|Q&A with Randolf Palmaira, Executive Director of the Center for Nursing and Rehabilitation (CNR), A Member of the Beth Abraham Family of Health Services|
|Randolf Palmaira, PT, MS, MSA, is a licensed physical therapist in New York. He has his MS in Physical Therapy and Administration. Today, Randolf is the Executive Director of the Center for Nursing and Rehabilitation (CNR), a member of the Beth Abraham Family of Health Services in the Bronx, New York. He was formerly the Corporate Director of Rehabilitation at Beth Abraham Family of Health Services. Randolf specializes in geriatric physical therapy and the IREX Interactive Rehabilitation and Exercise System.
Q: What motivated you to become a physical therapist?
1) The complexity and dynamism of the human body.
2) Having the chance to make a difference in someone's life day in and day out.
I have always been very interested in the human body. Science was my favorite subject in school. When I was in high school in the Philippines, I won an inter-school contest and became one of 10 Outstanding Young Scientists. Physical therapists can make a difference in a person's life each day.
Q: What kind of organization is Beth Abraham Family of Health Services? What is your role there?
A: Beth Abraham Family of Health Services, a not-for-profit organization, is one of the largest long-term care service providers in New York State.
I am currently the Executive Director of the Center for Nursing and Rehabilitation (CNR), a member of the Beth Abraham Family of Health Services. However, until recently, I was the Corporate Director of Rehabilitation Services at Beth Abraham Family of Health Services, overseeing four sub-acute rehabilitation facilities and seven adult day healthcare programs.
Q: Does Beth Abraham Family of Health Services offer any special programs?
A: One of our facilities, Center for Nursing and Rehabilitation (CNR), is accredited by CARF on Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP). Beth Abraham Health Services, Margaret Tietz Nursing and Rehabilitation Center, and Schnurmacher Center for Rehabilitation and Nursing will be working on CIIRP accreditation.
In addition, Beth Abraham and Margaret Tietz Nursing and Rehabilitation Center are being surveyed for Stroke Specialty. Schnurmacher Center for Rehabilitation and Nursing is being surveyed for Person-Centered Care and Dementia Care. CNR is being re-surveyed for Amputee Specialty, Stroke, Dementia Care, and Person-Centered Care.
As part of our CARF accreditation, we provide education sessions to each patient and their family members or caregiver, upon discharge. These education sessions are personalized to each patient and explain in detail, their individualized home exercise program. The goal is to give the patient the tools they need to live an active, independent lifestyle at home.
We provide Level I and Level II clinical affiliations for PT and OT students from Long Island University, Touro College, Sacred Heart, Mercy College, and SUNY-Downstate Brooklyn. We are also an approved Continuing Education provider by the New York State Education Department.
In addition, we provide a Residency Training Program in Physical Medicine and Rehabilitation to the residents of Albert Einstein College of Medicine. At the moment, three of our facilities, Margaret Tietz Nursing and Rehabilitation Center, Beth Abraham Health Services, and CNR offer virtual rehabilitation.
Q: Why did you choose to come to Beth Abraham Family of Health Services?
A: I started at Beth Abraham Family of Health Services in 2006. I was referred by my previous administrator to the company.
I came to Beth Abraham because of the organization's value set—caring, integrity, diversity, and creativity. Our organization offers a supportive environment is focused on person-centered care.
Department heads are given autonomy to develop and expand their programs with the full support of the executive team.
Q: What was your typical day like as the Corporate Director of Rehabilitation?
A: My typical day was visiting the various sites and overseeing their business functions and service deliveries in collaboration with the Facility Rehab Directors and program coordinators. I am very much involved in program development and the measure outcomes of the programs.
Q: What is the IREX Interactive Rehabilitation and Exercise System?
A: Interactive Rehabilitation and Exercise System places the patient in a computer-generated world that allows for isolated joint movement, combined joint movements, and full body functional movement of both the upper and lower extremities. It then measures, records and reports the kinematic data of various physical activities that the system offers.
The systems can be tailored to the specific clinical needs of the patient by isolating certain body parts and/or movements. Through interaction with on-screen objects, patients complete a comprehensive and clinician-controlled exercise program in which their performance and compliance is objectively measured and recorded in real time by the system's patented camera technology.
The difference between IREX and Wii is the real time biofeedback image and the ability of the therapists to isolate body movements to enhance function. The patient can actually see themselves in the monitor, as opposed to an animated object that you would see in Wii.
Q: How and why did you start using the system?
A: I was reading an article about technology and rehabilitation and came across virtual reality games. I thought it would be fun to have games and the technology to track patients' movements and act as an assessment tool for the therapists.
I believe there is always a "kid" in all of us. It would be a win-win situation; the patients will have fun and the therapist will have a quantifiable objective tool to help them enhance the accuracy of their assessments. Since the IREX tracks patient performance and is able to print out data after each session, patients would also have something tangible to track their progress. I conducted research and saw a video clip from the American Heart Association using virtual rehabilitation with stroke patients.
This strengthened my interest in virtual rehabilitation and, as a result, I started the virtual rehabilitation in CNR. We were actually the first in New York City to have the Interactive Rehabilitation Exercise System.
Q: What are the benefits of the IREX System?
A: The benefits include:
• Improving balance, coordination, and strength;
• Can be used to enhance executive functioning and cognitive abilities;
• Fun for the patient. It's play and not work;
• Greater compliance of exercise regimes;
• Increased therapeutic output and muscular capacity;
• Therapeutic exercise is more enjoyable;
• Encouragement of experiential and active learning;
• Can be done in a challenging and safe environment;
• Prevents cross contamination;
• Flexibility of individualized and graded therapeutic treatment protocols;
• Capacity to objectively measure and record performance.
Q: What has the patient response been like?
A: Our patients love it. They can't wait to have therapy the next day. In fact, when our patients observe someone using the system, they will ask, "When is my turn?" I will never forget two of our patients' comments. "You brought me back to 60 years ago. I was a professional soccer player in my country. I can't believe at 78 and I'm playing soccer again." And, "When I'm doing the regular exercise, I can stop anytime but when you're in the game, you can't. You have to keep going."
Q: Would you recommend the system to other physical therapists?
A: Yes, because of the benefits this tool has to offer to both the patients and the therapists. It encourages the patients to do better and compete with their own score. It aides therapists by providing a more accurate and objective printable data that is not only beneficial to the therapists, but to the payer source as well, because it helps justify patient progress and continued need of therapy services.
Q: Are there other areas of physical therapy that interest you?
A: I'm interested in Robotics and Rehabilitation—the "R and R" of PT; a techno-gadget. We can see the prevalence of interrelationship between man and technology everywhere. In fact, we feel so lost and incomplete without our GPS, mobile phones, lap tops, and Blackberries. I call it the celebration of human imagination that knows no boundaries.
Q: What are the greatest challenges you face in your job?
A: The greatest challenges are the constant changes of the rules and regulations, the budgetary constraints of healthcare plus the pressing demands of the payer source. It affects the patients greatly for they are not given enough of a chance to achieve their highest functional capacity.
Q: What does it take to be a successful physical therapist?
A: You need a combination of heart and skill. I believe that for someone to be a successful physical therapist, he/she must have compassion, skill, and creativity. Someone can teach a patient to properly walk and correct gait deviation patterns, but the knowledge and skills of the therapists are useless if they can't convince their patients to get up from a chair.
Q: Are you currently involved with any research projects?
A: We are currently doing a research on the efficacy of virtual rehabilitation vs. traditional therapy. I would like to get involved in bringing technology, human skill, and physical capacity to a new height.
Q: Do you feel that the role of PTs has changed over recent years?
A: Definitely. The value and contribution of physical therapy in the healthcare arena and human rehabilitation is without a doubt unquestionable. You can see physical therapists everywhere from wellness centers, acute care, and sub-acute care, veterinary clinics, academia, administration, geriatrics, pediatrics, industrial engineering to bio medical engineering, and the list goes on and on.
You can see PTs doing everything from designing a chair to enhance proper ergonomics to promoting accessibility for the physically- and cognitively-impaired. You can see PTs doing everything that involves wellness promotion, restoration, and rehabilitation of the living.
Q: What do you feel is of the greatest concern to physical therapists today?
A: I believe the greatest concern for PTs today is, whether or not our patients will receive the optimal benefits of physical therapy in the future; given the constraints of the insurance companies and the sky rocketing costs of healthcare.
Q: What is the most important thing you've learned about physical therapy so far?
A: Technical skill and knowledge are not enough. Compassion, caring, creativity, and competency are required ingredients for success.
Remember the three C's—Competency, Compassion, and Creativity.
Q: How has working in geriatrics allowed you to grow?
A: Given the multiple co-morbidities and complexities in treating geriatric patients, being a physical therapist gave me the opportunity to treat different impairment groups. I was able to see the importance of the correlation between the social dynamics, payer source, architectural barriers of patients' homes, family involvement, and the lack thereof, which affects the overall outcome and rehabilitation process of our patients.
Q: What is the most rewarding part of your job?
A: To see someone smile, so elated after a first step or being able to stand again for the first time. It's priceless.