The History of the Center of Rehabilitation Medicine, Part 2: 1959-1999

1959-1986

In January 1959, Lawrence A. Wisham, M.D., was appointed chairman of the Department of Physical Medicine. Shortly after his appointment, on March 10, 1959, the name of the department was changed to Physical Medicine and Rehabilitation (PM&R). Dr. Wisham is best known for his investigations on the clearance of sodium from human muscle, some of which did in collaboration with Rosalyn Yalow, the Nobel Prize recipient for medicine and physiology in 1977. During Dr.   Wisham’s tenure, the department primarily provided consultation services to inpatients on the acute wards of the hospital and in various outpatient clinics, but did not have an active inpatient service. In the spring of 1964, the Rehabilitation Workshop, a project of the Women Auxiliary Board, began providing paid employment in a sheltered environment for outpatients with disabilities - individuals were unable to work in a competitive commercial environment but who hoped to gain employment in the future. On July 1, 1966, the department began a three-year training program in PM&R. with eight residents and fellows who had received a federal traineeship grant from the Vocational Rehabilitation Administration.

During the early 1980s, there were five physiatrists on the faculty at Mount Sinai. Besides Dr. Wisham, these were Drs. Frances Dworecka, Danuta Janiszewski, Somchat Chiamprasert and Beatrice Kaplan. A residency training program for 24 residents was directed by Jerry Weissman, M.D., at Elmhurst Hospital. These. residents rotated through hospitals: Elmhurst City Hospital, Beth Israel Medical Center, The Bronx Veterans Affairs Medical Center (VAMC) and The Mount Sinai Hospital. There were no federally funded research programs within the department.

On the national scene during the 1950s and 1960s, a small number of academic medical centers established their own departments of PM&R which incorporated inpatient hospital beds for the rehabilitation of persons with severe physical disabilities. Teams of rehabilitation professionals were created consisting of specialists in PM&R (physiatrists) physical, occupational and speech therapists, as well as rehabilitation nurses, psychologists, social workers, vocational counsellors, recreational therapists, etc. These people worked together under the direction of the physician to reach the goals of rehabilitation medicine. The goals were defined as maximizing the function of the disabled person physically, psychologically, socially and vocationally. In 1965, the US Congress passed legislation creating Medicare and Medicaid, and through diligent advocacy of leaders in the field of PM&R, rehabilitation services for both inpatients and outpatients were included in the Medicare/Medicaid health care package. Since that time rehabilitation services have become a standard component of health care services in the United States for all persons with a new onset of physical disability. On May 20, 1968, the name of Mount Sinai's Department of Physical Medicine and Rehabilitation was changed to its current name: The Department of Rehabilitation Medicine.

1986-1999

By the mid-1980s, it was clear that both The Mount Sinai Medical Center and its Department of Rehabilitation Medicine were about to undergo major changes. A new hospital building was being planned and a search committee was established to find a new chairman for the department. When Mount Sinai applied for a certificate of need (CON) for the new hospital building, to the New York State Commissioner of Health, David AxeIrod, M.D. the CON was ultimately granted with the provision that there would be reduction in the total number of beds in the hospital, but that 50 beds would be set aside for inpatient rehabilitation.

By July 1986, when Kristian T. Ragnarsson, M.D. assumed the chairmanship, Mount Sinai had made known its new commitment to provide comprehensive rehabilitation services for people with physical disabilities and to facilitate rehabilitation research and education. Since that time remarkable growth has occurred in the various activities of the department, including expansion of inpatient and outpatient care services, educational programs and externally-funded research. This has involved a large increase in the number of faculty and staff in the department.

In December of 1986, eight inpatient rehabilitation beds were opened on the seventh floor of the old Housman Pavilion and the service grew to 17 beds in 1987. The inpatient service grew to 36 beds early in the year 1990, when if moved to the new Guggenheim Pavilion, and in 1992 it grew to 50 beds. In 1996, the inpatient rehabilitation service moved to renovated. state-of-the-art facilities on the second and third floors of the Klingenstein Care Center (KCC). Each inpatient unit of 25 beds was self-contained, with all rehabilitation services provided on the same floor as the nursing unit. One unit was primarily for patients with spinal cord disorders, while the other unit provided services for patients with disabilities caused by stroke and traumatic brain injury. In December of 1997, a third self-contained inpatient rehabilitation unit was added; it is located on the fifth floor of KCC. The unit is intended to provide services primarily for patients with physical disabilities of non-neurological causes.

Outpatient rehabilitation services have expanded both on and off the Mount Sinai campus. In 1986, outpatient rehabilitation services were provided only in the sub-basement level of 5 East 98th Street the old Guggenheim Hall but in 1996 the outpatient services moved completely to the current Facilities in the new Guggenheim Pavilion.

Working closely with Mount Sinai's Center for Corporate Health, has provided consultation services for persons with musculoskeletal disorders, as well as for sports- and work-related injuries.

There has been considerable interaction with hospitals within the Mount Sinai Health System, other than the traditional academic affiliates. One very significant development has been the close collaboration with Jersey City Medical Center and Meadowlands Hospital in New Jersey, in opening, staffing and operating the Liberty Rehabilitation Institute at Meadowlands Hospital. A 30-bed inpatient rehabilitation unit opened there in December of 1996. The department has also provided guidance and assistance to many other hospitals within the Mount Sinai Health System regarding establishment of new rehabilitation medicine services and recruitment of professional staff including medical directors. In July of 1998, 26 representatives from 12 system hospitals with rehabilitation medicine services met for the first time at Mount Sinai to discuss future collaboration and networking.

At the same time as the clinical programs have grown; federally funded rehabilitation research projects have increased significantly. In 1986 the department was funded by the National Institutes of Health (NIH) for a research project on diagnosis and treatment of post-stroke depression. In 1987, the department was designated and funded by the National Institute of Disability and Rehabilitation Research (NIDRR) for five years as a traumatic brain injury (TBI) model system of care. In 1989, the Spinal Cord Damage Research Center at the Bronx VAMC opened. In 1990, the department received a designation and federal funding as a spinal cord injury model system of care, the only such system operating in New York State at the time.

The History of the Center of Rehabilitation Medicine, Part 1: 1910-1959

The Department of Physical Therapy of the Mount Sinai Hospital Dispensary was established on December 5, 1910 as an independent unit with representation on the Medical Board by its chief, Heinrich Wolf, MD.

Prior to this time the physical therapy services had been “under the supervision of the orthopedic division" According to a report written by Dr. Wolf in 1912, the treatment provided by the medical staff of the department consisted mostly of applying hot air and performing massage for such medical conditions as bone fractures, joint diseases and constipation reportedly with good results. Dr. Wolf believed that The Mount Sinai Hospital was the first hospital to acquire a modern diathermy apparatus and one of the first to use artificial fever in the treatment of disease.

1935-1959

There is little information available about activities within the department until 1935, when William Bierman M.D., one of the pioneers of physical medicine as a specialty was appointed attending physical therapist (and apparently director of the department). (In those days all physical therapists were physicians.) Dr. Bierman, together with two other founders of the specialty, Frank Krusen, M.D., and John Coulter, M.D., established the American Board of Registry for Physical Therapy Technicians in 1934, in order to evaluate and register therapists who were considered qualified.

In 1936, Dr. Bierman was elected President of the American Congress of Physical Therapy, now the American Congress of Rehabilitation Medicine. That same year, Dr. Bierman was one of the first to advocate establishing physical medicine as a specialty, to the AMA Advisory Council for Medical Specialties. (now the American Board of Medical Specialties). In 1937, Dr. Bierman organized the first international conference on fever therapy in New York City. For his contributions in this field, the French government awarded him the rank of Chevalier (Knight) of the Legion of Honor.

Under his leadership, the department expanded and opened an inpatient division which, in 1938, obtained new quarters with a well-equipped gymnasium for therapeutic exercises, hydrotherapy facilities, a wide range of devices for electromagnetic therapies, and three rooms with equipment for fever therapy.

In 1938, Dr, Bierman helped found the Society of Physical Therapy Physicians, now known as the American Academy of Physical Medicine and Rehabilitation. He served as the third president of this organization from 1940— 1941. In 1941, Dr. Bierman received the Gold Key Award, the highest honor given by the American Congress of Physical Therapy (the other recipients that year were President Franklin Delano Roosevelt and Bernard Baruch, the financier and philanthropist).

There is little material available to describe activities within the department during the 1940s. During this period, antibiotics became widely available, eliminating the need for fever therapy in the treatment of infectious disease. During World War Il, the focus of physical medicine broadened to include rehabilitation of persons with physical disabilities. This development was partly due to the large number of wounded soldiers in military hospitals, but also due in part to the passing of new legislation aiding persons with physical disability. During the war, Howard A, Rusk, M.D., introduced into Army Air Corps hospitals the concept of active rehabilitation of injured soldiers, emphasizing physical training as well as psychosocial counseling. In 1943, the Barden-LaFollette Amendment, commonly known as Public Law 113, was passed by Congress to permit availability of funds for physical restoration, in addition to vocational training, for persons with physical disabilities. After the war, Dr. Rusk and his colleagues initiated rehabilitation programs for civilians with physical disabilities and began efforts to establish rehabilitation medicine as a new medical specialty with approved residencies.

In 1950, the name of the board changed to Physical Medicine and Rehabilitation as these two medical specialties merged into one. This merger was not approved by all; one of the most vocal opponents was a physician, Sidney Licht, who had trained and worked with Dr. Bierman at Mount Sinai. There is no indication that any comprehensive rehabilitation programs were established at Mount Sinai, either for inpatients or outpatients during this period. Most of the treatments involved the use of physical agents, although there are numerous indications in the Mount Sinai Annual Reports that physical exercise and skills training for patients with physical disabilities were gradually becoming more important.