About Physical Medicine & Rehabilitation
The Department of Physical Medicine and Rehabilitation features an integrated academic practice model, linking the main campus with nine acute care hospitals, three inpatient rehabilitation hospitals, more than 50 outpatient therapy venues, skilled nursing facilities, long-term acute care hospitals and Cleveland Clinic's Center for Connected Care. This enterprise employs a fully operational disease-based rehabilitation care delivery system. All of the department's clinicians work side by side with the surgeons and medical specialists who share their subspecialty interests and expertise. Patients benefit from innovative rehabilitation strategies provided by a unified academic faculty, with access to the full range of specialty consultants, sophisticated laboratory and imaging resources and Cleveland Clinic treatment protocols and carepaths.
Committed to the concept of teamwork, the department features an inclusive leadership structure that engages all of the therapy disciplines in meaningful roles. This collaboration has allowed us to be able to provide approximately 700,000 rehabilitation visits each year. Clinical, research and educational services are supported by the nation's premier information management platform that advances an efficient and value-based rehabilitation brand.
The department's commitment to helping patients maintain good health and improve function extends through outpatient clinics, inpatient rehabilitation hospitals and consultation in skilled nursing facilities. The clinical staff is charged with teaching the principles of rehabilitation care to over 1,000 Cleveland Clinic residents and fellows, and to the medical students of Cleveland Clinic Lerner College of Medicine and Case Western Reserve University. Our Physical Medicine & Rehabilitation Residency Program, inaugurated in 2016, is the capstone of this effort.
Cleveland Clinic Rehabilitation Hospitals (Avon, Beachwood and Edwin Shaw) share a common medical faculty, common electronic medical records, laboratory and radiology systems, and a commitment to use Cleveland Clinic's size and resources to create efficient and effective treatment protocols that will define the future delivery of rehabilitation services in the United States.
The rehabilitation research team partners with colleagues of many medical specialties and scientific fields to investigate novel treatments and therapies. This work elevates the level of care that is provided to patients, and sets the stage for development of Cleveland Clinic rehabilitation brand regionally, nationally and internationally, with new facilities in Las Vegas and Abu Dhabi.
Measuring and understanding outcomes of medical treatments promotes quality improvement. Cleveland Clinic has created a series of online Outcomes for each of its clinical institutes. Designed for a physician audience, these Outcomes contain a summary of many of our surgical and medical treatments, with a focus on outcomes data and a review of new technologies and innovations.
What We Treat
The Department of Physical Medicine and Rehabilitation integrates main campus with nine acute care hospitals, three inpatient rehabilitation hospitals, more than 50 outpatient therapy venues, skilled nursing facilities, long-term acute care hospitals and Cleveland Clinic's Center for Connected Care.
Collaborative care is also communicated with our Department of Rehabilitation and Sports Therapy. Rehab and Sports Therapy consists of 650 specialty-trained therapists at more than 45 locations. Our highly trained physical, occupational and speech therapists provide more than 20 specialty rehabilitation and sports therapy services and programs to help patients improve function and recover from injury or surgery. Our therapists guide practice excellence through the development of standardized, evidence-based practice protocols.
This enterprise employs a fully operational disease-based rehabilitation care delivery system. All of the department's clinicians work side by side with the surgeons and medical specialists who share their subspecialty interests and expertise. Patients benefit from innovative rehabilitation strategies provided by a unified academic faculty, with access to the full range of specialty consultants, sophisticated laboratory and imaging resources, and Cleveland Clinic treatment protocols and carepaths.
If you have been hospitalized for stroke, a traumatic injury, major surgery or a severe illness, your doctor may refer you for acute inpatient rehabilitation before you go home.
Our outpatient rehabilitation physician services include:
- Botox and Baclofen Pump Clinic
- Cognitive rehabilitation
- Disability and counseling services
- Interventional pain management and spinal procedures
- Musculoskeletal rehabilitation physician clinical services
- Musculoskeletal/Sports injury assessment and treatment
- Neurological rehabilitation
- Neuropsychological testing
- Pelvic floor EMG
- Pelvic floor rehabilitation
- Rehabilitation psychology
- Spasticity clinic
- Stroke and spinal cord outpatient clinic
- Ultrasound guidance injection
Cancer Physical Medicine & Rehabilitation
Cancer physical medicine and rehabilitation physicians provide ongoing evaluation, medicinal treatment and therapy for the causes of symptoms which impact a person’s function or ability to perform their usual daily activities such as dressing, bathing, meal preparation, walking, doing household chores and working.
As you go through cancer treatments, your body can be impacted by those treatments. It is best to have a full evaluation by a physical medicine and rehabilitation specialist when you start your cancer treatments, so that you have someone who knows your baseline function and will help you with preventing disability, monitoring your body changes, and treating your symptoms as you receive treatment.
Cancer related impairments that can be helped with physical medicine and rehabilitation include:
- Cognitive dysfunction such issues with learning, memory, perception, and problem solving
- Deconditioning (loss of muscle tone and endurance)
- Decreased coordination
- Dysarthria (difficulty or unclear articulation)
- Dysphagia (difficulty or discomfort when swallowing)
- Gait instability
- Impaired daily activities such as dressing, bathing, meal preparation, walking, working & household chores
- Joint dysfunction such as stiffness, swelling, pain
- Myopathy (muscle weakness)
- Peripheral neuropathy (tingling, burning, loss of feeling from nerve damage due to chemotherapy)
- Spasticity (muscle tightness)
- Vocal cord dysfunction
Our pediatric rehabilitation team at Cleveland Clinic Children’s Hospital for Rehabilitation develops individualized treatment plans to help patients with physical and cognitive disabilities improve function, prevent progression of disability and disease complications and assist caregivers.
Our pediatric rehabilitation team at Cleveland Clinic Children’s Hospital for Rehabilitation consists of board-certified pediatric physiatrists, case managers, nurses, therapists, psychologists and social workers, among other professionals.
This team evaluates each child’s needs and develops treatment plans based on individual goals. Our pediatric rehabilitation program serves patients with physical and cognitive disabilities — improving function, preventing progression of disability and disease complications, and assisting caregivers. Specialized pediatric therapy services include:
Programs & Services
- Physical Therapy
- Occupational Therapy
- Speech/Language Therapy
- Aquatic (water) Therapy
- Recreational Therapy
- Music and Art Therapy
- Day hospital
- Feeding Disorders Program
- Constraint-induced Movement Therapy
- Motor Control Program
- NICU Follow-Up Clinic
- Pediatric Pain Rehabilitation Program
- Seating and Mobility Clinic
- Spasticity Program
- Technology Resource Center
Learn more at clevelandclinicchildrens.org.
Make an Appointment
For general questions or to schedule an appointment, please call 216.636.5860 or toll-free 866.588.2264.
Select patients can now see our specialists online from their home or office by using the Cleveland Clinic Express Care® Online tool. This service allows patients a fast, secure and easy way to receive care from their healthcare team in a live virtual visit using a smartphone (iPhone or Android), tablet or computer. The benefits of choosing this appointment option include no travel or parking, no co-pays, significant time savings and the convenience of seeing your physician from wherever you choose.
If you would like to use Express Care Online for your next visit, please call your provider’s office. If you are eligible, our team will schedule your virtual visit and provide details on the cost of your appointment and setup instructions.
Refer a Patient
If you would like to refer a patient, please call us at 216.445.7342 or toll-free at 800.223.7723 ext. 57342.
Research & Clinical Trials
Bionic Skeleton Suit
Our patients benefit from the latest technology, training and rehabilitation research strategies. Click on the video to see the latest addition to our therapy training capabilities. Bionic skeleton suit technologies now allow paralyzed patients to attain an upright posture and take steps with assistance. These devices are licensed for use as rehabilitation training devices, but are not yet approved for private use in the United States.
Clinical trials are designed to identify treatments and therapies that are potentially more effective and/or have fewer side effects than standard treatment protocols. Patients in the Department of Physical Medicine and Rehabilitation have access to numerous studies, some designed by Cleveland Clinic physicians, others as a part of multi-center trials in partnership with organizations. These associations contribute to the exciting environment of clinical trial research and development, discussion and the sharing of data that is so important to the dynamic evolution of the therapeutic protocols of tomorrow.
Current Open Protocols & IRB Studies
- Hand Sensorimotor Function and Carpal Tunnel Syndrome
- Use of Computer Gaming as an Adjunct during Outpatient Stroke Rehabilitation to Obtain Task-Specific Upper Extremity Practice Repetitions
- Brain Stimulation-Aided Stroke Rehabilitation: Neural Mechanisms of Recovery
- Effect of Mental Motor Actions on Functional Recovery after Human Cerebral Stroke
- Directing Neuroplasticity to Improve Rehabilitative Outcomes of the Upper Limb in Incomplete Quadriplegia
- Novel Brain Stimulation Therapies in Stroke Guided Expressions of Plasticity
- Electrical Stimulation of the Dentate Nucleus for Upper Extremity Hemiparesis Due to Ischemic Stroke (EDEN)
Musculoskeletal Biomedical Rehabilitation Laboratory
Our research interest lies in musculoskeletal biomechanics, motor control and rehabilitation of the upper extremities, with a focus on the hand. Our research team currently focuses on carpal tunnel mechanics and hand sensorimotor function with a clinical focus on carpal tunnel syndrome. Relating to carpal tunnel mechanics, the research involves studying the material properties of the transverse carpal ligament, the structural properties of the carpal tunnel, and creating a computational model for the wrist complex. Relating to hand sensorimotor function, we examine pathokinematics and pathokinetics of the hand using state-of-the-art bioengineering methods such as motion analysis, imaging, electromyography, and robotics.
Neuro Control Laboratory
The primary focus of our research is to understand central nervous system and neuromuscular mechanisms underlying neurological disorders and processes of functional recovery resulting from medical rehabilitative interventions. Major research techniques performed in the laboratory are electrophysiology and functional imaging. Our laboratory also does research involving development of new technologies and therapies to aid patients with motor disabilities.
Current Projects and Funding
Motor Recovery Post Stroke
Conventional motor rehabilitation post stroke is a process of usage-dependent motor skill relearning, during which patient actively repeats movements and daily activities under the help of the physical therapist to promote and reinforce neural reorganization and motor control. This approach focuses on interventions at the periphery of the body, specifically the upper and lower limbs, and requires patients having remaining movement ability post stroke or regaining some movement ability after spontaneous recovery or other surgical or pharmaceutical treatment. Conventional rehabilitation (except subacute passive exercise) might have the disadvantages that: 1) there might be a significant delay waiting for it to start, while early treatment is widely reported critical for stroke recovery; 2) it promotes the cortical reorganization through peripheral treatment and training, thus it might have a lower efficiency than the interventions that directly address CNS plasticity. This might partially explain why after being “rehabilitated” with conventional therapy, 30%-60% of stroke patients still suffer residual functional disability. Various methods related to direct cortical stimulation or training have been brought up to facilitate motor recovery and mobility post stroke, for example, mental-practice of motor tasks, direct cortical rTMS or TDCS stimulation, brain-computer interface, etc. These interventions not only directly train and guide CNS plasticity to improve motor function and mobility, but also can potentially be applied at an earlier stage for post-acute rehabilitation when a stroke patient with limited movement ability is clinically stable.
Motor Recovery After Spinal Cord Injury
An injury to the spinal cord can result in paralysis to the arms and legs. Therapy has the potential to improve arm and leg function after such paralysis. However, less than 1% of individuals show full recovery after traditional therapy routines. One key reason therapeutic exercise remains limited is that the portions of the brain that control paralyzed muscles become overshadowed by the portions of the brain that control non-paralyzed muscles. As such, the brain comes to represent only non-paralyzed muscles and favors them preferentially after injury, while “forgetting” their association with paralyzed muscles. Fortunately, non-invasive techniques can be used to “re-train” the brain and improve communication between the brain and weak, paralyzed muscles. These interventions are paired with rehabilitation to create plasticity changes in the brain, for example transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).
Management of Chronic Pain and Relief of Chronic Fatigue
Patients with chronic fatigue syndrome/fibromyalgia experience debilitating fatigue lasting for at least six months that cannot be alleviated by bed rest, with concurrent occurrence of at least four of eight symptoms such as muscle and joint pain, headache, sleeping problems, abnormalities in memory and concentration, tender lymph nodes, sore throat, etc. The current body of research has suggested various treatments, such as immunological therapy (i.e., immunoglobulin, interferon), pharmacological therapy (hydrocortisone, antidepressants), psychological therapy, behavioral relaxation training, nutritional supplements, graded exercise therapy (GET), and cognitive behavioral therapy (CBT). These treatments, however, address only a single symptom or a single possible cause (e.g., antidepressants for depression, interferon for immune dysfunction), with limited effect and sometimes even adverse side effects (i.e., adrenal suppression from hydrocortisone). The most promising interventions thus far, GET and CBT, address only the patient’s overall well-being and physical and cognitive functions instead of symptomatic relief. CFS is heterogeneous in origin and is associated with a wide range of symptoms. Directly relieving these somatic and psychological symptoms is critically important to improving quality of life and helping CFS patients build up a positive belief and attitude toward their condition.
Acupuncture and Acupressure Treatment in Rehabilitation
Traditional Chinese medicine emphasizes on balance and harmony. Although the underlying mechanisms are still unknown yet, some distinct effects have been widely observed and documented in evidence-based medicine. Among them, acupuncture has been reported to serve as an effective complement to standard care of postoperative and chemotherapy nausea and vomiting, addiction, headache, myofascial pain, low-back pain, migraine, and stroke rehabilitation; and acupressure used to restore motor function and mobility at the chronic stage after injury and disability. Acupuncture stimulates anatomical points on the body by hair-thin needles (sometimes in combination with electrical stimulus or with heat). Acupressure is a noninvasive therapeutic massage during which anatomical points on the body are stimulated by fingers-pressing (sometimes in combination with massage along “meridians”). Both of them work on the same presumed network of energy channels in the body outlined in traditional Chinese medicine, which are not evidenced in Western medicine yet. Thus debate exists in the literature regarding their effectiveness and more rigorous clinical trials are needed before any convincing conclusion can be made.
TBI/Nerve Regeneration Laboratory
Our laboratory studies the potential treatment of spinal cord injury using nerve regeneration strategies and neurorehabilitation approaches to restore functional recovery. Pathological changes at spinal cord injury site creates non-permissive environment for axonal regeneration. The key leads to regain functional recovery are to encourage more axons to cross the damaged site and have proper connection with target neurons. A major focus is using peripheral nerve transplantation with growth factors, artificial conduits, and also combining other cellular transplantation or rehabilitation methods to promote systematic recovery such as motor, sensory, skeletal muscles, and autonomic function after spinal cord injury. Another project area is focused on the problems of post traumatic stress disorder, hearing, and autonomic disorders after traumatic brain injury and the potential solutions for these problems.
Current Projects and Funding
The bladder recovery after spinal cord injury (NIH/NINDS R01 grant) Traumatic brain injury and autonomic disorders.
- Magnetic stimulation and seizure
Rehabilitation Outcomes 6-Clicks Laboratory
The Department of Physical Medicine and Rehabilitation is major participant in the Knowledge Program©, sponsored by Cleveland Clinic's Neurological Institute. In addition, discreet and searchable outcomes data is collected on patients in our acute hospitals and inpatient rehabilitation hospitals through a branching logic platform which is seamlessly integrated into the medical record. Since 2011, active collaborations with Boston University’s Rehabilitation Outcomes Center and the University of Vermont Department of Rehabilitation and Movement Science have promoted refinement and academic study of several rehabilitation outcomes tools. The “6-click” Inpatient Short Forms derived from Boston University’s Activity Measure for Post Acute Care are the subject of ongoing study that encompasses more than 200,000 patient encounters across multiple venues of care.
The 6-Clicks tool has now been downloaded for use in over 400 health care facilities across the world. This platform allows for a quick measurement of physical and self-care function – the factors that play the most important role in determining utilization of post-acute services. The 6-Clicks short form has been instrumental in developing pathways by which patients can access skilled nursing care without the delay of a three-day hospital stay and cumbersome payor precertification. Widespread use in acute care hospitals has allowed hospital therapists to target their treatments to patients who most will benefit from them – reducing hospital length of stay and frivolous referrals.
The patient reported outcomes (PRO) process currently employs conventional test theory, with validated measures of health, function and quality of life. The Knowledge Program©'s Query Tool software allows research access to nearly 1.5 million patient encounters. Selected outcomes measurement is a part of every patient encounter. These outcomes are logged into the database adjacent to a wide array of discrete clinical and descriptive data (demographics, medications, radiology testing, site of care, etc).
Data collection is carried out through the pre-appointment delivery of PRO packages, completed by the patient or their surrogate, either in the waiting room (via tablet computer) or at home via a secure internet link. Over 30 different outcome measurement tools are utilized.
Our current efforts aim to:
- Measure the utility of employing 6-Clicks to reduce unnecessary hospital therapy visits.
- Demonstrate the factors that affect 6-Clicks' precision in gauging the need for skilled post-acute services.
- Demonstrate the utility of 6-Clicks in reducing the delivery of skilled services in the Medicare population through bypassing conventional precertification and hospitalization requirements.
- Demonstrate the acceptance and utility of a pre-visit digital outcomes measurement system in a rehabilitation clinic that serves patients who are disabled from a wide range of medical conditions.
- Determine whether subgroups in the rehabilitation clinic have different profiles with respect to existing, validated measures of quality of life and depression.
- Promote the widespread acceptance of patient reported outcomes measures in the field of Physical Medicine and Rehabilitation.
- Promote the use of Computer Adapted Testing and Item Response Theory strategies for use in rehabilitation research, allowing greater precision in measurement and reduced burden for the respondent.
- Integrate the discreet data in our health system-wide rehabilitation electronic medical record with the Knowledge Program©.
For Medical Professionals
Our department sponsors one ACGME-accredited fellowship position in Sports Medicine. Our fellow joins three surgical and three family practice colleagues in Orthopaedic Sports Health for an intense, one year experience that includes collaboration with world-renowned faculty, and extensive sideline experience.
Also, in collaboration with the Northeast Ohio Spinal Cord Injury System/MetroHealth, the Department of Physical Medicine and Rehabilitation (PM&R) hosts 1-2 ACGME Spinal Cord Injury fellows each year for three month subspecialty rotations in Neurosurgical Spine Traumatology, Neurourology and Spasticity Clinic.
The Department of Physical Medicine and Rehabilitation hosts medical students from Cleveland Clinic Lerner College of Medicine and Case Western Reserve University Medical School as part of required rotations in the care of persons with disabilities. Our faculty is also active in didactic medical student teaching and administrative committees in the Lerner College. Medical student rotations and externships are also tailored to meet the interest and needs of first through fourth year medical students. Opportunities for research and clinical training are available in areas related to disability and the therapy disciplines, musculoskeletal rehabilitation, spine rehabilitation, pain management, and electrodiagnosis. Most rotations are four weeks in duration. The broad scope of training available at Cleveland Clinic brings students from around the world to our campus.
Resident Education and Fellowships
In July 2016 we welcomed our first class of resident trainees into the new residency in Physical Medicine and Rehabilitation at Cleveland Clinic. Working through the National Resident Matching Program we have not recruited our fourth group of residents.
Residents benefit from an innovative curriculum, superb faculty mentors, and the magnificent clinical, educational and research resources supplied by Cleveland Clinic.
Our department is also a popular choice for visiting residents choosing elective rotations in sports, pain management, and neurological rehabilitation. Training rotations are also made available to visiting graduate medical education trainees appropriate to the level of their training licensure, and malpractice coverage.
Cleveland Clinic has a distinguished history of offering fellowship training to postgraduate Physical Medicine & Rehabilitation residents in the following disciplines:
- Brain Injury Medicine (in collaboration with MetroHealth Medical Center, Cleveland, OH)
- Musculoskeletal Medicine and Ultrasound
- Multiple Sclerosis
- Pain Medicine
- Spinal Cord Medicine (in collaboration with MetroHealth Medical Center, Cleveland, OH)
- Spine Medicine
- Sports Medicine
Visitors from countries around the world are welcomed to our Department throughout the year to observe our practices and techniques of treatment.
Continuing Medical Education
Formal educational offerings include: Accredited Monthly PM&R Grand Rounds series, Resident journal club, chairman's teaching rounds, and special endowed lectures (e.g. the Noll Lectureship) are sponsored throughout the year.
Occupational Therapy (OT) and Physical Therapy (PT) Education
The OT and PT Education Coordinators host a variety of professional courses that enhance the quality of education available to the physical and occupational therapy staff. Courses are offered to therapists employed by Cleveland Clinic, as well as therapists in the community.
Other educational activities include weekly OT and PT staff in-services, including lectures by staff members, therapy specialists and guest speakers. Physical and Occupational Therapy also provides a broad range of student experiences through identified educational contracts with universities.
The members of Rehabilitation Technology section place high priority to provide training and education to students in medicine and rehabilitation technology. Lectures and presentations are given to resident physicians, engineering students, nurses and therapists at the Foundation, Cleveland State University and the R.B. Trumbull School of Enterostomal Therapy.
The graduate level Human Factors Engineering/Industrial Ergonomics course at the Cleveland State University continues to be offered through the instructorial contribution of M. Tom Adams enhancing the engineering students’ knowledge of the ergonomic principles of work site design.
Physical Medicine and Rehabilitation is committed to:
- Helping our patients maintain good health and improve their function.
- Learning from our colleagues and partnering with them in our research efforts.
- Teaching rehabilitation principles to 1,000 residents and fellows, and to our medical students in the Cleveland Clinic Lerner College of Medicine.
- Recording useful data, and gaining knowledge from each of our 600,000 patient encounters each year.
- Developing our rehabilitation brand regionally, nationally and internationally, starting with our newest facilities in Las Vegas and Abu Dhabi.
- Using our size and resources to create efficient and effective care paths that will define the future delivery of rehabilitation services in the United States.
Join Cleveland Clinic’s Physical Medicine and Rehabilitation Team
Published by the Cleveland Clinic Department of Physical Medicine and Rehabilitation, this annual newsletter provides updates on diagnostic and therapeutic techniques and current research for physiatrists, neurologists and neurosurgeons.
Cleveland Clinic’s Neurological Institute's forum for discussion of the latest advances in patient care, research, and technology — specifically for healthcare professionals.
The Department of Physical Medicine and Rehabilitation is committed to delivering world-class rehabilitation services. This entails providing superior physician and therapy services to our patients and their families, and pursuing innovations in our research studies.
The Department of Physical Medicine and Rehabilitation is part of the Neurological Institute, one of 26 institutes at Cleveland Clinic that group multiple specialties together to provide collaborative, patient-centered care. The department offers full cross-disciplinary rehabilitation for patients with physical, psychosocial, cognitive and vocational impairments. Patients receive coordinated care across a continuum that spans inpatient rehabilitation, skilled nursing and outpatient therapy at Cleveland Clinic facilities throughout the region.
Visit Cleveland Clinic's event calendar, where you will find a variety of classes for patients, athletes, care providers, parents and coaches both to rehabilitate and help prevent injuries.