Feature
Redefining
Treatment of
Disorders of
Consciousness
Continues on page 4
now
spaulding
Summer 2012
Latest News
Focus on Education
Fellow Profile
Libyan War Wounded
at Spaulding
Guiding the
Next Generation
Going Global at the
2012 Olympics
Spaulding clinicians helped deliver
on a promise by Secretary of State
Hillary Clinton to help the people
of Libya scarred by war.
With a 5-year Midcareer Investigator
Award from the National Institutes
of Health, Dr. Jonathan Bean is
mentoring a new generation of
physiatrists.
As a member of the 2012 London
Olympic Medical Team, Erik Brand, MD
will share an insider’s view of treating
the world’s top athletes.
Continues on page 6
Continues on page 7
Continues on page 6
A publication of the Harvard Medical School Department of Physical Medicine and Rehabilitation
Brief Sampling of Publications
Li X, Forman DE, Kiely DK, LaRose S, Hirschberg R,
Frontera W, Bean JF. Validity of an exercise test based
on habitual gait speed in mobility-limited older adults.
Arch Phys Med Rehabil. 2012:93(2), 344-50.
Fusco HN, Mancinelli C, Sheridan RL, Ryan CM,
Bonato P, Schneider JC. A novel gaming system for
children with upper extremity burn. J Burn Care Res
2012; 33: S154.
Kasotakis G, Schmidt U, Perry D, Grosse-Sundrup
M, Benjamin J, Ryan C, Tully S, Hirschberg R, Waak
K, Velmahos G, Bittner EA, Zafonte R, Cobb JP,
Eikermann M.The surgical intensive care unit optimal
score predicts mortality and length of stay. Crit Care
Med, 2012 Apr,40(4):112-8.
Ryan CM, MD, Schneider JC, Kazis LE, Lee A, Li
N, Palmieri T, Pidcock F, Reilly D, Tompkins RG. The
Young Adult Outcome Questionnaire. J Burn Care Res
2012; 33: S128.
Battaglino RA, Sudhakar S, Lazzari A, Garshick
E, Zafonte R, Morse LR. Circulating sclerostin is
elevated in short-term and reduced in long-term SCI.
Bone, 2012 May 7; 22575440.
Shenton ME, Hamoda HM, Schneiderman JS, Bouix
S, Pasternak O, Rathi Y, Vu MA, Purohit MP, Helmer
K, Koerte I, Lin AP, Westin CF, Kikinis R, Kubicki M,
Stern RA, Zafonte R. A review of magnetic resonance
imaging and diffusion tensor imaging findings in mild
traumatic brain injury. Brain Imagining Behav, 2012
Mar 22; 22438191.
Pardasaney PK, Latham NK, Jette AM, Wagenaar
RC, Ni P, Slavin MD, Bean JF. Sensitivity to change
and responsiveness of four balance measures for
community-dwelling older adults. PTJ. 2012:92(3),
388-97.
Tan WH, Goldstein R, Gerrard P, Ryan CM, Niewczyk
P, Kowalske K, Zafonte R. Outcomes and predictors
in burn rehabilitation. J Burn Care Res, 2012 Jan-Feb;
33(1):110-7
Blauwet C, Borg-Stein J. Osteoblastoma as the
cause of persistent lumbosacral pain in a female
high school athlete. Curr Sports Med Rep 2012
Jan;11(1):24-7.
Wayne P.M., Kiel D.P., Buring J.E., Connors E.M.,
Bonato P., Yeh G.Y., Cohen C.J., Mancinelli C., Davis
R.B. Impact of Tai Chi Exercise on Multiple FractureRelated Risk Factors in Post-Menopausal Osteopenic
Women: A Pilot Pragmatic, Randomized Trial, BMC
Complement Altern Med. 2012 Jan 30;12(1):7
Schneider JC, Qu HD, Lowry J, Walker J, Vitale E,
Zona M. Efficacy of inpatient burn rehabilitation: A
prospective pilot study examining range of motion,
hand function and balance. Burns 2012; 38: 164-171.
For a full listing visit http://pmr.hms.harvard.edu
From the Chair
Research
A Message from Ross Zafonte, DO
Colleagues,
As we approach another season of graduations, it’s
a wonderful chance to take a moment and reflect
on past accomplishments while considering the
promise ahead. Our department is extremely
proud to graduate our seventeenth class, all of
whom bring dynamic talents and a spectrum
of interests that will enrich both our care and
research knowledge base. I salute all of the graduates across the country
who are ready to embark on new paths of discovery for our profession.
In this issue, we celebrate the spirit of discovery. We feature the tremendous work
of our colleagues, Dr. Joseph Giacino, here at Spaulding and Dr. John Whyte that
was recently published in the New England Journal of Medicine on the novel use
of Amantadine. The study is a stunning demonstration of the power to change
our understanding that collaboration and novel approaches can provide. The
impact of the study will be told in the years to come as it creates a foundation
for improved treatment and research for a complex patient population.
As we look ahead to the summer months the world gathers to celebrate the
thirtieth Olympiad in London. Dr. Erik Brand, a Sports Medicine Fellow in our
department, was recently selected to serve on the Medical Team for the games.
We are excited to announce that Erik will be blogging on the department’s
website as well as updates via twitter @spauldingrehab, while in London.
As I informed you in our last issue, Spaulding was chosen by the Libyan
National Transitional Government in concert with the State Department to be
the first US Hospital to deliver on a promise by Secretary Clinton to support
and treat the war wounded of Libya. The group of twenty-two patients who
came recently completed their treatment and have gone home with marked
functional gains. The lasting bonds forged between our clinicians and their
patients only reinforce that care transcends language and cultural barriers.
Finally, I’m proud to share that in less than one year the new state-of-the-art
Spaulding Rehabilitation Hospital will open its doors. I invite you to visit
www.newspauldinghospital.org for the newest photos and updates. The new
facility has already been hailed as a model for inclusive and green design. I’m
certain that it will serve as an important touchstone to further the spirit of
discovery that drives all we do in research, teaching and patient care. 
Ross Zafonte, DO
Professor and Chairman of Physical Medicine and Rehabilitation
Vice-President, Medical Affairs, Research, and Education
2
Spaulding Now | Summer 2012
Poster & Paper Presentations
THE SPIRIT OF
Discovery
Harvard Medical School Department of PM&R
2012 AAP Annual Meeting
BMI Influence on Rehabilitation of Amputations David T.
Burke, MD, MA; Claire L Castellano; Nitin B Jain, MD, MS
Recurrence of Radicular Pain after Lumbar Disk Herniation
Pradeep Suri, MD, MS; James Rainville, MD; David J
Hunter, MBBS, PhD; Jeffrey N Katz, MD, MS
Dr. Paolo Bonato
Fostering International Collaborations
At the invitation of the National Science Foundation (NSF)
and the World Technology Evaluation Center (WTEC), Paolo Bonato, PhD,
Director of Spaulding’s Motion Analysis Lab, recently joined a team of US
based rehabilitation experts who were tasked with gathering information
on European innovations in mobility technology for people with disabilities.
The group’s goals were to evaluate the latest advances, guide US research
investments and seek opportunities for international partnerships. Dr. Bonato
and his colleagues met with counterparts from 15 cutting-edge research
sites in Belgium, Denmark, France, Germany and the United Kingdom.
The team identified eight major trends in mobility technology
research, and published their findings in the April 20, 2012
edition of the Journal of NeuroEngineering and Rehabilitation, for
which Dr. Bonato currently serves as editor-in-chief.
Major European trends observed by Dr. Bonato and his colleagues include:
1.Assistive technologies are being designed to integrate more closely with
the user. Seamless integration is often facilitated by smaller, better movement
sensors and embedded computation that takes advantage of sensor data.
2.While research into technologies for rehabilitation therapy is beginning
to transform clinical practice, significant unmet needs continue to
exist in the area of therapy technologies that can be used at home.
3.Within mobility technology research, there is a fundamental
need for better neuromusculoskeletal models that can be tailored
to predict optimal treatments on an individual basis.
4.Wearable sensors and pervasive systems will improve health, wellness and
safety monitoring, as well as home rehabilitation, assessment of treatment
efficacy and the early detection of mobility impairment disorders.
The group did observe an important structural distinction between American and
European work environments. In comparison to their US counterparts, European
funding agencies are openly using their mandates to require multi-country
collaboration, and to actively foster commercialization by integrating corporate
partners into many research projects. The multi-country, multidisciplinary teams
that emerged from these mandates were among the most highly innovative
and productive groups who met with Dr. Bonato and his fellow observers.
Pictured, from left to right: Mary Rodgers, PT, PhD University of Maryland School of Medicine and Senior
Advisor for Biomedical Imaging, Ted Conway, PhD National Science Foundation, Dr. Paolo Bonato, HMS Dept of
PMR at Spaulding, Jorg Kruger, PhD and Henning Schmidt, PhD, Fraunhofer Institute for the Production of Systems
and the Design of Technology, Berlin, Germany, Hassan Ali, PhD World Technologies and Services, Arlington, VA
Radiographic Lumbar Spinal Stenosis Is Common In Older
Adults, Irrespective Of Back Pain Pradeep Suri, MD, MS;
Asako Miyakoshi, MD; David J Hunter, MBBS, PhD; Jeffrey
G Jarvik, MD, MPH; James Rainville, MD; Ling Li, MPH;
Jeffrey N Katz, MD, MS
Are Facet Joint Bone Marrow Lesions and Other Facet Joint
Features Associated with Low Back Pain? A Pilot Study Aisha
S Dharamsi, MD; Zacharia Isaac, MD; Glenn C Gaviola,
MD; Pradeep Suri, MD, MS
Expression of TNF-A is Increased in Circulating Monocytes
Derived From Individuals With SCI-Induced Osteoporosis Jonah
W Saltzman; Ricardo A Battaglino, PhD; Antonio A Lazzari,
MD, PhD; Eric Garshick, MD; Leslie R Morse, DO
Reliability and Validity of a New Device Measuring Ankle
Strength and Power Jaclýn Barcikowski, MA; Courtney S
Opalenik, BA; Evan D Williams, BA; Alexander H Slocum, Jr;
Raymond MA; Jonathan F Bean, MD, MPH
Unusual Hip Injury in a Recreational Soccer Player: A Diagnosis
Not To Miss Rachel Egyhazi, MD; Kelly C McInnis, DO
Precision of DXA Scanning at the Knee in SCI is Inversely
Related to Bone Density at Time of Testing Supreetha
Sudhakar, MPH; Ricardo Battaglino, PhD; Antonio A Lazzari,
MD, PhD; Eric Garshick, MD; Leslie R Morse, DO
Characteristics of Patients with a Primary Diagnosis of
Cerebrovascular Disease in the 2004 National Nursing Home
Database Paul Gerrard, MD
Clinical Expression of Environmental Dependency Syndrome
in the Minimially Conscious State Nicole L Mazwi, MD;
Ronald E Hirschberg, MD; Joseph T Giacino, PhD
A Rare Presentation of Posterior Cord Impingement Associated
with Sternoclavicular Joint Dislocation and First Rib
Pseudoarthrosis Regina Eum, MD; Erik R Ensrud, MD
Rehabilitation of a Patient with Opsoclonus-Myoclonus
Syndrome Paul Gerrard, MD; Amy X Yin, MD;
Seth D Herman, MD
Inhibition of Rho-Kinase (Rock) Confers Neuroprotection
Following Focal Cerebral Ischemia in Normotensive Mice and
Hypertensive Rat Qing Mei Wang, MD, PhD
Participation in Organized Sports is Positively Associated
with Employment in Adults with Spinal Cord Injury
Cheri Blauwet, MD; Supreetha Sudhakar, MPH;
Eric Garshick, MD; Leslie Morse, DO
Awards
Association of Academic Physiatrists 2012 Young
Academician Award: Leslie Morse, DO
Association of Academic Physiatrists 2012 McLean
Outstanding Resident/Fellow Award: Nitin Jain, MD, MSPH
Association of Academic Physiatrists 2012 Cheri Blauwet,
MD: Electrode Store Best Paper Winner (Resident Category)
“Participation in Organized Sports is Positively Associated
with Employment in Adults with Spinal Cord Injury”
Spaulding Now | Summer 2012
3
On the Cover
Redefining Treatment of
F
or most of medical history, clinicians treating
persons in minimally conscious or vegetative states
have faced difficult obstacles. Often these populations
were thought of as lost causes and given few options for
improvement or recovery.
For Joseph Giacino, PhD, Director of Rehabilitation
Neuropsychology at Spaulding Rehabilitation Hospital, his
career has been devoted to uncovering the secrets of the
brain to create novel treatments for this patient population.
Recently, Dr. Giacino co-led a study that he and his
collaborators hope can unlock entirely new avenues of care.
The multi-national study published in the New England
Journal of Medicine in March revealed a significant
breakthrough in the treatment of patients in vegetative and
minimally conscious states. The study showed that the drug
amantadine hydrochloride accelerated the pace of functional
recovery during active treatment in patients with posttraumatic disorders of consciousness.
4
Spaulding Now | Summer 2012
The study, funded by a 5-year, $3 million grant from the
National Institute on Disability and Rehabilitation Research,
involved 184 patients at 11 clinical trial sites in three
countries. JFK Johnson Rehabilitation Institute in Edison, NJ
and MossRehab in Philadelphia served as the lead centers for
the international study.
The patients involved were receiving inpatient rehabilitation
and were in a vegetative or minimally conscious state
between four and 16 weeks after traumatic brain injury.
During the four week treatment period, recovery was
significantly faster among patients who were administered
amantadine than those in the placebo group.
“The results of this study provide convincing evidence that
it is possible to increase the speed of recovery from severe
traumatic brain injury when treatment is initiated within
four months of onset. These findings engender optimism for
a medical condition that is often viewed as untreatable,”
said Giacino.
Disorders of Consciousness
The study results pave the way for additional studies of a
drug whose therapeutic value was previously undetermined.
“Now that we know that amantadine can accelerate
neurologic recovery, we need to explore the dose and
treatment schedule that provides the greatest and most
durable treatment impact,” said study co-leader, John Whyte,
M.D., PhD, Director of Moss Rehabilitation Research Institute.
“Importantly, this study adds to the growing evidence that
patients with disorders of consciousness have rehabilitation
potential that we are just beginning to tap.”
In addition to JFK Johnson Rehabilitation Institute
and MossRehab, nine other rehabilitation institutions
participated in the study including Braintree Rehabilitation
Hospital in Braintree, MA.; Bryn Mawr Rehabilitation
Hospital in Malvern, PA; Carolinas Rehabilitation in
Charlotte, NC; Fachkrankenhaus Neresheim Hospital in
Neresheim, Germany; Copenhagen University Hospital in
Glostrup, Denmark; Methodist Rehab Center in Jackson,
MS; Schoen Klinik Bad Aibling in Bad Aibling, Germany;
Sunnyview Rehabilitation Hospital in Schenectady, NY; and
Texas Neurorehab Center in Austin, TX. In addition, the
Department of Biostatistics in the Mailman School of Public
Health at Columbia University in New York City served as
the Data Coordinating Center under the direction of Emilia
Bagiella, PhD.
Going forward, Dr. Giacino plans to maintain his leadership
role in the “Consciousness Consortium,” a group of thought
leaders and researchers who share ideas, research and
collaborate on projects designed to push our understanding
of consciousness and create new avenues of care. While there
is much work ahead, each addition to the knowledge base
improves the prospects for patients and families who now
have a new hope for recovery. 
The study’s publication generated over 400 media hits internationally
with features by the New York Times, Boston Globe, Associated Press,
ABC News and Bloomberg News, among others.
Spaulding Now | Summer 2012
5
In the news
» Libyan
War Wounded at Spaulding
The war and subsequent overthrow of long-time dictator
Moammar Gadhafi resulted in an urgent humanitarian
need in Libya, with thousands wounded and severely
injured. The Libyan National Transition Council (LNTC)
with support from Secretary of State Hillary Clinton and
the US State Department reached out to care facilities
in the United States for experts in rehabilitative care
and selected the Spaulding Rehabilitation Network to
begin to treat some of the wounded Libyan fighters.
The first group of 22 Libyan war wounded was sent
to the Spaulding Hospital North Shore in Salem,
Massachusetts in late October 2011. Many of these
patients sustained various injuries in the conflict
from complex orthopedic injuries, multi-level trauma
and nerve damage. The group had various complex
medical conditions and nerve damage requiring intense
rehabilitation as well as some surgical interventions.
The immense multi-disciplinary effort also involved
transforming an entire unit to accommodate cultural,
dietary and social needs unique to the group. The group
returned home in phases, some requiring long term
interventions collaborated by Spaulding clinicians with
Libyan based counterparts. The US State Department
with a letter from the Secretary of State, returned in
May this year to recognize and celebrate the Spaulding
staff for the resounding success of the program.
A letter excerpt to the Spaulding staff from
Secretary of State Hillary Clinton read:
“The men arrived a mere week after my visit to Tripoli
where I witnessed firsthand the plight of Libya’s injured
war heroes at the Tripoli Medical Center. I was deeply
moved by the sacrifices these brave men made to bring
freedom to their country and fellow citizens, and remain
grateful for your speedy and compassionate response
to the Government of Libya’s request for assistance.
From counseling your staff on Islamic tradition before
patients arrived, to providing them with opportunities
to observe their religious obligations, and opening
your doors to the Libyan-American community,
your efforts in caring for and healing these brave
warriors showed the compassion, understanding and
dedication that are hallmarks of American values.” 
The efforts were featured in Al Jazeera, AL Hurra TV, CNN,
Associated Press, ABC, CBS, NBC and Fox affiliates nationally,
PBS News Hour, NPR and over 800 media outlets internationally.
6
Focus on Education
Spaulding Now | Summer 2012
Dr. Jonathan Bean
Guiding the Next Generation
As the multidisciplinary science of rehabilitation continues
to evolve, seasoned mentors—medical leaders who are experts
in a myriad of work processes, scientific methodologies, research
protocols and regulatory requirements—are playing an increasingly
critical role in developing the next generation of patientoriented investigators to navigate the new healthcare terrain.
Over the last 12 years, Jonathan F. Bean, MD, MS, MPH, Medical
Director of Spaulding Cambridge Outpatient Center and Director
of Research Training and Education, Department of PM&R, Harvard
Medical School, has become a well respected mentor. Following
in the tradition of his own mentor, Walter Frontera, MD, PhD, and
driven by a passion to advance the role of rehabilitation science,
Dr. Bean has mentored 16 young physician-scientists in Patient
Oriented Research (POR). Now, with the support of a 5-year
Midcareer Investigator Award from the National Institutes of Health
(NIH), he will mentor 1–2 young investigators per year on the
responsible conduct of research, as well as best practices in project
management, including data analysis and biostatistical reporting.
“Jonathan Bean is only the second physiatrist to receive this type of
NIH funding within the last decade,” commented Ross Zafonte, DO,
Professor and Chairman of Physical Medicine and Rehabilitation,
“The K24 award speaks volumes about his commitment to
producing a better evidence base around rehabilitative care.”
That deep sense of commitment, combined with Dr. Bean’s reputation
as one of the country’s leading physiatrists, were the driving forces
behind Tracy Paul’s decision to pursue a 4-month research fellowship
at Spaulding. Paul, a second year medical student at Case Western
Reserve University School of Medicine, is currently being mentored
by Dr. Bean as she writes her thesis on the relationship between lower
back pain and trunk endurance in geriatric patients. “He’s both a great
teacher and a great doctor,” she said, “If I have a problem or need
some help, he always finds a way to give me as much time as I need.”
According to the terms of the K24 award, mentees working
with Dr. Bean will have the opportunity to participate in one
of two ongoing research projects: the Boston Rehabilitation
Impairment Study of the Elderly (Boston RISE) or The Boston
Rehabilitation Outcomes Center (BROC) Network. 
Fellow Profile
Follow
Spaulding
Sports
Fellow
Every Two Years, the “youth of the world” assemble
in the spirit of sportsmanship and competition giving the
world unforgettable stories of perseverance and achievement.
Athletes devote their whole lives training for a fleeting
moment of glory. For those in the sports medicine world
the games also serve as the pinnacle of the profession. For
Erik Brand, M.D., M.Sc., Sports Medicine Fellow for Harvard
Medical School Department of Physical Medicine and
Rehabilitation at Spaulding, the upcoming Olympic Summer
Games in London represent the culmination of a life long
dream as well.
at the
2012
Olympic
Games
Dr. Brand was chosen to serve as a Sports Medicine Physician
at the London 2012 Olympic Games. Dr. Brand was selected
from among 250,000 volunteer applicants by the London
Organizing Committee, host of the Olympic Games.
Dr. Erik Brand
Brand has a diverse background in sports medicine, both
as an elite athlete himself as a rower at the University of
Washington and the University of Oxford, as well as a
physician. He also has significant international competition
experience as observing team physician for the United States
Rowing Team at the 2011 Junior World Championships.
This will be his second Olympic experience; serving as a
Transportation Services volunteer at the 2010 Winter Olympic
Games in Vancouver.
“As a rower at the University of Washington and Oxford, I
was fortunate enough to spend six years training alongside
athletes and coaches of the highest caliber. As a Sports
Medicine physician, this experience helps me relate to my
patients because I speak their language and understand
the demands of training and competition. Through Sports
Medicine, I have an opportunity to express my belief in the
value of sport and exercise and serve the Olympic ideal.”
During his residency at Johns Hopkins Hospital, Dr. Brand
served as Chief Resident of Physical Medicine & Rehabilitation
and trained under team physicians for the Baltimore Orioles.
In 2011, he was selected for a Resident Scholarship Award from
the American Medical Society for Sports Medicine, one of
three resident awards chosen annually.
Currently based at Spaulding Rehabilitation Hospital and Mass
General Hospital as a Sports Medicine Fellow, Dr. Brand plans
to pursue a career in Sports Medicine helping athletes of all
descriptions use exercise as a form of medicine. 
You can follow Erik as he prepares for the London Games
as well as during with blog updates and photos at
pmr.hms.harvard.edu or on twitter @spauldingrehab
Spaulding Now | Summer 2012
7
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Spaulding is once again ranked by US News and World Reports Best Hospitals at #5 in 2011.
now
spaulding
In Pictures
From the Ground Up: Rebuilding Haiti
Having arrived in Haiti during the
immediate aftermath of the devastating
2010 earthquake, Dr. Andree LeRoy
continues to spearhead Spaulding’s
response. Recently, Dr. Cheri Blauwet,
former Chief Resident, joined
Dr. LeRoy treating patients and
educating local clinicians on
rehabilitation and accessibility.
Oz Mondejar, VP of Human Resources,
Communications & Community
Relations joined them, documenting
Discover more: http://pmr.hms.harvard.edu
their efforts and conducting
educational seminars on disability
advocacy in support of the Haitian
Secretary of State’s movement to
integrate the over 800,000 Haitians
living with disabilities. 
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