Only two months into the

Transcription

1 by Devon O Brien Only two months into the job, the Department of Veterans Affairs (VA) newly appointed Under Secretary of Health, David Shulkin, MD, appeared in front of almost 800 spinal-cord injury and disease (SCI/D)-focused health care providers at the Paralyzed Veterans of America (PVA) 5th Annual Summit and Expo in September. Sworn into a government agency riddled with problems blasted nationwide, Shulkin is making an effort to initiate change. The VA has come through a very rough time over these past 18 months and this is a year where we re going to be building upon the momentum to build back the strength and confidence that people have in the VA health system, Shulkin says. We re going to do it in a number of ways and we re making some terrific progress. Core Concentration Luckily for veterans with SCI/D, Shulkin considers specialty care services a core program of the VA, and an aspect to focus on. Specialty care services are really the core of what we do at the VA and it s what VA does in particular in terms of its emphasis on treating veterans, Shulkin says. My role as undersecretary of health is to make sure that we have the right resources and the right allocations of staffing and equipment to make sure that specialty care services are providing state-of-the-art care. During his first day on the job, Shulkin met with veterans service organization (VSO) leadership and now, two months later, he continues to build a relationship with PVA at its Summit in Jacksonville, Fla. I view our relationships with PVA and other VSOs as absolutely vital. They are our partners and without their help and support we would not Bottom right, opposite page: Paralyzed Veterans of America (PVA) Associate Executive Director of Medical Services and Summit Task Force Chair Lana McKenzie (left) and PVA Deputy Executive Director Sherman Gillums Jr. (center), pose with newly appointed Department of Veterans Affairs Under Secretary of Health David Shulkin, MD, (right) at the 2015 PVA Summit and Expo. 26 PN November 2015

2 SCI/D care within the VA, robotic suits to help people walk and new discipline tracks for brain injury were among the highlights of September s 5th Annual PVA Summit & Expo. COURTESY OF PARALYZED VETERANS OF AMERICA Above: Only two months into his position as the Department of Veterans Affairs (VA) Under Secretary of Health, David Shulkin, MD, spoke at the Paralyzed Veterans of America 5th Annual Summit and Expo about progress being made in the VA Health Care System and his focus on specialty care services such as spinal-cord injury and disease. November 2015 PN 27

3 Executive Director of the Department of Veterans Affairs (VA) Spinal-Cord Injury and Disorders (SCI/D) System of Care Sophia Chun, MD, steps up in a session about the Veterans Access, Choice and Accountability Act to share how it affects SCI/D care in the VA. be able to do the type of work that we do every day, Shulkin says. And I consider their council and advice and guidance extremely important to the success of our organization and look forward to continued relationships with them. Permanent Choice The buzz at this year s Summit started in the first breakout session, which focused on one of PVA s main points of concern with the VA s health care the Veterans Access, Choice and Accountability Act and how it affects specialty care services at the VA. One of the things that Paralyzed Veterans of America does besides health policies and besides benefits is we have a legislative agenda. So, we get involved in any legislation or proposed bills that are intended to impact care in New at the Summit For the past five years, the Paralyzed Veterans of America (PVA) Summit and Expo has focused on health care surrounding veterans with spinal-cord injury and disease. This year, the event, comprised of various sessions on an education track that allows attendees to learn about new and different practices from their peers, added a new discipline to the agenda: traumatic brain injury (TBI). I think it s widely welcomed by these clinicians who obviously have a piqued interest in anything related to the spine, brain and nerves, says Lana McKenzie, Summit task force chair and PVA associate executive director of medical services. So I think we are going to continue that path and eventually incorporate part of that practice and information into the next Summit. McKenzie also mentioned other upcoming changes to the Summit including adding some interactive workshops to what has been three full days of lecture-style sessions. Therapists, they like to do some demonstrations how to fit patients in a better wheelchair, wheelchair measurements. Those types of things that can be very interactive, engaging, versus lecture, she says. 28 PN November 2015

4 Ann Spungen, EdD, associate director of the Department of Veterans Affairs (VA) Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury (SCI) at the James J. Peters VA Medical Center in New York has been leading a study on exoskeleton use in SCI rehab, which will soon expand to 10 additional VA SCI centers. some way, said PVA Deputy Executive Director Sherman Gillums Jr., in that first session. With news of a recent bill introduced by Sen. John McCain (R-Ariz.) that could make the VA choice program permanent, many Summit attendees and presenters in the sessions expressed concern on how it affects care. Executive Director of the VA SCI/D System of Care Sophia Chun, MD, stepped up in the session to share how the Choice Act threatens comprehensive lifetime care because it would lend itself to fragmented care. Comprehensive vs. Fragmented In a comprehensive lifetime model, care is given based on a patient s condition versus a provider s specialty. This is how VA spinal-cord injury centers are currently run. You can be treated for SCI/Drelated complications, like pressure sores, but also receive care Veteran Gene Laureano (center in red shirt) demonstrates the ReWalk exoskeleton at the 2015 Paralyzed Veterans of America Summit and Expo. Hello, Exo! It s no doubt exoskeletons robotic suits to help people with lower-limb paralysis walk are gaining popularity in rehab for people with spinal-cord injury and disease (SCI/D). Ann Spungen, EdD, associate director of the Department of Veterans Affairs (VA) Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury at the James J. Peters VA Medical Center in New York, has been studying the use of exoskeletons, specifically the Food and Drug Administration-approved ReWalk, for SCI/D rehab in a pilot study at the VA and presented the results at September s Paralyzed Veterans of America Summit. The SCI technology to allow individuals to walk is lagged behind because it s a much more difficult technology. But it s here now. It s in a primitive form. But perhaps us in the rehabilitation field need to rethink our paradigm for rehabilitation, says Spungen in her keynote speech. None of us would not prescribe an eligible amputee a prosthetic limb, and that s because we all know that staying in a wheelchair is not good for us. So with this new technology, as it develops and gets better, perhaps we should consider opening our eyes and consider those spinal-cord injured patients who would be interested in walking. The reported findings from the pilot study show similar results to starting a new exercise program, including increased energy, fat loss, improved bowel and bladder function, improved mental health, and reduction in pain. Spungen says these benefits in health and mobility are reasons to advance the field, which is exactly what the VA plans to do after receiving a grant to expand Spungen s research into a five-year study at 10 more centers. Six centers will start research in year one of the study and four more centers will join the following year. Each center is required to enroll eight participants in its first year of research and an additional eight the following year for a total of 160 participants in the study. COURTESY OF PARALYZED VETERANS OF AMERICA November 2015 PN 29

5 COURTESY OF PARALYZED VETERANS OF AMERICA for other ailments such as severe urinary tract infections, cancer, etc., from the providers who know your history from life until death. On the other hand, in a fragmented model, you would go to a cardiology unit when you have a problem with your heart, get a separate oncologist if you have cancer, visit a urologist for a urinary tract infection or any doctor available at an urgent care center. Paralyzed Veterans of America (PVA) Deputy Executive Director Sherman Gillums Jr., (left) socializes with PVA Summit attendees at the welcome reception. Paralyzed Veterans of America Summit Task Force Chair Lana McKenzie pumps up the crowd at the welcome reception. 30 PN November 2015

6 Excellence Awards Each year at the Paralyzed Veterans of America Summit and Expo four people are honored with Advocacy/Clinical Excellence Awards in four categories. Opposite page, PVA Summit Task Force Chair Lana McKenzie (far left) and Program Committee Chair Paul Gutierrez, MD, MS (far right), present the awards to the 2015 recipients. From left to right: Mary Susan Sue Biggins, MBA, BSN, RN, CRRN of the Edward Hines Jr. VA Hospital in Hines, Ill. (nurse award); I. Manosha Wickremasinghe, MD, Chief of the Spinal Cord Injury Center at the North Texas VA Medical Center in Dallas. (physician award); Jeri Muse, PhD, DAAPM, of the VA San Diego Healthcare System (psycologist award); Adrienne Toubbeh, OTR/L, of the New Mexico VA Healthcare System in Albuquerque, N.M. (therapist award). The other thing that I see with this choice is that it s taking the SCI system of care backwards to the fragmented care era, Chun says. It basically is a situation where you re not getting care by staff and clinicians who are familiar with SCI and who have expertise in SCI. And that was the whole reason why spinal-cord injury system of care in the VA system was started. Of course, someone with SCI/D could choose care at any of the country s 14 private spinal-cord injury model systems. However, Chun says those centers only offer comprehensive acute rehab. VA is the only system of care that actually has a health care system that s actually built around a medical condition, which is spinal-cord injury. It s a complex medical condition and in this model, the patient is at the center, so all the specialties that belong and need to be part of this SCI health care system is all under one umbrella in one location. So it s a huge sort of shift in thinking for health care, Chun says. So, certainly on the rehab side if they go to a model system they will get truly an interdisciplinary comprehensive care. But if a patient had medical problems or surgical problems, then you re still back to the fragmented care where you have to go to a surgeon who really hasn t had any SCI background or hasn t seen enough SCI patients to really understand; and so this choice is kind of essentially taking SCI backwards to a time pre-world War II. Paralyzed Veterans of America (PVA) Associate Director of Meetings Stacy Kulig (left) and PVA Prosthetics Consultant Fred Downs (right) socialize at the PVA Summit and Expo welcome reception. Paralyzed Veterans of America 5th Annual Summit and Expo attendees dance the night away at the welcome reception. November 2015 PN 31