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Physical medicine and rehabilitation at Baylor University Medical Center.

The specialty of physical medicine and rehabilitation now resembles the trunk of a tree whose growth is complete, now ready to branch off in multiple directions.

--James T. Demopoulous, MD, 1990

Few institutions can match Baylor's commitment to be a leader in physical medicine and rehabilitation (PM&R). Sensing an emerging need in the community, Baylor established the department in 1950--at a time when this specialty was barely recognized by the international medical community.

The first PM&R society was not formed until 1939. At that time, only 12 physicians practiced the specialty, and only 2 residency programs offered a full training curriculum. With the influx of wounded and physically disabled World War II veterans and the subsequent polio epidemic, however, the specialty achieved greater recognition, and the Advisory Board of Medical Specialties of the American Medical Association established the American Board of Physical Medicine and its rigorous certification process in 1947. Two years later, "and Rehabilitation" was added to the board's official title.

BAYLOR UNIVERSITY HOSPITAL AND BAYLOR UNIVERSITY MEDICAL CENTER, 1950-1985

The first chairman, Dr. Edward M. Krusen

Spearheading Baylor's first search committee for a chairman in PM&R were Boone Powell, Sr., Dr. Marvin Knight, and Dr. Robert Sparkman. The committee quickly identified Dr. Edward M. Krusen, first assistant in physical medicine at the famed Mayo Clinic, as the best physician for the job (Figure 1). Dr. Krusen was appointed chairman of the department in October 1950. He was accompanied by his wife, Ursula, also a physiatrist. The Krusens had trained at Mayo Clinic under the supervision of Edward's uncle, Dr. Frank Krusen, a pioneer in this specialty and author of the first textbook on physical medicine.

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Patients served

At the end of Dr. Krusen's first year, he and his staff recorded a staggering 34,094 treatments. Among Dr. Krusen's first patients were 35 inpatients with polio, who received virtually the same treatment protocol as that at the Mayo Clinic (Figure 2). This included the use of iron lung machines, chest cage pumps, and the Hubbard tank (Figure 3). The treatment was extensive and exhaustive, taxing the small staff's resources from the beginning.

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A diagnosis of polio was once considered a virtual death sentence, and survivors of acute attacks, depending on involvement, required an average of 6 to 7 years of onerous physical work and emotional effort to attain maximum function and self-sufficiency. By the 1960s, almost miraculously, the disease was eradicated due to Salk's improved polio vaccine. Still, it was during the difficult years of the polio epidemic that physiatrists finally won full acceptance as specialists within the medical community.

Some of the early patient stories are telling. Bob Gary, an engineer who is now 76 years old, recalled his experience with Baylor's PM&R department. In November 1953, when he was 27 years old and had just come out of the Marines in World War II, he contracted polio. Paralyzed for 3 months, Bob was treated at Baylor Polio Convalescent Division. He remembers his daily trips to the Hubbard tank, being wheeled in a rickety gurney: "The water temperature had to be exactly the temperature of my body. If it was too cold, I could get pneumonia. If it was too hot, I would get fatigued." A stretching and strengthening program followed hydrotherapy. And at night, Bob was placed in a rocking bed "because of my trouble breathing."

During the course of his months at Baylor, Bob worked with 17 very aggressive physical therapists, particularly Jack Hays, who took a special interest in him. "For an hour each day, I learned to isolate primary from secondary muscles; I learned kinesiology and the reeducation of muscles to prevent atrophy. There was also a lot of pain. I was completely dependent. While in bed, I did mental exercises whereby I exercised my right big toe on up. Some muscles I could move and some I could not. Then I moved down to the left big toe. I did this a hundred times."

Bob's muscles were tested twice a week with those of other polio patients, not all of whom recovered. At the end of the fourth month, he was discharged to his home, aided only by a cane. "I had a total of 18 months of outpatient therapy. In 1969, I was in good shape. I officiated in the Southwest Conference for the next 30 years (15 weeks per year on the football field). Dr. Krusen, Jack Hays, and staff were great! I am a success story."

Baylor continued to attract national attention for its rehabilitation work with both paraplegics and quadriplegics. Two newspaper articles from the late 1950s tell of other success stories. One such story from the July 1957 Dallas Morning News tells of Donald Morton, who touched the hearts of the Baylor staff with his determination and relentless good cheer. Paralyzed after a horrific fall, Donald's rehabilitation was aided by "an array of gadgets and devices" constructed by members of the PM&R department to assist accident victims in regaining some degree of independence.

A Dallas Times-Herald article from June 1958 tells the story of Robert Donald Foster, who was injured in a waterskiing accident. Some doctors had not expected Robert to live, much less achieve a degree of self-sufficiency. But under the coordinated expertise of the staff, including Jack Hays, Virginia Chandler, OTR, Wendell Guess, and Carpenter G. T. King (who rigged a device that allowed patients to feed themselves), Robert was able to return home 9 months later.

Equipment and facilities for the growing department

According to Peck Shirley, the first physical therapy aide, the original department had 4 treatment tables and 2 additional items of equipment crammed into an 85-sq ft cubbyhole in the hospital basement. Patients, if they were physically able, were forced to climb steep ramps to reach the un-air-conditioned treatment room. Once there, they found a claustrophobic space, overhung with creaking utility pipes and a single overhead window.

Fortunately, Grady Vaughn, a Texas millionaire who suffered a stroke in 1947 and completed a successful rehabilitation program at Baylor, donated $133,000 (roughly equivalent to $1 million today) to the PM&R department. Mr. Vaughn's generosity enabled the department to purchase diathermies, Hubbard tanks, paraffin and contrast baths, whirlpools, a Delorme table, and other vital equipment.

Through the generosity of the Caruth Foundation, Dr. Krusen also acquired the first electromyogram machine in North Texas in the early 1950s (Figure 4). In earlier trials on animals, the electromyogram machine had proven that muscles produced electric current. In patients, the machine was invaluable in diagnosing lumbar and cervical root compressions and neuromuscular diseases (both acute and chronic) and in performing nerve conduction velocity studies. In 1963, the Baylor Auxiliary donated parallel bars, a tilt table, and other rehabilitation equipment.

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The year 1972 marked the opening of the 25-bed inpatient rehabilitation service at Collins Hospital. The opening of Collins served as a further impetus for the physiatrists and residents to provide total patient care. The facility provided an integrated, comprehensive team approach for acute treatment of conditions such as strokes, closed head injuries, spinal cord injuries, brain surgeries, joint replacements, fractures, amputations, Parkinson's disease, decubitus ulcers, and other conditions requiring rehabilitation.

The Baylor Arthritis Center opened in 1979, making the department available for physiatric consultations and providing physical and occupational therapy services to this patient population.

The Vaughn Physical Therapy School

A growing shortage of trained and experienced personnel prompted Dr. Krusen to establish the Grady Vaughn Physical Therapy School in October 1951. A bachelor's degree was required to enter the school, which provided 18 months of training for certification in physical therapy (Figure 5). Erika Weber was the first graduate.

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In July 1952, 4 students were enrolled in the physical therapy school, including Jack Hays, who later became the physical therapy director and eventually the administrative director. The following year, the burgeoning school affiliated with Parkland Hospital, Gonzales Warm Springs Rehabilitation System, the Veterans Administration Hospital in McKinney, and the Dallas Society for Crippled Children. In 1960, the physical therapy rotation expanded as the school developed affiliations with Moody State School for Cerebral Palsied Children in Galveston, the Texas Rehabilitation Commission in Gonzales, Texas, and the Fort Worth Society for Crippled Children and Adults.

In 1969, a general loan fund for the department was established from a donation of a former patient, Cy Arnold. He specified that the money was to be used for student loans. Other scholarships/loans that provided much-needed assistance to physical therapy students came from the Bromberg Mayer Scholarship Fund, the Elks National Foundation, and the Georgia Society for Crippled Children and Adults.

In 1971, upon the opening of the Southwestern Allied Health Sciences School at the University of Texas Southwestern Medical Center, the physical therapy school closed. It had trained 266 therapists in its 20 years of existence. The PM&R department continued to provide rotations for the physical therapy students from various schools, both inter- and intrastate. The physical therapy internship program was the impetus in hiring the therapists to join the staff. An occupational therapy internship program was also established during this time, with affiliations with several institutions.

The residency training program and externship program

The year 1955 marked a major hallmark in the PM&R department's history: the formation of the first residency training program. The first resident to graduate from the program in 1958 was Dr. Yvonnie Cordray, who began her training with a preceptorship with Dr. Krusen. She attended physical therapy school classes and endured a rigorous rotation at Parkland. She eventually became Dr. Krusen's associate director (Figure 6).

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Dr. Krusen expected his residents to use their time efficiently, be thorough in their work, rotate through physical therapy school, and observe therapists treating patients. Cadaver dissection (in conjunction with the Baylor College of Dentistry) was also included in the training. Residents had the opportunity to instruct students in both the physical therapy and dental schools, particularly in the difficult subjects of anatomy and physiology.

Research and publication were required of residents. Three times a week, the indefatigable Dr. Krusen sat down and quizzed residents on what they had learned. Residents were also sent to either the University of California Los Angeles or Northwestern University for courses in prosthetics and orthotics.

In 1975, Dr. Krusen and his staff met at Parkland with faculty from the University of Texas Southwestern Medical School (led by Dr. Phala Helm) to discuss long-range goals for the PM&R residency program. The meeting resulted in a 3-month resident exchange wherein Baylor residents rotated through the burn unit and different specialty clinics while Parkland residents rotated for clinical outpatient practice. The joint Baylor PM&R-University of Texas Southwestern Medical School meeting also resulted in a combined lecture series and a weekly journal club with staff participation.

The Table lists the residents who graduated from the program. Some stories related to the residents are as follows:

* Dr. B. Stanley Cohen, now considered a pioneer in the PM&R field, was a resident in the program from 1963 to 1965. He had practiced internal medicine for nearly a decade before coming to Baylor. Dr. Krusen was intrigued with Dr. Cohen's skills and apparently tailored his program to allow him to concentrate on physical medicine. Dr. Cohen (who also taught anatomy and physiology) described both his attendance in the physical therapy school and his personal observation of patient therapy treatment sessions as "invaluable." He described Dr. Krusen as a "tremendous neurologist and electromyographer and an extremely intelligent physician." Dr. Cohen later returned to Maryland, where he served as chairman of the PM&R department at Sinai Hospital for 20 years. He also served as chairman of the American Board of PM&R from 1984 to 1988 and as chief executive officer of Sinai Hospital until his retirement in 1991. He is widely credited for his efforts in refining and developing dual board certification programs with pediatrics, internal medicine, neurology, and other specialties.

* In 1967, Dr. Phala Helm entered the program after completing her internship at Baylor Hospital. A graduate of the Grady Vaughn Physical Therapy School, she first worked for a year and then entered Southwestern Medical School. She later chaired the PM&R departments at both Parkland and Children's Medical Center. Dr. Helm is well known for her scientific contributions in the field of burn rehabilitation and the care of diabetic foot problems. She also chaired the American Board of PM&R examination committee and served as vice chair of the American Board of PM&R from 1987 to 1992. In 1998, she was honored as a distinguished physician by the Dallas chapter of the American Medical Women Association. In the summer of 2002, she was honored with the Phala Helm Distinguished Lectureship by the PM&R department of Southwestern Medical School.

It was not uncommon for residents to enter the PM&R residency program after practicing medicine for several years. In the 1970s, for example, about half the residents did so.

Soon after the development of the residency program, Dr. Krusen secured a federal grant for a summer externship program in the department. Among the early participants was James W. Caldwell, who spent 3 summers with Dr. Krusen during medical school and joined the residency program after graduation in 1960. Dr. Caldwell later said that he would not have even known of the specialty had he not participated in the program.

Four residents joined Baylor's staff: Dr. Robert Bruce, Dr. Evangeline Cayton, Dr. Caldwell, and Dr. William L. Parker. Dr. Caldwell became associate director in 1963, and Dr. Parker became the medical director of inpatient rehabilitation in 1971 (Figure 7).

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New programs

A number of new programs were developed under the director of occupational therapy, Virginia Chandler, including acute physical disabilities therapy, a comprehensive hand program, adult and adolescent psychiatric programs (for inpatients and outpatients), eating disorder programs, recreational therapy, and the Boomerang Club. The Boomerang Club was the first stroke support group in Dallas. It provided both community information and a wide range of support activities to the families of stroke patients.

Dr. Parker was the head of a multidisciplinary team including physical, occupational, and speech therapists, as well as nurses, social workers, dietitians, and psychologists. The therapists worked together to enable each patient to achieve a maximal level of independence through therapeutic exercise, training in activities of daily living, gait training (which can include the progression from wheelchair to walker to simple cane mobility), and a speech program to attain effective and functional communication. Dr. Parker also oversaw the serial casting and splinting programs to ensure that the splints were fabricated for proper positioning and to assist in functional movements. Other programs at Collins Hospital, such as reality orientation, therapy for sensory integration, therapy for perceptual deficits, expressive writing, woodworking, and return to home and work (such as relearning typing skills) were also emphasized.

Honors and leadership in professional organizations

In 1954, Employers Mutual of Wausau cited Baylor's PM&R department as one of the 8 most outstanding in the nation in the care of paraplegics and quadriplegics. In addition to this award for the entire department, Dr. Krusen received many personal honors, including the Civic Achievement Award from Goodwill Industries for his work in "introducing" physical medicine to the medical profession in Dallas.

Dr. Krusen was the first chairman of the PM&R section of the Southern Medical Association when it was established in 1953. He was elected secretary of the first PM&R section of the Texas Medical Association in 1960. On the national front, Dr. Krusen was involved in the specialty board as a member and an oral examiner. In addition, Dr. Krusen chaired the United Palsy Advisory Board, served as advisor to the North Texas Chapter of the Arthritis and Rheumatism Foundation, served on the executive committee of the Muscular Dystrophy Texas chapter, was elected to serve on the American Board of PM&R from 1965 until 1976, and in 1977 served as the first president of the Dallas-Fort Worth Metroplex PM&R Society, a chapter of the Texas PM&R Society.

Research and publications

Some of the publications that came out of Baylor's PM&R section are listed in the Appendix.

In 1972, the first Vaughn Seminar was held on the Brunnstorm technique, which is a neuromuscular facilitation technique used by physical therapists to treat strokes. A year later, the H. L. S. Browning Seminar was established by Ms. Hattie Browning's 2 sons and gifts from friends. The first conference on arthritis was widely attended.

In 1978, the first Carrell-Krusen Symposium was established, honoring the 2 physicians for their contribution to the care of patients with muscular dystrophy. This annual event is cosponsored by the Texas Scottish Rite Hospital and the University of Texas Southwestern Medical Center at Dallas to discuss recent advances in basic and clinical research in the management and treatment of neuromuscular diseases. The symposium also provides continuing medical education (CME) credits to physicians and allied health care providers.

BAYLOR UNIVERSITY MEDICAL CENTER AND BAYLOR HEALTH CARE SYSTEM, 1981-1989

A new dimension in medicine began in the 1980s. Health care professionals were inundated with a bewildering new wave of acronyms, such as Health Care Financing Administration (HCFA), preferred provider organization (PPO), relative value resource-based system (RVRBS), diagnosis-related group (DRG), health maintenance organization (HMO), and quality assurance (QA). Physicians were also required to document CME credits.

The second chairman, Dr. James W. Caldwell

In 1985, Dr. Krusen retired. His retirement sparked a round of well-attended accolades and well-deserved tributes held at the Faculty Club at the University of Texas Southwestern Medical School, as befitting a true pioneer in the discipline. Dr. Krusen was succeeded by Dr. James W. Caldwell (Figure 8).

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During Dr. Caldwell's era, the department took a true multidisciplinary approach. Physical therapy, occupational therapy, and speech therapy staff met regularly with physiatrists, and the various disciplines developed programs using a team approach and a spirit of collaboration which continues through the present.

Development of new rehabilitation programs

Several inpatient and outpatient rehabilitation programs continued to be developed, including a mastectomy program, an expanded rehabilitation program for cancer patients and survivors, a postamputation prosthetic clinic, neonatal programs including those for brachial plexus injuries and developmental stimulation, and postpartum exercise programs. Lasers began to be used for pain and wound healing, and total contact casting was used for neuropathic and vascular ulcers. The department began treating asthma and transplant patients.

The disciplines of speech pathology and occupational therapy developed a dysphagia program, which officially began in 1987 according to Kathy Formichella, one of the founders of the program. "We knew there were a lot of patients with dysphagia who needed help," she recalled. "Our goal was to help them regain their ability to eat, one of the most common activities of daily living, without compromising their medical status." PM&R developed a strong relationship with the radiology department, which provided the instrumentation needed to make effective decisions for the patient's treatment. The dysphagia program continues through the present under the leadership of the speech-language pathology department.

Existing PM&R programs also received national recognition. For example, in 1987 the Adult Visual-Perceptual Assessment compiled by Baylor's occupational therapy department to evaluate adult perceptual dysfunction became accepted as the worldwide standard. The booklet is now sold across North America and is in its sixth printing.

New rehabilitation facilities

Because of the growing need for more rehabilitation beds, Baylor purchased the Swiss Avenue Hospital, a small, freestanding acute hospital, in 1981, and named it Baylor Institute for Rehabilitation (BIR). When BIR opened in December, 25 inpatients from Collins were transferred there. Over the next 5 years, it grew to 74 beds. It also became known as a regional center for catastrophic conditions such as spinal cord injuries and traumatic brain injuries.

The volume of referrals from the 5 neighboring states increased at such a rapid rate that Baylor purchased the 92-bed Gaston Episcopal Hospital to meet the demand. Following a $5.5 million state-of-the-art renovation, BIR moved there in February 1989 (Figure 9).

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Residency training

During the 1980s, 12 residents were trained and became board eligible. When Dr. Caldwell retired from practice in 1989, a $500,000 endowment was established in his name to benefit the PM&R residency training program.

Community service programs

In 1988, BIR introduced the community service program "Feet First, First Time." The program targeted Dallas schools and youth groups and stressed safety to all young adults who participated in sports or recreational activities. The goal of the program was to spread the word that many traumatic head or spinal cord injuries are preventable. A documentary film, A Life of Their Own, was also released. The film helped to educate the public about the various services at BIR. It captured the winning attitude of BIR staff and demonstrated the importance of family involvement in the rehabilitation process. Throughout the film, patients, family members, and therapists were shown working together so the patient could achieve maximum independence. Also, BIR celebrated "Life . . . Be in It Day" to raise money for the department's wheelchair sports program. Another groundbreaking program introduced in 1989 was pet therapy.

Honors

Dr. William L. Parker was named physician of the year by Governor Mark White in 1983. He was also selected to participate in the Governor's Commission for Disabled Persons. Dr. James W. Caldwell was elected to the Texas State Medical Board by Governor Mark White.

BAYLOR UNIVERSITY MEDICAL CENTER AND BAYLOR HEALTH CARE SYSTEM, 1989-2002

During the 1980s, Baylor Health Care System (BHCS) initiated a strategic move to serve the community in facilities beyond the confines of the East Dallas campus. As the health care system expanded its venues, PM&R played an important role. The physicians within the department established physiatric services in many of these areas and along with the newly created Baylor Rehabilitation System demonstrated an effective model for integration of clinical services among geographically distant sites.

The third chairman, Dr. Barry S. Smith

When Dr. Caldwell decided to retire as chairman, BUMC elected to look outside the system for his replacement. The department needed a leader experienced in resident education, research, and program development beyond the traditional hospital-based setting. A search committee with representatives from all of the related clinical departments was formed. After an intensive round of interviews, Dr. Barry S. Smith was selected (Figure 10). Dr. Smith came to BHCS in September 1989 from the faculty of the Department of Physical Medicine of Baylor College of Medicine in Houston. He had been the residency training program director as well as the chief of PM&R at the Harris County Hospital District, St. Luke's Hospital, and Texas Children's Hospital.

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Baylor Institute for Rehabilitation

In the decade preceding Dr. Smith's arrival, BIR had established itself as one of the leading centers in the Southwest for the delivery of comprehensive inpatient rehabilitation services. Through the leadership of Dr. Parker, the founding medical director, BIR had developed a renowned program for the rehabilitation of patients with traumatic brain injury. With this program as a springboard, BIR initiated the development of centers of excellence in specific areas of rehabilitation medicine.

The traumatic brain injury service continued to develop under the direction of Dr. Parker until he moved to the position of senior medical director. A national search for his replacement brought Dr. Milton Thomas to BIR in 1991. Dr. Thomas continued to expand the regional reputation of this program until his departure in 1994. He was replaced by the current medical director of the traumatic brain injury service, Dr. Mary Carlile. Under her direction, the service has gained a national reputation. In addition, Dr. Carlile has been extremely active in advocating for the care of brain-injured persons. She was appointed by Governor George W. Bush as the chair of the Texas Traumatic Brain Injury Advisory Board. In this capacity, she was able to drive legislation to benefit the brain-injured disabled community.

The care of patients with spinal cord injuries had long been an area of special expertise for the physiatrists practicing at BIR. In recognition of this expertise, a special spinal cord injury service was established. The natural choice as medical director was Dr. Lance Bruce, who had been at BIR since completing his residency at Baylor in 1979. He had long focused his practice on the treatment of spinal cord injuries. His clinical leadership has vaulted this program into regional if not national prominence.

Dr. Les Porter was recruited to Baylor in 1991. Shortly after arriving, he was appointed medical director for the institute, succeeding Dr. Parker. Because of his expertise in the rehabilitation of orthopaedic problems, he leads the orthopaedic rehabilitation service. Dr. Amy Wilson completed her PM&R training at Baylor in 1996. She was then appointed the director of the amputee service at BIR.

By 2000, it was apparent that the need for rehabilitative services for patients with chronic disabling conditions was increasing both locally and regionally. An expansion program was initiated at BIR to create a greatly enlarged outpatient department. In 2001, as the outpatient service was nearing completion, the department was fortunate to recruit Dr. Milton Thomas back to Dallas as the service's medical director.

Outpatient services at the Landry Center and Baylor Spine Center

Outpatient rehabilitation services at BUMC had been an integral part of the department throughout its history. These services had traditionally been integrated with the inpatient rehabilitation programs of the department in a single area within the hospital. As the medical center expanded around the department in the Jonsson Hospital, access for outpatient services was limited. The Baylor Tom Landry Center opened on the Dallas campus in 1991 (Figure 11). With easy access for patients as well as the availability of excellent health club facilities including pools for aquatic therapy, the Landry Center was the logical choice for the outpatient department. This move has resulted in a tremendous growth in outpatient rehabilitative services. The clinical focus there has been on musculoskeletal injuries.

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In 1999, the Baylor Spine Center began operation. Under the medical direction of Dr. Craig Callewart, this unique center combines the skills of spine physicians trained in diverse medical specialties with highly trained spinal physical therapists to afford an unmatched outpatient program for patients with musculoskeletal spinal injuries.

Baylor Specialty Hospital

In 1989, BHCS began a new enterprise at the site of the former Swiss Avenue Hospital on the East Dallas campus. This facility was reopened as the Baylor Center for Restorative Care, a long-term acute care hospital. Rehabilitative care is an essential component of a long-term acute care hospital. Therefore, the department worked closely with the organizers of this new facility to be certain that rehabilitative and physiatric services were well established. These relationships have evolved over the past decade. The facility has been renamed the Baylor Specialty Hospital to better reflect its mission (Figure 12). The physiatric role in the facility has also evolved to best serve the patients in the facility. Currently, Dr. Jean deLeon serves as an associate medical director for the facility. Full-time physiatric consultative services are available to all of the inpatients in Baylor Specialty Hospital. In addition, the BUMC PM&R department has been instrumental in the development and physician staffing of a wound care clinic at Baylor Specialty Hospital to care for patients with chronic open wounds.

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Pediatric rehabilitation and Our Children's House

The rehabilitation of children had not been a focus at Baylor prior to the 1990s. However, as the programs of care for newborn infants in intensive care expanded, multiple rehabilitative needs became evident. Baylor was fortunate to recruit Dr. Frank McDonald, who is board certified in both pediatrics and PM&R. As the care for these special patients grew, it became obvious that even more specialized care was needed to meet the rehabilitative needs of children. An extensive search for the best solution led to the development of Our Children's House, a pediatric rehabilitation center for children of all ages on the Baylor Dallas campus (Figure 13). The only facility of its kind in the Southwest, Our Children's House is renowned as a regional center for inpatient pediatric rehabilitative care. The mission of Our Children's House has continued to grow over the past decade. Outpatient care has become a natural extension of inpatient services. Growth has been dramatic in all areas of pediatric rehabilitative care, and plans are under way to expand the facility and increase physiatric care for the pediatric disabled population.

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PM&R services in community hospitals

BHCS acquired what is now Baylor Medical Center at Garland in the early 1990s. The hospital had just opened a rehabilitation unit that was managed by an outside firm. The PM&R department assumed management of the unit, and 2 graduates of the residency program, Dr. A. J. Bisson and Dr. Peter Rappa, became the first full-time physiatrists at the facility. They and all the subsequent physiatrists at Garland have been full-time members of the department's teaching faculty. When Baylor Medical Center at Garland subsequently underwent a major renovation, the inpatient rehabilitation service was expanded to 24 beds in the new patient wing. The relationship between BUMC and Baylor Medical Center at Garland has been a cornerstone of the integrated delivery system of rehabilitative services for the health care system.

The physiatric services at Garland have continued to expand and develop. Currently led by department members Dr. Rita Hamilton and Dr. Christine Johnson, these services now include a full array of outpatient physiatric services in addition to the well-established comprehensive inpatient care programs.

In the 1980s, when BHCS acquired 2 small community hospitals in Ellis County, it had no specific space for the delivery of outpatient therapy services. Such services were nonexistent in Ellis County and were needed especially for the large segment of persons employed in the county's small industries. The physiatrists in the department worked closely with the administration at the Baylor Waxahachie facility to open Baylor Worx, a freestanding outpatient facility for the delivery of physical medicine services, in 1993. Early on, physiatrists at BUMC saw patients at BaylorWorx for 2 1/2 days a week. Because of the tremendous increase in patients, it soon became evident that a full-time physiatrist was needed. In 1996, Dr. Christopher Garrison was recruited by the department to fill this position. Continued expansion of these physiatric services has significantly improved the level of medical care available in Ellis County for individuals with work-related and musculoskeletal injuries.

In 1995, BHCS developed a strategic merger with the Irving Community Hospital. The primary hospital facility was renamed Baylor Medical Center at Irving. This facility had in place an 18-bed inpatient rehabilitation unit. However, at that time the unit did not have a medical director, and physiatric leadership in the facility was unavailable. The BUMC PM&R department worked with the Irving hospital administration to correct this leadership gap. In 1995, Dr. Peter Rappa of the department was appointed medical director of the inpatient unit. Since then, the unit has grown to be an integral part of the overall health care delivery system at Irving, bridging the gap between acute hospital care and return to home for patients with physically disabling conditions. The department has also established an outpatient program to support the delivery of physiatric care to patients in the Irving area.

Baylor Medical Center at Grapevine became a part of BHCS in 1981. Located in one of the fastest-growing areas in the Dallas -Fort Worth metroplex, it did not have any physiatric services when the BUMC PM&R department was consulted in 1994. Its greatest area of physiatric need was for outpatient services, particularly for injured workers. A program was initiated with great success. In 1995, the department selected Dr. Helen Patel, one of its faculty members, to lead this effort. A specific work injury program was developed in the Grapevine department of physical therapy, and Dr. Patel continues to provide physician direction to this program. The department has also developed an expanded outpatient program as well as an inpatient consultation service for the hospital in Grapevine.

In summary, the decade of the 1990s was one of significant expansion for the Baylor PM&R department. As the department celebrated its 50th anniversary in 2000 (Figure 14), it looked back on its evolution from serving the needs of BUMC and its East Dallas campus to delivering physiatric care to the entire Baylor network throughout the Dallas-Fort Worth area. The department grew from 6 physiatrists in 1989 to its present size of 17 in 2002 (Figure 15). These dramatic successes led to Baylor being named by U.S. News & World Report as one of the best facilities for rehabilitation 6 times during this period.

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Sports medicine

Sports medicine has become an area of increasing interest for physiatrists, and focus has been placed on it in PM&R training programs across the country. To respond to this trend, Dr. Robert Wilder, a physiatrist with fellowship training in sports medicine, was recruited. Under his direction, the department developed an extensive program. Although Dr. Wilder was later recruited to the University of Virginia to head its PM&R fellowship training program in sports medicine, the faculty and residents provide sideline coverage for 3 high school football teams and interact with athletes at the club, high school, junior college, and professional levels. An important liaison to the local sports community is Baylor Sportscare, which provides a multitude of services to the sporting community. The faculty and residents of the department work closely with this Baylor entity to enhance Baylor's position as a leader in the provision of care to athletes throughout the area.

Residency program

The Baylor PM&R residency training program has undergone significant growth since 1989. At that time, it graduated 1 or 2 residents each year, drawing resident physicians predominantly from the local area. It has expanded to consistently graduate 3 residents each year. Rather than training only at BUMC and BIR, the residents receive training at all of the Baylor campuses throughout the health care system. This expansion and diversification of training has led the Baylor PM&R training program to be one of the best-known programs in the country. Each year, more than 300 physicians apply for each position, and the residents come from across the nation to participate. The quality of the training program is now demonstrated by the residents as a group placing in the top third of all training programs in national self-assessment examinations.

National activity

Participation in national organizations is vital community service that demonstrates the commitment of a department to medical care, education, and research. Recognizing the need for this servanthood, BHCS has encouraged department members to participate in associations at a national level. Dr. Smith served as the president of the American Academy of PM&R in 1998 and the president of the Association of Academic Physiatrists from 1999 to 2001. These are the only 2 national organizations of the specialty. Dr. Smith currently serves as the chairman of the residency review committee for PM&R, the national accrediting organization for PM&R residency programs. He also serves as a director of the American Board of PM&R, the national certifying organization.

APPENDIX. SELECTED PUBLICATIONS OF BAYLOR'S PM&R DEPARTMENT, 1950 TO 2002

Krusen EM. Physical treatment of fractures. South Med J 1952;45:663-666.

Krusen EM. Hemiplegia: with special emphasis on problems of the shoulder. South Med J 1955;48:612-616.

Krusen EM. Pain in the neck and shoulder, common causes and response to therapy. JAMA 1955;159:1282-1285.

Krusen EM, Krusen UL. Cervical syndrome, especially tension-neck problems: clinical study of 800 cases. Arch Phys Med 1955;36:518-523.

Ford DE, Krusen EM. Conservative management of certain types of back injury: analysis of results. Arch Phys Med 1957;38:395-401.

Krusen EM. Rehabilitation of the elderly. South Med J 1958;51:225-228.

Cordray YM, Krusen EM. Use of hydrocollator packs in the treatment of neck and shoulder pains. Arch Phys Med 1959;40:105-108.

Krusen EM. Acute injuries to the neck. Modern Medicine 1960;200-215.

Caldwell JW, Krusen EM. Effectiveness of cervical traction in the treatment of neck problems: evaluation of various methods. Arch Phys Med 1962;43:214-221.

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Acknowledgment

This article is dedicated to the memory of Dr. Edward M. Krusen. The authors thank Cindy Orticio, Beverly Peters, Carolyn Trammell, and Kathy Formichella for their contributions to and editing of the manuscript.

Evangeline T. Cayton, MD, and Barry S. Smith, MD

From the Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, Texas.

Historical articles published in Proceedings will be reprinted in the centennial history of Baylor University Medical Center. Readers who have any additional information, artifacts, photographs, or documents related to the historical articles are asked to forward such information to the Proceedings' editorial office for possible inclusion in the book version.

Corresponding author: Evangeline T. Cayton, MD, Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246.
Table. Graduates of Baylor's Physical Medicine and Rehabilitation
Residency Training Program, 1955 to 2002

Tracey R. L. Adams, MD Naheed Khan, MD
Concordia Angelo, MD Kelly W. Lobb, MD
William J. Barrish, MD Henrick Madsen, MD
Stephen J. Becker, MD William C. Maxwell, MD
Jay B. Bender, MD Owen Paul McCutcheon, MD
Albert J. Bisson, MD Donald McPhaul, MD
Katherine Blanchette, MD Shailen K. Mehta, MD
Lawrence R. Blaty, MD Jorge Minor, MD
Michael K. Boone, MD Eric H. Mok, MD
Terry Brown, MD Robert Muckleroy, MD
Robert Lance Bruce, MD Cecil Nepomuceno, MD
Louie Cabiling, MD Earl Olmstead, MD
James W. Caldwell, MD William L. Parker, MD
Bin Cao, MD Arvind V. Peddada, MD
Michael J. Carl, MD Joe T. Powell, MD
Evangeline T. Cayton, MD Robert W. Prevost, Jr., MD
B. Stanley Cohen, MD Ashfaq A. Qureshi, MD
Yvonnie Cordray, MD Peter J. Rappa, MD
Charles Crane, MD Michael Rhodes, MD
M. Todd Daniels, MD Stephen N. Rosenberg, DO
Jewell Daugherty, MD Wm. Scott Rowe, MD

H. Gregg Diamond, MD Rebecca A. Schmidt, MD
Becky A. Fain, MD Omar F. Selod, DO
Glenn Ferris, MD Kathleen M. Sisler, MD
Gwen A. Fields, MD Gregg H. Small, MD
Julie A. Floyd, MD Margarita Solis, MD
Alfred H. Grimes, MD Byron E. Strain, MD
Oscar Guzman, MD Layton Sutton, MD
Jeffrey L. Halford, DO Steven Tynes, MD
Rita G. Hamilton, DO Joseph A. Volpe, MD
Dennis Harris, MD Susan K. Warden, MD
Phala Helm, MD Don West, MD
Billy Hoover, MD Donna White, MD
Syeda F. Huq, MD James E. Williams, Jr., MD
Ralph Johnson, MD Amy J. Wilson, MD
Herbert Judy, MD
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Cayton, Evangeline T.; Smith, Barry S.
Publication:Baylor University Medical Center Proceedings
Geographic Code:1U7TX
Date:Jan 1, 2003
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