 |
Ohio BPI Specialists/Clinics
NeuroMuscular Restoration Center
Department of Orthopaedics
MetroHealth Medical Center
Cleveland, OH 44109
Michael W.Keith, MD
Harry A. Hoyen, MD
Response to UBPN questionnaire:
NOTE: Only questions answered are included here
When was your Brachial Plexus Injury Clinic established?
1999.
Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including
physical/occupational therapists, if any.
Orthopaedic Hand and Microvascular Surgeons, Pediatric Neurologist, Orthopaedic Nurse Practitioner, Pediatric Neurology Nurse Practitioner, Pediatric OT and PT as applicable, Physical Medicine and Rehabilitation for EMG diagnostics and botox therapy, Pain Management
What does your clinic specialize in treating?
- Adult brachial plexus injuries
- Obstetrical brachial plexus injuries
- Trauma or other brachial plexus injuries
Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment:
Number of children (obstetrical brachial plexus injuries): 10
Number of children (trauma or other brachial plexus injuries): 15
Number of adults (obstetrical brachial plexus injuries): 25
Number of adults (trauma or other brachial plexus injuries): 50
State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children.
Early intervention for brachial plexus birth palsy is our goal. Infants who are not recovering arm movement within the first week of life are referred to the NeuroMuscular Restoration clinic for evaluation. We are a participating center in an international study on the treatment of BPBP led by Peter Waters, MD, Children's Hospital, Boston, MA. The indications for surgical intervention are determined in the first six months of life. A priority is placed on the motor recovery in the shoulder and elbow. Ancillary studies including MRI are used to develop an overall plan. We are striving to better classify the lesions such that we will be able to eventually predict which lesions will recover without surgical intervention.
State you/your clinic philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in children.
The evaluation of traumatic injuries begins during the hospitalization. It is imperative to determine the type of traumatic lesion. Preganglionic injuries should be identified as root avulsions as early as possible, as it is known that these lesions will not recover. Nerve transfers are then planned when the patient condition permits surgical intervention. The purely postganglionic injuries are followed for recovery in the first three months after the injury. When progressive nerve regeneration is not occurring, surgical intervention is considered. A treatment plan is determined through serial physical examinations, advanced MR imaging, and CT myelogram when indicated.
State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in adults.
We have developed a plan for evaluation and management based on the motor/muscle recovery. Joint motion is important in the determination of the need for reconstructive procedures. An individualized plan is necessary as each patient has specific motor recovery patterns. Functional evaluation prior to surgery is necessary as the goals of each patient should be verified. We have developed similar programs for spinal cord injury. Evaluations for peripheral nerve injuries are being developed.
State your philosophy regarding evaluation, referral and treatment of trauma or other brachial plexus injuries in adults.
The Orthopaedic NeuroMuscular Restoration Center at MetroHealth has expanded to include the evaluation of traumatic and obstetrical injuries. We have a long-standing program for spinal cord injury and have expanded our method of evaluation and treatment strategies to peripheral nerve injuries. We believe that the patient goals are important and that outcome measures should be developed. These outcome measures can then be used to appropriately evaluate different treatment methods. We would like to offer our services to those in the Ohio, Michigan, and Pennsylvania area.
State your philosophy regarding pain management and brachial plexus injuries.
For patients not responding to oral medication, typically narcotics and neuropathic pain medications, pain management is consulted for optimal treatment and management of pain. A comprehensive pain management program has been developed with the departments of anesthesia, physical medicine and rehabilitation, and neurology. It is important to identify the different pain pathways after peripheral nerve injury. The different types of neurogenic pain require specific treatments. Only with a multi-modality approach can we address the different pain mechanisms.
Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries.
We are a participating center in an international study on the treatment of BPBP led by Peter Waters, MD, Children's Hospital, Boston, MA.
Do you accept any national/governmental payment for services or are you enrolled in any state medicaid plans? Please provide information on these plans and include
which states you are enrolled in for medicaid services.
We accept Ohio Medicaid, Ohio BCMH, Workman's Compensation, Medicare and commercial insurance. For out of state patients, single case agreements with Medicaid and 3rd party payers may be negotiated.
|
