Clinical Sites & Rotations

• Primary Pediatric Rehabilitation rotation clinical site for all PRM Fellows and Pediatrics/PM&R Residents on pediatric rehabilitation rotations.  Combined residents also rotate at CHCO, Denver Health, University of Colorado Hospital, Craig Hospital, the VA (see Pediatrics and PM&R programs for those site details.

• US News & World Report Best Children’s Hospitals Honor Roll – Top 10 Children’s Hospitals in the nation

  • Nationally ranked in ALL pediatric specialty areas by US News & World Report

• Only Level 1 Pediatric Trauma Center in 7-state region (MT, WY, CO, NM, SD, NE, KS)

• Our patients are from 49 states and 22 countries

• We have 23 COVID-19 research collaborations 

• Statistics (as of 2019)

  • Licensed beds: 564

  • Available beds: 528

  • Inpatient admissions: 16,509

  • Total surgeries: 25,135

  • Total days of inpatient care: 111,200

  • Length of stay (days): 67

  • Outpatient visits: 591,418

  • Emergency and Urgent Care visits: 168,394

• Payer Mix (as of 2019)

  • Medicaid: 45.1%

  • Managed care/commercial: 47.4%

  • Other government: 5.5%

  • Self-payment and indigent: 2.0%

• Team Member Statistics

  • Total number employees: 7,732

  • Total medical staff: 2,106

  • Total residents and fellows: 274

  • Total volunteers: 2,749

• Physiatrist led unit with consult support for all pediatric subspecialities.

• Average patient census: 11-12 (range 5-15 patients).

• Approximately 130 admissions per year

• Wide age range: 0 months – young adult

• Most common diagnoses:

  • Brain Injury (acquired, AHT/NAT, trauma, stroke, infectious, etc)

  • Trauma

  • Neuro-Oncology (brain and spine)

  • SCI (trauma, stroke, acute flaccid myelitis, autoimmune, etc)

  • s/p epilepsy surgery

  • s/p SDR

  • Other: burns, dermatomyositis, autoimmune encephalopathies

• Attendings: Dr. Powell, Dr. Mann, Dr. Dichiaro

• Approximately 225 consults per year - in the PICU, NICU, cardiac units, inpatient units, ED.  Occasional outside hospital consults from Denver Health and other surrounding hospitals.

• Most common consult diagnoses:

  • Brain Injury (acquired, AHT/NAT, trauma, stroke, infectious, concussion, etc)

  • Neuro-Oncology s/p tumor resection

  • Trauma

  • SCI (trauma, stroke, acute flaccid myelitis, autoimmune, etc)

  • Intrathecal baclofen pump management

  • s/p epilepsy surgery

  • s/p SDR

  • Other: tone management, encephalopathy, amputation, deconditioning, EMG, burns

• Attendings: Dr. Mann, Dr. Mayer, Dr. Dichiaro, Dr. Powell, Dr. Apkon, Dr. Stratton

• >5,000 outpatient visits per year

• General Rehabilitation with all attendings

• Brain Injury/Concussion with Drs. Wilson, Dichiaro, Stratton, Kanallakan, Powell

• Inpatient Follow-up clinics with Drs. Powell, Dichiaro, Mayer, Mann

• Torticollis/Plagiocephaly with Drs. Oleszek, Stratton, Kanallakan, Sarmiento

• NCS/EMG with Dr. Mayer

• Chemodenervation injections with all attendings

• Intrathecal Baclofen Pump refills/management including test doses with Kim Sawyer, NP

• TeleHealth clinics: all physicians

• Multidisciplinary Clinics (see below)

• Outreach/Continuity Clinics (see below)

Colorado pediatric physiatrists are integral members of over 40 multi/interdisciplinary care clinics each month: 

• Acquired Brain Injury with Dr. Dichiaro/Powell/Mann/Mayer, Neurology, PT/OT/SLP, Rehab Psych, BIAC

• Amputee/Limb Deficiency with Dr. Wilson, Orthopedics, PT/OT, prosthetists

• Angelman's Syndrome with Dr. Apkon, PT/OT/SLP, Genetics

• Arthrogryposis with Dr. Mayer, Orthopedic Surgery, OT

• Batten Disease Clinic with Dr. Mann, Neurology, Therapy, Nursing

• Brachial Plexus with Dr. Stratton, Orthopedic Surgery, OT

• Cerebral Palsy with Dr. Matthews/Wilson/Oleszek/Stratton/Mayer/Kanallakan, Orthopedic surgery, PT, SW

• CMT with Dr. Apkon, Neurology, PT, Genetics

• Concussion with Dr. Kanallakan/Pierce, PT, Neuropsychology, Rehab Psychology

• Epilepsy Surgery with Dr. Dichiaro/Kim Sawyer, Neurology, Neurosurgery, Neuropsychology

• Neuromuscular with Dr. Oleszek/Stratton/Apkon, Neurology, Pulmonology, RT, PT, Nutrition, SW, MDA, Genetics

• Muscle Adult with Dr. Apkon, PT, Pulm, Nutrition, SW

• Muscle Carrier clinic with Alison Ballard, Genetics

• Non-Accidental Brain Injury Care Clinic (NAIBCC) with Dr. Dichiaro/Powell/Mann/Mayer, Neurology, PT/OT/SLP, Neuropsychology, Child Abuse Protection (CAP) team

• Neuro-Oncology with Dr. Mayer, Neuro-Oncology, Neuropsychology, Endocrine

• Neurofibromatosis with Kim Sawyer, Neurology, Neurosurgery, Neuro-Oncology

• Osteogenesis Imperfecta with Dr. Kanallakan, Orthopedic Surgery, PT, Endocrine, Genetics/Pediatrics

• Pain clinic with Dr. Tow, Anesthesia Pain Medicine 

• Rett/Rett-like Syndromes with Dr. Stratton, Neurology, PT, Neuropsychology, Social work

• Seating with Dr. Wilson/Kim Sawyer, PT, DME vendors

• Skeletal Dysplasia with Dr. Oleszek, Orthopedics, Genetics, Special Care Pediatrician

• SCI with Dr. Powell/Wilson, Urology, PT, Rehab Psychology, SW

• Spinal Defects with Dr. Wilson/Kim Sawyer, Orthopedics, Neurosurgery, Urology, PT, Rehab Psych, SW

• Stroke with Neurology, Hematology, Neuropsych, SW; Rehab provider varies

• Surgical Tone with Dr. Oleszek, Neurosurgery, Neurology, PT

  • Selective Dorsal Rhizotomy, ITB Pump candidates

• Tuberous Sclerosis clinic with Kim Sawyer, Neuro-Oncology, therapy, social work

PRM Fellows learn about systems based practice of rural and community pediatric rehabilitation medicine by attending Outreach Continuity clinic at varying sites.

• Frequency - depending on site...

  • 4-6 times per year

  • Travel by car (Colorado Springs, Pueblo) or air (Alamosa)

• Colorado Networks of Care and Outreach Clinic sites:

  • CHCO North Campus in Broomfield with Dr. Wilson, Dr. Mayer, Ortho, PT

  • CHCO South Campus in Highlands Ranch with Dr. Oleszek, Dr. Kanallakan, Ortho, PT, orthotics

  • Alamosa with Dr. Oleszek, Dr. Ratnasingam, Dr. Vernacchia, DME vendor

  • Pueblo with Dr. Pierce, Dr. Desmarais, Dr. Ratnasingam, Dr. Mundy, DME vendor

  • Colorado Springs with Dr. Pierce, Dr. Desmarais, Dr. Roberts

  • Durango with Dr. Mayer

  • Fort Collins with Dr. Wilson

  • Sterling with Dr. Dichiaro/Wilson

• Cheyenne, WY with Dr. Powell

• TeleHealth with all providers and fellows

PRM Fellows and Pediatrics/PM&R combined residents become proficient in...

• Chemodenervation / Chemoneurolysis

  • Onabotulinum toxin injections (Botox, Dysport, Myobloc, Xeomin)

    • In procedure center or operating rooms with general anesthesia

    • In clinic with or without anxiolysis with intranasal or oral midazolam, with or without topical analgesia

  • Neuronolysis with Phenol 6% injections to obturator nerves to hip adductors, sciatic nerves to hamstrings, musculocutaneous nerves to elbow flexors

    • In procedure center or operating rooms with general anesthesia

  • Guidance: E-stimulation, EMG, anatomical; ultrasound curriculum in development

• NCS/EMG with Dr. Mayer and Child Neurology (elective options with Dr. Melissa Wright or Dr. Yang)

• Intrathecal Baclofen (ITB) Pump refills, management, side port access, dye studies with Kim Sawyer, Dr. Wilson

Fellows and residents have opportunities to participate in...

• Intraoperative Neuromonitoring with Dr. Oleszek during SDR cases.

• Orthopedics: VDRO, TAL, Strayer, Evans, tendon transfer, hemiepiphysiodesis, hardware removal

• Neurosurgery: epilepsy surgery, shunt management, ITB pump placement, SDR, lumbar punctures for intrathecal administration of baclofen or nusinersen

• Pulmonology/RT: ventilator management, tracheostomy management

Common pediatric rehabiliation related elective opportunities at Children’s Hospital Colorado include but are not limited to the following: 

NeuroICU, Neurology, Orthopedics, Sports Medicine, Genetics, Rheumatology, Pulmonology, Neurosurgery, Palliative Care, Pain, Movement Disorders, Burn, Wound Care, Nutrition, Urology, Center for Inclusion and Disability Engineering (CIDE, formerly known as Assistive Technology Partners, ATP) -- DME.

• Fellows and residents are required to complete a research project and present findings.

• Publication/poster is strongly encouraged.

• Support is available to present at national meetings.

• Active areas of research at CHCO

  • Adaptive sports

  • Clinical trials in onabotulinum toxin use

  • Clinical trials in neuromuscular diseases

  • Concussion / Brain Injury including Abusive Head Trauma outcomes

  • Center for Gait and Movement Analysis

  • MD STARnet

  • National Spina Bifida Patient Registry

  • PICU early mobilization

  • Oncology care

PRM Fellows participate in the GME Quality and Safety Academy through Institute for Healthcare Quality, Safety & Efficiency (IHQSE).  They attend up to 6 half-days sessions (session titles below) to learn QSI principles to apply to a fellow QSI project.  Combined residents can participate in these sessions as well, but have additional QSI training in their residency programs.

• • Patient Safety

  • Applied Patient Safety

  • Quality Improvement & Change Management

  • Acquiring Data to Drive Change

  • Spreading Change Locally and Nationally

  • Coaching and Teaching Quality Improvement

CHCO PRM QSI Projects

• • Patient-Centered Inpatient Rounding

  • PICU Early Mobilization 

Other opportunities to participate in QSI:

• Quarterly Hospital-wide Multidisciplinary Collaborative Case Review

• Quarterly PM&R Department QSI series - fellows present project updates once per year here

• CHCO Pediatrics Rehab Practice Meeting QSI updates: fellows update PRM group on case reviews monthly and QSI project updates every 2 months

• CHCO Quality/Safety Committee - optional

• Fellows and combined residents will have opportunities to teach medical students (medical students from CU and rotating) and CU PM&R residents through clinical/bedside teaching and formal lectures.

• Fellows and combined residents have the opportunity to participate in the Residents and Fellows as Medical Educators Elective rotation that is held twice per year (December, May) if a trainee is interested in education and developing a curricular project.  This is a 3-week elective during daytime work-hours and trainees are not in clinic during the scheduled learning sessions.  If a matched fellow is interested in this elective, notify the PD immediately following the match.

• In 2020-2021, Pediatric Rehab faculty participated in the Faculty Development series in Education led by Mary Jane Rapport, PT, DPT, PhD, FAPTA a series for Department of PM&R Faculty for further training in education, teaching the adult learning and innovative practices in education.