TIRR Memorial Hermann and Memorial Hermann – Texas Medical Center

The Rotation at TIRR MH and MHH-TMC provides exposure to recently injured patients and the acute rehabilitation process. Two of the six months are spent at the TIRR MH outpatient clinic (and others) where fellows are exposed to caring for new and established individuals with chronic SCI, interventional spasticity management (including injections and ITB pump management), urology clinic (including fertility clinic with exposure to electroejaculation procedures and UDS) as well as spina bifida clinic, hand surgery clinic, and neurourology clinic at nearby sites. These two months are made up of 8-9 half day clinics per week with ½ day or, at times, a full day for educational activities such as getting 1:1 training on its management, working with the exoskeleton team (including donning it), research, etc.

Other specialists that fellows can choose to spend time with, if so desired, include a musculoskeletal physiatrist, internists, a wound physician, clinic physical therapist, social worker and others.

The remaining 4 months of this rotation involve managing an inpatient service at TIRR MH, a freestanding acute rehabilitation hospital with 2 active inpatient SCI services. TIRR MH is internationally recognized for excellence in rehabilitative medicine and part of the SCI Models System. Each member of the teams on the SCI service (PT, OT, RN, psychology, social work, etc.) see SCI patients almost exclusively – allowing for a focus and expertise not only of the physician but of the whole team. At TIRR MH, fellows are exposed to specialty wheelchair and seating clinic, management of patients on mechanical ventilators (one of our unique features as PM&R is who does the management) along with exposure to implantation of diaphragmatic pacers and/or phrenic nerve stimulators, robotics, and other cutting-edge practices not commonly seen in rehabilitation centers with a smaller SCI census.

Additionally, during part of these months, fellows also spend time doing consults at one of the busiest level one trauma centers in the country — which receives patients from many areas of Texas and surrounding states (occasionally the brain injury team at TIRR also consults as, allowing for exposure to the dual diagnosis population as well). At MHH-TMC, the fellow is a consultant responsible for making recommendations for the acute management of SCI patients in the intensive care unit setting, working closely with neurosurgeons and intensivists. The fellow is exposed to multiple levels of spinal cord injuries from traumatic and atraumatic cases. TIRR MHH’s Case Mix Index indicates that we care for some of the most acute and medically complicated patients seen by any rehabilitation facility in the country. At any given time, each inpatient service at TIRR MHH may carry 2-4 patients on ventilators. By the end of their time at TIRR MHH, fellows should be competent to care for the most complex SCI patients.