Physical Medicine and Rehabilitation
The Department of Rehabilitation Medicine at Montefiore Medical Center offers comprehensive evaluations of chronic pain and is committed to providing safe and innovative therapies, so each patient can combat discomfort and realize increased range of motion. The following therapies have helped countless patients at Montefiore realize this goal and ultimately enjoy a better quality of life.
Our certified physicians use this modality of rehabilitation as an alternative to, or in conjunction with, medications or physical therapy. It is especially helpful for reducing pain and stiffness in the back, neck, shoulders and other musculoskeletal areas.
It is difficult to treat multiple painful areas, but an effective way to treat them is to place the patient in our heated pool to exercise against the resistance of water. Since water reduces stress on joints, patients are able to walk more easily utilizing the parallel bars in the pool. Painful joints can be exercised to increase their motion and strength using the water for both buoyancy and resistance. Aquatic therapy is also helpful for patients with arthritis or considerable weakness in their legs.
When physicians recommend lifestyle changes that include exercises, many patients need a structured and supervised program to achieve the fastest recovery possible. Our board certified rehabilitation team offers monitored exercise, cardiac risk factor modification, education and counseling services to patients recovering from a heart attack, heart transplant, bypass surgery and congestive heart failure or the placement of a stent. Individual muscle strengthening and cardiovascular conditioning programs are developed utilizing a variety of equipment, free weights and isotonic machines.
Foot and Ankle/Prosthetics/Orthotics
We custom design wedges, inserts and heel cups for patients with foot conditions such as overuse, rheumatologic and sports injuries. Several non-operative treatments such as physical therapy, ultrasound guided injections, preparatory orthosis, taping and unna boot are available. Prostheses such as artificial arms and legs are also custom made for amputees, as well as orthodics (braces) for the back or dropped foot. Rehabilitation for these patients begins with obtaining the proper device, but continues with training them how to properly use it.
Injections for soft tissues (muscles, tendons, and ligaments), spasticity (peripheral nerve or motor point block) and the spine are useful in conjunction with physical or occupational therapies in combating musculoskeletal pain and neurological disabilities. Many patients with carpal tunnel syndrome, knee pain, myofascial pain, tennis elbow, chronic pain, and spinal/nerve disorders experience a significant amount of pain relief and a substantial increase in motion as a result of these therapies.
Interventional Spine Program and Pain Management
Individuals experiencing acute and chronic pain from spinal origin (back and neck pain) receive a comprehensive consultation, evaluation and treatment plan. Our multidisciplinary team draws on various experts to confirm the precise diagnosis of the spinal condition. Together, with the patient, we customize a treatment plan to manage the pain. This may entail medication, therapy and/or spinal interventional procedures. We perform all spinal injections (i.e. cervical, thoracic, lumbar and hip) using image-guided fluoroscopy to pinpoint the exact localization for each. Additionally, physical therapy, occupational therapy and evaluation for braces for back and neck pain are available on site.
Pediatric Outpatient Rehabilitation
A dynamic physician, trained in both pediatrics and physical medicine and rehabilitation and certified by the American Board of Electromyography, provides comprehensive pediatric rehabilitation services. These include: physical therapy, occupational therapy, prosthetic and orthotic evaluations, spasticity management, wheelchair evaluations and aquatic therapy. Some of the most common conditions we treat are: cerebral palsy, rheumatologic and neuromuscular diseases, developmental delays, scoliosis, lower back pain, sports injuries and post-fracture care.
Pelvic Floor Rehabilitation
We recognize the importance of helping men and women experiencing pelvic floor dysfunction regain control. Some of the most common diagnoses we treat include: urinary incontinence, fecal incontinence, vaginal pain syndrome, rectal pain syndrome, pelvic pain syndrome and incontinence related to trauma, pregnancy, aging and surgery. Upon a thorough evaluation of the pelvic and lower back region, we recommend a structured program to recondition the muscles. This may be achieved through: pelvic muscle strengthening exercises, vaginal and rectal myofascial release techniques, neuromuscular re-education or biofeedback and electrical stimulation.
Our physical therapists work with patients experiencing pain, loss of mobility or weakness resulting from aging, injury, or disease. They not only develop exercise and training plans to restore functional abilities, but they also recommend devices, crutches or canes when warranted, and educate the patients as to how to properly use them.
For those having difficulties with daily life activities stemming from impairments or limitations of their upper extremities, our occupational therapists provide assistance to increase their dexterity by developing and restoring their performance. Specific therapies for hand tendon repairs, joint replacements, or fractured wrists, as well as application of ergonomic principles and physical modalities are employed to better enable patients to accomplish work tasks and daily routines.
Speech and Language Pathology
Difficulties with communication and/or swallowing may arise from illnesses and disorders, including cancer, stroke, Parkinson's disease, ALS, dementia, and cerebral palsy, as well as having undergone a laryngectomy. These can be improved through physical strengthening exercises, instructive or repetitive practice, sign language, and the use of audio/visual aids. Our team of speech pathologists identifies and diagnoses disorders through FEES (fiberoptic endoscopic evaluation of swallowing) and various tests in order to determine the best possible treatment to maximize speech restoration, while enhancing cognitive and swallowing capabilities.
A nationally recognized pioneer in this discipline, Dr. Stanley Wainapel evaluates and treats many patients with significant visual impairment or blindness. Treatment programs may be coordinated with organizations such as the Lighthouse or the Jewish Guild for the Blind (two local facilities providing specialized services for the blind and visually impaired individuals. Patients with low vision or no vision are equipped with comprehensive programs designed to improve visual motor and perceptual-cognitive deficiencies. Many of our patients are referred to us by ophthalmologists at Montefiore and from various institutions in the tri-state region.
A multidisciplinary Wheelchair Clinic is held at Montefiore for outpatients who require evaluations for wheelchairs, scooters or seating devices. The clinic team includes a fulltime attending physiatrist, resident physician, occupational therapist and the wheelchair vendor. Together we provide the full spectrum of services, ranging from providing simple wheelchairs to custom-molding systems for children with spinal deformity.