Center News Magazine: Memorial Sloan Kettering Opens Outpatient Rehabilitation Center

Friday, October 1, 2010
Physical therapist Tiffany Kendig guides a patient in strengthening her lower body. Physical therapist Tiffany Kendig guides a patient in strengthening her lower body.

Memorial Sloan Kettering greatly expanded its capacity to help patients with cancer regain physical function and a sense of well-being with the opening recently of its state-of-the-art Outpatient Rehabilitation Center.

Located at 515 Madison Avenue, “this new center allows us to improve our quality of care and help patients maximize their physical potential,” said Teresa W. Fitzpatrick, Manager of the Outpatient Rehabilitation Center. “With more space and a larger staff, we can also meet the increased demand for our services, and patients are able to recover in a beautiful environment.

Cancer and its treatments — such as surgery, chemotherapy, and radiation — can interfere with the proper function of nerves and muscles. As a result, patients may have trouble regaining strength and mobility after treatment and can struggle with everyday tasks such as walking, dressing, cooking, showering — and even eating or speaking clearly. To help alleviate symptoms and restore patients’ functional capacity to the fullest extent possible, Memorial Sloan Kettering physicians refer them to rehabilitation specialists, who have expertise in helping patients to regain functional independence.

These specialists include physiatrists, physicians who treat and manage neuromuscular, musculoskeletal, and cardiopulmonary disorders; physical therapists (PTs) and occupational therapists (OTs), who help patients recover physical skills through a variety of approaches, such as therapeutic exercise, neuromuscular training, and cardiopulmonary rehabilitation; and lymphedema therapists, who help patients manage lymphedema — a side effect that may occur after surgery for some types of cancer, particularly breast cancer, in which lymph nodes in the armpit may be removed for examination by pathologists. After such surgery, lymphatic fluid can accumulate, causing swelling of an extremity.

Memorial Sloan Kettering’s physical and occupational therapists previously served inpatient and outpatient needs in Memorial Hospital. As demand for their services increased, the department needed more space and staff for outpatient therapy. A generous gift from Robert F. X. Sillerman and Laura Baudo Sillerman through their Tomorrow Foundation enabled the building of the new outpatient center and the hiring of additional therapists.

A First-Rate Facility

Gymnasium The new center’s spacious gymnasium houses advanced equipment.

The 22,500-square-foot center occupies the entire fourth floor and half of the fifth floor at 515 Madison Avenue, which can be entered on East 53rd Street. Memorial Sloan Kettering’s Facilities Management selected the location due to its proximity to the Rockefeller Outpatient Pavilion — located two blocks east on 53rd Street and at which much of Memorial Sloan Kettering’s outpatient care is delivered — and the main Memorial Sloan Kettering campus, at 68th Street and York Avenue.

On the fourth floor, 15 treatment bays enable PTs and OTs to provide hands-on care in a private setting, and two additional rooms are dedicated to the management of lymphedema. The most arresting feature on the floor is a spacious gymnasium, which resembles a full-service health club with advanced equipment. Many of the machines here are wheelchair compatible or have other adaptations to accommodate people who have physical impairments. One even combines sophisticated pressure sensors with computer games, offering patients an enjoyable and effective way to build strength and coordination.

Sharlynn M. Tuohy, Assistant Manager of the Outpatient Rehabilitation Center, said patients appreciate the facility’s ambience and location away from Memorial Hospital. “I have the pleasure of seeing patients’ positive reactions when they first see our bright, expansive facility. Our location outside of the hospital fosters a sense of well-being and contributes to patients’ confidence in returning to the activities they enjoyed prior to their illness. In fact, patients report they feel that they can really heal here.

Tiffany Kendig, one of four PTs at the center, said the new equipment allows for the assessment and rehabilitation of patients in ways not possible before. “I treat many individuals who present with a variety of neurological impairments, which can cause problems with balance and postural control,” she said. “With our new machines and devices, it’s easier to understand the nature of the dysfunction and design a program to correct it.

One new tool at her disposal is the Balance Master EquiTest®, a machine similar in shape to a phone booth with a platform and walls that move in order to test balance control. (A harness protects against injury from falls.) A simulated park located at the center of the gymnasium allows patients to practice stepping on and off curbs and walking on the uneven surfaces — grass, road-type asphalt, or inclines — that they may encounter in the real world.

OTs such as Gabrielle Miskovitz focus more on upper-body motor skills, helping patients relearn how to complete activities of daily life such as buttoning a shirt, using a pen, cooking, or bathing. The fourth floor includes a simulated kitchen with a dishwasher and refrigerator, and a bathroom with grab bars so patients can practice routine household tasks safely. “We try to dissect exactly what the limitation may be and then show compensatory steps people can take to perform tasks safely and effectively,” she explained.

The floor also has a separate exercise room with mirrors and ballet bars for group instruction and floor exercise, and a conference room for holding educational seminars. Patient Financial Services has staff located in the center, working on the patients’ behalf to secure authorization for insurance coverage or to address other financial questions that arise. A patient van is available for transportation between 515 Madison Avenue and other Memorial Sloan Kettering sites in Manhattan.

The therapists on the fourth floor now serve about 50 to 60 patients per day — roughly twice as many as before — and the number is expected to increase. “We still have a waiting list because the need for our services has exploded,” Ms. Fitzpatrick said. “We’ll be adding even more staff now that we have the space.

Rehabilitation Medicine

Physical therapist with patient Therapists use hands-on treatments to help patients regain mobility.

The fifth floor houses the center’s clinical component, including the offices for three physiatrists. The physiatrists see patients referred by their primary Memorial Sloan Kettering physicians and assess pain and dysfunction in nerves, muscles, and bones that may be limiting mobility or causing discomfort. Six examination rooms are available for the evaluation and treatment of these conditions, which often takes the form of injections to muscles and joints to reduce pain or rigidity. Two of the rooms have electromyography machines, which test a patient’s peripheral nervous system using tiny electric shocks to identify the cause and location of a dysfunction.

Physiatrist Michael D. Stubblefield said he and his colleagues see a large number of patients who have had head and neck cancer, Hodgkin’s disease, and breast and prostate cancer; but these are not the only types of cancer that can produce impairments. After performing a thorough evaluation, the physiatrist refers the patient to an appropriate therapist for the necessary exercise program. Sometimes the physiatrist outfits the patient with a specialized brace or other prosthetic to improve function and independence.

Dr. Stubblefield said the new space has made a significant difference in the number of patients who can be seen in the course of a day. In some cases, a therapist or physiatrist can go at a moment’s notice to address a specific patient need, a flexibility that eliminates delay. “We now are able to help more patients more quickly,” he said. “Therapy is one of the major tools in our kit, and having more staff helps us improve the quality of life for patients.

Growing Importance of Rehabilitation

Memorial Sloan Kettering neuro-oncologist Andrew B. Lassman, who primarily treats brain tumors and cancer that has spread to the brain from elsewhere in the body, often refers patients for outpatient physical and occupational therapy because of problems with walking, balance, and neuropathy (numbness or pain in the feet or hands). Some patients may need therapy immediately after surgery in order to be flexible enough to receive further treatments such as radiation. In specific cases, patients need to regain a certain degree of neurological function in order to be eligible for a clinical trial.

Dr. Lassman has already noticed the impact the outpatient center has made. “Because of the larger space and increased availability of therapists, my patients get in for therapy more easily, and the facility itself is absolutely space-age, state of the art,” he said.

Ms. Fitzpatrick, the outpatient center’s manager, said the need for rehabilitative services will become more critical over the long term as new treatments transform cancer into a less fatal, more chronic disease. The hope is that the new center will help Memorial Sloan Kettering’s specialists use their expertise to advance the entire field of rehabilitation therapy.

Even more than the beautiful facility, what is really making the difference is the quality of our staff and the experience they have taking care of the unique issues cancer patients face,” she said. “These therapists have their hands on such patients day after day, and they have learned exactly how to guide the patients back into normal living after coming out on the other side of their treatment.

To learn more about the work of a Memorial Sloan Kettering outpatient physical therapist, visit our 2009 Annual Report Web site.