In the photo, from left to right, Amanda Lindenberg, DO, MOT; Sara Liegel, MD; Melissa Villegas, MD; Deanna Jewell, DO; and Lauren Fetsko, DO.
Photo by Kate Feldt/Department of Pediatrics
In September, Amanda Lindenberg, DO, MOT, joined the Department of Pediatrics as an assistant professor in the Division of Developmental Pediatrics and Rehabilitation Medicine. She had recently completed a fellowship in Pediatric Rehabilitation Medicine and knew how fortunate she was to join the department and division.
“There are only about 400 board-certified pediatric rehabilitation subspecialists in the whole country,” Lindenberg noted. “Most medium-sized departments like this one may have only one or two physicians.” With her addition, the Pediatric Rehabilitation Medicine group now numbers five full-time physicians and Michael Ward, MD, associate professor in the division, who works part-time. Such a large group is rare and valuable: six physicians can serve many more patients and address many more conditions.
Pediatric Rehabilitation Medicine is a Physical Medicine and Rehabilitation subspecialty, with a board certification since 2003, that focuses on the prevention, diagnosis, treatment, and management of congenital conditions as well as acquired disabilities in children. Pediatric rehabilitation medicine physicians address each patient as a whole person and how that person’s condition affects daily living. The “system” or “symptom” pediatric rehabilitation medicine physicians treat is function and the impairment of function. Their knowledge and skills are founded on a deep understanding of the life course of disability.
Common congenital conditions that physicians address include cerebral palsy, spina bifida, limb deficiency, brachial plexus injury, developmental delay, and neuromuscular disorders. Acquired conditions they regularly see include traumatic or non-traumatic brain injuries such as stroke or tumors, amputations, and spinal cord injuries. Management includes the evaluation and treatment of muscle tone, mobility, range of motion, communication, activities of daily living, bone health, neurogenic bowel and bladder management, sialorrhea, and community integration. Common interventions include such treatments as prescription of therapies, systemic and focal tone management, evaluation for equipment and bracing, and medical management of Paroxysmal Sympathetic Hyperactivity.
Pediatric Rehabilitation Medicine has been a part of the University of Wisconsin for several years as a subset of the Department of Orthopedics and Rehabilitation. The Pediatric Rehabilitation Medicine program grew with the addition of Sara Liegel, MD, assistant professor, who was hired in 2017, followed in 2018 by Melissa Villegas, MD, assistant professor. In 2020, the Pediatric Rehabilitation Medicine group became a part of the Department of Pediatrics.
In the fall of 2021, two more Pediatric Rehabilitation Medicine physicians joined the group as patient needs continued to expand. Lauren Fetsko, DO, and Deanna Jewell, DO, are assistant professors in the division. This highly motivated group of physicians was determined to offer a wide variety of services to pediatric patients through an increasing number of rehabilitation medicine specialty clinics.
The group’s general Pediatric Rehabilitation Medicine clinics are located in the UW Health 2275 Deming Way Clinic on Madison’s west side, and they see patients in multidisciplinary clinics at American Family Children’s Hospital (AFCH). The multidisciplinary cerebral palsy clinic is located in the Waisman Center, with Villegas serving as clinic director. The group has recently passed the initial stages of being admitted as a member of the Cerebral Palsy Research Network. A nationwide research effort, this network is the largest and most comprehensive network of hospitals and community members working together to improve health outcomes for those with cerebral palsy. Liegel serves as the medical director of the inpatient pediatric rehabilitation unit at AFCH. All of the Pediatric Rehabilitation Medicine physicians work on the inpatient rehabilitation unit at AFCH, see inpatient consults at AFCH, and also provide outreach rehabilitation services for the Short-Term Medical Unit at the Central Wisconsin Center. The Central Wisconsin Center located on the northeast side of Madison is one of three centers run by the Wisconsin Department of Health Services for individuals with intellectual and developmental disabilities. “Patients may come for post-op recovery or after a significant illness/hospitalization to receive medical care and therapy prior to a transition to home,” Liegel explained. “We also see children and adults from the community that come in for an all-around evaluation of medical, nutrition, therapy, or equipment needs.”
“I meet patients and their families in the hospital right after they have sustained an injury or new life-changing diagnosis that impedes their function,” Liegel continued. “They can be brain injuries due to motor vehicle accidents, spinal cord injuries, strokes, or after a specific surgery that requires rehab, such as a tumor resection or hemispherectomy for seizure management. Patients sometimes need intensive rehab before they can go home.”
During their inpatient time, the physicians also help manage conditions such as paroxysmal sympathetic hyperactivity, hypertonicity, pain, arousal, and prehabilitation discussions on their consult service.
“Kids can come to our clinics a few different ways,” Villegas said. “They are typically referred by their primary care physician, developmental medicine, or neurology for a variety of reasons that can include new diagnoses of cerebral palsy or other concerns about development and management of high muscle tone, including spasticity and dystonia.”
Some new patients transition from the Waisman Newborn Follow-up clinic once they graduate. Some patients come based on their diagnosis, such as those with spina bifida. Jewell and Fetsko are both specialists in the spina bifida clinic in AFCH, where Fetsko also serves as the clinic’s medical director. She also sees patients in the cerebral palsy clinic. Jewell is a part of the neuromuscular and limb differences clinics. Lindenberg will be working in a variety of clinics including neuro-oncology, and brachial plexus injury. Fetsko, Jewell, Lindenberg, and Villegas all perform botulinum toxin procedures for spasticity management. These occur at Deming Way and in the Pediatric Sedation Clinic at AFCH.
Jewell started new clinics at the Deming Way site for children with congenital limb deficiencies as well as for children with acquired amputations. The multidisciplinary clinic includes Pediatric Rehabilitation Medicine, Plastic Surgery, and Occupational Therapy.
Fetsko noted that she was drawn to the position because it was within a pediatrics department. “I knew I would have the ability to collaborate closely with other specialists to best serve the patients in my clinic.” She noted that the division chief, professor Maria Stanley, MD, and everyone in the group was “focused on supporting our professional growth in addition to our clinical work.”
Beyond the multidisciplinary clinics, each physician sees patients with a vast array of diagnoses that are associated with functional impairment in their general rehabilitation clinics. In addition, these physicians help patients get involved in the community with activities such as adaptive sports and performing arts.
“Pediatric Rehabilitation Medicine physicians focus on quality of life and help patients and their families achieve their goals,” Jewell said. “Now that our group is larger, we have improved access for patients in our clinics.” The group looks forward to collaborating with primary care providers and specialists to support their patients.