Melanie Cole, MS (Host): Welcome to Better Edge a Northwestern Medicine Podcast for physicians. I'm Melanie Cole, and we have three physical medicine. And rehabilitation specialists for you today from Northwestern Medicine Marianjoy Rehabilitation Hospital to highlight elevating care, the impact of fellowship-trained physiatrists. Joining me is Dr. Anton Dietzen He's fellowship-trained in pediatrics. Dr. Ishaan Hublikar is fellowship-trained in spinal cord injury, and Dr. Julie Witkowski is fellowship-trained in brain injury doctors.

Thank you so much for joining us today and Dr. Hublikar Let's start with you. What drew you to physiatry and motivated you to pursue a fellowship?

Ishaan Hublikar, DO: So physiatry um, in general attracted me because of my upbringing My mom actually was a pediatric, uh, occupational therapist. So I grew up around rehab and it really opened me up to the field of physiatry as a whole and rehab as a whole. So when I knew I was going to medical school, one of the first people that I shadowed was a physiatrist and helped me understand, um, how medicine and rehab are integrated.

Um, so that was. getting into the specialty As a whole, and then as I was in residency, I really was into spinal cord injury because of the amount of different types of care you can provide, the unique aspects that a spinal cord injury, um, causes a patient in terms of their physiology of their body and the longitudinal care you get to provide, um, really lifelong for those patients.

Melanie Cole, MS: Well, thank you for that, Dr. Dietzen Same for you.

Anton Dietzen, MD: yeah, it's interesting to hear, you know, hear that, uh, you know, your perspective. Ishaan I didn't know that, um, about your mom. I kind of had a similar experience. My, my brother-in-law has, um, spastic quadriplegic, cp, and, um. My wife and I were, uh, high school sweethearts and, and so in the summers I was kind of his caregiver and just sort of just got immersed in the world of, you know, kind of, uh, going to East Shields and taking him to therapy and, and just, you know, being around that.

And ultimately I was kind of introduced to Dr. Keen, um, who's one of our other peds rehab doctors here at Marianjoy and so after the first time I met her, I was like, well, this is, you know, what I want to do the specialty that I want to do, even before I was.

You know, a medical student. So, it was an early, early interest definitely for me. I.

Melanie Cole, MS: Dr. Witkowski, tell us your story.

Julie E. Witkowski, MD: Yeah. That's so interesting to hear because, um, I have a very different story than both of you. I had absolutely never heard of physiatry until I was halfway through medical school. Um, I went into medical school with some other interests, um, that do overlap with physiatry, but I didn't actually even know that it was a specialty, like a lot of people, um, until I think I was a second-year medical student and one of my eventual mentors had come and given a.

Lecture to our medical school class on what is physiatry. And I kind of learned throughout the process and as I was going through, um, my different rotations, that it had a lot of the facets of different specialties that I liked, that I had heard of previously, incorporating some neurology knowledge of the central nervous system, some peripheral nervous.

Nervous system knowledge. Also, I had had a previous interest in perhaps something like orthopedics, but it had some, you know, non-surgical orthopedics knowledge, like musculoskeletal system, um, and how the nervous system and the musculoskeletal system integrate. Um, and then I also had a big. Sports background growing up. Um, so I knew there was a good amount of sports medicine and um, just a whole bunch of things that went into making the specialty of physiatry.

So, um, it was interesting as I was listening to his lecture on what is physiatry, I was sitting there thinking to myself, this sounds. Right to me. Um, and about four people came up to me after the lecture and said, you know, this sounds like a good specialty for you.

I said, I was thinking the same thing. Um, so I looked into it a little bit further. Uh, did a couple rotations in physiatry and eventually decided on that as my specialty. Um, also as I was going through my residency program, um. I have a lot of interest and I was drawn to a lot of subspecialties within physiatry.

Uh, but it really kept coming back to brain injury. I loved pediatric physiatry, but I realized that I really loved the brain injury patients that I was seeing in the, on the pediatric service. Um, I really liked spinal cord injury as well. Um, I really liked the neuro rehab aspect.

Um, but what ultimately drew me to a fellowship in brain injury was just that. Every patient I saw would present, you know, in a different way. Um, because brain injuries are variable and they affect every single person differently. Um, and so at the end of my residency training was when I finally settled probably a little bit later than, um, some others on, uh, absolutely pursuing a fellowship.

And I decided to ultimately pursue a fellowship in brain injury, um, and be a brain injury-certified physiatrist.

Melanie Cole, MS: What great stories, all of them. I'd like to ask you each how your fellowship training shaped your approach to patient care. So Dr. Dietzen you're in pediatrics. How did that training help you to work with these children

Melanie Cole, MS (Host): in a,

Melanie Cole, MS: in a much different way?

Anton Dietzen, MD: Yeah. Well, I mean, you know, the pediatric, um, fellowship I think is unique in that, you know, a lot of the other fellowships within physiatry are, you know, kind of condition specific. You have, like brain injuries, spinal cord injury, um, you know, pain. And so, you know, you're kind of focused on one, you know, really building your expertise in one kind of very specific, you know, niche within physiatry.

Um, but you know, in pediatrics it's, you know, we see every basically congenital-acquired you know. Disability from, you know, birth injury, genetic conditions, burns, um, you know, the whole kind of spectrum and then you go into it having already completed your adult residency. So, you know, a lot of times we've had, you know, the ability to, you know, have kind of see how people age with these different conditions.

And so I think one of the things that's, you know, that's really valuable is being able to start, you know, with a child, you know, early on, maybe you're seeing them when they're. You know, two, three months old, even like at a, in uh, NICU followup appointment. And, you know, trying to think, okay, what are the things that I can do to help, you know, help this child really achieve their max, you know, potential and avoid, you know, complications and, you know, and things kind of down the, you know, down the road.

And so, you know, as a result, I think. Pediatric physiatry in particular is, you know, a lot of pattern recognition because there's too many, you know, every day there's a new kind of genetic condition. I see a patient almost every day that I'm like, oh, I never heard of that condition before.

There are you know, three in the world, six in the world. And so we spend a lot of time doing kind of pattern recognition. Is there, you know, truncal, hypotonia, is there ataxia? Is there increased muscle tone, decreased muscle tone, um, maybe difficulty with swallowing? Is there a vision component?

And so, um, you know, I always do a really thorough kind of review of systems and kind of go like top to bottom. Um, and then sort of. You know, pull from that the things that I think are most important. And then try to match that up where, you know, where the parents kind of, um, you know, where their idea of the most important kind of, uh, you know, things to focus on are.

And make sure that, that we're kind of, you know, creating a plan together. Because obviously when you're, you know, you're treating a child, you're treating the parent as well. because they're the ones who have to do all the things that you're, you know, asking them to follow up on all the other appointments, all the other tests and um, and therapies and things.

So I always try and make sure that my vision for what I think. You know, especially where the child aligns with, you know, with what the parents says and, and, um, so I think those are kind of two sort of unique aspects of, you know, of pediatric, uh, you know, fellowship is, is that kind of like working on that early kind of pattern recognition and, and using all the tools that we have at our disposal, um, medications and therapies and injections and bracing and all these types of things, um, to kind of look down the road and say, okay, how can I use these tools to really.

Help this child to achieve their max, you know, max potential. And then, um, really to kind of partner with, you know, with the family, with the parents, and, you know, even the siblings and, um, know, trying to make as much of the, you know, what often is medicalized fun or engaging in things for the child.

Melanie Cole, MS: Well, it's certainly a comprehensive approach, especially as you said, when you're working with parents, because we all know how we can be right. And when our child is ill,

Melanie Cole, MS (Host): it's,

Melanie Cole, MS: it's a tough time. It's a terrifying time. So thank you for explaining that. Dr. Witkowski, how about you? How has your fellowship training shaped your approach to patient care for patients with brain injury?

Julie E. Witkowski, MD: Well, actually it's um, an interesting segue because in the brain injury world, again, kind of a little similar to the pediatric world. In the pediatric world, as Dr. Dietzen mentioned, we're treating the patient but also their family. Um, and in the brain injury world we're often, I. Also working with the patient and their family.

Um, brain injuries come in all shapes and sizes. I see all kinds of patients, especially on my brain injury rehab unit. Um, and so that could be anything from a traumatic brain injury, so a fall with. You know, head trauma, brain bleeding. Um, also we see non-traumatic brain injuries, which can be from encephalopathy or from, say, a tumor resection or a brain surgery or VP shunt placement, um, or other kind of alterations in someone's mental status for a variety of reasons.

And one of the things that's pretty unique about the brain injury population is most of the time when someone has a brain injury, some. Measure of cognitive impairment also comes along with the brain injury, at least for a period of time afterwards. And so one of the things that I got to practice a lot during my fellowship was being more, um, you know, the leader of the team when working with brain injury patients is you get to do that a little bit more in your family, in your, uh, fellowship training, than in residency training, and really learning how to integrate.

Not just the medical care for the patient themself. Because brain injury patients have a lot of complex medical needs as well. Um, but also incorporating their family, loved ones, caregivers, other people who are going to be assisting them after their rehab discharge. Um, whether that be cognitively, physically, or both.

Um, and again. Making those care plans and helping them shape the next steps of what the recovery and the rehab are going to look like after they leave the hospital, making sure they have all the followup appointments and everything that they need. Um, so I think my fellowship training really gave me, um, a good comprehensive overview on how to navigate those difficult situations.

Um, also having. Um, you know, sustaining a brain injury is not typically in anyone's plan for their day, right? So this is usually a big life-altering event or, you know, an accident, incident illness, an injury, um, that led someone to come be under my care. Um, and so there's a lot, not just medically, but you know, socially, psychologically that goes along with that.

And so, um, I think really learning to guide patients, their families through that process is really a big part of the specialty itself. And also my fellowship training.

Melanie Cole, MS: So important, the points that you made and Dr. Hublikar what about you and spinal cord injury? How did your fellowship training shape your approach to patient care?

Ishaan Hublikar, DO: Yeah, so you know, when I was finishing residency or as, as I was going through residency. I really found a connection to spinal cord injury. Um, you know, my personality is such that I really like to delve into like every nook and cranny and understand why does this work, why does, why do certain aspects of the body work the way in which they do?

So I really felt that I wanted the extra year to explore all the smaller areas within a spinal cord injury. Uh, truly spinal cord injury affects, um, almost every organ system. It can affect your cardiovascular function, your respiratory function. Bladder, your bowel function, um, and, uh, other types of, uh, upper motor neuron conditions such as spasticity, uh, very similar to, to to brain injury in, in a lot of ways.

And so I wanted the opportunity to have extra time and extra exposure to all these patients dealing with these. Um, issues within their spinal cord injury. Um, also in relation to their rehab, um, rehab impairments as well, and have the opportunity to go into each of those areas within a fellowship.

And that's really what it allowed me to do. It, it helped me, um, increase my exposure and my comfort level with all of these types of patients. Um, in my fellowship, I was also helping to manage. Patients on ventilators as a result of their spinal cord injury. Um, I got to do specialized clinics, for example, in spasticity management, uh, where I focused on, uh, how to discern between different types of oral medications, uh, injections or interventions such as, uh, a baclofen pump.

Um, and then I get to work with specialists that we work with. very closely In spinal cord injury. So I got to, uh, have the opportunity to do clinics with neurosurgery and urology and really see the aspects of, uh, the care that they get, um, from the patients as well.

Um, so overall that and, um, just the increasing amount of patients you get to see over time in a fellowship, um, was, was really important to me. The last thing that I found was really important was, um. Having the opportunity to have more mentorship within the area that I was specializing in as well.

So I got to see the different practices of a multitude of spinal cord injury specialists during my year in fellowship, um, and still really keep in close contact with them, and that really helped me. See aspects of, uh, different attendings that I got to take pieces from in terms of their management, in terms of their practice, and really help me adapt what I wanted to bring into my own practice, um, coming into this first year as an attending.

Um, so overall, you know, I think the. The, the one-liner would be, it helped me to anticipate their needs a little bit better in terms of what not only is going on right now with their injury, but over time as their injury evolves, what can I anticipate that they're going to need into the future, and how can I help that in, in the current state?

Melanie Cole, MS: Very well said, Dr. Hublikar and Dr. Dietzen after. You completed your residency at Marianjoy what factors influenced your decision to return?

Anton Dietzen, MD: Yeah, that's a good question. I, I, uh, you know, Dr. Hublikar and I, and, and, and, uh, one of the other, um, brain injury specialists, um, other than, uh, Dr. Witkowski all came back after. Um, and so I, you know, I was kind of thinking about that as I was preparing for the, you know, the talk today.

And, um, I mean I really wanted to go and train outside the system because I wanted to have something unique to bring back. but ultimately, I think Marianjoy in particular is just, you know, it's a very mission-focused organization and, and you know, the, you know, the patients here really get wraparound care.

you know, when I was, uh, in my fellowship, I actually reached out to the spiritual care team here at the time because they were doing, um, prayer shawls. And I had, you know, had, um, gotten a couple prayer shawls here for patients, you know, as a resident. And I had a patient, um, in Maryland during fellowship who I. You know, I could, you know, just knew the mom would really appreciate it.

And they, um, you know, the, uh, spiritual care person here at the time actually sent, you know, sent a prayer shawl out for us, you know, for us out there. And, um, and that was the kind of thing, it was just really, I felt like people, you know, the culture here at Marianjoy is really just to go, you know, above and beyond for patients, um, and their families.

And, and I think that was the thing that, that kind of most. You know, drew me back was just that everybody's on the same mission and the mission is just to, you know, try and, and get the patient better. As you know, as much as we're able.

Melanie Cole, MS: Same question to you, Dr. Hublikar After you completed your residency there at Marianjoy what factors influenced you to return?

Ishaan Hublikar, DO: Certainly. So, you know what, what, uh, Dr. Dietzen also, uh, me and him share in common, in addition to being residents here, is we were both chief residents in our, in our fourth year of residency in the program. And so, you know, there was this intrinsic motivation I felt to come back here and help.

Give back not only to the community is in the patient community, but also to the residency program as well. Um, in terms of going to another institution in a different region, um, picking up skills and, and knowledge, um, and coming back and, and bringing some of the. The aspects that we learned back to a place that we knew really well, and um, and, and growing not only the patient population, but also the residency program as well.

Um, there was one other, uh, spinal cord injury physician who's still here, Dr. Kou And so she was one of my mentors in residency and I really look up to her and so I, I really look forward to the opportunity to working. With her and, uh, under her mentorship and growing the spinal cord injury program, I think that's been a goal of ours overall.

Um, we have the unique opportunity that, uh, outside of the city, we're really the only SCI program, uh, here, um, all the way out basically until Iowa and up until uh, Wisconsin. And so, um, having the opportunity to catch more patients and bring more to our spinal cord injury patients and um, also.

being able to mentor the residents here and, uh, and, and bring that knowledge back was, was some factors that I really couldn't pass up.

Melanie Cole, MS: I would like you each to answer how your fellowship training prepared you to tackle the challenges in your specialized fields, because you are all working with these very complex patients. So I'd like Dr. Hublikar for you to start first, and how have you worked on tackling these challenges?

Ishaan Hublikar, DO: Yeah, so I think, you know, ultimately, um, having the extra year of fellowship really helped me, uh, be challenged in terms of the most complex patients that I could possibly try to treat. I think that was one of my goals going into Fellowship, is I want to see the most complex and.

and Potentially like the hardest patients to, to manage from a medical standpoint and from a rehab standpoint, while I was still under, um, the, the fellowshiphood of being able to ask my attending any questions or seek guidance at that standpoint. And so that's what I was able to bring back is I really feel confident that, um, in many ways that.

I won't, uh, be surprised by, by hopefully too many cases where I feel at least confident with the, with the training I've got to, to start the management. And I also have the benefit of having partners that I can, uh, bounce ideas off of. Um, so really that's, that's what I've been able to bring back is a lot of confidence.

And in terms of knowing that, um, between my residency, between my fellowship, that I've. seen Some of the more, more complex situations that I would likely deal with on a day-to-day basis. Um, that being said, you know, medicine is unpredictable and you always get some surprises and challenges, but I think that's also why, uh, medicine is a lifelong learning field as well.

Melanie Cole, MS: Dr. Witkowski, what about you? How have you really learned to tackle the challenges for brain injury? I.

Julie E. Witkowski, MD: Well, one the nice things about staying for an additional year of training and brain injury for a fellowship, um, I actually stayed at the same institution where I did my residency. I was a little different than Dr Hublikar and Dr Dietzen I was at Mayo Clinic for my PM&R residency, and I ended up staying at the same institution for another year for my brain injury fellowship.

And then coming back out here to, um, where I was born and raised in the Chicagoland suburbs, um, to work at Marianjoy which is always one of the my goals of mine since it, you know, growing up everyone, we, um. I'd always heard of Marianjoy or had friends or family members that had been to Marianjoy Um, so I was really excited to be able to come out here and use some of the skills I learned in my residency and fellowship.

Um, and when I really stayed for that additional year of fellowship, I was able to be more fully, fully immersed in the brain injury world. Um, and that that's really across the entire, you know, continuity and spectrum of, of care areas in which you might see a brain injury patient.

I got to spend more time. In three different places really, first in on the consult service, so I was doing a lot more brain injury consults. So I was seeing patients in the acute care hospital following monitoring, assisting with their care there. Um, also weighing in on their candidacy appropriateness for something like an acute rehab program or other levels of rehab care I. And then getting more of the opportunity then to also follow them on the inpatient rehab setting.

So on, you know, on the inpatient rehab unit, which is something that we have here at Marianjoy um, and a number of double in, um, subspecialized units. Um, then I was really able to immerse in. Just the inpatient care of these patients'. Brain injuries. Um, there's a lot of complex medical management that goes into brain injury care at times, different complications, electrolyte imbalances, things like SIADH um, autonomic storming, things that, um, spasticity, different.

Medication titrations, um, agitation management, which is something that happens, um, not uncommonly after brain injury. So really getting to then experience a full panel of brain injury patients over multiple months on the inpatient side. And really fine tuning my skills and, um, managing those conditions. And then the other nice thing was having a really comprehensive outpatient brain injury clinic throughout my fellowship year where I was able to follow.

A full panel of brain injury patients that were really became my own patients Um, some which I saw once or twice or, you know, a couple times in a consult, but other patients who I followed regularly throughout my entire fellowship year, um, and really was able to work with them as they transition from the hospital setting to the outpatient setting.

Um, there's a lot of other things that go into rehabilitation medicine in general, but a lot of tools that we utilize probably a little bit more in the brain injury world, like working with neuropsychologists. And learning more about neuropsychometric testing and how to review that, go through it with patients, um, and also really helping folks if they, um, are.

Able and ready to transition back into other roles in the community, like working on things moving towards return to work or return to school, return to driving, and the different resources that are available for that. Um, so during my fellowship year, I really got to be fully immersed in kind of that entire spectrum of brain injury, rehabilitation and, um, you know, practice those skills with a large number of patients.

Melanie Cole, MS: Dr. Dietzen you're up now. How has your fellowship? Training really prepared you to tackle the challenges of pediatrics.

Anton Dietzen, MD: you know, the pediatric fellowship, uh, is. Unique in that it's, it's it's the only two-year fellowship out of the, uh, the physiatric fellowships. Um, and really that's because as I alluded to earlier, it's, you know, the, the patient population that we see is, you know, so broad. So, um, we see so many different types of patients.

And so, you know, like Dr. Hublikar mentioned, I wanted to train somewhere with a, with a big inpatient unit and, you know, the sickest kind of kids on the spectrum. So I took care of kids who were, you know, who were on vents and kind of learned the vent weaning, um.

You know, Johns Hopkins sort of pioneered the early mobilization. So we would, um, help kind of get, get patients ready for rehab really early in their, you know, in their hospital stay. And so I think it was helpful, you know, for me just, just to kind of stretch my, um, know, my mind in terms of what, you know, when the rehab sort of process begins.

you know, it wasn't uncommon to see patients, you know, pediatric patients in the PICU at Hopkins. You know, walking on ecmo, up, walking, intubated, and ventilated. Um, things that, like if somebody sort of described you, you'd be like, that, that's not possible. You know? Um, they have a team of like eight people behind them making sure everything was working.

But, you know, movement is medicine and the earlier we can get patients up and moving, um, whether that's after something, you know, traumatic that's happened, that's, you know, interrupted their life or, you know, as they're starting out with, with, um, you know, with challenges, um, know, and so I think.

You know, really being able to be exposed to, to, to people who are thinking outside the box and, you know, trying to push those limits of how we can do that. Um, and trying to bring some of those ideas back. Um, and then also realizing that, you know, two years even though it's, you know, long, long on the pediatric or on the, um, you know, fellowship side for PM&R um, it's really just kind of where, you know, education begins.

And so I think, um, you know, coming back to a place like Marianjoy where I have. You know, Dr. Keen and Dr. Pavone who are both just, you know, tremendous mentors and kind of, you know, pediatric rehab legends, um, you know, in the community to, you know, continue that mentorship and, um, you know, sometimes I'll be, you know, in clinic upstairs and have, you know, one of them on each side and I'm like, oh my gosh, this is like, you know, I'm so fortunate because, you know, between the two of them they've seen so many different things and, um, and so it's, you know, just an incredible kind of team to work with and, and to

be able to kind of exchange ideas with.

Melanie Cole, MS: This is really such an enlightening eyeopening discussion. You all have so much knowledge to share for providers that are thinking about going into these specialties, and I'd like to give you each a chance for some final thoughts and Dr. Hublikar What advice would you give to those considering a fellowship in spinal cord injury in your specialty?

And what do you see? What do you hope, and what do you see as the most exciting advancements on the horizon in your field?

Ishaan Hublikar, DO: Great question. So for part one, in terms of advice, I would say, I find that spinal cord injury really is a perfect hybrid of rehab. And, and, and medicine. Um, so for those that have those types of interests, it provides, in my opinion, obviously I'm biased, but the best of those, those two aspects, um, as well as having that longitudinal care just over the course of their lifetime and really, you know, being, um.

Being an expert on, on, specific pathology that can affect everything really for the patients. Um, as far as the second question, where I see the field going, you know, really the new frontier is neuromodulation in terms of the spinal cord injury population. There's a lot of different studies going on around the world in terms of how can we help.

Some of their, uh, recovery in different ways. So whether that be motor recovery or helping their spasticity or helping their cardiovascular function, that's really going to be the exciting kind of next five to who knows how many years going in the future of what is available to our patients and what might really, uh, change the expectations and, and the ceiling for what the rehab could be, um, over, uh, their whole lives.

So it's, uh, only time will tell, but that's why the whole field of rehab is, uh, really exciting.

Melanie Cole, MS: It certainly is. And Dr. Witkowski, same question to you. What advice, if you were talking to other providers, would you recommend that they listen to when it comes to thinking about joining brain injury? And what do you see as exciting happening in your field? Technology innovations in the future.

Julie E. Witkowski, MD: Yeah, so actually this is, um, a fairly easy one for me to answer, especially the first part. Because I, um, mentor a number of, uh, residents and medical students, and I get asked this question a lot. Um, one of the things that I like to share with people who are considering doing a brain injury fellowship is really anywhere you practice as a physiatrist, whether or not you decide to specialize, you're probably going to encounter, um, patients on your service or in your patient caseload that have a brain injury in one.

Shape or form. So when I was deciding on whether or not to do a brain injury fellowship, you know, there are multiple possible outcomes that can come out of that. One could be doing something what, like what I'm doing now, which was obviously one of my goals, um, where I'm the medical director of an inpatient rehab unit, um, with a locked brain injury unit with a high proportion of brain injury patients.

So of course I'm seeing a large number of brain injury patients, inpatient, outpatient, on consults. Um, but that being said, that I wasn't certain when I was applying for fellowship where I was going to end up working later. Um, and so a lot of folks in physiatry end up going into a whole variety of practice settings, a lot of times practicing more as a generalist in PM&R we all have general PM&R training.

Um, but I knew that really any practice setting that I'd go into, say a subacute rehab facility, a general rehab unit, a sub-specialized inpatient unit, more of an outpatient practice. Patients who have suffered. Some, um, form of brain injury, either traumatic or non-traumatic, are always going to end up on your patient caseload because, um, folks often, um, have a brain injury or have some cognitive impairment when they're in the hospital for one reason or another.

So I really felt that the brain injury training that I received was going to be really helpful and marketable really anywhere I worked in any practice setting. Um, and that I could always, you know, hone in on that sub-specialized knowledge for certain patients when needed. and similar Dr. Hublikar there's a lot of up and coming things and, um, exciting things in, you know, research and technology for brain injury and spinal cord injury.

I think during our careers, as we're all relatively early practice physiatrists, um, we're going to see a lot of changes in how um, you know, medicine approaches recovery from brain injury and spinal cord injury, um, and other, uh, neuro rehab. Um, I think there's up and coming things like using complex imaging studies and more sideline testing for, um, or, you know, um, faster testing after concussive head injuries, really spanning the entire spectrum from a mild to a more severe traumatic brain injury.

Um. There's always advancing technologies, um, on how to work with folks who have sustained a brain injury. Um, one of the things that's not necessarily new and up and coming, but we're excited to have here at Marianjoys We recently got a balance tutor. Um, I think we're one of the only, um, facilities in Illinois or, um, you know, in the surrounding area that has a balance tutor.

So it's been really helpful for a lot of my patients to work on their higher level balance here, both inpatient and outpatient because it's a machine that, um, incorporates. Both, um, forward, forward and backwards and side to side perturbations of someone's balance. And that can be done while stationary or also while walking.

Um, as we're or running, um, as we're trying to gradually improve the mobility of our patients, being able to use that tool to kind of give them some higher level balance challenges, I think has been really great and something that I'm really excited we. were recently Able to get here at Marianjoy So I think there's going to be a lot of advances in technology and diagnostic imaging, neuromodulation treatment, and also, um, some technologies to help patients, um, recover just their functional, um, status.

Melanie Cole, MS: Thank you so much. And Dr. Dietzen last word to you, what advice would you give to those considering fellowship in pediatrics and what's exciting, what's coming up on the horizon? Technology innovations, what would you like the key messages and takeaways to be from today's discussion?

Anton Dietzen, MD: I mean, I. think

Melanie Cole, MS: in terms of advice

Anton Dietzen, MD: you know, just use your elective time and, and, you know, try things out and, and, um, once you figure out what you're passionate about and what you want to do, you know, put everything into, uh, into making yourself the best at it that you can be. In terms of, you know, peds because it's so broad, there's some areas where there's a lot of innovation and technology happening, and there's other areas where, you know, we're using the same medicines and same tools that we used 20 years ago.

Um, I think one thing that I hope, changes is more like, you know, the kind of equitable access to care. Um, you know, for my patient population in particular, because you have some patients who can, you know, have resources, they can go to other countries and do, you know, spend thousands of dollars on stem cell injections.

And then I have other patients who are, you know, can't get. Therapy because, you know, there's nowhere, um, that accepts their, you know, their, um, insurance plan, their Medicaid plan, or whatever it is. And so, um, you know, I think really, you know, we know what helps kids, um, you know, develop and, and, um, you know, make those, make those gains in therapy.

And it's really just the good old fashioned bread and butter, you know, therapy. And so, um, you know, I hope that the. You know, innovation or, or, um, uh, you know, kind of improvement with time is just being able to get that to all of them.

Melanie Cole, MS: I want to thank you all so much for joining us and sharing your expertise for other pro. Providers that are considering these very unique specialties. Thank you so much again for joining us and to refer your patient or for more information, you can always visit our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers.

That concludes this episode of Better Edge a Northwestern Medicine Podcast for physicians. I'm Melanie Cole.