey from an acute medical event such as a limb loss, concussion, severe injury, heart attack, or multi trauma, back to best case function in the community. Personalized rehabilitation plans include medical management, medical risk modification, patient education, therapy, assistive device evaluation and prescription (wheelchair, walker, cane, etc.), orthotic and prosthetic device evaluation and prescription, care transition, coordination and community resource facilitation. Each patient's progress is additionally tracked over the course of their care using standard measures to ensure optimal progress.

In order to provide the best care, our Neurorehabilitation physicians work closely with several other rehabilitation disciplines at Washington University, including Occupational Therapy, Physical Therapy, Neuropsychology, Speech Therapy, Respiratory Therapy, Case Management and Nursing.

Specialized Rehabilitation Services for Continuum of Care

Physical Medicine and Rehabilitation Hospital Consult Service
Our consult service works collaboratively with other medical teams such as neurology, neurosurgery, surgery, trauma and intensivists for acute rehabilitation management of conditions such as limb loss, brain injury, stroke and spinal cord injury. Another major role is working with case management and therapy teams to facilitate appropriate transition to post-acute care, including to The Rehabilitation Institute of St. Louis.

Inpatient Rehabilitation (The Rehabilitation Institute of St. Louis)
In the rehabilitation hospital setting, our neurorehabilitation physicians lead a multidisciplinary team of therapists, nurses, case managers and other rehabilitation professionals to provide comprehensive care for patients admitting from the hospital (and sometimes home) to enable safe and independent return to the community. Internists, nephrologists, neurologists, neuropsychologists and wound care professionals provide complementary consult services to enable specialized medical management where needed. We have three specialty services:

  • Brain-Injury and Stroke Inpatient Rehabilitation Service: Led by Brain Injury medicine physicians, this service provides rehabilitation care for persons who have recently had a stroke, traumatic brain injury, non-traumatic brain injury, brain tumors, and other brain-related neurologic conditions.
  • Spinal Cord Injury and Pre-prosthetic Inpatient Rehabilitation Service: Led by subspecialty- certified Spinal Cord Injury Medicine physicians, this service provides comprehensive care for persons with spinal cord injury, tumors, and other neurologic conditions such as multiple sclerosis. This service also provides care for patients who have recently undergone limb loss surgery, referred to as preprosthetic rehabilitation. These patients are referred to the post-limb loss Rehabilitation Clinic for prosthetic candidacy evaluation and prescription.
  • Medically-Complex and Prosthetic Inpatient Rehabilitation Service: Led by physical medicine and rehabilitation physicians and nurse practitioners, this service coordinates closely with transplant and cardiac teams to provide rehabilitation care for patients who have recently received an organ transplant, such as liver, kidney or heart and LVAD placement, as well as those who have underwent or are undergoing oncology management.

Additionally, this service treats limb loss patients who have just received a prosthetic device and have been are admitted from home to learn how to use their prosthetic device safely and independently while minimizing future risks, referred to as prosthetic rehabilitation.

Cardiopulmonary deconditioning and Polytrauma rehabilitation are supported on all services.

Rehabilitation Clinics (Center for Advanced Medicine on the Washington University Medical Campus)
In the rehabilitation clinic setting, our neurorehabilitation physicians provide continuity of rehabilitation care for people who have completed rehabilitation at the Rehabilitation Institute. The clinics also serve people referred for impairments in function. The focus of our clinics is specialized rehabilitation management, including a combination of patient and caregiver education, spasticity management, recommendations and coordination for orthotics and prosthetics, assistive devices, and therapy, and community resources. We have four specialty clinics:

  • Brain-Injury and Concussion Rehabilitation Clinics: Care focuses on rehabilitation management of related impairments such as cognition, speech, mobility, and spasticity. Spasticity management includes both Botulinum toxin and Baclofen pump management. The concussion clinic develops individualized treatment plans for ongoing symptoms related to head injury to assist in supervised and structured return to previous level of activity.
  • Spinal Cord Injury Rehabilitation Clinic: Care focuses on rehabilitation management of related impairments such as bowel and bladder, mobility, spasticity and pain.
  • Post-Limb Loss Rehabilitation Clinic: The prosthetist is typically present for this visit with the physiatrist to enable detailed patient and caregiver education and patient inclusive informed decision-making. Care focuses on prosthetic candidacy evaluation, prosthetic component selection, rehabilitation setting determination, and prosthetic gait analysis for prosthetic modification and rehabilitation recommendations.
  • Adult Cerebral Palsy and Community Transition Rehabilitation Clinic: The Adult Cerebral Palsy clinic helps young adults with cerebral palsy transition into adult medical care by managing spasticity, meeting adaptive equipment needs, and sharing resources for community integration. Patients discharged from The Rehabilitation Institute of St. Louis who require continued rehabilitation care but do not meet the above diagnoses, are seen in the Community Transition clinic.

Leadership

Our physicians hold leadership positions in national physiatry organizations such as the American Congress of Rehabilitation Medicine and American Academy of Physical Medicine and Rehabilitation.
Our physicians serve in leadership roles as program medical directors for Stroke, Spinal Cord Injury, Brain Injury and Amputation rehabilitation at The Rehabilitation Institute of St Louis.

Professional and Patient Education

Our physicians play a vital role in training Washington University Neurorehabilitation fellows, PM&R residents and medical students. By serving in editorial capacity for professional educational resources such as PM&R KnowledgeNow, they play a vital role in national professional education as well. Service on patient advocacy organizations such as the Scientific and Medical Advisory Committee at the Amputee Coalition furthers enables our physicians to contribute to national patient education.

Research & Clinical Trials

For information on current clinical trials related to orthopedics, or to make an appointment with a specialist with Washington University Orthopedics, please call (314) 514-3500 or toll free (866) 867-3627.

Meet Our Team

Photo of Dr. Alejandra Camacho-Soto

Alejandra Camacho-Soto, MD, MPHS

Assistant Professor, Orthopaedic Surgery and Neurology

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Alexandre R. Carter, MD, PhD

Associate Professor, Orthopaedic Surgery and Neurology

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Prateek Grover, MD, PhD, MHA, FAAPMR

Assistant Professor, Orthopaedic Surgery and Neurology 
Division of Neuro Rehabilitation
Interim Division Chief, Division of Neuro Rehabilitation
Medical Director, The Rehabilitation Institute of St. Louis
Program Medical Director, Amputation Rehabilitation, The Rehabilitation Institute of St. Louis


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Thy Huskey, MD, FAAPMR

Professor, Orthopaedic Surgery and Neurology

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Sindhu Saji Jacob, MD

Associate Professor, Orthopaedic Surgery and Neurology
Program Medical Director, Brain Injury Rehabilitation, The Rehabilitation Institute of St. Louis

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Neringa Juknis, MD

Associate Professor, Orthopaedic Surgery and Neurology 

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Rimma Ruvinskaya, MD

Associate Professor, Orthopaedic Surgery and Neurology

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Jonathan Tiu, MD

Assistant Professor, Orthopaedic Surgery and Neurology

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Naomi Hampton, MSN, APRN-BC, GCNS-BC, ANP

Adult Nurse Practitioner

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Susan Jones, MSN, APRN, AGNP-C

Adult-Gerontology Primary Care Nurse Practitioner

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Patient Education

Brain Injury Rehabilitation

Post-limb Loss Rehabilitation

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