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The Tiniest Strengths for the Greatest Purposes: Achieving Remarkable Results in Rehabilitation

Prometheus Unbound Statue

The words of TIRR Memorial Hermann's founding physician, Dr. William Spencer, inscribed at the base of the sculpture Prometheus Unbound that stands at the hospital's entrance: "Man uses the tiniest of strengths for the greatest purposes."

“Man uses the tiniest strengths for the greatest purposes.” These are the words of William A. Spencer, MD, founder of the Texas Institute for Rehabilitation and Research, known today as TIRR Memorial Hermann, and they embody the spirit of the rehabilitation hospital’s employees and affiliated physicians as they work to change lives by improving outcomes and maximizing independence for people with disabling injury or illness. That simple sentence is inscribed at the base of an uplifting statue, Prometheus Unbound, which stands at the hospital’s entrance.

As TIRR Memorial Hermann prepares to celebrate its 60th anniversary, the hospital ranks as the best in the southern half of the United States, according to U.S. News & World Report’s annual listing of Best Hospitals for Rehabilitation. The hospital has ranked among the top five in the country in all but three years since the magazine began publishing the list 29 years ago in 1990.

Clinical Excellence

Gerard Francisco, MD

“Our pioneering work for our patients stems from our comprehensive approach to rehabilitation, the pillars of our system includes clinical care, research, education and advocacy,” says Gerard Francisco, MD, chief medical officer at TIRR Memorial Hermann and professor and chair of the department of Physical Medicine and Rehabilitation at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). “Our reputation for clinical excellence is based on our outcomes. We accept the challenge of the most complex cases, with a very high rate of discharge to the community, and measure excellence based on objective data required by regulatory agencies, but the stories of our patients are the most telling tribute to our success. Photos of former patients who have returned to productive lives line our hallways. It’s a daily reminder that they are the reason we come to work.”

Dr. Francisco attributes TIRR Memorial Hermann’s long track record of excellence to resilience. “We have been able to overcome the fiscal challenges that limit the amount of rehabilitation we can provide for our patients,” he says. “We continue to be able to achieve great outcomes because of the resiliency of our physicians, staff and leadership, even with resources more limited today than ever before. We attract the best in the field – residents, fellows, attending physicians, nurses, therapists and other employees – because they know we’ll challenge their skills. I believe every rehabilitation professional should live by those famous words of Dr. Spencer.”

The Early Years

In 1951, Dr. William Spencer, a young pediatrician just out of the United States Army, was recruited by Baylor College of Medicine and the National Foundation for Infantile Paralysis to lead a staff of clinicians at the Southwestern Poliomyelitis Respiratory Center in Houston. As the polio epidemic swept the nation, patients from across the United States were sent to the center, which at one time managed more than 10 percent of the 38,000 new cases of polio that occurred annually. When the polio vaccine all but eradicated the disease, Dr. Spencer refocused the core clinical knowledge developed from the rehabilitation of patients with polio to the care of people with catastrophic injuries and illnesses.

"When the polio epidemic hit, my father became frantic. As a pediatrician and old-school doctor, he was committed to curing kids. But he couldn't cure this disease, and when he saw the crippling and the stigma associated with it, the kids confined to iron lungs and young people being sent to nursing homes for the rest of their lives, he wanted to do something innovative."

Widely regarded as the “Father of Modern Rehabilitation,” Dr. Spencer guided TIRR Memorial Hermann to become a worldwide model for comprehensive medical rehabilitation programs. Under his leadership, the hospital gained national recognition for its innovative and pioneering programs. He served on presidential task forces and was the first acting director of the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). He served as president of TIRR Memorial Hermann from its opening until his retirement in 1987.

“When the polio epidemic hit, my father became frantic,” says Susan Spencer Tully, Dr. Spencer’s daughter, of Potomac Falls, Virginia. “As a pediatrician and old-school doctor, he was committed to curing kids, but he couldn’t cure this disease, and when he saw the crippling and the stigma associated with it, the kids confined to iron lungs and young people being sent to nursing homes for the rest of their lives, he wanted to do something innovative. He always said, ‘Even though the body is broken, the mind still works.’ He wanted to make sure that people with disabilities had the opportunity to use their skills and talents to the greatest degree possible. He was also very committed to research into ways to live with paralysis.”

Innovation Through Research

Mark Sherer, PhD, ABPP, FACRM

TIRR Memorial Hermann has historically balanced its clinical treatment program with initiatives in applied research. Early on, the hospital collaborated with NASA to carry out research on the effects of weightlessness, and in studies to determine the potential usefulness of centrifuge therapy for astronauts on deep-space missions. Longstanding affiliations with Baylor College of Medicine and McGovern Medical School at UTHealth have led to local collaborations with researchers from the University of Houston, Rice University, Texas Woman’s University and several other academic institutions, as well as national collaborations with researchers around the country and international projects with universities in Mexico, Spain and China. “TIRR Memorial Hermann’s history is replete with examples of advances in clinical approaches to rehabilitation fostered by imaginative research initiatives,” says Mark Sherer, PhD, ABPP, FACRM, senior scientist and associate vice president for research at TIRR Memorial Hermann and a clinical professor of physical medicine and rehabilitation at McGovern Medical School and Baylor College of Medicine. “Investigators at the hospital believe that the future depends on research to guide innovation in clinical approaches and improve the quality of life for people with disabilities in the U.S. and around the world. Our research is focused on clinical needs that our patients, families and clinicians identify. In almost all cases, the results of the projects offer fairly immediate benefit to our patients and, through our collaborations, to other patients with similar issues around the country and world. Many new projects involve adaptations of interventions already shown to be helpful with a particular population of patients.”

TIRR Memorial Hermann currently holds research funding of nearly $30 million. “Our research projects integrate the input of physicians, nurses and therapists, many of whom are engaged in their own research projects,” Dr. Sherer says. “Like most endeavors, to reach the highest level of success you need context and a solid foundation. From the beginning, our leaders have been committed to providing that infrastructure. Dr. Spencer was the right person at the right time in terms of integrating TIRR Memorial Hermann into the Texas Medical Center, which gave us access to enormous research resources and investigators at other institutions, particularly Baylor College of Medicine and UTHealth. That access has kept us at a critical mass to continue moving forward with research.”

Passport to the Future

Rhonda Abbott, PT, FTPTA

As part of TIRR Memorial Hermann’s commitment to ensuring the most advanced care, more than 60 percent of its clinical staff hold advanced certifications. “We encourage and support certification and we’re also committed to being a teaching and academic affiliation location for all disciplines that treat patients here. That includes physical medicine and rehabilitation, neuropsychology, spinal cord injury medicine, brain injury medicine, neurologic physical therapy, nursing, therapeutic recreation, music therapy, pharmacy, clinical social work, speech-language pathology and occupational therapy,” says Rhonda Abbott, PT, FTPTA, vice president of operations at TIRR Memorial Hermann and the Memorial Hermann Rehabilitation Network. “The TIRR Memorial Hermann Education Academy provides a comprehensive education package that allows our employees and students and professionals from around the world to expand their knowledge and keep their clinical skills up to date, so that they can remain leaders in their fields of expertise. In 2018, we offered 25 courses through our education academy.”

Areas of education include the Advancing Clinical Practice Series, which offers courses on spinal cord injury, brain injury, stroke rehabilitation, pediatric rehabilitation, neurodegenerative diseases and limb loss. Other courses focus on robotics, cancer rehabilitation, Parkinson’s disease and neurologic music therapy.

Students and professionals may also apply for a residency, fellowship, clinical rotation or internship, or participate in student observation.

Physical medicine and rehabilitation residents and fellows are a key point of medical contact for patients, working under the guidance of attending physicians. Each year TIRR Memorial Hermann accepts one brain injury fellow and two spinal cord injury fellows from McGovern Medical School and one brain injury fellow from Baylor College of Medicine. Their experiences at TIRR Memorial Hermann are transdisciplinary. “We don’t provide care in silos. Our residents and fellows are in the mix with the entire team,” Abbott says.

Abbott and her team work with schools across the country to offer preceptorships, opportunities for education and volunteer options for more exposure to the rehabilitation hospital experience. “We have a long waiting list of schools that reach out us for opportunities for their students,” she says. “When their academic programs align with what we’re looking for on the student side, we assess our abilities to provide clinical instructors to match their needs. We truly see this as a commitment to the next generation, and we benefit as well. They come out of school with the latest knowledge in their disciplines, passion and energy, and they share it. We’re lifelong learners. We harness what makes sense and add new evidence-based practices. Our education programs are a win-win opportunity.”

Changing What Is into “What Should Be” Through Advocacy

“Advocacy is woven into our fabric,” says Jerry Ashworth, FACHE, CEO of TIRR Memorial Hermann. “It began with Dr. Spencer, who early on turned his attention to Washington to obtain federal recognition and support for medical rehabilitation programs and rehabilitation research, and to advocate for people with disabilities. Advocacy continues today through our support of numerous programs that help break down barriers and especially through the work of Lex Frieden and his colleagues at ILRU.”

“Dr. Spencer set the tone for advocacy,” says Frieden, director of the Independent Living Research Utilization (ILRU) program at TIRR Memorial Hermann and widely regarded as a chief architect of the Americans with Disabilities Act (ADA). “For people with disabilities, the ADA was our emancipation act. Before the ADA, a person could look you in the eye and deny you a job or deny you entrance to college simply because you were in a wheelchair and it was perfectly legal to do so.”

Frieden was a freshman in college in 1967 when he suffered a spinal cord injury in an auto accident. Following rehabilitation at TIRR Memorial Hermann, he was denied readmission to the university. He later completed a Bachelor of Science in Psychology at the University of Tulsa and a Master of Arts in Social Psychology at the University of Houston.

“I was a graduate student when Dr. Spencer told me that if I was interested in rehabilitation research, I should look into getting funding for a program for independent living research at TIRR Memorial Hermann,” says Frieden, a professor of biomedical informatics at The University of Texas Health Science Center at Houston (UTHealth). “He connected me with Congressman Olin Teague, and at 24, I rolled into his Washington office in my wheelchair and explained that there was a national need for independent living programs. Congressman Teague’s support led to the establishment independent living centers, funding for rehabilitation research and the creation of the National Institute for Disability, Independent Living and Rehabilitation Research.”

Federal research grants and funds donated by the Moody Foundation in Galveston and others helped underwrite ILRU, a national center for information, training, research and technical assistance in independent living. The program’s goal is to expand the body of knowledge about independent living and improve the use of results of research programs and demonstration projects in the field.

Since ILRU was established in 1977, program staff members have developed a variety of strategies for collecting, synthesizing and disseminating information related to the field of independent living. ILRU staff, the majority of whom are people with disabilities, serve independent living centers, statewide independent living councils, state and federal rehabilitation agencies, consumer organizations, educational institutions, medical facilities and other organizations, both nationally and internationally.

The independent living movement began with eight centers; today there are more than 400 in the United States. “ILRU is tracking, observing and keeping statistics and records on the nationwide network of independent living centers and programs,” says Frieden, who, at the invitation of President Ronald Reagan, ran the National Council on the Handicapped, which developed the ADA. “We’re also doing training for the programs and helping them expand the scope of their work to include people who are developing disabilities due to aging. ILRU plays an important role as the think tank that ties all the centers together.”

TIRR Memorial Hermann’s advocacy for people with disabilities extends from the research at ILRU to the founding and lead sponsorship of ReelAbilities Disabilities Film Festival in Houston, and support for artwork by members of the disability community through Celebration Company, which teaches life skills and provides meaningful employment to individuals with disabilities who create products “that celebrate the good of life.”

“We serve on the Mayor of Houston’s Committee on Disabilities and were influential in helping Mayor Sylvester Turner recruit the director of the city’s Office on Disabilities from Washington, DC, to Houston,” Jerry Ashworth says. “We advocate through our community wellness program, Strength Unlimited, and through adapted sports programs, which include an adult wheelchair rugby team, three wheelchair basketball teams and two wheelchair softball teams. We’re very proud of our commitment to help athletes excel and, with the junior teams, pursue a college education through scholarships. We’re committed to raising awareness, educating people about the inequalities that exist and removing barriers. When we’re aware of a need, we readily lend a hand.”

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