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Rehab Facilities Let Patients Replicate Everyday Tasks Before They Go Home

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By Tony Glaros
Special to The Washington Post
Tuesday, August 11, 2009

The day I dragged my arthritis-riddled hips into Judy Lazor's pre-surgery class at St. Agnes Hospital in Baltimore, I had no inkling of what to expect. Radiating Kentucky folksiness and an endearingly absent-minded style, the registered nurse proceeded to nail down the whys and wherefores that are woven into the DNA of any recovery program.

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A dozen of us, all with penciled-in dates for orthopedic overhauls, gathered around a conference room table, munching snacks and paging through the booklet she distributed. Patients-to-be sank weathered chins into hands. The rising chorus of sighs signaled certain doom and gloom.

Lazor, though, saved the best for last. Toward the close of our 90-minute meet-and-greet, she escorted us into an adjoining room. What lay before us was a virtual Any Town, U.S.A. I felt as if I was standing smack-dab in the middle of a new exhibit at the Smithsonian's Museum of American History.

Independence Square is a 4,800-square-foot virtual Main Street designed for patients following surgery. Learning to negotiate one's way around the square helps reorient patients to the task of performing everyday activities.

The facility, built in 2003 in a corner on the fourth floor, is chockablock with everything from a bedroom and bath to a tiny grocery store with plastic fruits and veggies. There is an ATM and a real car (a Saturn, adorned with a Ravens logo). A colorful mural depicts familiar nearby sites such as Oriole Park at Camden Yards. Real-life encounters also are reflected in the assortment of surfaces, including sand, gravel and cobblestone.

Having a micro-city at your fingertips is a vital ingredient in the postoperative regimen, Lazor said. "It gets people back to their daily activities. It's like a little community. The key thing people want to deal with is the simple stuff, like how to get in and out of a car."

Cathy Ellis, chief of inpatient occupational and physical therapy at the National Rehabilitation Hospital in the District, said the typical time a patient spends in Independence Square each day "is from two to five hours, depending on the plan of care involving car use -- Geico donated the car -- kitchen activities, ambulation on various surfaces and community reintegration."

David Guynes, a one-time architecture student and backwoods potter from Oregon, designed the first Independence Square, initially under the trademark Easy Street, for Phoenix Memorial Hospital in 1984. Guynes, 59, said he was asked to take the vision that a young occupational therapist had had and to create a space for urban activities of daily living. "I had no idea what they were talking about, brandishing phrases like 'neuromuscular' and 'musculo-skeletal disorders,' " he recalled.

He turned the idea into a career and has since designed and built 102 projects. Most of his clients have been nonprofit hospitals, with each project costing between $250,000 and $300,000, he said.

Sam Sydney, chief of orthopedic surgery at St. Agnes, said that Independence Square is an important part of recovery because it can help restore balance and calm. "Patients see other patients going through the same thing, and that takes some of the fear away. . . . They don't have to go through therapy in a cubicle."

Like others facing knee-reconstruction surgery, Freddi Hammerschlag was gripped by fear. But the alternative, the prospect of curbing her double passions, hiking and ornamental gardening, seemed almost unthinkable. In March, the Highland resident, a 65-year-old retired scientist with the U.S. Department of Agriculture, checked into St. Agnes for the procedure. Her big surprise was the rehabilitation facility.

"The thing that struck me was the car," Hammerschlag recalled. "Practicing getting in and out of it. Another thing I liked was the flow, moving from one section to another," a compact zone extending from the furnished bedroom to the fully equipped bathroom. "They had me go up steps and down steps." The space, she added, "was so extensive, so colorful, so clean and with a very insightful design. They have everyday things in your home, in your neighborhood, that fit in there."

Other hospitals have also simulated the local environment in their Guynes-designed rehab facilities. The National Rehabilitation Hospital has a pedestrian crosswalk, "with a real timer on it, like on the D.C. streets," Ellis said. "And there's a great diner with a booth in it."

Ellis said the walls at NRH's Independence Square show such scenes as the Washington Monument and brownstone houses on Capitol Hill. She recalled visiting a rehabilitation hospital in Lincoln, Neb., whose Independence Square mural includes a huge tractor, reflecting its location in the heart of the Corn Belt. Another Independence Square she toured in Edison, N.J., was set up like a New York or New Jersey neighborhood.

One unique aspect of NRH's Independence Square is its putting green. Ellis explained that it was installed at the direction of the hospital's founder, president and chief executive, Edward A. Eckenhoff, a paraplegic. Ellis said long leg braces help Eckenhoff stand up, "and he swings with his right arm only. It's wild. He had his crutches modified for the golf green so that the base is much wider than normal. He doesn't want to damage the green."

Comments: health@washpost.com.


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