He’s inquisitive. When you talk with Ravi Lakkaraju, MD., you have his full attention. He’s set exceptionally high achievement standards for himself, his staff, and inpatients in the Neuro Rehabilitation Center on Bay Regional’s west campus. As medical director, his focus is clear: "Only in rehabilitation do we have the maximum chance to have an impact on patients’ long-term quality of life. We work as an interdisciplinary team, so no matter what therapist a patient is seeing, they find ways to work on each patient’s rehabilitation goals."

Bay’s Neurological Rehabilitation Center provides a safe, inpatient space where therapy – physical, occupational, speech, psychological and recreational – is designed to stimulate understanding, mobility, and socialization for each patient. No ‘cookie cutter’ approaches here. Patients are here to recover ‘quality of life’, following stroke, brain injury, brain or spinal tumor removal, or spinal cord surgery. For admission, a patient must be able to do three hours of therapy each day.

"We use a bio-psycho-social model," says Dr. Lakkaraju. "We involve caregivers right from the beginning. Our patients have experienced serious life-changing surgeries, and some must totally re-build skills they learned in childhood. The earlier we can intervene with therapy, the greater a patient’s chance those skills will start to come back. Family and other caregivers are very important in understanding how they can help their loved one improve once they leave our center.

"We start with short-term, simple realistic goals. Once they achieve a goal, it is a positive reinforcement to work toward the next goal level. All team members meet daily, so no matter what the therapist’s discipline, they work together to reinforce the patient’s goals as they move from one therapy to another.

"We see a lot of stroke patients. Therapists are trained to use techniques that cause brain stimulation. The brain uses a process called ‘neuroplasticity’ to adjust and reorganize by ‘Constraint-Induced Movement Therapy.’ This forces patients to use the affected limb and re-learn function and mobility, rather than using the non-affected limb to do the work.

"These techniques force ‘brain mapping, or cortical reorganization.’ Non-damaged areas within the brain begin to re-channel and re-communicate with the damaged areas. The therapist works to stimulate the affected side of the brain, so it encourages areas that can communicate to help the affected side re-adapt and learn new adaptations and motor behaviors.

"If someone has had a spinal cord injury, the brain inhibits them from understanding what it feels like to be upright. By putting the patient in a body harness on a light gait treadmill, they get a sense of what it would feel like to stand up, and improves space orientation, trunk control, and weight bearing. It stimulates nerve centers in the spinal cord that are responsible for gait.

"In cases of brain injury or stroke injury, a patient may not be able to open their affected hand. It’s clenched like a fist. By stimulating the muscle motor points that cause the hand to open and close, we begin to create new signals and re-channel pathways so the desired response begins to occur. It can take a long time, but if the patient keeps focused on exercises and activities that allow the affected side to re-adapt, considerable recovery is possible.

"I evaluate each patient admitted to the rehab unit from hospital acute care. Our team goal is to help patient and caregivers understand what to expect, and to encourage the patient to be as independent and functional as possible. If a patient has speech problems, we work on cognitive re-training and improving memory recall. Our recreational therapist works on a patient’s motor skills, and arranges for socialization experiences in the community.

"It’s hard to imagine how significantly these patients’ lives have been changed. The ‘hard wiring’ they were born with has been shattered. We push patients to recover as much mobility and function as possible in the time they are here. But this is a lifetime recovery process. I hope patients see themselves achieving a quality-of-life they didn’t think was possible."