October, 2009
By Helen K. Kelley
The influence and significance of Shepherd Center reach well beyond Atlanta, the state of Georgia and even the United States. Shepherd Center draws patients who need treatment for spinal cord injuries, acquired brain injuries, multiple sclerosis, chronic pain and other neurological conditions from every state in the country, plus as many as 30 foreign countries.
Shepherd Center actually had a relatively “small” introduction. In 1973, Alana and Harold Shepherd’s 22-year-old son James sustained a spinal cord injury in a surfing accident while on vacation in Rio de Janeiro. After spending several weeks in a Brazilian hospital struggling to survive, the Shepherds brought James back to the United States, where he spent another six months at a rehabilitation facility in Colorado. There, he regained his ability to walk while using a cane and a leg brace.
Frustrated that James couldn’t receive this kind of specialized care anywhere in the Southeast, the Shepherds were not content to stop after his recovery. With his parents’ support, James founded Shepherd Center in 1975 to bring high-quality spinal cord injury care closer to home. At that time, the center was simply a six-bed unit that operated out of leased space in an Atlanta hospital.
From those humble beginnings, Shepherd Center has grown from six beds to 120, has roughly 1,300 employees and is recognized around the world as a rehabilitation treatment facility for catastrophic illnesses and injuries, and as an advocate for people with disabilities. The hospital runs at nearly full capacity all of the time, with a census of more than 100 patients, almost daily.
Medical Director Donald Peck Leslie, M.D., notes that Shepherd Center receives a large number of referrals from other facilities, particularly because it can handle highly complex cases.
“For example, Grady Memorial Hospital here in Atlanta is our No. 1 source of referrals. As a Level 1 trauma center, they often have patients who must be transferred to a treatment facility with an intensive care unit,” he explains. “We have our own ICU here at Shepherd, which most rehabilitation hospitals do not have. We’re in touch with the trauma surgeons at Grady almost daily.”
Referrals have increasingly come from other states and countries. Dr. Leslie adds that this is the first year Shepherd Center surpassed the percentage of patients being referred in state by referrals from other states and countries. He attributes this trend to Shepherd Center’s active presence in the international health care arena.
“We belong to a number of international organizations and make presentations at conferences and meetings around the world, and we’ve been asked to help other facilities put together their own rehabilitation programs,” Dr. Leslie states. “But the reality is that most countries don’t have the resources and expertise needed to start a rehabilitation treatment facility.”
Dr. Leslie attributes much of Shepherd Center’s phenomenal growth to the community support it has received since its inception.
“We’ve been fortunate to have such an incredible response from the Atlanta community and beyond,” he says. “Of the 14 model system spinal cord injury treatment centers around the U.S., we’re the largest, and the only one that is not part of a bigger medical center.”
Not Just For Rehabilitation Anymore
Shepherd Center is not simply a rehabilitation hospital. It’s also a world-renowned center for neurorehabilitation research, focused on developing, refining and evaluating new treatments, drugs, surgical techniques, diagnostic tools and various therapy interventions. Its clinical studies on spinal cord injury, brain injury, multiple sclerosis and neuromuscular disorders are conducted in collaboration with leading experts at other hospitals, research centers, medical schools and universities around the world.
One of Shepherd Center’s premier areas of study occurs in its Spinal Cord Injury Research Program. Directed by Keith Tansey, M.D., Ph.D., this program is especially interested in restorative neurological research and conducts studies that address the recovery of function in residual, reorganized or regenerated neural circuitry in patients with spinal cord injury. Shepherd Center’s Spinal Cord Injury Research Program is developing a human studies laboratory called the Spinal Cord Injury Lab (SCIL) to expand its capacity to translate discoveries made in basic scientific research to studies in people with spinal cord injury.
“I’ve encouraged Shepherd to step closer to the basic science research bench. There’s a narrow pipeline between the basic scientists and clinical research,” says Dr. Tansey, noting that nearby universities – Emory, Georgia Tech and the University of Georgia – are all doing interesting research on the spinal cord in animals. “Right now, there are a lot of things that work successfully in the animal lab, and we’d love to know if they work on humans. I’d like to know not only if an idea is going to work, but also how it’s going to work.”
To find that out, human subjects must participate in lab studies. “Someone has to study the first 10 to 15 human patients in a lab setting as if they were doing a basic science experiment with lab rats, where they look with great precision at the biology,” Dr. Tansey explains. “In the case of spinal cord injury, by doing this type of research, we can learn how changing the specifics, such as with locomotor therapy, can increase patients’ ability to realize greater functional recovery.”
Shepherd Center’s spinal cord injury research using human subjects will help provide an understanding of how the nervous system responds in any predictable way, answering questions about whether patients improve by applying a given therapy, by reductions or increases in that therapy, by using a combination of drugs or electrical stimulation and therapy, and more.
SCIL’s first area of study will be neural plasticity, Dr. Tansey notes, and it will involve electrophysiological techniques to determine how a patient’s muscles and reflexes are working, in addition to using robotic devices to measure improvements in strength and movements.
“We want to look at interventions that can regulate and help the patient recover, and what changes can be made in rehabilitation therapy to make it more effective. The use of robotics will be particularly helpful in providing us with information,” he says. “We’ll also be able to change individual parameters using robotics, which can help determine how to get the patient to the next level of recovery. It’s evidence-based evolution of therapy.”
In addition to spinal cord injury research, Shepherd Center has programs that conduct research in acquired brain injury, multiple sclerosis, assistive technology and more. Shepherd Center’s research also works to improve the effectiveness and cost-effectiveness of clinical services, as well as to document the long-term effectiveness and benefits of rehabilitation to improve patient outcomes.
Revolutionary Technologies, Advanced Patient Therapies
Shepherd Center employs some of the latest specialized technologies to help its patients regain function they’ve lost. One such technology, the NeuRx Diaphragmatic Pacing System (DPS), provides crucial assistance to patients who’ve suffered phrenic nerve damage due to spinal cord injury. Because the phrenic nerve gives neurological capability to the diaphragm, damage to the nerve can render a patient unable to breathe without assistance from a ventilator.
Shepherd Center Associate Medical Director Brock Bowman, M.D., along with physicians at other facilities, such as Piedmont Hospital and the Cleveland Clinic, led clinical trials on the pacing system. Since the pacing system received FDA approval in the summer of 2008, 10 Shepherd Center patients have undergone the procedure to implant the NeuRx DPS.
According to Shepherd Center consulting surgeon Saeid Khansarinia, M.D., the NeuRx DPS can make a significant and dramatic improvement, especially in the lives of quadriplegic patients. “The DPS system frees our quadriplegic patients from the constraints and limitations of the ventilator, thus allowing them the closest thing to natural breathing,” he explains. “They have the freedom to move with less equipment, they experience the return of natural speech, taste and sense of smell, and there is less risk of lung infection.”
The system works by surgically placing a pacemaker onto the actual diaphragmatic muscle to assist the patient in breathing on his or her own; a small computer device regulates the pacing. For some people, this means being able to take a break from being on a ventilator; for others, it may mean being able to wean off a ventilator permanently.
“The pacing system has helped people with Lou Gehrig’s disease, who get worse very slowly over time, as well as people with spinal cord injuries,” Dr. Leslie says. “It’s giving hope to patients who want to get off the ventilator, at least some of the time. We’re fortunate to be able to help them, since so many people who suffer this kind of nerve injury don’t even make it to the hospital.”
Shepherd Center’s therapeutic treatments are as advanced as its technologies. Many of its patients are benefiting from a program called “Beyond Therapy,” in which they have completed traditional rehabilitation protocol, but can opt to continue a nontraditional therapy of electrical stimulation of musculature that focuses on one particular aspect of rehabilitation, such as walking. The electrical stimulation is delivered to the selected muscles via a Swiss-engineered piece of equipment called the Lokomat, which Shepherd Center has two of. The Lokomat is a system of external orthoses that straps onto the patient. The robotic orthoses have motors in the hip and knee joints to move the patient’s legs. It can also give feedback as to how much the patient is working with the machine.
“It’s amazing to see people who haven’t walked for days, weeks or even months, do some limited ambulation,” Dr. Leslie says, “and the Lokomat can help patients who simply need muscle strengthening. The more they use it, the more close to normal range of motion they can get.”
As its research program develops and its staff develops even higher levels of expertise, Shepherd Center will continue to help its patients achieve better outcomes and become more independent, fulfilling its pledge to provide a high quality and complete continuum of care for those in need of rehabilitation.
To learn more about Shepherd Center, its patient care, its research programs and more, log on to www.shepherd.org and shepherdTV.org. Patients interested in participating in clinical research studies can even sign up online.
