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Moving Forward

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LOUISVILLE Kathrin LaFaver, MD, has always been amazed with the human brain. And now, as the Raymond Lee Lebby chair of Parkinson’s disease research and the director of the U of L Physicians–Parkinson’s Disease and Movement Disorders Clinic, she is engrossed in it every day.

“To me it’s the most fascinating thing, and it’s what makes us human – how individuals arrive at certain conclusions and thought processes, how our psychological makeup and specific influences change people’s lives,” states LaFaver. “I have always been drawn to the field of neurology and wanted to help people that are affected by disorders of the brain.”

LaFaver is most definitely living out her dream by taking care of over 2,000 patients day in and day out who are fighting against Parkinson’s disease, tremor, dystonia, Huntington’s disease, and other movement disorders at the U of L Parkinson’s and Movement Disorders Clinic.

LaFaver joined U of L in 2013 and became the director of the clinic last year. Her experience is vast, including a neurology residency from Mayo Clinic, a movement disorders fellowship from Beth Israel Deaconess Medical Center in Boston, and a two-year stint in the Human Motor Control lab at the NIH Clinical Center in Bethesda, Md., with Mark Hallett, MD.

The majority of patients evaluated and treated at the Movement Disorders Clinic suffer from Parkinson’s disease, but the center serves patients with a variety of movement disorders including tremor, dystonia, chorea, tics, ataxia, and gait disorders. “The field of movement disorders is exciting because we have many options for treatment available and always strive to improve the quality of life of patients in our care” says LaFaver. Interventions include medical management, botulinum toxin injections, deep brain stimulation surgery, and other forms of invasive therapy for movement disorders.

The center has a multidisciplinary team philosophy and works closely with physical and occupational therapists, speech therapists, psychologists, and social workers. Just named a Center of Excellence for Huntington’s disease, the clinic offers comprehensive care in treating the disorder, which is a genetic condition that often requires psychological and physical therapy in addition to medical treatments. “Our goal is to provide all patients with movement disorders with the best care possible,” states LaFaver. “Our team is ready to listen to patients and families, determine their needs, and help them reach their treatment goals. Whatever the need may be, we will try to make it a reality.”

One of those reality makers is Diane Stretz-Thurmond, case manager and program coordinator with Frazier Rehab Institute, part of KentuckyOne Health, which provides rehab services as a partner in the Movement Disorders Clinic. As a certified rehabilitation counselor with a master’s in educational psychology and counseling from U of L, Stretz-Thurmond joined Frazier Rehab Institute in 2007 at the inception of the Movement Disorders Clinic and assists patients and their families with a plethora of resources and support within the community.

“My main role is helping patients and their families navigate the healthcare system, and truly understand the social services available to them,” states Stretz-Thurmond. “I try to offer information and counseling, as well as provide the educational and psychological support needed in dealing with these life-changing chronic conditions.”

Stretz-Thurmond has just been named a social worker for the Huntington’s Disease Clinic, as well as the clinic coordinator for the Motor Reprogramming (MoRe) Clinic, which just opened this past January. The MoRe Clinic is an interdisciplinary, inpatient rehabilitation program for patients with functional movement disorders offered at Frazier Rehab Institute. Functional movement disorders may be caused by psychological stress or other adverse events in patients’ lives and can lead to chronic disability if not treated adequately. The program uses strategies aimed at improving patients’ motor symptoms, regaining control over abnormal movements, and learning better coping skills. The program has been successful for many patients in regaining normal motor control and is drawing patient referrals from several states outside of Kentucky.

Victoria Holiday, MD, also a member of the Movement Disorders Clinic team, is a graduate of the University of Kentucky College of Medicine and underwent a movement disorders fellowship at Oregon Health & Sciences University in Portland, Ore. Holiday joined the practice recently as the medical director of the deep brain stimulation program and to provide extra help for the clinic’s expanding patient volume.

Deep brain stimulation (DBS) surgery is a neurosurgical intervention used to treat complex patients with essential tremor, Parkinson’s disease, and some forms of dystonia. Joseph Neimat, MD, chairman of neurological surgery and specialty trained functional neurosurgeon, works with Holiday and the rest of the Movement Disorders Clinic, to provide state of the art care for patients in the area. DBS is a device implanted in the brain to manage neurological symptoms that have been difficult to manage with medication alone. U of L is one of just a few sites in the region that provide this type of service in an ever-evolving field of technological advancement.

“We try to address movement disorders from all angles,” states Holiday. “We make sure the patients have all the resources they need, aside from the medications that we prescribe, because it’s so much more than that in order to take care of a movement disorder patient.”

The clinic is also committed to research in the field of movement disorders and is a study site for the Parkinson’s and the Huntington’s study groups. Patients currently have the opportunity to be involved in potentially disease-slowing treatment trials for early stages of Parkinson’s and Huntington’s disease. With the research facilities on site, patients are able to be treated in the clinic as well as participate in research. The connection is the key.

“Our patients spend a lot more time in research because they have built strong relationships within the clinic and know these individuals are fighting to find a cure,” adds Stretz-Thurmond. “It’s so exciting, especially for folks that have children because that’s who they’re really here for.”

Clinical research nurse Annette Robinson, RN, has been conducting research studies in the U of L Neurology Department for seven years. Robinson is currently collaborating with U of L neurologist Robert Friedland, MD, on an investigator initiated study exploring the microbiota in the gut and nose in patients with Parkinson’s disease. The importance of a healthy bacteria flora in the gut has recently been recognized to be of importance for neurodegenerative disorders such as Parkinson’s disease, and U of L is hoping to contribute in unraveling some of the unknown factors influencing the development of the disease.

The Parkinson’s Buddy Program is another venture breaking new ground. A partnership between the Parkinson’s Support Center of Kentuckiana, U of L Medical School, and the Movement Disorders Clinic, the Parkinson’s Buddy Program pairs first year medical students with Parkinson’s patients over the course of one year for an in depth look into what it really means to suffer from a neurodegenerative disorder.

“The program gives a face to the disease, instead of just learning textbook knowledge,” states LaFaver. “I always tell students that no matter what specialty they’ll go into later, this is a good opportunity to learn how to create a connection with patients and be supportive of someone, not just be in charge of prescribing medications.”

And that’s just the beginning of new and exciting advances in the clinic. The Bill Collins Parkinson’s Education Center, located in the lobby of Frazier Rehab, is dedicated to enhancing education and outreach centered on Parkinson’s disease and related conditions. Made possible by a large donation from the Bill Collins family through the Jewish Hospital & St. Mary’s Foundation, the center will offer a monthly speaker series, weekly exercise classes, and special events, all free of charge for patients and their families.

LaFaver makes it clear she wants to do what’s best for her patients and work hand-in-hand with providers in the community. “Referring a patient to us doesn’t have to mean losing a part of that patient’s care,” she says. “We’re happy to see someone for a second opinion just to confirm they’re on the right track or to make suggestions about what else can be done. The goal is for the patient to receive the best treatment possible, and we will do whatever it takes for that to happen.”

Our mission is to be a referral center for movement disorders in the region, to provide the best clinical care, offer opportunities to participate in research, and provide patient-centered educational opportunities. It’s the trifecta of care.– Dr. Kathrin LaFaver

We provide a really well-rounded level of care, from the beginning to the end of a patient’s disease, and make an effort from a research perspective to not only help quality of life, but also help prolong life and slow the disease process down.– Dr. Victoria Holiday