RUSK Insights on Rehabilitation Medicine: Recent Episodes
Dr. Thomas Elwood
RUSK Insights on Rehabilitation Medicine is a top podcast featuring interviews with faculty and staff of RUSK Rehabilitation at NYU Langone Medical Center. These podcasts are being offered by RUSK, one of the top rehabilitation centers in the world. Your host for these interviews is Dr. Tom Elwood. He will take you behind the scenes to look at what is transpiring in the exciting world of rehabilitation research and clinical services through the eyes of those involved in making dynamic breakthroughs in health care.
Dr. Kellie Owens, is an assistant professor in the section of medical ethics at NYU Grossman School of Medicine. She's a sociologist and empirical bioethicist studying how digital technologies are woven into the fabric of healthcare and society and how governance structures can better support those affected by technological change. She also leads the responsible AI review process for the Division of Applied AI Technologies and with the IRB.
Part 1
Dr. Owens began by indicating that by AI, she means any computer system that's designed to perform tasks that typically require human intelligence, which could be things like recognizing patterns, interpreting data, making predictions, or even making decisions. In the health care context, that means AI systems that analyze complex. medical data that assist with diagnosis or risk prediction that can help automate some routine processes. She wants to talk mostly about the less fun side, the sort of limitations and potential harms that we have to be aware of to make sure that we're using this technology responsibly. Her focus today is on the people and process side of AI integration and not the technical side. Examples raised today focus specifically on health care implementation. She indicated that there are increasing calls from AI developers and users and regulators and folks in ethics to increase evidence standards for implementing new AI systems. The majority fall outside of FDA regulation, which means they really haven't undergone any formal review for safety and efficacy. The stated goals of ambient documentation, ambient scribes, are to give doctors more time with their patients or more time with their families. We are going to have to vigorously defend that time savings. Otherwise, that free time will be used in plenty of ways that don't touch the problem of physician burnout at all. She wants to be really intentional about how we think about time savings and efficiency regarding AI.
Dr. Capozzi is a board-certified orthopedic surgeon with specialty training in joint replacement surgery. After receiving his bachelor's degree from Columbia University, he obtained his medical degree from Mount Sinai School of Medicine. He completed his orthopedic training at Mount Sinai and the Otto Alfrank Adult Joint Reconstructive Fellowship at the New England Baptist Hospital in Boston. In addition to performing hip and knee replacements, Dr. Capozzi specializes in difficult revision surgery, utilizing the newest techniques in joint reconstructive surgery.
Part 2 Figuring out what happened took them less than a day because the cause of the crash was fuel exhaustion. The plane ran out of gas. Why it happened took about 15 months to figure out all that took place, how a plane runs out of fuel on its approach. So, what transpired? The crash analysis in the NTSB report indicates that there were significant communication errors. Keep this in mind when dealing with matters in the hospital. When there's really an urgent situation, you're very mindful of how you're conveying that urgency. To air traffic control, saying that we're running out of fuel doesn't mean anything significant. It's like if I'm in the operating room and I say that a patient's blood pressure is a little low. Well, pressure is always a little low. There's blood loss, there's anesthesia, there's pain medication, we're operating. The pressure is expected to be low. But if the patient's crashing, I would assume there'd be more sense of urgency in that statement. It is called mitigated speech when it downplays or sugarcoats or when wanting to be polite or the speaker is ashamed, embarrassed or trying to be deferential to authority. So doing away with mitigated speech, doing away with ambiguous terminology, and really being clear when there's a patient safety concern that needs to be brought up. Again, this is classic for an operating room.
Dr. Capozzi is a board-certified orthopedic surgeon with specialty training in joint replacement surgery. After receiving his bachelor's degree from Columbia University, he obtained his medical degree from Mount Sinai School of Medicine. He completed his orthopedic training at Mount Sinai and the Otto Alfrank Adult Joint Reconstructive Fellowship at the New England Baptist Hospital in Boston. In addition to performing hip and knee replacements, Dr. Capozzi specializes in difficult revision surgery, utilizing the newest techniques in joint reconstructive surgery.
Part 1 This presentation is about tenets of high reliability organizations involving modes of communication errors and communication training. When looking at studies of large organizations that perform complex and dangerous tasks, a couple of principles stand out that have some common themes. One is that the work tends to be highly technical and inherently dangerous. Very often there are high time constraints and time pressures that entail rushing to complete work in very tight environments, which sounds like any of our operating rooms or ICUs. At some point, most of these entities are going to fail spectacularly. The government defines a high-reliability organization as one that can operate in complex, high-hazard domains for extended periods of time without serious accidents or catastrophic failures, which pretty much defines what we do every day in the hospital. These organizations tend to have five key principles that define all of them the same way. One is a deference to expertise. Second is a reluctance to simplify. Third is a sensitivity to operations. Fourth is a commitment to resilience. Fifth is a preoccupation with failure. Two not-too-distant past failures are interesting. One is the Chernobyl nuclear disaster and the second is the Avianca plane crash on Long Island.
Dr. Mahya Beheshti is a physician-scientist at Rusk Rehabilitation, NYU Langone Health, where she works at the intersection of medicine and engineering to advance neurorehabilitation and assistive technologies. Her research focuses on neurorehabilitation, human–machine interfaces, EEG-based pattern recognition, and wearable technologies. She is particularly interested in how eye–hand coordination and multimodal neurophysiological signals can inform the development of intelligent rehabilitation systems for individuals with stroke, multiple sclerosis, and vision impairment. Fascinated by the powerful synergy between medicine and engineering, she earned her medical degree from Gulf Medical University and she is pursuing a part-time Ph.D. in mechanical and aerospace engineering while continuing her clinical and scientific work at Rusk.
The discussion included the following topics: reason for choosing to do research in the area of visual impairment rehabilitation; research involving centers on sensory–motor coordination; key research findings; what is missing when doing traditional motor control assessments; how subtle timing disruptions between the eyes and hands affect daily functioning; and new investigations that may be undertaken in the next 12 months.
Dr. Sofiya Prilik is Clinical Director of Cardiopulmonary Rehabilitation and Transplant Rehabilitation and Clinical Assistant Professor of Physical Medicine and Rehabilitation at the NYU Rusk Rehabilitation department. Dr. Greg Sweeney is a Clinical Instructor in the Department of Rehabilitation Medicine at the NYU Grossman School of Medicine.
Part 2
The discussion included the following topics: phases of cardiac rehabilitation; impact of mobile apps and wearables; common barriers that patients face in obtaining care; challenges aligning cardiac care with other comorbidities; provision of virtual services; research that led to modifying health care delivery models; evidence that patients who participate in rehabilitation have better health outcomes; role of government in expanding access to rehabilitation; and possible ways of making cardiac care more accessible.
Dr. Sofiya Prilik is Clinical Director of Cardiopulmonary Rehabilitation and Transplant Rehabilitation and Clinical Assistant Professor of Physical Medicine and Rehabilitation at the NYU Rusk Rehabilitation department. Dr. Greg Sweeney is a Clinical Instructor in the Department of Rehabilitation Medicine at the NYU Grossman School of Medicine.
Part 1
The discussion included the following topics: nature of a webinar to be offered on June 12 at NYU on the topic of cardiac rehabilitation; measuring whether the webinar achieves its objectives; outcomes or activities attendees can be expected to undertake afterward; kinds of health conditions and problems that qualify patients to be eligible to participate in cardiac rehabilitation; role played by disparities in obtaining health care; and kinds of patients that benefit most from cardiac rehabilitation.
Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury.
He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions.
Part 3
The discussion included the following topics: measures used to monitor patient safety, quality of care, and patient satisfaction during the transition period; approaches to dealing with staff burnout; challenges that continue to exist after 18 years when positive outcomes proved highly difficult to achieve; and the likelihood that any new clinical divisions will be created at Rusk or the number of residency slots and accredited fellowships will be increased.
Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury.
He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions.
Part 2
The discussion included the following topics: Dr. Whiteson was asked if there is any kind of new knowledge he may have to acquire to be successful in his upcoming role and how he is obtaining it; he also was asked how he intends to preserve Dr. Flanagan's accomplishments while balancing them with the development of new priorities; and short-term and long-term challenges involved in incorporating AI in the work at Rusk.
Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at Rusk. He provides care for patients with physical and cognitive disabilities. He specializes in treating those who are recuperating from a stroke or brain injury.
He is accompanied in this interview by Dr. Jonathan Whiteson who holds the rank of professor in both the Department of Medicine and the Department of Rehabilitation at Rusk Rehabilitation. Dr. Whiteson's skills and expertise focus on patients recovering from coronary and lung conditions.
Part 1
The discussion included the following topics: when they both began working at Rusk; how Rusk looked 18 years ago (e.g., amount of external research funding); potential upsides and downsides of selecting an insider to take over leadership responsibilities versus bringing in an outsider; when planning for the transition was started; and the kinds of engagement with groups that could be affected by this transition, such as teaching faculty, clinicians, patients, and labor unions.
Ted Joyce is a Professor of Economics at Baruch College and the Graduate Center, the City University of New York and a Research Associate in the National Bureau of Economic Research's program in Health Economics. He has published extensively in the area economic demography and reproductive health policy. His work on abortion policy has appeared in the Journal of Political Economy, New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Human Resources and the Review of Economics and Statistics. His most recent work is on the evaluation of programs to improve the academic outcomes of low-income students in higher-education. Dr. Joyce is on the Editorial Board for the Journal of Policy Analysis and Management.
Part 2
The discussion included the following topics: the speed at which change can occur; AI impact on higher education institutions and academic health science centers; trends regarding how AI and online learning might influence one another; and emerging ethical questions that must be addressed.
Ted Joyce is a Professor of Economics at Baruch College and the Graduate Center, the City University of New York and a Research Associate in the National Bureau of Economic Research's program in Health Economics. He has published extensively in the area economic demography and reproductive health policy. His work on abortion policy has appeared in the Journal of Political Economy, New England Journal of Medicine, the Journal of the American Medical Association, the Journal of Human Resources and the Review of Economics and Statistics. His most recent work is on the evaluation of programs to improve the academic outcomes of low-income students in higher-education. Dr. Joyce is on the Editorial Board for the Journal of Policy Analysis and Management.
Part 1
The discussion included the following topics: does tension exist between AI and online learning; whether AI transforms online learning into something more effective; role played by AI in measuring student performance; and determining certainty that the work produced by a student is by that individual.
Both corticosteroid injection and PRP demonstrate initial efficacy where steroid appears to provide superior pain relief, as you can see here going down within the first four weeks, whereas PRP demonstrated longer lasting effect, as you can see that the VAS score is actually going down all the way up to 24 weeks, where the corticosteroid injections kind of peak at four weeks, and then slowly the pain comes back to its original level by 24 weeks, maybe around, even like a 12 weeks' time mark. So, both steroid and PRP are considered safe and an effective treatment for the GTPS. But in more recently years, it seems like PRP has a better efficacious indication over CSI for the treatment of GTPS. In a recent system review, it was concluded that PRP seems to be safe and effective when treating degenerative meniscus tears. However, additional studies are warranted. It seems like I'm going to sound like a broken record here, but truly understanding clinical implications of PRP on meniscus treatment due to heterogeneity of the studies reviewed. Similarly, in a recent review, although PRP appears to yield improvements in clinical outcomes. its clinical significance remains uncertain given, again, heterogeneity of the studies. Regarding knee ligament injuries, injection treatment is typically not common for knee ligament related injuries, but injection therapies have a role in reflective cases or when there are significant functional limitations due to pain.
Introduction by Dr. Francis Lopez.
Q&A followed Part 2.
Dr. Haruki Ishii discussed a review paper on the risks and benefits of corticosteroid injections versus plasma injections in patients. The aim of this review was to compare the evidence for clinical applications of these injectates as a treatment for a variety of musculoskeletal conditions in patients. Platelet-Rich Plasma (PRP) injections for clinical use as discussed here, is defined as autologous plasma, extracted from minimally processed blood, and then containing activated platelets. So PRP delivers concentrated growth factors and cytokines acting as extra cell signaling molecules at the side of the injection. Key clinical applications of PRP include tendinopathies, osteoarthritis, muscle injuries, and then post -surgical healing treatment. The first study looked at is one published in 2021, a systemic review article. What it showed was that the corticosteroid injection yielded significant superior functional recovery and in pain compared with the PRP injections for rotator cuff lesions during the short -term follow-up period. He referred to an article that looked at the difference between a corticosteroid injection and a PRP injection for frozen shoulder patients, involving the functional outcome between those two injectates.
Introduction by Dr. Francis Lopez.
Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology.
The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings.
Part 2
Eighty percent admittedly is an arbitrary number, but it's one that most exercise scientists use as a sort of the minimum threshold for deeming someone adherent to the protocol. There were no differences in pain reduction between those with neuropathic versus musculoskeletal pain, but the small ends, small sample sizes for those two groups, make it difficult to really confirm that there is no difference in exercise outcomes for those two groups. She thinks we need to look at that further with bigger samples for each type of pain. Given the pragmatic nature of the trial that we let people exercise on their own in the community, she thinks this speaks to the feasibility of using exercise as a pain self-management strategy, but with the caveat that it's likely not going to be effective for everyone. Fifty percent of people with spinal cord injury report no leisure time physical activity whatsoever. In other words, no activity that could potentially improve cardiorespiratory fitness or muscle strength. And that's not the fault of people with spinal cord injury. Factors that influence physical activity don't just rest within the person, but they rest within society.
Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology.
The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings.
Part 1
One of her objectives is to present recent data showing the physical and mental health benefits of exercise for adults with spinal cord injury. She wants to introduce exercise guidelines for adults with SCI. Starting with the benefits of exercise from a mental and physical health perspective, probably the best two areas, best two outcomes for which there is evidence are improving insulin sensitivity and cardiovascular disease risk in this population. The fitness guideline stipulates that to improve cardiorespiratory fitness and muscle strength, adults with SCI should do at least 20 minutes of moderate to vigorous intensity, aerobic activity twice per week, and strength training exercises twice per week. The guideline for cardiometabolic health stipulates that a minimum of 30 minutes of moderate to vigorous intensity physical activity is required three times per week. She discussed how exercise improves well-being. She also talked about exercise in chronic pain. She described the Epic SCI trial, a pragmatic, randomized controlled trial, testing the effects of exercising according to the scientific SCI exercise guidelines on SCI chronic pain.
With over 20 years of extensive clinical experience, Dr. Kedzierska is a Board Certified Clinical Specialist in Neurologic Physical Therapy from the American Board of Physical Therapy Specialties. She serves as a faculty member of an Accredited Physical Therapy Neurology Residency Program. She mentors department staff on assessment/treatment for related diagnosis. She has presented in local and national conferences and is a published author in the ANPT newsletter and Brain Injury Journal. She received her Master's Degree in Physical Rehabilitation in Poland, Advanced Master's Degree from NYU and a doctorate degree from Northeastern University serving a variety of populations.
Dr. Fay is a board certified Neurologic Clinical Specialist through the American Board of Physical Therapy Specialties and is a member of the faculty of the Neurological Residency program at Rusk Rehabilitation at NYU Langone Medical Center. She is an active member of the American Physical Therapy Association (APTA), and has served on the APTA's Vestibular EDGE Task Force; a select group of therapists chosen to review measures designed for assessment and treatment of patients with vestibular deficits. She has lectured at both local and national conferences on Vestibular Rehabilitation and is a published author in the Journal of Pediatric Physical Therapy. Her areas of special interest include vestibular rehabilitation in individuals with symptoms of dizziness.
Part 1: The interview included the following topics: common vestibular disorders; challenges treating patients with vestibular disorders; other specialists involved in providing treatment; overlapping symptoms; advances in diagnosis; distinguishing between peripheral and central vestibular disorders; patient compliance; and involvement of family members in treatment.
Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45.
Part 2
The discussion included the following topics: challenges that patients face during the recovery period; factors determining treatment outcomes; preventing concussions; composition of the interdisciplinary treatment team; and the role of technology in treatment interventions.
Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45.
Part 1
The discussion included the following topics: age groups of patients receiving treatment; types of cases treated; distinguishing medical terms for brain injuries; common symptomology; patient journey from initial assessment through recovery; and collaboration with patients' families.
Dr. Zhu is a clinical assistant professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. Her clinical interests include the management of a range of symptoms associated with cancer and its treatment, including weakness, pain, neuropathy, and limited range of motion. Throughout her career, she has been dedicated to proactive healthcare engagement, working closely with a team to provide comprehensive care. Her practice emphasizes patient education, along with helping individuals understand the causes of their symptoms and the changes their bodies are undergoing. She received her medical degree from Rutgers New Jersey Medical School. She then went on to complete a PM&R Residency at NYU Grossman School of Medicine and a Cancer Rehabilitation Fellowship at the University of Miami.
Part 1 The discussion included the following topics: primary purpose of this offering, educational objectives. Summit format, target audience, topics to be covered, and expected outcomes for participants.
Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines.
Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association.
Part 2
The discussion included the following topics: quality measures used to determine if desired outcomes are being achieved; challenges or potential downsides associated with a transition from pediatric to adult care; integration of artificial intelligence into pediatric rehabilitation; and current pediatric research conducted at NYU.
Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines.
Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association.
Part 1
The discussion included the following topics: kinds of health problems and conditions treated; age range of patients; clinical guidelines and evidence-based treatment protocols used; holistic approaches to treatment; collaboration with families of patients; and composition of the health care team
Dr. Ira Rashbaum specializes in mind–body care and treatment of patients who have tension myoneural syndrome, previously known as tension myositis syndrome, a condition that causes pain and symptoms associated with tension and stress factors. His expertise is in diagnosing and treating individuals who have psychosomatic pain disorders. He has an extensive list of publications, national meeting presentations, and media appearances. As study guide committee chairperson of the American Academy of Physical Medicine and Rehabilitation, he led a project that compiled information on advances in rehabilitation medicine for more than 10,000 physicians worldwide. This position placed him at the forefront of all aspects of rehabilitation medicine.
Dr. Samuel Mann is a physician and researcher, specializing in hypertension. He has spent the past 40 years as a specialist in this condition, combining patient care, research and teaching at his institution. As a researcher, he has published 65 articles in medical and psychology journals, along with 10 book chapters on hypertension, and three books. His most recent book is “Hidden Within Us; A Radical New Understanding of the Mind-Body Connection (2022). He emphasizes that in most patients, hypertension is not a mind/body disorder. But when it is, it is not related to emotions, such as anger and anxiety that patients report, but to powerful repressed emotions, often related to a past history of stress or trauma, that are completely hidden from conscious awareness.
Part 2
The discussion included the following topics: accuracy of adults in recalling traumatic events that may have occurred in childhood, communicating with patients reluctant to discuss emotional aspects other than physical health ailments; possible distinctions among patients in different demographic groups, non-pharmacologic kinds of treatment, and status of research aimed at understanding the connection between emotions and physical health problems.
Dr. Ira Rashbaum specializes in mind–body care and treatment of patients who have tension myoneural syndrome, previously known as tension myositis syndrome, a condition that causes pain and symptoms associated with tension and stress factors. His expertise is in diagnosing and treating individuals who have psychosomatic pain disorders. He has an extensive list of publications, national meeting presentations, and media appearances. As study guide committee chairperson of the American Academy of Physical Medicine and Rehabilitation, he led a project that compiled information on advances in rehabilitation medicine for more than 10,000 physicians worldwide. This position placed him at the forefront of all aspects of rehabilitation medicine.
Dr. Samuel Mann is a physician and researcher, specializing in hypertension. He has spent the past 40 years as a specialist in this condition, combining patient care, research and teaching at his institution. As a researcher, he has published 65 articles in medical and psychology journals, along with 10 book chapters on hypertension, and three books. His most recent book is “Hidden Within Us; A Radical New Understanding of the Mind-Body Connection (2022). He emphasizes that in most patients, hypertension is not a mind/body disorder. But when it is, it is not related to emotions, such as anger and anxiety that patients report, but to powerful repressed emotions, often related to a past history of stress or trauma, that are completely hidden from conscious awareness.
Part 1
The discussion included the following topics: definitions of repressed and suppressed emotions;
common emotions that patients tend to repress; extent to which the biomedical model may have to be augmented or replaced as a means of having a greater emphasis on emotions and their unrecognized relationship to some physical health conditions; strength of evidence supporting a connection between emotions and physical health conditions; and the role played by emotional trauma on the onset of various physical health conditions.
Dr. Ronald (James) Cotton who is an electrical engineer, neuroscientist, and physiatrist working as a physician scientist at Shirley Ryan Ability Lab, and assistant professor in the Northwestern University Department of Physical Medicine and Rehabilitation.
We have this one paper where we can use diffusion models and generate a bunch of probabilistic samples of movements and they constrain them by what we see in the cameras and have shown that we can actually estimate the confidence and the uncertainty in a reliable way. He indicated that we can use something called the myoskeleton that allows us to track all joints in the body down to the individual fingers. Our Portable Biomechanics Laboratory is kind of a combination of a smartphone app that records the rotation and movement of the phone itself. He discussed how he would like to establish validity as a predictive biomarker. He asked what do we actually want and what do we mean by precision rehabilitation? In his mind, the best formalism of it is something called the optimal dynamic treatment regime, which essentially is some kind of function, probably a learned function that looks at all the health information, all the biomarkersof an individual at any point in rehabilitation, kind of condenses that into a phenotype, and then predicts what is the next intervention that should be given. He spoke briefly about a case studythat applies to another line of research in his lab, which is EMG-based biofeedback and also about Next Generation Brain Machine Interface Chips.
Dr. Ronald (James) Cotton who is an electrical engineer, neuroscientist, and physiatrist working as a physician scientist at Shirley Ryan Ability Lab, and assistant professor in the Northwestern University Department of Physical Medicine and Rehabilitation.
PART 1 All of us probably believe and understand that how someone moves and walks is hugely informative. People are exuding all this information about their health status, but we don't measure it and obviously a core treatment of rehabilitation is how people move. We don't actually routinely measure that and the reason is that we need better, more clinically accessible tools to measure the clinically meaningful things about movement and then use those to guide our treatment programs. We've never really had the tools. So, I'm going to discuss a plurality of methods we've been developing in my lab, including tools that use multi-view video, monocular video from a smartphone, for example, as well as sensor technology and then how we're trying to extract clinically meaningful metrics from these methods. A challenge we've been addressing in the lab is that the tools developed by the AI community don't necessarily solve the problems that we need or produce clinically relevant outputs. It's really important to have confidence intervals on what you measure. If we're going to use anything for decision making, we have to know we can trust it. A problem with a lot of computer vision algorithms is they don't provide anything like confidence intervals. Even if they pretend to, they're often uncalibrated and unreliable.
Dr. Steven Flanagan, a nationally renowned expert in the field of traumatic brain injury (TBI), has worked at the Rusk Rehabilitation Institute at NYU Langone Health since 2008. He serves as the Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. A former President of the American Academy of Physical Medicine & Rehabilitation (PM&R), he is certified by the American Board of PM&R (Brain Injury Medicine). A graduate of the University of Medicine & Dentistry of New Jersey, he completed his medical residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation.
Part 3
The discussion covered the following topics: social prescribing, artificial intelligence, reducing length of hospital stay, hospital readmission of patients, and implications of an obesity epidemic.
Dr. Steven Flanagan, a nationally renowned expert in the field of traumatic brain injury (TBI), has worked at the Rusk Rehabilitation Institute at NYU Langone Health since 2008. He serves as the Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. A former President of the American Academy of Physical Medicine & Rehabilitation (PM&R), he is certified by the American Board of PM&R (Brain Injury Medicine). A graduate of the University of Medicine & Dentistry of New Jersey, he completed his medical residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation.
Part 2
The discussion covered the following topics: Rusk’s interprofessional approach to patient care, future hiring needs, health promotion efforts to enhance health of staff, preparing Rusk residents for the future in health care, and putting patients first.
Dr. Steven Flanagan, a nationally renowned expert in the field of traumatic brain injury (TBI), has worked at the Rusk Rehabilitation Institute at NYU Langone Health since 2008. He serves as the Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. A former President of the American Academy of Physical Medicine & Rehabilitation (PM&R), he is certified by the American Board of PM&R (Brain Injury Medicine). A graduate of the University of Medicine & Dentistry of New Jersey, he completed his medical residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation.
Part 1
The discussion covered the following topics: his involvement at Rusk in patient care, research, and professional organizations; impact of COVID on Rusk; traumatic brain injury biomarkers; and recruitment and retention of health professionals.
Dr. Molly Fuentes is medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital. Dr. Fuentes is an assistant professor of rehabilitation medicine at the University of Medicine. She also is a pediatric physiatrist. She completed her undergraduate degree at Stanford University and is a graduate of the School of Medicine at the University of Michigan. She completed her residency at the University of Washington and later completed a pediatric fellowship at the Seattle Children’s Hospital. She then completed a research fellowship in pediatric injury at the Harborview Injury Prevention and Research Center at the University of Washington. She is the medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital.
Part 2
She indicated that the Indian Health Service per capita receives half of what Medicaid receives. Treaty-bound trusts for providing health care are chronically underfunded. The Indian Health Service operates under a funding cap, which is annually appropriated. In contrast, Medicare and Medicaid are entitlement programs. She then returned to looking back at the injury-equity framework. She wanted to dive into the pre-event phase factors for native children and teens. An example pertains to motor vehicle injuries. Tribal sovereignty means that tribal laws are what is important to safety on reservations roads, e.g., speed limits and seat belt use. She described various programs that aim to improve safety on tribal roads. She then discussed the post-event phase involving rehabilitation and the golden hour that affects health outcomes. Where native people mostly reside in the U.S., there are fewer trauma centers. A related topic is models of access to health care services. The acceptability of these services by patients is a key element in the quality of health care provided. High rates of health uninsurance affect this population negatively.
Dr. Molly Fuentes is medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital. Dr. Fuentes is an assistant professor of rehabilitation medicine at the University of Medicine. She also is a pediatric physiatrist. She completed her undergraduate degree at Stanford University and is a graduate of the School of Medicine at the University of Michigan. She completed her residency at the University of Washington and later completed a pediatric fellowship at the Seattle Children’s Hospital. She then completed a research fellowship in pediatric injury at the Harborview Injury Prevention and Research Center at the University of Washington. She is the medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital.
Part 1
Dr. Fuentes described her life experiences that influenced her choice of a career in the area of pediatric disability. In this presentation, she wanted to: review the injury epidemiology literature for American Indian and Alaska Native children and teens, identify some historical traumas that impact native people, recognize the utility of the injury-equity framework, the international classification of functioning disability and health model, conceptualize rehabilitative care, and describe some barriers to rehabilitation care. A health disparity is just that difference in health status between population groups. A health disparity becomes an inequity when that disparity is due to systematic differences in social, economic, environmental, or health care resources. There is a health care inequity when there is a difference in access to health care utilization or receipt of health care services. Looking specifically at disability and functional difference among American Indian and Alaska Native children, there really is not that much published literature on the prevalence of disability in this population. Dr. Fuentes concluded Part 1 by discussing historical relationships between Native American tribes and the federal government, which have had a significant deleterious impact on individual and community health status of these individuals. For example, boarding schools or residence schools represent another kind of push in the direction of forced assimilation where traditional practices were punished.
Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion. Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion. Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field.
Part 2
We call them psychobiotics because these specific probiotics actually are helping the targeting of treatment of things we are trying to do.) Next, we are going to discuss nutritional support of these patients. She discussed the role of nutritional supplements, such as Vitamin E. The brain requires high levels of Vitamin C after a traumatic brain injury, It is a potent antioxidant. Magnesium levels drop acutely right after a concussion. It reduces stress and promotes relaxation. It helps in sleeping. She identified which magnesium supplements should be used. She furnished information about jockeys who are at a high risk for experiencing concussions. Additionally, in order to meet requirements in competition, many of them starve themselves to arrive at their goal weight. They talk openly about their eating disorders. Another topic covered in her presentation is mitochondria and fatigue. She also indicated the use of various alternative and complementary substances.
Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion. Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion. Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field.
Part 1
Today’s topic is something none of us got in medical school. What makes her successful in treating her patients is having this approach, sort of a 180-360 approach to nutritional status among the head-neck , vestibular balance, and everything else we do. When a concussion occurs, we often have disruption of the blood-brain barrier. There also is inflammation. Ultimately, there can be cell death. We have an opportunity for nutritional repair in concussions. There is an energy crisis in the brain. We need to increase the brain’s need for anti-inflammatory and antioxidant nutrients. We will discuss in this presentation how to get that into a person’s brain or diet and look at why diet matters.
Avery Menaker is a senior occupational therapist at NYU Rusk Rehabilitation. She is certified as both a stroke rehabilitation specialist and a brain injury specialist. She co-leads an initiative at NYU to bring high intensity practice to patients participating in occupational therapy.
Faye Bronstein is the inpatient rehabilitation clinical specialist at Rusk Rehabilitation. She is board certified in neurology, geriatrics, and physical therapy, and has led initiatives to bring high intensity training practice into the NYU inpatient setting over the past three years. The following topics were among those discussed in the interview: how high intensity training differs from traditional therapy approaches and what its benefits are; kinds of patients for whom high intensity training is appropriate; research to support high intensity training; equipment needed for this intervention; what a typical high intensity treatment session looks like in physical therapy and occupational therapy; implementation challenges; whether high intensity training is done in every therapy clinic and if all therapists know about it; and contents of an NYU continuing education course on high intensity training that will be offered on May 17-18, 2025.
Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist. He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation. He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology.
Part 3
The discussion covered the following topics: spiritual aspects of health care, use of wearable devices by patients, role of physical exercise in the care of patients, influence of dietary practices on patients’ health status, and personal research underway and expected to begin in the near term.
Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist. He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation. He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology.
Part 2
The discussion covered the following topics: launching new program initiatives, professionals involved in holistic neuropsychological rehabilitation, addressing health care disparities, willingness of patients to cooperate in their care, role of informal caregivers, and use of telehealth as an intervention.
Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist. He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation. He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology.
Part 1
The discussion covered the following topics: diagnosing acquired brain injuries; biomarkers for neurological impairments; Long COVID and neurological symptoms; recruitment and retention of health personnel; and composition of the health care team.
The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.
Sara Cuccurullo MDis Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services
Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.
Part 2
Dr. Flemming described the functional results obtained from their intervention. They specifically chose the activity measure proposed for post-acute care, abbreviated as AM-PAC. It showed improvement over time and it allowed looking at specific subsections within rehabilitation, such as basic mobility, daily activity, and cognitive scores. An AM-PAC score is a recognized tool by Medicare used in multiple post-acute care settings. Dr. Cuccurullo indicated that according to an article published in 2011 in the journal Stroke, the all-cause mortality for stroke patients in the U.S. is 31%. In one year, the all-cause mortality in their program was 1.47%. Their results were published in the American Journal of Physical Medicine and Rehabilitation. The paper received the Excellence in Research Writing Award for the most impactful article of the year. Significantly, the manuscript attracted the attention of Medicare officials who asked them to present their findings. CMS wanted to know if it can be proved that the stroke recovery program saves money, can they validate their previous improvement in mortality with more patients, and can they replicate the results at other institutions nationally. Drs. Fleming and Cuccurullo described what they did in response to these questions.
A Question & Answer period followed.
The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.
Sara Cuccurullo MDis Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services
Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.
Part 1
Dr. Cuccurullo began by discussing their stroke recovery program, specifically investigating and analyzing the effects of a comprehensive initiative on all-cause mortality, function, and readmissions. She listed the learning objectives for today’s grand round presentation. Strokes are the number one admission in their inpatient rehab facility. Twenty-two percent of their patients comply with going to the facility. Their patients have a finite resource for Medicare once they leave inpatient or the acute care setting. Payment caps compromise the ability to have outpatient therapies that prevent them from having a full recovery. Dr. Flemming pointed out that there is an overlap with patients who have neurologic disease after stroke as well as patients who have cardiac disease. So, they designed their program to combine both elements of neurorehabilitation and a modified cardiac rehabilitation program, which starts with an outpatient visit with a stroke physiatrist. Common challenges that need to be addressed are patients with: weakness on their one side versus the other, cognitive or attention deficits, poor safety awareness, and post-stroke fatigue. They decided that it would be important to collect medical and functional outcome data to see if the program could affect hospital readmissions, the recurrence of stroke, and overall mortality.
Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company.
Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years. Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York. Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt.
Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health. Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists. She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT).
Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases. She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University. Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field.
The discussion covered the following topics: influence of artificial intelligence, and research endeavors pertaining to occupational therapy, physical therapy, and speech-language pathology.
Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company.
Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years. Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York. Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt.
Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health. Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists. She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT).
Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases. She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University. Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field.
The discussion covered the following topics: involvement of informal caregivers in treatment, staying on top of new developments, use of assistive technology, provision of care via telehealth, and impact of Long Covid on patient care.
Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company.
Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years. Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York. Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt.
Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health. Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists. She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT).
Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases. She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University. Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field.
The discussion in Part Two covered the following topics: types of patients treated, impact of health care disparities, and patient cooperation in health care interventions by providers.
Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company.
Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years. Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York. Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt.
Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health. Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists. She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT).
Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases. She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University. Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field.
The discussion covered the following topics in Part One: a description of each of the three professions, educational requirements to become practitioners, and recruitment and retention of clinicians.
Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation.
Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program. She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness.
Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals.
Part 3
The discussion covered the following topics: phases of treatment when mindfulness and self-compassion can be introduced to achieve optimal effectiveness; the role of telehealth; extent to which a group-based approach is used; availability of commercialized digital resources on the Internet, such as apps; use of wearable devices by patients; and the impact of artificial intelligence on patient care.
Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation.
Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program. She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness.
Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals.
Part 2
The discussion covered the following topics: persistence of sleep disorders and the role of physical exercise in treating them; definition of mindfulness; kinds of interventions included under the heading of mindfulness; examples of how it aims to address the severity of various TBI-related health problems; duration of mindfulness treatment; and self-compassion as another type of non-pharmacological intervention.
Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation.
Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program. She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness.
Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals.
Part 1
The discussion covered the following topics: concussions and TBIs; pediatric care; use of biomarkers; common causes of a TBI; common symptoms and their length of duration; involvement of informal caregivers; and occurrence of sleep disorders.
Dr. Steven DeKosky is professor of Alzheimer’s research at the University of Florida College of Medicine and Deputy Director of the McKnight Brain Institute at that institution. He also is a professor of neurology and neuroscience there. Previously, he served as vice president and dean of the University of Virginia School of Medicine and was chairperson of the department of neurology at the University of Pittsburgh.
Part 2
For the short-term, with mild to moderate traumatic injury you can have altered synaptic structure and function. For the longer term, chronic inflammation and chronic oxidative stress can lead to subsequent degeneration and also some chronic microglial activation, which may turn on mechanisms that you do not necessarily want, including cleaning up partially injured neurons that may recover. Especially in patients who get the disease in an older age, there is other pathology in the CTE. There are nerve fibrillary tangle and Lewy body. Amyloid beta can be elevated in both white matter and grey matter and might add to the cascade that is thought amyloid leads to, which leads to degeneration especially Alzheimer’s disease, but cannot prove it. Participants in contact sports all are at significant risk. APOE 4 increases the risk of Alzheimer’s disease and the risk of tau deposition. Currently, when patients arrive for rehabilitation, they are going to have things a lot better described than was the case previously. We can look at disruption of structures, see hemorrhage and inflammation. We know that CTE is not a new disease, but we do see the pathology in other contact sports and we do not view it in autopsy series unless the individual had a history or repetitive head injury.
A Question & Answer period followed.
Dr. Steven DeKosky is professor of Alzheimer’s research at the University of Florida College of Medicine and Deputy Director of the McKnight Brain Institute at that institution. He also is a professor of neurology and neuroscience there. Previously, he served as vice president and dean of the University of Virginia School of Medicine and was chairperson of the department of neurology at the University of Pittsburgh.
Part 1
Dr. DeKosky described how CTE has a fascinating history, There still are questions about it. Some questions are old while some are new, but they all are interesting with respect to injury to the brain and how you try to repair it. Future directions also will be covered because the data arrive quickly. Mild traumatic brain injury usually means at least being knocked unconscious. It is not clear whether there is short-term pathology that lasts. Recovery usually is good. It is not clear exactly how much of an increased risk of Alzheimer’s disease there is with a single severe TBI while more is being learned about the long-term effects. Only recently has CTE been defined clearly. Boxing is where CTE came from initially. He indicated that football helmets first were used at the U.S. Naval Academy in 1894 because one player needed protection against experiencing another head injury. He mentioned that the NCAA owes its origins to efforts to reduce brutal injuries sustained by football players. President Theodore Roosevelt led governmental efforts to prevent such injuries. Several examples were provided of developments that occurred over the decades to obtain a greater understanding of the prevention and treatment of brain damage. Apart from head injuries in sports, an uptick in interest in such uncommon disorders resulted from modern day wars in the middle east involving blast injuries from IEDs and the discovery that playing football and other sports led to many injuries viewed as being more common.
The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. His remarks ended at the 2 minute: 24 second mark.
Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders.
Part 1
Dr. Kaelin described the interesting relationship between the University of Louisville Frazier Rehabilitation Institute and NYU Rusk in New York. The Institute has its origins at NYU. His presentation had a focus on cellular level and pathophysiology that contribute to complications of brain injury, Alzheimer’s type dementia, Parkinson’s Disease and some similarities that exist. He began a literature review one-year ago on this topic, which has led to today’s discussion. It is important to start by talking a little about the pathophysiology TBI and cerebral insults. It can have some correlation to stroke and other insults to the brain and central nervous system. He also talked a little bit about things that we don’t think about much as physiatrists –astrocytes and microglia and what their roles are in the brain and in brain trauma. He indicated that astrocytes are the scaffolding or the structure upon which neurons and other cells hold themselves to and create the structure and shape of the brain. Microglial cells help in brain infection and brain inflammation. In a resting, healthy brain they are highly mobile and will undergo morphological changes following a brain trauma. He indicated that synapses between neurons are significantly affected both mechanically and in becoming lost in severe brain injury. He discussed the importance of sleep for patients with a brain injury.
Part 2
Repetitive mild brain injuries also can result in the same kinds of findings. So, it is not just moderate to severe, but repetitive mild injuries that increase the risk. Although there may not be a direct causal relationship, certainly having a brain injury, multiple mild brain injuries or a moderate to severe brain injury increases the risk of developing neurodegenerative processes like Alzheimer’s and Parkinson’s. He tells his patients that the likelihood of developing a neurodegenerative process may be there, but in each individual it can be different. We don’t know specifically what it might mean for you. On average the risk may go up, but it still is very small. He talked about some potential neuro-protective treatments that might exist out there or are in the process of being looked at. He stated that this patient population is heavily heterogeneous, especially in how it presents and responds to trauma. Additionally, patients in the U.S. don’t all receive exactly the same treatment after their trauma, which is a confounding variable that results in a very different outcome for each of those kinds of patients. Nutrition is a highly important factor when it comes to recovery and outcomes. Parenteral nutrition goes a long way in helping their outcomes. It also is important to keep an eye on vitamin and mineral levels. Zinc is a key supplement for many patients and magnesium can help in recovery. He closed by describing a disorders of consciousness program at his institution called the Emerge Program.
A Question &Answer period followed.
The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.
Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders.
Part 1
Dr. Kaelin described the interesting relationship between the University of Louisville Frazier Rehabilitation Institute and NYU Rusk in New York. The Institute has its origins at NYU. His presentation had a focus on cellular level and pathophysiology that contribute to complications of brain injury, Alzheimer’s type dementia, Parkinson’s Disease and some similarities that exist. He began a literature review one-year ago on this topic, which has led to today’s discussion. It is important to start by talking a little about the pathophysiology TBI and cerebral insults. It can have some correlation to stroke and other insults to the brain and central nervous system. He also talked a little bit about things that we don’t think about much as physiatrists –astrocytes and microglia and what their roles are in the brain and in brain trauma. He indicated that astrocytes are the scaffolding or the structure upon which neurons and other cells hold themselves to and create the structure and shape of the brain. Microglial cells help in brain infection and brain inflammation. In a resting, healthy brain they are highly mobile and will undergo morphological changes following a brain trauma. He indicated that synapses between neurons are significantly affected both mechanically and in becoming lost in severe brain injury. He discussed the importance of sleep for patients with a brain injury.
Part 2
Repetitive mild brain injuries also can result in the same kinds of findings. So, it is not just moderate to severe, but repetitive mild injuries that increase the risk. Although there may not be a direct causal relationship, certainly having a brain injury, multiple mild brain injuries or a moderate to severe brain injury increases the risk of developing neurodegenerative processes like Alzheimer’s and Parkinson’s. He tells his patients that the likelihood of developing a neurodegenerative process may be there, but in each individual it can be different. We don’t know specifically what it might mean for you. On average the risk may go up, but it still is very small. He talked about some potential neuro-protective treatments that might exist out there or are in the process of being looked at. He stated that this patient population is heavily heterogeneous, especially in how it presents and responds to trauma. Additionally, patients in the U.S. don’t all receive exactly the same treatment after their trauma, which is a confounding variable that results in a very different outcome for each of those kinds of patients. Nutrition is a highly important factor when it comes to recovery and outcomes. Parenteral nutrition goes a long way in helping their outcomes. It also is important to keep an eye on vitamin and mineral levels. Zinc is a key supplement for many patients and magnesium can help in recovery. He closed by describing a disorders of consciousness program at his institution called the Emerge Program.
A Question &Answer period followed
Dr. Julie Silver is an associate professor and associate chairperson in the department of physical medicine and rehabilitation at Harvard Medical School
PART 1
Her presentation is a data-driven lecture for individuals who believe in science. A big theme in her work is to focus on tipping points that will drive change faster. An important large study reported in the journal Lancet in 2018 attracted widespread attention. Researchers looked at clinical practice guidelines. They found that the representation of female authors was low, but even lower for female physicians. Looking at PM&R since then shows similar findings. Problems were not being solved because while medical societies indicated that they were not at fault, their journals expressed the same opinion. It became obvious that many organizations were working together in ways that were complicit. Not many women were included in the clinical practice guidelines. Compensation is an important issue that also was studied extensively. Dr. Silver provided an example of how men were compensated more than women for performing similar procedures. She discussed medical recognition awards that also reveal a considerable amount of disparity that favors men over women. The same holds true for minoritized groups as explained using the concept of inexorable zero. A promotion problem is involved in this situation, which can be fixed. Additionally, her lecture also focused on challenges pertaining to faculty retention. Women physicians are more likely to leave academia at all career stages. A key issue is enabling individuals to feel that they belong.
PART 2
In Part 2, Dr. Silver began by indicating that thinking about belonging and social integration are super important. There are two bodies of literature--a retention literature and a belonging literature. Very few studies have looked at them together. One investigation that did so found that women who have fewer belonging components are more likely to leave their workplace and more likely to stay if they have more of these components. What can be done right now to improve the situation? Her answer is that individuals should be told that they belong. Inclusion is not a synonym of belonging. She provided examples of constructive steps that have been implemented at other academic institutions. Mentoring is a critically important model. She described how she works with individuals in helping them to feel that they belong and indicated five strategies that leaders can implement. Let’s not assume that progress happens. Instead, let’s believe the science and follow the data. When looking at the proportion of women on specialty boards, they found in a comparison study that six boards decreased and that two stayed the same. Progress does not just happen on its own. In PM&R, there was an increase, but it still is not really at the equitable level. We must continue to focus on it. The same holds true when looking at race and ethnicity.
Dr. Julie Silver is an associate professor and associate chairperson in the department of physical medicine and rehabilitation at Harvard Medical School
PART 1
Her presentation is a data-driven lecture for individuals who believe in science. A big theme in her work is to focus on tipping points that will drive change faster. An important large study reported in the journal Lancet in 2018 attracted widespread attention. Researchers looked at clinical practice guidelines. They found that the representation of female authors was low, but even lower for female physicians. Looking at PM&R since then shows similar findings. Problems were not being solved because while medical societies indicated that they were not at fault, their journals expressed the same opinion. It became obvious that many organizations were working together in ways that were complicit. Not many women were included in the clinical practice guidelines. Compensation is an important issue that also was studied extensively. Dr. Silver provided an example of how men were compensated more than women for performing similar procedures. She discussed medical recognition awards that also reveal a considerable amount of disparity that favors men over women. The same holds true for minoritized groups as explained using the concept of inexorable zero. A promotion problem is involved in this situation, which can be fixed. Additionally, her lecture also focused on challenges pertaining to faculty retention. Women physicians are more likely to leave academia at all career stages. A key issue is enabling individuals to feel that they belong.
PART 2
In Part 2, Dr. Silver began by indicating that thinking about belonging and social integration are super important. There are two bodies of literature--a retention literature and a belonging literature. Very few studies have looked at them together. One investigation that did so found that women who have fewer belonging components are more likely to leave their workplace and more likely to stay if they have more of these components. What can be done right now to improve the situation? Her answer is that individuals should be told that they belong. Inclusion is not a synonym of belonging. She provided examples of constructive steps that have been implemented at other academic institutions. Mentoring is a critically important model. She described how she works with individuals in helping them to feel that they belong and indicated five strategies that leaders can implement. Let’s not assume that progress happens. Instead, let’s believe the science and follow the data. When looking at the proportion of women on specialty boards, they found in a comparison study that six boards decreased and that two stayed the same. Progress does not just happen on its own. In PM&R, there was an increase, but it still is not really at the equitable level. We must continue to focus on it. The same holds true when looking at race and ethnicity.
Nicole Lund is a registered dietitian at NYU Langone’s Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team.
Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master’s degree in public health nutrition from Hunter College.
Part 2
The discussion covered the following topics: complementary and alternative therapies; accuracy of patients' nutrition knowledge; influence of demographic factors on the adequacy of nutritional status; provision of nutritional health care care via telehealth; prevention of health problems related to participating in vigorous physical activities; and how improved dietary practices may help to prevent health problems.
Nicole Lund is a registered dietitian at NYU Langone’s Sports Performance Center. A certified health and well-being coach and certified personal trainer, as a former dancer her love of movement led her into a career as a step aerobics instructor and personal trainer. Through her work, she recognized a need for a discussion about food and its impact on everything from performance to health. She sees medical nutrition therapy patients via insurance and self-pay sports. She is a clinician with the Running Lab and works with athletes on the USA Nordic team.
Her expertise is in sports and performance nutrition while her clinical interests include chronic inflammation, weight loss, migraines, and menopause. She has a master’s degree in public health nutrition from Hunter College.
Part 1
The discussion covered the following topics: how and when she began to develop an interest in performance nutrition; types of patients she treats; the role that diet plays in improving problems involving overweight and obesity; and use of dietary supplements by patients.
Dr. David Jevotovsky is in the second year of a residency program at the Rusk Rehabilitation Institute at NYU Langone Health. A former graduate of NYU Grossman School of Medicine, he is keen on pursuing a fellowship in interventional pain medicine. Having experienced a traumatic brain injury during his medical training, he possesses a unique understanding of both the patient and provider perspectives of this condition.
As patients differ on the basis of age, gender, and racial/ethnic background, whether they also tend to differ in how they express what it is like to experience a TBI and live with its aftermath; the role played by social media in the residency program; whether beneficial outcomes can result from having patients with a TBI participate in physical exercise activities; why it is hard for many patients, their loved ones, and even PM&R physicians to understand how a brain could be rewired; and different perspectives that patients and physicians may have regarding agitation/delirium, cognition, return to work, and support systems.
This unique episode features course directors Dr. Salvador Portugal, Dr. Surein Theivakumar, Dr. Julia Iafrate, Dr. Jina Libby and Dr. Haruki Ishii for the course taking place 6/7-6/9.
The following link has more information, if you or anyone you know is interested in registering: https://www.pathlms.com/nyurusk/courses/66458.
Dr. Jina Libby completed her PM&R residency in Michigan. Her dedication to that profession and sports medicine extends beyond clinical practice as she serves on the executive committee for the International Rehab and Global Health Committee of AAPM&R. Her fervor for education is evident through her commitment to teaching physical medicine and rehabilitation, not only locally, but also by championing its integration on an international scale.
Beyond her current role as a fellow physician, Dr. Laurenie Louissaint's compassionate spirit leads her on frequent global impact trips, where she provides critical medical support to underserved communities, such as Haiti and Namibia. She also is an active member of the New York City cycling community while also providing medical care for injured cyclists and developing related research.
Part 1
The discussion in Part 1 included the following items: demographic aspects of Namibia, major health problems in that nation, how health care is financed, similarities with western allopathic health practices, use of traditional and alternative health care interventions, status of health professions educational institutions, and nature of the auspices sponsoring the visitation trip by U.S. clinicians to that country.
Part 2
The discussion in Part 2 included the following items: types of health professionals in the group visiting Namibia, kinds of Namibian practitioners interacted with during the visit, most evident aspects of health care in that nation where improvements would appear to be beneficial, possibly reversing the flow of clinicians to enable Namibians to spend time in U.S. clinical facilities, and health professional literature produced in that country.
Dr. Jina Libby completed her PM&R residency in Michigan. Her dedication to that profession and sports medicine extends beyond clinical practice as she serves on the executive committee for the International Rehab and Global Health Committee of AAPM&R. Her fervor for education is evident through her commitment to teaching physical medicine and rehabilitation, not only locally, but also by championing its integration on an international scale.
Beyond her current role as a fellow physician, Dr. Laurenie Louissaint's compassionate spirit leads her on frequent global impact trips, where she provides critical medical support to underserved communities, such as Haiti and Namibia. She also is an active member of the New York City cycling community while also providing medical care for injured cyclists and developing related research.
Part 1
The discussion in Part 1 included the following items: demographic aspects of Namibia, major health problems in that nation, how health care is financed, similarities with western allopathic health practices, use of traditional and alternative health care interventions, status of health professions educational institutions, and nature of the auspices sponsoring the visitation trip by U.S. clinicians to that country.
Part 2
The discussion in Part 2 included the following items: types of health professionals in the group visiting Namibia, kinds of Namibian practitioners interacted with during the visit, most evident aspects of health care in that nation where improvements would appear to be beneficial, possibly reversing the flow of clinicians to enable Namibians to spend time in U.S. clinical facilities, and health professional literature produced in that country.
Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.
Part 1
Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.
Part 2
Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.
Dr. Sharon Kolasinski is a professor of clinical medicine at the University of Pennsylvania and chief of the Division of Rheumatology at Penn Presbyterian Medical Center.
Part 1
Her objectives in the presentation are to help listeners by learning about evidence-based treatment for patients with osteoarthritis (OA), to understand the process by which guidelines are developed that might help us figure out our evidence-based approach, to review the recommended treatments for OA, and to review some treatments that are not recommended for OA. Her basic evidence-based reference is a University of Pennsylvania guideline that was published in 2020. Numerous other guidelines are available, which she described. She discussed her work with a case involving a 55-year-old male patient. He arrived for routine follow-up care for immunosuppressive medication monitoring. He described pains that he was experiencing and was diagnosed with OA. She indicated the impacts OA has on patients. Clinicians find it a daunting challenge to provide satisfactory treatment. For example, for some clinicians, the guidelines do not appear to be clear and provide a roadmap. Also, they do not always believe in the recommendations contained in the guidelines. In this presentation, she wants to see if she can change some minds about guidelines. She provided an example based on investigations conducted at her institution. The outcome was a series of recommendations that she described.
Part 2
Dr. Kolasinski began Part 2 of her presentation by continuing to focus on the importance of having patients with OA engage in physical activity. She stated that “they are worn out and the implication is that a doctor is needed to fix them.” Perhaps a perspective should be taken of a more participatory discourse where we encourage physical therapy and emphasize that physical exercise is safe when you have arthritis and focus on what the patient can do, empowering them to exercise. A starting point is to give patients a physical therapy prescription. She discussed the extent to which physical therapy is useful, along with indicating how much and how frequently exercise is beneficial (e.g., for 20 minutes, three times a week). Losing weight is an effective way of reducing symptoms. Food choices can affect OA symptoms. Diet and exercise used together can produce effective results. References were made to several studies that involve the status of steroid injections on improving patient health status. Acupuncture also was mentioned. She indicated conditional recommendations on the use of pharmacological interventions. She concluded by describing how to treat the 55-year-old patient she mentioned in Part 1 of her presentation.
Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.
Part 1
The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.
Part 2
The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.
Dr. Natalie Azar is an Associate Clinical Professor of Medicine & Rheumatology at NYU Langone Health. Certified by the American Board of Internal Medicine, she is a designated long Covid provider in rheumatology. Her practice locations are at the Langone orthopedic center and Washington Square, and she has been in private practice since 2001. A graduate of Wellesley College, Dr. Azar’s medical degree is from Cornell University Medical College. She completed her internship, residency, and fellowship at New York University. Her fellowship in rheumatology was at the Hospital For Joint Diseases. She has been a medical contributor to NBC News since 2014.
Part 1
The discussion in Part 1 included the following items: clinical definition of Long-COVID; predictability of developing Long-COVID; whether patients with existing rheumatic disease are more susceptible to developing Long-COVID; whether COVID-19 could trigger rheumatic disease; differences and similarities between Long-COVID and rheumatic disease; whether Long-COVID can occur following mild acute illness; risk factors associated with developing Long-COVID; presence of fatigue as a risk factor for developing Long-COVID; and major symptoms of Long-COVID.
Part 2
The discussion in Part 2 included the following items: organ systems and tissues most affected by Long-COVID; variations in symptoms and disease severity among patients; diagnostic and prognostic biomarkers for Long-COVID; protective effects of vaccine; episodic aspects of Long-COVID; use of medications and non-pharmaceutical treatment interventions; and personal and NYU involvement in conducting Long-COVID studies.
Dr. Jacques Hacquebord is Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery.
The discussion in Part 2 included the following items: other types of clinicians who provide treatment for patients who need hand surgery; influence of artificial intelligence (AI) on hand surgery; complications that could arise during hand surgery and how to mitigate them; management of post-operative pain; dealing with pre-operative anxiety experienced by patients; quality of patient information on the Internet about hand health problems; advice on how to prevent health problems regarding the hands; personal lessons learned that have implications for improving patient care; and research involvement at NYU Langone Health.
Dr. Jacques Hacquebord is Chief of Hand and Upper Extremity Surgery at NYU Langone Health. He also serves as the co-chief of the Hand Surgery service at Bellevue Hospital (a Level 1 trauma and regional replant center) and co-chief of the Center for Amputation Reconstruction. He did his surgical residency in orthopedic surgery at the University of Washington and the world-renowned trauma center Harborview Medical Center and did his fellowship in Hand/Microsurgery at the University of California at Irvine with Dr Neil Jones. He then completed two traveling fellowships in reconstructive microsurgery and brachial plexus surgery with the first in China and then the second at Ganga Hospital in India. His principal clinical interest and passion within hand and orthoplastic surgery is the primary management and secondary reconstruction of the traumatized upper extremity. This includes replantation surgery, reconstruction of bone and soft tissues deficits in the upper extremity, and complex nerve reconstruction surgery.
The discussion in Part 1 included the following items: reason for deciding to practice in hand surgery; common health problems that result in patients undergoing hand surgery, influence of gender on the onset of health problems, kinds of health problems children experience, patient expectations of what will result from hand surgery, use of wide-awake local anesthesia no tourniquet surgery (WALANT), and patients’ level of cooperation in achieving positive surgical outcomes.
A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.
Part One
He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis.
Part Two
Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.
A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine.
Part One
He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis.
Part Two
Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.
In this episode, the two discuss how and when they began to develop an interest in performing arts medicine; health screening of performers prior to participation in these activities; failure to admit the existence of a health problem because of a fear of being replaced by a healthier performer; types of clinicians involved in treating performing artists; and approaches to preventing health problems in performing artists.
Dr. Tracy McKay is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. She specializes in Integrative Sports and Spine Medicine with a special interest in Performing Arts Medicine. Dr. McKay is Chairperson of the Performing Arts Medicine Community of the American Academy of Physical Medicine and Rehabilitation and served as consulting medical director for the Broadway show, Here Lies Love. She is a staff physician at the Harkness Center for Dance Injuries and provides care to professional dance companies that include Complexions, Alvin Ailey, Ballet Hispanico, and AIM.
Dr. Rosa Pasculli is a non-operative Sports Medicine physician at Emory Orthopedics at Grady Health System in Atlanta. Her primary clinical area of interest is performing arts medicine. She serves as a consulting physician for the Atlanta Ballet, the Georgia Ballet, and she is a faculty member of the Female Athlete Program. She also serves as a team physician for Emory University, the College Park Skyhawks, and several Atlanta high schools. Dr. Pasculli completed medical school at New York University School of Medicine and her residency was in Physical Medicine and Rehabilitation at NYU. She also had a fellowship in Primary Care Sports Medicine at Emory University.
We should begin with every patient by validating that their pain is real. He discussed the role played by cognitive behavioral therapy (CBT). It is referenced most often because it has the best evidence, but we do not really know how to break that down for patients. He described three basic stages. It is important to recognize that CBT is not the best and only treatment. Exercise is important in a lot of musculoskeletal conditions, but it should be tailored to benefit that window between benefit and symptom aggravation. Next, is the question of what must be done with all the information he has provided in this presentation thus far. There seems to be evidence of some advantage to participating in athletics or being fit. Also, not everyone who is fit is having a good time and not everyone with a chronic condition can jump into fitness in the right way. So, we need to figure out how to meld that. Patients come to us because they are suffering. We need a team approach to close the performance gap they experience. A psychological battle must be dealt with at the same time as physical problems. He described strategies he would use. Find out what exercise they do now and for how many minutes, and their amount of sleep. Determine what they enjoyed doing in the past. It is important to focus on one of their problems and aim to achieve success in treating it. He described some available resources that are useful.
A Question & Answer period followed.
PART 1
Dr. Vasudevan began by discussing how pain is experienced by athletes and non-athletes, how to identify components of multidisciplinary care for both those groups, and incorporate some reasonable strategies that might help with exercise prescriptions and lifestyle modifications for those with chronic pain. He provided some definitions for various terms, such as pain medicine, sports medicine, and pain. The latter is in the brain, which is the summation of all inputs. As physiatrists, we look at what the pain is keeping you from doing what you want to perform. He addressed the question of whether there are gender differences in the perception of pain. The short answer is no. Strength and endurance matter more. Endurance athletes can tolerate pain better. He discussed some consequences of the overtraining syndrome. If an athlete cannot perform at a desired level, there is a higher mental risk. Insufficient sleep is a risk factor. A pertinent concern is how to improve mental health in athletes. He indicated what they do at Penn to address this matter. Non-pharmacological interventions are preferred for treating injuries, e.g., massage modalities. The use of topical medications can be effective from a systemic perspective. The discussion then switched to chronic pain.
Holly Cohen is the program manager of assistive technology and the driving rehabilitation program at NYU Langone Health. She is an Occupational Therapist with over 25 years of experience. She also is an adjunct professor at New York University where she teaches occupational therapy and engineering students on the importance of accessibility and adaptability in everyday technology. Additionally, she has lectured both nationally and internationally on the importance of assistive technology to improve function and quality of life for users.
The following items were discussed in Part 1: Determining the ability of patients to use various forms of assistive technology; examples of the kinds of assistive technology employed in providing care to patients; kinds of patients treated; treatment offered in the clinical setting and by telehealth; if patients ever abandon using assistive devices; whether patients influence the kinds of assistive technology used; use of a patient group-based treatment approach; emerging technology; and key lessons learned in improving patient care.
This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.
This is the third of three special episodes...
Dr. Lindsey Gurin specializes in Dementia & Alzheimer's, Neuropsychiatry and is Assistant Professor, Department of Neurology at NYU Grossman School of Medicine, an Assistant Professor, Department of Psychiatry at NYU Grossman School of Medicine ,and an Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine She is also Director of both the Neurology/Psychiatry Residency Program and Behavioral Neurology, NYU Langone Orthopedics Hospital.
Dr. Prin Amorapanth is an Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine . He completed his residency at the Rehabilitation Institute of Chicago, Rehab Medicine and his fellowship at NYU Langone Medical Center, Brain Injury Medicine.
Dr. Jessica Rivetz is currently a resident physician in Physical Medicine and Rehabiitation at NYU Grossman School of Medicine and will be applying for her fellowship in brain injury medicine.
This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.
This is the second of three special episodes...
Dr. Jonathan Whiteson is Assistant Professor, Department of Rehabilitation Medicine; Assistant Professor, Department of Medicine; Medical Director of Rusk Outreach and Growth; and Medical Director of Cardiac Rehabilitation. His research interests include: cardiac and pulmonary rehabilitation coping strategies during cardiac rehabilitation following cardiac surgery, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. He is also part of the Senior Leadership team of Rusk Institute and Medical Director of the Rusk Institute Outpatient program.
This is an exciting year for RUSK, celebrating our 75th anniversary! As part of our celebration, we are hosting a number of events including our Research Symposium, podcasts, and interviews. Our content continues to cover a wide range of topics within PM&R, and this particular segment includes special Rusk 75th Anniversary episodes featuring Rusk leadership, faculty, and residents.
This is the first of three special episodes...
Steven Flanagan, MD is professor and chairman of the Department of Rehabilitation Medicine, New York University School of Medicine, and the medical director of the Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center. Dr. Flanagan has served on medical advisory boards of many national and international committees and has presented at scientific meetings both nationally and internationally, most notably on topics pertaining to brain injury rehabilitation. He has authored numerous chapters and publications and has participated in both federally and industry sponsored research, funded by such organization as the National Institute on Aging.
Dr. Jonathan Whiteson is Assistant Professor, Department of Rehabilitation Medicine; Assistant Professor, Department of Medicine; Medical Director of Rusk Outreach and Growth; and Medical Director of Cardiac Rehabilitation. His research interests include: cardiac and pulmonary rehabilitation coping strategies during cardiac rehabilitation following cardiac surgery, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. He is also part of the Senior Leadership team of Rusk Institute and Medical Director of the Rusk Institute Outpatient program.
Dr. Weiss is Professor of Rehabilitation Medicine at the NYU Long Island School of Medicine. She previously was the Chairman and Director of Residency Training for the Department of Physical Medicine and Rehabilitation at Nassau University Medical Center. She also was the Director of Electrodiagnostic Medicine and Chair of the Ethics committee. She is Board Certified in both Physical Medicine and Rehabilitation and Electrodiagnostic Medicine and in November 2018 was among the first group of professionals to become Healthcare Ethics Consultant-Certified. Dr. Weiss has published numerous articles, book chapters, and authored 10 books. She is active in professional organizations on a national level. Her professional interests include electrodiagnostic medicine, ethics, and women in medicine.
The following items were discussed in Part 2:
Differences between monopolar and concentric needles; possible role of contaminants leading to diagnostic misinterpretation; training or certification required to become eligible to engage in EMG testing; kinds of clinical personnel who conduct EMG tests; size of the workforce engaged in EMG testing; the role of EMG wearables by patients; future studies of EMG testing; and personal current research involvement.
Dr. Weiss is Professor of Rehabilitation Medicine at the NYU Long Island School of Medicine. She previously was the Chairman and Director of Residency Training for the Department of Physical Medicine and Rehabilitation at Nassau University Medical Center. She also was the Director of Electrodiagnostic Medicine and Chair of the Ethics committee. She is Board Certified in both Physical Medicine and Rehabilitation and Electrodiagnostic Medicine and in November 2018 was among the first group of professionals to become Healthcare Ethics Consultant-Certified. Dr. Weiss has published numerous articles, book chapters, and authored 10 books. She is active in professional organizations on a national level. Her professional interests include electrodiagnostic medicine, ethics, and women in medicine.
The following items were discussed in Part 1:
Reason for deciding to practice in PM&R some indications for electrodiagnostic testing; difference between nerve conduction studies and EMG; most common health problems that govern EMG testing; kinds of musculature tested; how electrodiagnostic testing differs from MRIs and x-rays; if patient age affects EMG tests; diagnostic information furnished by needle insertion and placement of electrodes over the skin surface; and patient characteristics to take into account when inserting needles.
Dr. Tan participated in a Dual Residency Program in Physical Medicine and Rehabilitation/Pediatrics at Long Island Jewish Medical Center in New Hyde Park, New York. She has received Fellowship Grants and Support from the Christopher Reeve Foundation, the Medtronics/Allergan: Spasticity Management Workshop, and the Starlight Children’s Foundation. She served as Founder of the Philippine Chinese-American Medical Association and became President of that organization in 2014. Dr. Tan obtained her medical degree from the Faculty of Medicine and Surgery at the University of Santo Tomas in Manila, Philippines.
The following items were discussed in Part 2: role played by family in providing care; outcomes produced when treating with botox; implementation of alcohol blocks in treatment; what serial casting in treatment entails; use of oral medications; role played by complementary and alternative modalities; whether symptoms change with age; the transition from pediatric to adult care; potential of big data, machine learning, and artificial intelligence in treating patients with cerebral palsy; and her research interests in cerebral palsy and plans to be involved in any upcoming investigations.
Dr. Tan participated in a Dual Residency Program in Physical Medicine and Rehabilitation/Pediatrics at Long Island Jewish Medical Center in New Hyde Park, New York. She has received Fellowship Grants and Support from the Christopher Reeve Foundation, the Medtronics/Allergan: Spasticity Management Workshop, and the Starlight Children’s Foundation. She served as Founder of the Philippine Chinese-American Medical Association and became President of that organization in 2014. Dr. Tan obtained her medical degree from the Faculty of Medicine and Surgery at the University of Santo Tomas in Manila, Philippines.
The following items were discussed in Part 1: how she decided to become a pediatrician specializing in cerebral palsy; what causes cerebral palsy; if heredity plays a role; likelihood of any demographic factors involved in the onset of this condition; tools and practices used in early diagnosis; types of cerebral palsy; whether it can be acquired after birth; preventability; incidence of cerebral palsy in the U.S.; conditions other than neurological and gross motor disorders that affect these patients; and the kinds of team members engaged in furnishing treatment.
Dr. Morris currently works full-time as a researcher. She is founder and director of the Disability Equity Collaborative where her work focuses on provider and health care organization-level factors that negatively impact the quality of care delivered to patients with disabilities. Her work has been funded by the NIH and other key sources of support. She has published in major medical periodicals, including the *New England Journal of Medicine* and the journal *Health Affairs.* Dr. Morris has a Masters of Science degree in Speech-Language Pathology, a Masters of Public Health degree, and a PhD in Rehabilitation Sciences from the University of Washington. She completed post-doctoral fellowships at Northwestern University and the Mayo Clinic in health services research. She has served as a faculty member at the Mayo Clinic, Harvard Medical School, and the University of Colorado Medical School.
The following items were discussed in Part 2: how ableism, including structural ableism appear in the healthcare setting; how medicine, including the field of rehabilitation, contributed to ableism in society; the importance of having health care organizations systematically collect and record patients’ disability status within the electronic health record; challenges in achieving effective documentation in the record and how to overcome them; how to determine patients’ needed disability accommodations and implementing them into routine clinical and hospital care; and any ongoing studies in which she is involved and anticipates undertaking in the near term.
Dr. Morris currently works full-time as a researcher. She is founder and director of the Disability Equity Collaborative where her work focuses on provider and health care organization-level factors that negatively impact the quality of care delivered to patients with disabilities. Her work has been funded by the NIH and other key sources of support. She has published in major medical periodicals, including the New England Journal of Medicine and the journal Health Affairs. Dr. Morris has a Masters of Science degree in Speech-Language Pathology, a Masters of Public Health degree, and a PhD in Rehabilitation Sciences from the University of Washington. She completed post-doctoral fellowships at Northwestern University and the Mayo Clinic in health services research. She has served as a faculty member at the Mayo Clinic, Harvard Medical School, and the University of Colorado Medical School.
The following items were discussed in Part 1: her definition of the term ableism; meaning of the term structural ableism and how it is manifested in society; whether there can be a tendency for ableism to occur in conjunction with another kind of ism, such as racism; and how she developed an interest in focusing on the topic of ableism.
Akhila Veerubhotla is an Assistant Professor in the Department of Rehabilitation Medicine at NYU-Grossman School of Medicine. She completed her post-doctoral fellowship jointly at the Center for Mobility and Rehabilitation Engineering at the Kessler Foundation and in the Department of Physical Medicine and Rehabilitation at Rutgers – New Jersey Medical School. She has a PhD in Rehabilitation Science from the University of Pittsburgh and a Masters degree in Biomedical Engineering from Carnegie Mellon University. Her research focuses on using technology to help improve mobility, balance, and physical activity in individuals with neurological impairments. Her work primarily is focused toward individuals with stroke, traumatic brain injury and spinal cord injury.
The following items were discussed in Part 2: a Novel Core Strengthening Intervention for Improving Trunk Function, Balance and Mobility after a Stroke; variability in interventions may occur when therapists also provide assistance; risk of falls in individuals with traumatic brain injury; effectiveness of treadmills in conducting research that produces accurate measurements regarding falls; inclusion in studies of patients who have a communication disability as a result of a stroke; funding sources for studies involving technological devices in rehabilitation; role of artificial intelligence in rehabilitation research; and current studies underway or planned for the near future.
Akhila Veerubhotla is an Assistant Professor in the Department of Rehabilitation Medicine at NYU-Grossman School of Medicine. She completed her post-doctoral fellowship jointly at the Center for Mobility and Rehabilitation Engineering at the Kessler Foundation and in the Department of Physical Medicine and Rehabilitation at Rutgers – New Jersey Medical School. She has a PhD in Rehabilitation Science from the University of Pittsburgh and a Masters degree in Biomedical Engineering from Carnegie Mellon University. Her research focuses on using technology to help improve mobility, balance, and physical activity in individuals with neurological impairments. Her work primarily is focused toward individuals with stroke, traumatic brain injury and spinal cord injury.
The following items were discussed in Part 1: whether devices used in her studies also are available commercially for patients to use at home; a systematic review study involving wearable devices for tracking physical activity in the community after an acquired brain injury; why the transition of wearable devices from the laboratory to the community has gained momentum slowly in recent years; and the value of having a wider representation of participants from different population subgroups in clinical studies.
Dr. Kathleen Isaac is a licensed Clinical Psychologist and Clinical Assistant Professor at NYU Langone Health. As a Haitian-American, cis-gender female, she directs the Medical Student and House Staff Mental Health program, which provides individual, couples, and group psychotherapy to medical students, residents, and fellows. She also has a part-time private practice focused on serving BIPOC and LGBTQ+ clients with integrative treatment approaches, where she specializes in trauma, health psychology, and cultural issues. Dr. Isaac also is an adjunct lecturer in the City College of New York’s doctoral program in clinical psychology where she teaches an advanced practicum on intersectional therapy and a Group Psychotherapy course. She has been featured on multiple media platforms, including NBC and the New York Times. Recently, she has published in the journal *Psychiatry Annals* and in a book chapter dealing with *Her Clients’ Racial Identity Development During the Pandemic and the Black Lives Matter Movement.*
The following items were discussed in Part 2: whether NYU offers any standardized screening to identify residents who may be struggling with mental health and burnout concerns; if NYU has a mentorship program for residents; kinds of differences that may occur in the types of pressures and challenges that may arise depending on the medical specialty; cultivating resilience to increase an ability to cope with various everyday pressures; and enhancing self-management skills in self-monitoring, recognizing, and reporting symptoms of any mental health problems.
Dr. Kathleen Isaac is a licensed Clinical Psychologist and Clinical Assistant Professor at NYU Langone Health. As a Haitian-American, cis-gender female, she directs the Medical Student and House Staff Mental Health program, which provides individual, couples, and group psychotherapy to medical students, residents, and fellows. She also has a part-time private practice focused on serving BIPOC and LGBTQ+ clients with integrative treatment approaches, where she specializes in trauma, health psychology, and cultural issues. Dr. Isaac also is an adjunct lecturer in the City College of New York’s doctoral program in clinical psychology where she teaches an advanced practicum on intersectional therapy and a Group Psychotherapy course. She has been featured on multiple media platforms, including NBC and the New York Times. Recently, she has published in the journal Psychiatry Annals and in a book chapter dealing with Her Clients’ Racial Identity Development During the Pandemic and the Black Lives Matter Movement.
The following items were discussed in Part 1: regarding how she developed an interest in working with medical residents; how diversity is defined at NYU; why it is essential for the health workforce to be diverse from the perspective of both the clinicians and the patients whom they treat; kinds of structural barriers of an institutional nature within the learning environment that have the capability to hinder workforce diversity; and preparing residents at the beginning of their residency to deal with the kinds of hardship that are likely to develop during the early months of training.
Dr. Salvador Portugal is an Assistant Professor in the Dapartment of Rehabilitation Medicine at NYU Grossman School of Medicine. He is also Director of the Sports Fellowship program and Medical Director, Sports Medicine Rehabilitation. Dr. Portugal completed his residency at NYU Grossman and his fellowship at UMDNJ. He also received an MBA from Brandies in 2020.
In this segment, Dr. Portugal indicated that in 2014, a systematic review was done, which found that a combination of PT and mobilization was strongly recommended, especially in patients in stages two and three. Cortisone injections were found to be most effective early, and acupuncture plus therapeutic exercises improved pain, range of motion and function. Therapeutic sonograph treatment was not recommended. PT is recommended after phase one or after the painful phase. A Cochrane study concluded that PT should be provided in combination with other treatments. Patients that were compliant with home exercises are shown to be equally effective compared to supervised stretching exercises. He also discussed cortical steroid injections compared to other interventions. Similarly, platelet-rich plasma (PRP) was described in comparison to other forms of treatment, such as physical therapy. A related area of interest is the use of shock wave therapy in comparison to oral steroids. Many patients do well with non-surgical forms of treatment, but surgery may be an option for those who do not do so well with non-surgical treatment.
Dr. Salvador Portugal is an Assistant Professor in the Dapartment of Rehabilitation Medicine at NYU Grossman School of Medicine. He is also Director of the Sports Fellowship program and Medical Director, Sports Medicine Rehabilitation. Dr. Portugal completed his residency at NYU Grossman and his fellowship at UMDNJ. He also received an MBA from Brandies in 2020.
For this portion, he discussed several topics, such as clinical presentation, risk factors, pathophysiology, diagnostic testing, and non-surgical treatment options. He provided a review from the standpoint of what we should be doing in current practice. Shoulder injury usually is characterized as a marked decrease in range of motion. Patients often have difficulty reaching overhead or behind the back that causes a sensation of pain and stiffness. Prevalence in the general population is 2-5% and women are more affected than men. Pathophysiology is not often understood. Adhesive Capsulitis of the Shoulder after surgery potentially may be a risk. Prevalence is around 11% and women are affected more than men. He addressed the issue of which kind of imaging is important, such as X-rays and MRIs. He then moved on to additional diagnostic testing. Patients with a thyroid condition or diabetes are at increased risk of developing adhesive capsulitis. So, when should we begin considering testing or evaluating these conditions? Approximately one-third of patients with adhesive capsulitis are likely to have diabetes. Next, he focused on non-surgical forms of treatment and management.
Dr. Moroz attended the NYU School of Medicine and remained at NYU-Rusk Rehabilitation for residency training, and subsequently, his first and only job. He rose through the faculty ranks and currently is Director of Residency Training and Vice Chair for Education. Dr. Moroz sought out additional training and became a New York State certified acupuncturist, and is directing the Integrative Sports Medicine program, which includes an 18-month track for PM&R residents leading them to becoming certified physician acupuncturists.
Dr. Brian Sunwoo is a current administrative chief resident in the Physical Medicine and Rehabilitation residency program at NYU Langone Health. He attended Rowan School of Osteopathic Medicine, where he received the Dean's Recognition Award and will begin a fellowship in Interventional Spine after completing residency. As an NYU resident, he has served on the Rusk Health Equity, GME Diversity and Inclusion, and House Staff Leadership Committees. Dr. Sunwoo currently is completing his clinical acupuncture certification through the NYU PM&R residency program with plans to incorporate its use in his future practice.
The following items were discussed in Part 2: effectiveness of acupuncture treatment either pre- or post-operative in dealing with nausea and vomiting in the post-surgical period; use of acupuncture in treating mental health conditions; extent to which sham acupuncture is being used in research; whether expectancy data are collected beforehand to measure how strongly patients anticipate a positive acupuncture treatment outcome; health problems where research indicates a high-certainty level of evidence for acupuncture; use of artificial intelligence in acupuncture research and treatment; and current or planned research endeavors at NYU that involve acupuncture.
Dr. Moroz attended the NYU School of Medicine and remained at NYU-Rusk Rehabilitation for residency training, and subsequently, his first and only job. He rose through the faculty ranks and currently is Director of Residency Training and Vice Chair for Education. Dr. Moroz sought out additional training and became a New York State certified acupuncturist, and is directing the Integrative Sports Medicine program, which includes an 18-month track for PM&R residents leading them to becoming certified physician acupuncturists.
Dr. Brian Sunwoo is a current administrative chief resident in the Physical Medicine and Rehabilitation residency program at NYU Langone Health. He attended Rowan School of Osteopathic Medicine, where he received the Dean's Recognition Award and will begin a fellowship in Interventional Spine after completing residency. As an NYU resident, he has served on the Rusk Health Equity, GME Diversity and Inclusion, and House Staff Leadership Committees. Dr. Sunwoo currently is completing his clinical acupuncture certification through the NYU PM&R residency program with plans to incorporate its use in his future practice.
The following items were discussed in Part 1: number of participants in the residency program at NYU using acupuncture with patients; professional qualifications deemed necessary to use acupuncture in treating patients; insurance company coverage of acupuncture treatment; role of patients’ age in achieving desired clinical outcomes involving acupuncture; different kinds of instruments used by acupuncture practitioners; acupuncture as a lone intervention and also as an adjunct to western medicine; contributions that acupuncture can make in dealing with problems, such as stroke; and possible differences among clinicians in different health professions regarding the effectiveness of acupuncture treatments?
Dr. Byron Schneider is currently an associate professor with the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center and serves as the Director of the Interventional Spine and Musculoskeletal Medicine Fellowship. Previously, he completed his residency and interventional spine fellowship at Stanford University. He has nearly 100 publications, with a research focus on the safety and outcomes of interventional spine procedures. He has given over 100 lectures at national and international meetings. He currently is on the Spine Intervention Society Board of Directors as the Chair of Research, and within the North American Spine Society is Chair of the Interventional Spine and Musculoskeletal Section as well as Co-Chair for the Coverage Committee.
In Part 2 of his presentation, he indicated that the study by Wolf and his group was observational and retrospective, so there are some missing data. They enrolled patients based on provocation discography, which you hope would result in better outcomes. He stated that this number, 50 percent of people saying that they are 50 percent better is very common in pain literature. He wouldn’t say it is favorable. Over and over, these are the numbers we see that turn out to be dead ends. These are non-compelling data unless we are able to show they are non-placebo. You need RCTs to do that. He is a huge proponent of observational studies. They can give you very meaningful clinical information, but unfortunately for a new technology like this, we need at least some evidence that these things are doing something beyond placebo. Next, he indicated the discussion in his presentation would shift to discussing some RCTs that have been published more recently. As of right now, however, the totality of evidence because of the negative RCTs in the research done today, stem cells do not work as a treatment for disc-related low back pain. He then described four new RCTs that came out in the last two years that will shed some new light. The first study involved a comparison with saline treatment. Unwanted side effects, such as infections and other complications have occurred as a result of the treatments in the four studies. Safety continues to be a concern in developing effective treatments using stem cell and PRP approaches.
Dr. Byron Schneider is currently an associate professor with the Department of Physical Medicine and Rehabilitation at Vanderbilt University Medical Center and serves as the Director of the Interventional Spine and Musculoskeletal Medicine Fellowship. Previously, he completed his residency and interventional spine fellowship at Stanford University. He has nearly 100 publications, with a research focus on the safety and outcomes of interventional spine procedures. He has given over 100 lectures at national and international meetings. He currently is on the Spine Intervention Society Board of Directors as the Chair of Research, and within the North American Spine Society is Chair of the Interventional Spine and Musculoskeletal Section as well as Co-Chair for the Coverage Committee.
In Part 1 of his presentation, the focus was on a systematic review that was done of how stem cells and PRP pertain to back pain. He began by going over the history and regulations. Traditionally as it pertains to all biologics, they were largely exempt from the pathway of the FDA. Because they did not go through that process, these medicines were allowed to be done, but really did not have any insurance coverage. They became a cash cow for those offering fee-for-service treatment for things that did not have a lot of evidence behind them yet. It led to much public confusion, but that gap has shrunk in recent years. The FDA began issuing more restrictive language in 2020 regarding treatments that were not approved by that agency. The primary purpose of the aforementioned review was to look at 50 or more percent relief of low back pain at a six-month outcome. Based on those criteria, the number of citations was whittled down from 3,000 citations reviewed to 37, then finally down to only 12 that actually met the criteria. Those results should be alarming given that hundreds of clinics in the U.S. were providing treatments for cash payments that were based on only 12 research papers. Only one paper was on PRPs and one on stem cell treatment. He then described a study on PRP in 2015. He also provided summaries of other investigations that entailed PRP and stem cell treatments.
Dr. Baumhauer is a tenured Professor and serves as the Senior Associate Dean of Academic Affairs for the University of Rochester School of Medicine and Dentistry. She also is the Associate Chair of Academic Affairs within the Department of Orthopaedics at the University of Rochester. In addition to providing clinical care and performing surgery, she holds the position as the Director of the Clinical Health Informatics Core for the UR Healthcare System and is a board of director of Accountable Health Partners, ACO for the Rochester Region. She received her Doctorate of Medicine from the University of Vermont College of Medicine. She completed orthopaedic residency at the Medical Center Hospital of Vermont and a Fellowship in Foot and Ankle Surgery at the Medical College of Wisconsin. She also completed a Masters in Public Health degree from the University of Rochester. Dr. Baumhauer is the past president of the American Board of Orthopaedic Surgery, American Orthopaedic Foot and Ankle Society (AOFAS), and Eastern Orthopaedic Association. She currently is the President of the Patient-Reported Outcomes Measurement Information System (PROMIS) Health Organization and has published over two hundred peer reviewed papers and book chapters.
In Part 2, Dr. Baumhauer described research showing that patients who were able to report at times that were important to the patient ended up visiting the emergency room less and were experiencing more favorable outcomes. She discussed how data are used. The first time seeing a patient, it is important to know what their baseline values are, e.g., mild depression and moderate symptoms for physical function and pain. Trends can be noted that make it possible before meeting with a patient to look at the PROMIS scores and be able to anticipate how much time to spend with this individual. It enables the physician to triage, which patients appreciate. Patients also are asked anchoring questions, such as general health status questions that make it possible to link the medical visit. An example is are you worse, better, or the same since your last visit? Another question is can you live with your symptoms? She also discussed how patients can ask questions, such as whether there will be substantial improvement as a result of surgery. If such an outcome is unlikely, surgery should not occur. Another question patients ask is which of various treatment options should be selected? It is important to know what the patient wants to measure.
Dr. Baumhauer is a tenured Professor and serves as the Senior Associate Dean of Academic Affairs for the University of Rochester School of Medicine and Dentistry. She also is the Associate Chair of Academic Affairs within the Department of Orthopaedics at the University of Rochester. In addition to providing clinical care and performing surgery, she holds the position as the Director of the Clinical Health Informatics Core for the UR Healthcare System and is a board of director of Accountable Health Partners, ACO for the Rochester Region. She received her Doctorate of Medicine from the University of Vermont College of Medicine. She completed orthopaedic residency at the Medical Center Hospital of Vermont and a Fellowship in Foot and Ankle Surgery at the Medical College of Wisconsin. She also completed a Masters in Public Health degree from the University of Rochester. Dr. Baumhauer is the past president of the American Board of Orthopaedic Surgery, American Orthopaedic Foot and Ankle Society (AOFAS), and Eastern Orthopaedic Association. She currently is the President of the Patient-Reported Outcomes Measurement Information System (PROMIS) Health Organization and has published over two hundred peer reviewed papers and book chapters.
Part 1: Data are needed to help understand how a patient is feeling and functioning to implement preventive health strategies, maximize healthy behaviors, assess their treatment response, and understand how health care resources are being allocated. Dr. Baumhauer defined a patient reported outcome as information directly reported by the patient who experiences it and is not interpreted as when we usually obtain some health history and tell it in our terms and report it into the patient’s note. She provided examples of the disconnect between what is important to the patient and what the clinician believes is important for the patient. A validated number can be placed on how the patient is feeling and functioning. It is important that a validated instrument be used that is quick and does not hold up the clinician. At the University of Rochester, they landed on the use of PROMIS (Patient-Reported Outcomes Measurement Information System) on a custom platform called UR VOICE (Validated Outcomes in Clinical Experience). They collect the same information for each patient. They try to ask the right questions when the information is needed most. The aim is to be domain specific, such as symptom-based, using the core package of pain, physical function, and depression rather than focusing on various diseases. Depending on the medical specialty, the symptoms emphasized can be different. Compared to SF-36, PROMIS is a better measure since it is more responsive to change.
Dr. Kendall is a second-year resident physician at Rusk. She completed her undergraduate education in Nutrition Science with honors from Purdue University. Subsequently, she was awarded Master’s Student of the Year in 2017 by the Purdue University College of Health and Human Sciences for her graduate work in Cancer Epigenetics and Nutriepigenomics. Since discovering the field of physiatry as a medical student, she has adamantly pursued neurorehabilitation, spinal cord injury, and pain medicine research. She serves on the American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR) Resident Council, regularly provides mentorship to aspiring physiatrists, and serves on the Rusk Rehabilitation residency wellness committee. Her current rehabilitation interests include interventional spine medicine and movement disorders. The following items were discussed in this one-part interview: incidence and prevalence data for amyotrophic lateral sclerosis (ALS) in the U.S.; the role of heredity; demographic groups more likely to experience the onset of this disease; preventability of ALS;, tools for making a clear diagnosis; ability to acquire wheelchairs in a timely fashion; when to initiate a custom power wheelchair order; training patients to use power wheelchairs; prevention of decubitus ulcers from sitting in an unchanged posture; and seeking to have an impact on legislation regarding this disease.
Originally from Brooklyn, Dr. Klyachman is the son of two Russian speaking immigrants and among the first in his family to pursue a career in medicine. He attended the University at Buffalo for his undergraduate education and continued his medical education at Touro College of Osteopathic Medicine in Harlem. After graduating, he went to Florida to complete an internship and currently is in the fourth year of a rehabilitation residency at NYU Rusk. He recently matched into a fellowship at NYU where he plans to continue specialty training that starts in July 2023.
The following items were discussed in this one-part interview: a typical day in the life of a medical resident at Rusk; involvement in research at Rusk; area of specialization upon completion of the residency; types of components that should be included for residents in a skilled nursing facility level rehabilitation program, such as prediction tools for identifying and stratifying patients being discharged to a skilled nursing facility; social media developed for residents at Rusk; ways in which social media have played a constructive role in contributing to the mental and physical wellbeing of these clinicians; how social media can serve as a key adjunct to traditional residency learning in classrooms and on the wards; use of social media from the perspective of interacting with residency peers, instructors, and patients; role for physiatrists to play in enhancing social media skill development in patients; and empowering patients by providing them with the necessary knowledge and skills to promote constructive behavior change. Many patients have as a rehabilitation goal a successful reintegration into the society by returning to previous employment and renewing their social networks. Self-management programs may contribute to realizing the attainment of this goal. What role do you see being played by physiatrists, if any, in empowering patients by providing them with the necessary knowledge and skills to promote constructive behavior changes through self-management.
Dr. Lindsey Gurin is a clinical assistant professor of neurology, psychiatry, and rehabilitation medicine at NYU Langone Health. She is dual board-certified in neurology and psychiatry and currently serves as Director of Behavioral Neurology at NYU Langone Orthopedics Hospital, where she provides neuropsychiatric consultation to the Rusk acute inpatient brain injury rehabilitation service. She also is Director of the NYU Combined Psychiatry/Neurology Residency Training Program. Dr. Gurin has published on neuropsychiatric manifestations of brain injury and her current research interests include psychosis after brain injury; disorders of consciousness; and catatonia in patients with neurologic disorders.
Dr. Brian Im is heavily involved in program development and academic medicine. He has an active role in brain injury rehabilitation research at NYU. After completing medical school at SUNY Upstate Medical University, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. He remains involved in this research at Bellevue Hospital while at his current role as the director for brain injury rehabilitation medicine at NYU/Rusk Rehabilitation.
In Part One, the discussion included the following: a description of the care provided at NYU for patients who experience a brain injury from the perspective of the overall number and kinds of personnel involved and the clinical facilities in which they work; early neurorehabilitation and recovery from disorders of consciousness after severe COVID-19; and the kinds of challenges involved, such as arriving at a correct diagnosis of disorders of consciousness that could prove difficult because of a combination of patient and health system factors.
In Part Two, the discussion included the following: long COVID with brain fog and treatments that are being tried; a definition of the terms catatonia and hypoxia-ischemia and a description of their causes; challenges involved in diagnosing and treating catatonia effectively in a timely manner; possible outcome of ineffective treatment occurring if catatonia is under-recognized diagnostically, and current and future research endeavors at NYU pertaining to brain injury.
Dr. Lindsey Gurin is a clinical assistant professor of neurology, psychiatry, and rehabilitation medicine at NYU Langone Health. She is dual board-certified in neurology and psychiatry and currently serves as Director of Behavioral Neurology at NYU Langone Orthopedics Hospital, where she provides neuropsychiatric consultation to the Rusk acute inpatient brain injury rehabilitation service. She also is Director of the NYU Combined Psychiatry/Neurology Residency Training Program. Dr. Gurin has published on neuropsychiatric manifestations of brain injury and her current research interests include psychosis after brain injury; disorders of consciousness; and catatonia in patients with neurologic disorders.
Dr. Brian Im is heavily involved in program development and academic medicine. He has an active role in brain injury rehabilitation research at NYU. After completing medical school at SUNY Upstate Medical University, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. He remains involved in this research at Bellevue Hospital while at his current role as the director for brain injury rehabilitation medicine at NYU/Rusk Rehabilitation.
In Part One, the discussion included the following: a description of the care provided at NYU for patients who experience a brain injury from the perspective of the overall number and kinds of personnel involved and the clinical facilities in which they work; early neurorehabilitation and recovery from disorders of consciousness after severe COVID-19; and the kinds of challenges involved, such as arriving at a correct diagnosis of disorders of consciousness that could prove difficult because of a combination of patient and health system factors.
In Part Two, the discussion included the following: long COVID with brain fog and treatments that are being tried; a definition of the terms catatonia and hypoxia-ischemia and a description of their causes; challenges involved in diagnosing and treating catatonia effectively in a timely manner; possible outcome of ineffective treatment occurring if catatonia is under-recognized diagnostically, and current and future research endeavors at NYU pertaining to brain injury.
Part Two included a discussion of the barriers that students still face despite the ADA. They did not seek supportive accommodations because of stigma or fear. Dr. Rizzo wanted to draw attention to definitions of disability. He also emphasized that people with disabilities can help with accessibility and for coming up with empathetic dialogue that is critical in moving forward as a medical community. These agendas must be pushed here at NYU to ensure that we are doing enough to increase disability inclusion and also to ensure that patients are receiving the preventive medicine that they actually need. Dr. Wu indicated that in his research conducted 30 years ago, deans not only were asked how many medical school students have disabilities, but also “how did they do?” Did you do the right thing for society by producing good physicians at the end or did you pass along somebody who shouldn’t be there? The result was those students did as well and better than their able-bodied counterparts.
Part One of this grand round presentation delves into the struggle faced by individuals with disabilities and future directions to take to include them in the rehabilitation field. Both Drs. Rizzo and Wu have important stories to tell about living with a disability. An aim in this session is to understand the epidemiology of disability, the American with Disabilities Act (ADA), and be familiar with the barriers that individuals with disabilities face. According to new CDC data, the prevalence of disability in the non-institutionalized portion of the U.S. population is 26%. The data may understate the true prevalence. Data also were provided on the prevalence of disability among medical students, residents, and practicing physicians. These numbers also may under represent the true extent of disability among members of the medical community. A definition of disability in the American with Disabilities Act Amendments and its implications were discussed.
Part One of this grand round presentation delves into the struggle faced by individuals with disabilities and future directions to take to include them in the rehabilitation field. Both Drs. Rizzo and Wu have important stories to tell about living with a disability. An aim in this session is to understand the epidemiology of disability, the American with Disabilities Act (ADA), and be familiar with the barriers that individuals with disabilities face. According to new CDC data, the prevalence of disability in the non-institutionalized portion of the U.S. population is 26%. The data may understate the true prevalence. Data also were provided on the prevalence of disability among medical students, residents, and practicing physicians. These numbers also may under represent the true extent of disability among members of the medical community. A definition of disability in the American with Disabilities Act Amendments and its implications were discussed.
Veronica Alfaro is a senior Design Technologist on the NYU Population Health Research team. Her work occurs in the intersection between accessibility and health care through the fields of human-centered design, user experience, user interface design, and information visualization. Her most recent focus is on reimagining health care and the use of technology and design to improve the relationship between patients and health care providers in the FuturePractice| HiBRID lab. Additionally, she focuses on the design of frameworks for developing customizable assistive technologies for individuals with disabilities, which she developed as part of her residency in the NYU Ability Project. She has an MPS degree from NYU’s Interactive Telecommunications Program.
In Part 2, the following items were discussed: collaboration with entities within and outside of NYU; how design thinking and innovative strategies are influenced by members of specific clinical groups; taking into account during the design process that patients who experience diminishing capacities may have to abandon digital health technologies; possible unintended negative consequences relating to novel digital technologies; challenges involved in the adoption of new technologies; and launching new research endeavors.
Veronica Alfaro is a senior Design Technologist on the NYU Population Health Research team. Her work occurs in the intersection between accessibility and health care through the fields of human-centered design, user experience, user interface design, and information visualization. Her most recent focus is on reimagining health care and the use of technology and design to improve the relationship between patients and health care providers in the FuturePractice| HiBRID lab. Additionally, she focuses on the design of frameworks for developing customizable assistive technologies for individuals with disabilities, which she developed as part of her residency in the NYU Ability Project. She has an MPS degree from NYU’s Interactive Telecommunications Program.
In Part 1, the following items were discussed: how she became interested in designing assistive technologies; use of 3D printing in producing custom educational materials and medical devices; her role in the the FuturePractice/HiBRID team; and how the digital health component is integrated into the various FuturePractice/HiBRID activities.
Professor Arthur Matthews is chief operating officer of Matthews & Matthews Consulting, a boutique firm specializing in customized and divergent aspects of human resources, labor, and the workforce. His clients primarily are corporations, government agencies, unions, and 501(C)(3) organizations that include Johns Hopkins University, Con Edison, the Centers for Disease Control and Prevention, and New York City Health and Hospitals. Additionally, he is a Teaching Professor of Labor and Employment Relations at Penn State University and a Visiting Lecturer at the University of Arkansas. He began his teaching career in 1987 first at the Medgar Evers College/City University of New York and the Van Arsdale School of Labor Studies. Since 1989 he also has served on the faculty at NYU and Cornell University School of Industrial and Labor Relations. His law degree with a Concentration in Human Rights, Civil Rights, and Public Policy is from Howard University.
In this interview, he discusses the following: principles of leadership, going from a leader to becoming an ambassador, interchangeable skills for different situations, dealing with conflict, adding leadership training to the curricula at health professions schools, and the notion of shared leadership.
Dr. Linda Carozza is a clinical professor in the Department of Physical Medicine and Rehabilitation at NYU Langone Health. She has written extensively on the broad topic of communication and aging with a focus on creative approaches to improving the quality of life. Her publications include the topic of counselling in chronic aphasia: integrating theory with professional roles in clinical practice and also on the topic of non-pharmacological approaches to dementia. She has a Certificate of Clinical Competence from the American Speech-Language-Hearing Association. In 2021, she was selected a National Academy of Practice Speech Pathology Fellow. She has a doctorate in speech and hearing sciences from the Graduate Center at the City University of New York. Her baccalaureate and master’s degree in speech and hearing are from the City College of New York.
Topics discussed in Part 2 included the following: common symptoms that will be experienced by an individual who is beginning to reveal signs of dementia or Alzheimer’s disease; primary progressive aphasia (PPA); effective tools and resources used since 2019 when the World Health Organization published its first evidence-based guidelines on dementia risk reduction; roles played by informal and family caregivers and preparing them to do so; use of telehealth in treating patients; non-pharmacological approaches in assessment and treatment of dementia; and future research projects envisioned.
Dr. Linda Carozza is a clinical professor in the Department of Physical Medicine and Rehabilitation at NYU Langone Health. She has written extensively on the broad topic of communication and aging with a focus on creative approaches to improving the quality of life. Her publications include the topic of counselling in chronic aphasia: integrating theory with professional roles in clinical practice and also on the topic of non-pharmacological approaches to dementia. She has a Certificate of Clinical Competence from the American Speech-Language-Hearing Association. In 2021, she was selected a National Academy of Practice Speech Pathology Fellow. She has a doctorate in speech and hearing sciences from the Graduate Center at the City University of New York. Her baccalaureate and master’s degree in speech and hearing are from the City College of New York.
Part 1 included a discussion of the following: how she become interested in the area of adult neurogenic communication disorders; conditions encompassed by the term adult neurogenic communication disorders; professional qualifications for students or other individuals who wish to pursue this line of practice; some defining characteristics of dementia-communication changes and how they differ from stroke-treated communication changes; incidence and prevalence of dementia and Alzheimer’s disease in the US; whether the terms dementia and Alzheimer’s disease basically are the same, and if not, important distinctions between them; and some major causes of dementia.
Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.
The following topics were discussed in Part 3: Patient-Reported Outcome Measures employed in vascular technology at NYU and their utility; the extent to which patients who experienced a stroke are suitable candidates for becoming competent self-managers so that they can be effective in self-monitoring, recognizing and reporting symptoms, and treating side effects, and efforts undertaken at NYU to foster self-management by patients; if patients are treated at a presenting hospital, whether teleneurology is involved in providing care; and assessing the value of self-wearable devices for diagnostic purposes and their future prospects for achieving better health care outcomes?
Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.
The following topics were discussed in Part 2: once patients arrive at NYU Langone Health emergency rooms and a stroke is confirmed, the steps in treatment that will follow; after stroke treatments are provided, how prognostication is affected by the interplay between demographic factors, such as age, sex, and ethnicity, the kind of stroke, stroke causation, and clinical severity; the role, if any, that blood biomarkers play in improving the prognostic assessment; how a patient’s cognition is affected by having a stroke, the degree to which factors such as pre- and post-stroke physical fitness, smoking, and body weight play a role; and the kind of impact that related mental states, such as depression and anxiety can have on cognition.
Dr. Koto Ishida is an Associate Professor in the Department of Neurology at NYU Grossman School of Medicine. She also serves as Medical Director of the Stroke Program at NYU Langone Health and Director of Clinical Affairs at the Center for Stroke and Neurovascular Diseases. She is Board-certified both in vascular neurology and neurology by the American Board of Psychiatry & Neurology. Her medical degree is from the University of Rochester. She completed her residency in neurology at the Hospital of the University of Pennsylvania where she had a fellowship in vascular neurology. Dr. Ishida has her name on 70 publications in the professional literature.
This is a special three-part series.
The following topics were discussed in Part 1: how common strokes are; distinguishing features of ischemic and hemorrhagic stroke; some major causes of a stroke and if genetics and family history are among them; from the standpoint of sex and gender, if there are any differences in specific risk factors, differences in presentation, response to treatment, and stroke outcomes between what commonly are referred to as male and female; how the acronym FAST is applicable and the importance of going to a hospital as soon as possible upon experiencing stroke symptoms; and the likelihood that a patient may have a non-cerebrovascular disease that mimics a stroke, and if so, how to distinguish between stroke and non-stroke symptoms.
Douglas H. Smith, MD, is the Robert A. Groff Endowed Professor Neurosurgery and Director of the Center for Brain Injury and Repair at the University of Pennsylvania. He is the Scientific Director of the Big 10/Ivy League Collaboration on Concussion and also serves as a member on the Scientific Advisory Boards of the US National Football League (NFL), the National Collegiate Athletic Association (NCAA)-DoD consortium on concussion, and the International Concussion Society.
This is the second part of a two-part series. In this one, he points out that:
We find that when we are looking at over time the changes of profiles, it means they are appearing and disappearing. How does that look like compared to the appearance of those proteins in the blood? We are finding an interesting correlation that is kind of a combination between how open the blood brain barrier is and how much axon pathology is. It has become possible to diagnose the 20 percent of patients who will have persistent symptoms at the time they come to the ED and then we can direct them to you in rehabilitation. The next step is to have a clinical trial. He asked how all this links with neurodegeneration? Within hours of an injury, it can begin to look like an Alzheimer’s disease brain. Something is going on that is crazy. An axon injury is one that can keep on taking. Tau is what gets all the big news. It may be too simplistic a view. It is not just tau. It actually is a whole bunch of things happening to the brain. Many other different types of neuropathologies occur in the brain that are initiated by injury. A subset of patients will develop these changes. If males dominate concussions, which they do, in theory you would think that they possibly would dominate dementia or mild cognitive impairment later in life, but that is not true. Women have a higher rate. There is a lot of work to be done. A lot of people who have concussions are going to be fine and we need to find a way to avoid having people worry and cause stress. A Question and Answer period followed the presentation.
Douglas H. Smith, MD, is the Robert A. Groff Endowed Professor Neurosurgery and Director of the Center for Brain Injury and Repair at the University of Pennsylvania. He is the Scientific Director of the Big 10/Ivy League Collaboration on Concussion and also serves as a member on the Scientific Advisory Boards of the US National Football League (NFL), the National Collegiate Athletic Association (NCAA)-DoD consortium on concussion, and the International Concussion Society.
This is the first of a two-part series. In this one, he points out that:
An objective is to look at the biomechanics of concussion and how that selectively induces injuries to axons, and how to detect it non-invasively. Also, how does that time zero, when the injury occurs, cause neurodegeneration later on? It is weird that the definition of a concussion does not include what is going on in the brain, which is an actual true definition of a diagnosis. He showed different pathologies in concussion. White matter in the brain in particular seems vulnerable to the forces of a concussion. He discussed the role of axons in a brain injury, noting that Tau is our selective marker for axons. He talked about how multiple swelling occurs along the axon. Think of the brain being a kind of eavesdropping system, a shadow network. He indicated that in a sports injury in soccer, there is a higher rate of concussion and a worse outcome for women. Male axons are bigger and have a more complex microtubular array. On average, smaller axons are more vulnerable and subject to greater dysfunction and loss of synchrony, so normal functions of networks are impaired in females compared to males. Another change that does a lot in a concussion is disruption of the blood brain barrier. Think of a blood brain barrier disruption map as where we see the distribution of axonal pathology.
Dr. Karsten has more than five years of clinical experience across diverse healthcare settings and currently works full-time on an acute inpatient neurorehabilitation unit, evaluating and treating adults with acquired brain injury and other neurological & complex orthopedic conditions. She also serves as a mentor to other staff members and acts as a supporting faculty member of the Neurologic Residency Program in acute inpatient rehabilitation at NYU Langone Orthopedic Hospital. Dr. Karsten has presented posters at American Physical Therapy Association meetings and also at the 5th International Gait and Balance Symposium in Multiple Sclerosis. Her Doctor of Physical Therapy degree is from Hunter College and she has achieved Board Certification in Neurologic Physical Therapy.
Part 2 covers related topics, including: some challenges that may characterize treating different kinds of patients based on age; possible impairments associated with an ABI involving communication, loss of mobility, increased fatigue, sleep difficulties, and vision deficits; patients’ level of self-awareness; negative health behaviors exhibited prior to sustaining a brain injury; and challenges faced by caregivers.
Dr. Karsten has more than five years of clinical experience across diverse healthcare settings and currently works full-time on an acute inpatient neurorehabilitation unit, evaluating and treating adults with acquired brain injury and other neurological & complex orthopedic conditions. She also serves as a mentor to other staff members and acts as a supporting faculty member of the Neurologic Residency Program in acute inpatient rehabilitation at NYU Langone Orthopedic Hospital. Dr. Karsten has presented posters at American Physical Therapy Association meetings and also at the 5th International Gait and Balance Symposium in Multiple Sclerosis. Her Doctor of Physical Therapy degree is from Hunter College and she has achieved Board Certification in Neurologic Physical Therapy.
Part 1 covers various topics, including: an average day’s caseload size of patients who are being treated for an acquired brain injury or ABI; creation of a tool called the Preparedness for Caregiving Scale; kinds of skills being developed by caregivers; members of the rehabilitation team participating in caregiver training; Care Partner Carryover Day activities; and program limitations.
Dr. Jonas Sokolof graduated from the New York College of Osteopathic Medicine. He completed his PM&R residency at Harvard Medical School and his fellowship at the Kessler Institute. He joined NYU Langone Health and the Rusk Rehabilitation Institute in 2018 where he has served as director of oncological rehabilitation. His research interests include the role of lifestyle intervention in the rehabilitation of cancer patients.
Dr. Sokolof noted in Part 2 of his presentation that many patients may be reluctant to take medications. They don’t want injections and the last thing they look forward to is taking another drug or having something else done to them. Trismus is condition we often see in this population, developing from radiation. We tend to see it more as actual fibrosis of the muscles of mastication. Neuropathy also is quite common in this population. We often see it from the radiation itself. Post-radiation functional status and quality of life have a strong correlation with overall long-term survival in the head and neck cancer population. As physiatrists, not only do we have a role to play in restoring functioning, we are involved in altering the disease course itself. The fibrosis syndrome stemming from radiation is problematic and progressive. There is nothing out there so far that can cure it. An exciting emerging treatment in a study he is involved in at NYU is looking at photo biomodulation therapy or low-level laser light therapy. It is a technology used a lot in sports medicine to treat musculoskeletal pain and sports-related injuries. It basically is light therapy rather than heat therapy and works at the level of the mitochondria. The primary objective is to determine if this is a feasible treatment for head and neck cancer patients. He concluded by indicating that the earlier we can become involved in the whole cancer continuum as physiatrists the better, especially in radiation fibrosis. A question-and-answer question followed his presentation.
Dr. Jonas Sokolof graduated from the New York College of Osteopathic Medicine. He completed his PM&R residency at Harvard Medical School and his fellowship at the Kessler Institute. He joined NYU Langone Health and the Rusk Rehabilitation Institute in 2018 where he has served as director of oncological rehabilitation. His research interests include the role of lifestyle intervention in the rehabilitation of cancer patients.
In Part 1 of his presentation, he indicated that head and neck cancer is a unique pathology where a huge impact is made by physiatry. This kind of cancer is more commonly associated with older males, alcohol and tobacco use, genetics, and other factors. Head and neck cancer is on the rise in younger males. He mentioned different cancer subtypes, such as oral cavity and lip. Induction chemotherapy and chemoradiation tend to be the main forms of treatment presently rather than surgery alone. Radiation affects the surrounding tissue, which is where we as physiatrists come into play. The more common conditions encountered include pain, dysphagia, inability to open the mouth, and limited head and neck mobility. As physiatrists, there are conditions that we ourselves proactively can treat as opposed to speech and swallowing dysfunctions that we refer to other clinicians. Fibrosis can extend throughout the entire radiation field, affecting all the skin, nerves, muscles, and blood vessels. Radiation tends to disrupt the normal phases of healing. He described various effects that are irreversible. Patients usually are referred to physiatrists at the first sign of lymphedema. He stated that a high suicide rate is associated with this kind of cancer. Physiatry care should be involved in every stage of treatment. He carries over a sports medicine approach to oncological rehabilitation with the first step in the process being pain control followed by range of motion and strength and endurance. He also described some interventions for treating lymphedema.
Welcome back to this special two-part series. Part 1 covered various topics, including: pulmonary conditions that could lead to the need for a transplant; if the recent resurgence of the coronavirus and its continued display of new emerging variants has affected the ability to furnish care for patients; kinds of contributions physiatry, physical therapy, occupational therapy, and speech-language pathology clinicians can make in preparing patients for transplantation and in optimizing function; whether rehabilitation settings differ based on the kinds of health problems that patients have; and prevention of the occurrence of hospital readmissions.
Part 2 covers many new areas, including: how patients requiring rehabilitation services may differ according to personal characteristics, such as age and how such differences are taken into account when providing treatment; kinds of physiological changes patients can experience post-transplantation; prevention of the risk of infection; steps taken to deal with the issue of nonadherence of recommended treatment protocols; use of rehabilitation notebooks and peer support groups; comparison of telehealth and face-to-face interactions with patients; and kinds of key rehabilitation questions to address.
Megan Carroll is a Board Certified Clinical Specialist in Geriatric physical therapy. She has been an intensive care unit physical therapist working at NYU Langone Health since 2015.
Camille Magsombol works on developing occupational therapy programs to support patients' successful health management of their chronic diseases, including medication management.
Christina Moriarty's work focuses on speech/swallow assessment and treatment with head and neck cancer as well patients in the surgical intensive care unit, including those with heart and lung transplants.
Sofia Prilik is a physiatrist who serves as clinical director of inpatient cardiac and pulmonary rehabilitation, with a focus on inpatient rehabilitation of lung and heart transplant patients.
Welcome to this special two-part series with a panel of speakers. Part 1 covers various topics, including: pulmonary conditions that could lead to the need for a transplant; if the recent resurgence of the coronavirus and its continued display of new emerging variants has affected the ability to furnish care for patients; kinds of contributions physiatry, physical therapy, occupational therapy, and speech-language pathology clinicians can make in preparing patients for transplantation and in optimizing function; whether rehabilitation settings differ based on the kinds of health problems that patients have; and prevention of the occurrence of hospital readmissions. Megan Carroll is a Board Certified Clinical Specialist in Geriatric physical therapy. She has been an intensive care unit physical therapist working at NYU Langone Health since 2015.
Camille Magsombol works on developing occupational therapy programs to support patients' successful health management of their chronic diseases, including medication management.
Christina Moriarty's work focuses on speech/swallow assessment and treatment with head and neck cancer as well patients in the surgical intensive care unit, including those with heart and lung transplants.
Sofia Prilik is a physiatrist who serves as clinical director of inpatient cardiac and pulmonary rehabilitation, with a focus on inpatient rehabilitation of lung and heart transplant patients.
In Part 1, we discussed the incidence and prevalence of MS in the United States; whether MS is on the rise, holding steady, or in decline; kinds of symptoms that occur either singly or in combination and their impact on patients from the perspective of psychology; roles that stress and mood disturbances play in influencing various MS symptoms; how perception of illness perception by patients has an impact on psychological distress; other kinds of therapeutic interventions to treat symptoms; cultivation of resilience among patients; and helping patients to become adept as self-managers of MS.
In Part 2, we discussed the use of cannabis for medicinal purposes among patients with MS; non-adherence to prescribed treatment plans; the extent to which lockdown policies have disrupted normal lifestyle and the ability to access health services; use of telemedicine with patients and how it compares in effectiveness with face-to-face interactions; and key insights observed as a result of working with patients.
Felicia Connor is the Director of Internship and Training for an APA approved internship program at NYU Langone Health, Rusk Rehabilitation. She is Board Certified in Rehabilitation Psychology and is a licensed clinical psychologist in Delaware and New York. For the last decade, she has specialized in rehabilitation of individuals with medical and neurological conditions with Traumatic Brain Injury, concussion, stroke and multiple sclerosis. She administers neuropsychological assessment and provides cognitive remediation and individual and group psychotherapy for individuals who are adjusting to their medical conditions.
Barbara Cicero is the Program Manager of the Adult Outpatient Psychology Service at NYU Langone Health, Rusk Rehabilitation. She received her Ph.D. from the Graduate Center of CUNY and completed a post-doctoral fellowship in Rehabilitation
Psychology at Mount Sinai Medical Center. In addition to her administrative responsibilities, she conducts neuropsychological evaluations and provides individual and group treatment to individuals with a variety of medical and neurological conditions. Her clinical interests include the assessment and treatment of individuals with traumatic brain injury and multiple sclerosis.
In Part 1, we discussed the incidence and prevalence of MS in the United States; whether MS is on the rise, holding steady, or in decline; kinds of symptoms that occur either singly or in combination and their impact on patients from the perspective of psychology; roles that stress and mood disturbances play in influencing various MS symptoms; how perception of illness perception by patients has an impact on psychological distress; other kinds of therapeutic interventions to treat symptoms; cultivation of resilience among patients; and helping patients to become adept as self-managers of MS.
Felicia Connor is the Director of Internship and Training for an APA approved internship program at NYU Langone Health, Rusk Rehabilitation. She is Board Certified in Rehabilitation Psychology and is a licensed clinical psychologist in Delaware and New York. For the last decade, she has specialized in rehabilitation of individuals with medical and neurological conditions with Traumatic Brain Injury, concussion, stroke and multiple sclerosis. She administers neuropsychological assessment and provides cognitive remediation and individual and group psychotherapy for individuals who are adjusting to their medical conditions.
Barbara Cicero is the Program Manager of the Adult Outpatient Psychology Service at NYU Langone Health, Rusk Rehabilitation. She received her Ph.D. from the Graduate Center of CUNY and completed a post-doctoral fellowship in Rehabilitation
Psychology at Mount Sinai Medical Center. In addition to her administrative responsibilities, she conducts neuropsychological evaluations and provides individual and group treatment to individuals with a variety of medical and neurological conditions. Her clinical interests include the assessment and treatment of individuals with traumatic brain injury and multiple sclerosis.
Dr. Aaron Johnson is a researcher and speech-language pathologist specializing in voice debilitation and rehabilitation. His research laboratory is funded by the National Institutes of Health. He uses novel translational research methods to examine the effects of vocal training on laryngeal neuromuscular mechanisms in the aging larynx. His professional background includes a decade-long experience serving as a classical singer and teacher of singing. Dr. Johnson began Part 2 of his presentation regarding how the idea of exercise is to have some sort of repeated muscle use or stress designed to induce specific adaptations. The goals are to increase the strength or endurance of the muscles. Vocal exercises are built on both sides of the continuum. Endurance training involves a long duration of this activity under low load with high repetitions so we can have a power output over longer periods of time. With resistance training, we are thinking of short durations of activity with high load and typically not many repetitions. Resistance training with the voice is trickier to apply. He referred to his work at the University of Wisconsin prior to arriving at NYU. He discussed the advantages of using a rat model based on ultrasonic vocalizations. Rats produce these by using the same underlying laryngeal neuromuscular mechanisms that we use to produce our vocalizations as humans. He showed a video of how rats are trained and discussed some findings of research that was undertaken, showing how louder vocalizations were achieved. Another study included younger rats and changes in muscle fiber type composition.
Dr. Aaron Johnson is a researcher and speech-language pathologist specializing in voice debilitation and rehabilitation. His research laboratory is funded by the National Institutes of Health. He uses novel translational research methods to examine the effects of vocal training on laryngeal neuromuscular mechanisms in the aging larynx. His professional background includes a decade-long experience serving as a classical singer and teacher of singing. In Part 1 of his presentation, Dr. Johnson reviewed typical changes in the voice that relate to aging. His research group does MRI work and imaging studies in both humans and rodents. An increase in the number of older adults has helped to shift research into how to improve the quality of life among this group. He likes the following definition of aging: "It is a time-independent series of cumulative, progressive, intrinsic, and deleterious functional and structural changes that usually begin to manifest themselves in reproductive maturity and eventually culminate in death." A hallmark of aging is individual variability. Changes due to aging are intrinsic and should be considered independently from external factors such as disease. The sound of our voice changes in pitch and vocal quality as we grow older. He compared the voice of actress Katherine Hepburn on two occasions separated by 50 years, involving factors, such as speech rate and articulation. He discussed the underlying physiology of voice production. With age, the primary effect on the vocal tract is muscle atrophy, which in relation to aging is called sarcopenia. He discussed the respiratory system. The primary change that influences voice is calcification of the costal cartilages and weakening of respiratory muscles, which leads to decreased respiratory capacity. A big cause of an increased effort to get the voice to work is what happens at the level of the larynx.
Dr. Rizzo currently serves as director of innovation and technology in the department of rehabilitation medicine. He has published extensively. His research topics include: biomechanics; assistive and wearable technology; blindness and visual impairment; and sensory augmentation. He is a graduate of New York Medical College and completed his residency in physical medicine and rehabilitation at NYU as well as a clinical research fellowship at the Rusk Rehabilitation Institute.
Dr. Rizzo began Part 2 of his grand round presentations with the question, “OK, what were our findings?” With existing GPS data sets, we need to be mindful of side view versus front view in where cameras are positioned. A data set being described had more side view images than front view, which can be extremely important for the visually impaired. He pointed to being excited about a collaboration with the United Nations. We have shared these data with that organization and they are quite impressed with our results, which can be of potential use to blind individuals navigating the UN building. We are creating a cellphone application that uses vision in place recognition. The UN is providing some funding support for a master’s student working on this project. Dr. Rizzothen responded to a question regarding falls and whether there is information to assess the relative slipperiness of surfaces. Ground surfaces are attracting more attention, such as puddles and how to reroute pedestrians around hazardous terrain. He then described a reconstruction project that is underway to change different environments by developing new approaches to navigating subway stations consisting of multiple floors and tracks. He played a video clip that shows how reconstruction is occurring. He addressed the question of how we handle all this video data for these mobility platforms and what a technician must do with all this high-resolution video data arriving. He also indicated that we currently are looking at sending the data and having new transmission policies, and also work being accomplished on dual connectivity. A question-and-answer period followed his presentation.
John-Ross (JR) Rizzo, MD is a physician scientist at Rusk Rehabilitation. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury. Dr. Rizzo has been recognized as a Top 40 under 40 by Crain’s for his industry-leading innovation and dedication to transforming the lives of those with vision deficiencies worldwide.
Dr. Rizzo began Part 1 of a two-part grand rounds presentation by asking, “What if the lights suddenly went out in this room?” He then proceeded to discuss virtual reality demonstrations of the three biggest vision killers in the U.S.: age-related macular degeneration, glaucoma, and diabetic retinopathy. He showed a filter and asked the audience how disturbing it would be if you had it constantly sitting on top of your visual perception? He displayed views to demonstrate profound differences between clear visual perception and altered perception secondary to these conditions. The problem is going from bad to worse. In the U.S., there are 27 million adults ages 18 and older who report vision loss, and by 2050, the number can be expected to approach 52 million. Impaired vision can affect mobility and lead to many problems, such as massive unemployment rates, quality of life losses, and functional dependencies. He then described current mobility solutions, such as primary mobility tools. A worry is that the standard of care can lead to an immobility downward spiral. So as a consequence, obesity, stroke, and diabetes among other problems such as falls all jump upward. He provided a description of many devices being developed to deal with vision loss. The differences between the spatial world of the blind and the sighted were illustrated. Dr. Rizzo described a lengthy itemization of impediments to navigation on city sidewalks that visually impaired individuals must attempt to deal with successfully.
Dr. Antonio Stecco is an Assistant Professor at Rusk Rehabilitation, New York University. A physiatrist, he has been President of the Fascial Manipulation Association since 2010, Assistant to the President of the International Society of Physical Medicine and Rehabilitation from 2012 to 2014, and President of the International Myopain Society since 2020. His scientific activity is devoted to the study of the human fasciae from a macroscopically, histologically and patho-physiologically point of view. He personally made over 100 cadaver dissections for research. From 2007, he organized and personally held theoretical-practical courses about the Fascial Manipulation method in all five continents. The author of more than 50 in extensor papers about the fascia, Dr. Stecco has co-authored 5 books and is co-author of different chapters of international books. His medical degree and PhD degree are from the University of Padova in Italy.
In Part 1, we discussed: what attracted him to accept a position at NYU Langone Health; whether the COVID resurgence affected his ability to do research and furnish care for patients; results of his research on a comparison between traditional rehabilitation treatment and fascial manipulation of chronic neck pain; the results of a study he conducted on the role played by fasciae in ankle injuries sustained by basketball players; differences between males and females in the kind of injuries they sustain to their ankles and other body parts playing basketball; his training of major league baseball players in using fascial manipulation to decrease injury and improve performance; how to decrease injury among soccer players; and how fascial or muscle stretching exercises are an integral part of rehabilitation and athletics.
In Part 2, we discussed: why determining the underlying cause of elbow pain can prove to be difficult; what new developments have occurred since he co-authored an article on the topic of treatment options for fascial disorders; apart from treatment modalities he described, how other interventions such as surgery, medications, and physical therapy are applied; patients' use of complementary, alternative, and integrative forms of treatment; his use of telemedicine in the treatment of patients; the time lag between when medical innovations occur and their widespread adoption; and current studies in which he is involved or expects to undertake with his NYU colleagues
Dr. Antonio Stecco is an Assistant Professor at Rusk Rehabilitation, New York University. A physiatrist, he has been President of the Fascial Manipulation Association since 2010, Assistant to the President of the International Society of Physical Medicine and Rehabilitation from 2012 to 2014, and President of the International Myopain Society since 2020. His scientific activity is devoted to the study of the human fasciae from a macroscopically, histologically and patho-physiologically point of view. He personally made over 100 cadaver dissections for research. From 2007, he organized and personally held theoretical-practical courses about the Fascial Manipulation method in all five continents. The author of more than 50 in extensor papers about the fascia, Dr. Stecco has co-authored 5 books and is co-author of different chapters of international books. His medical degree and PhD degree are from the University of Padova in Italy.
In Part 1, we discussed: what attracted him to accept a position at NYU Langone Health; whether the COVID resurgence affected his ability to do research and furnish care for patients; results of his research on a comparison between traditional rehabilitation treatment and fascial manipulation of chronic neck pain; the results of a study he conducted on the role played by fasciae in ankle injuries sustained by basketball players; differences between males and females in the kind of injuries they sustain to their ankles and other body parts playing basketball; his training of major league baseball players in using fascial manipulation to decrease injury and improve performance; how to decrease injury among soccer players; and how fascial or muscle stretching exercises are an integral part of rehabilitation and athletics.
Part 2
Advance care planning involves talking now about the future and the setting where someone has deteriorating health and is not able to converse with clinicians about patients’ wishes, preferences, fears, expectations of what is going on, and their hopes. At this juncture, there can be a discussion about a patient’s quality of life and what he or she would like it to be. Sometimes, patient preferences can be put into advance directives (e.g., a living will or a medical power-of-attorney). Some barriers to advance care planning were described. Examples of patient barriers are procrastination, apathy, and fear of burdening the family. Some provider barriers are a lack of desire in talking about a negative future outcome and not wanting to burden patients and families by discussing this topic. Two other big considerations are time constraints on the part of providers and a general lack of knowledge about advance directives. It is important to be able to offer some sort of direction to families regarding possible health care outcomes even when there is a lot of uncertainty. End-of-life care can make some individuals nervous, which is understandable. Withholding or withdrawing interventions that are not in line with patient goals is OK. We do not want to cause any harm or do inappropriate things. As long as we are eliciting what is important to families and doing what meets their goals, generally speaking, we are doing the right thing.
Part 1
Although cancer is the second lead cause of death in the U.S., the rate has been falling. It is becoming more of a chronic disease and has a treatment paradigm that is different from the past. Cancer also is the second most common cause of disability claims. Breast and prostate cancer have a heightened incidence of disabling complications, which is relevant because it is a potential interplay area of palliative care and rehabilitation. Fewer patients are dying in hospitals while the home and hospice settings are on a little upswing. He mentioned common symptoms (e.g., pain and shortness of breath) at end-of-life that differentiate patients with cancer from those who do not have it. The ultimate goal of palliative care and rehabilitation is to improve quality of life. Palliative medicine is one component of the bigger group of palliative care interventions. Regarding hospice care, someone may or may not be eligible for hospice services because of the insurance situation, but everybody is eligible for good end-of-life care and that is what can be provided regardless of insurance status. He then discussed what rehabilitation entails. One main focus is pain management. He indicated ways in which rehabilitation and palliative care can be provided together effectively in four domains, e.g., caregiver support.
Dr. Jonas Sokolof is Director of the Division of Oncological Rehabilitation and Clinical Associate Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. He is certified by the American Board of PM&R both in Sports Medicine and in Physical Medicine & Rehabilitation. His doctor of osteopathy degree is from the New York Institute Of Technology. His Residency occurred at the Harvard Medical School and the Spaulding Rehabilitation Hospital in Boston. He also had a fellowship in sports medicine from Rutgers New Jersey Medical School. Prior to arriving at NYU Langone Health in 2018, he was at the Memorial Sloan Kettering Cancer Center in New York City.
In Part 1, we discussed the following: if the recent COVID resurgence affected his ability to furnish care for patients with cancer; the types of cancer in which most of his patients can be found; what manual medicine entails; assessment of patients' emotional needs; supportive needs of patients of an informational, spiritual, or social nature; whether patients are requested to produce autobiographical accounts of how they experience life as a cancer patient and the treatment they receive; and efforts to enable patients to become adept as self-managers of cancer so that they can be effective in self-monitoring, recognizing and reporting symptoms, and treating side effects. In Part 2, we discussed the following: from the perspective of osteopathic medicine, how rehabilitation can be used to deal with undesirable side effects; extent to which telemedicine is employed in the treatment of patients; current status of an exercise oncology initiative known as “Moving Through Cancer;” challenges involved in motivating patients to exercise whose lifestyle prior to the onset of cancer did not include efforts to be physically fit; and topics involving cancer rehabilitation where more research could prove to be advantageous in improving patient care, along with research that either is underway or projected to occur.
Dr. Jonas Sokolof is Director of the Division of Oncological Rehabilitation and Clinical Associate Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. He is certified by the American Board of PM&R both in Sports Medicine and in Physical Medicine & Rehabilitation. His doctor of osteopathy degree is from the New York Institute Of Technology. His Residency occurred at the Harvard Medical School and the Spaulding Rehabilitation Hospital in Boston. He also had a fellowship in sports medicine from Rutgers New Jersey Medical School. Prior to arriving at NYU Langone Health in 2018, he was at the Memorial Sloan Kettering Cancer Center in New York City.
In Part 1, we discussed the following: if the recent COVID resurgence affected his ability to furnish care for patients with cancer; the types of cancer in which most of his patients can be found; what manual medicine entails; assessment of patients' emotional needs; supportive needs of patients of an informational, spiritual, or social nature; whether patients are requested to produce autobiographical accounts of how they experience life as a cancer patient and the treatment they receive; and efforts to enable patients to become adept as self-managers of cancer so that they can be effective in self-monitoring, recognizing and reporting symptoms, and treating side effects.
PART TWO
In Part 1, Dr. Kim presented information about the historical and legal background for cannabis, variations in policies in the states, and the status of current research. In Part 2, she discussed cancer pain that is not neuropathic. She described the results of a study that involved opioid refractory cancer pain. Evidence currently shows that patients who have increased access to cannabis actually have higher rates of opioid overdose and deaths. She reviewed a case of one of her patients who had prostate cancer. This individual was not amenable to physical therapy and was weaned off opioids because they were not effective. Finally, they decided to try different types of cannabis for pain and sleep and he is doing quite well. He eventually used a combination of low and high THC capsules and was weaned off all other drugs. She and her colleagues also looked at how patients considered the use of cannabinoid therapy and found that overall they preferred it for their future chemo. Even though cannabis is a natural product, it is not true that it is free of side effects. There is some concern that it can have interactions on the heart, result in psychotic symptoms, affect psychomotor performance, and lead to an increase in tolerance, making it necessary to use higher and higher doses to achieve the same effect. A question-and-answer period followed her presentation.
PART ONE
In Part 1 of a two-segment presentation, Dr. Kim discussed historical and legal background for medical cannabis and cannabis in general; mechanism of action; applications for pain and symptom management; the science behind cannabis for cancer care; relative safety issues; contraindications and monitoring; and some public health concerns. She defined cannabis, marijuana, hemp, and indicated various code names for recreational marijuana. Marijuana was criminalized and removed from the U.S. Pharmacopeia in 1941, Most recently, some states have legalized it both medically and recreationally. For medical purposes, there is a lot of variation in what states will allow. A concern has been about the presence of contaminants in many products. Based on current research, the science and the evidence are not where they could be ideally. She discussed marijuana and how it works, mentioning the endocannabinoid system. Different ways exist to act on that system. She described the entourage effect and how it functions.
D
Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.
In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s. Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).
In Part 2 of his presentation, he continued describing the current state of research on the use of PNS, which to some degree is lacking, but certainly it potentially is increasing. He referred to a multi-center, randomized, double-blind investigation that looked at PNS technologies in a variety of pain conditions. He then described a product that was cleared by the FDA in July 2016. It involves the use of multiple electronic leads rather than using a single one. The implant used is of a temporary nature (60 days) rather than something permanently. He pointed out that because the technology is much smaller, no incision is necessary. The micro lead is much smaller in diameter and does not have to be as close to the nerve. He showed a video about a typical implant for a shoulder, involving the 60-day version of technology being used. While it played, he narrated some of the steps shown in the video regarding the implant of the electrode. Everything becomes stabilized as the electrode moves closer to the nerve. His presentation concluded with his fielding questions asked by participants at this event, including two by Dr. Steven Flanagan, Director of the Rusk Rehabilitation Institute at NYU Langone Health.
Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.
In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s. Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).
Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado. Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University. In Part 2, we discussed: advanced surgical techniques employed for both hip and knee surgery; time after surgery when physical therapy interventions are initiated; other kinds of members of the health care team at NYU Langone Health involved both pre- and post-surgery to make possible same-day discharge; additional therapy provided once patients return home and when it is initiated; the role of telehealth in delivering home-based care; situations at home that may result in patients seeking emergency room care or requiring in-patient hospitalization; whether patients who undergo bilateral hip and knee surgery are suitable candidates for same-day discharge; and kinds of research being conducted at NYU involving same-day discharge.
Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado. Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University. In Part 1, we discussed: the effect of the COVID pandemic on performing hip and knee replacement surgery and providing post-operative care; typical hospital length of stay experienced by patients prior to implementing same-day discharge; number of these surgical procedures performed on a weekly basis; the proportion of these operations resulting in same day-discharge; kinds of factors used to identify patients who are excellent candidates for same-day discharge following hip and knee replacement surgery; factors indicating that certain patients should be excluded from participating in same-day discharge; and contents of a "playbook" used during the preoperative consultation phase.
In Part 2 of his presentation on the topic of diversity and inclusion in medicine, Dr. Lopez continued describing the use of a holistic approach to interview candidates for admission to NYU’s PM&R residency program. Factors currently being taken into account other than board scores, include socio economic hardship, commitment to the underserved, work experience, and fluency in other languages. A task force also was formed to review every candidate individually. Interviews presently involve taking a closer look at structured behavioral interview questions, which can be used to measure factors, such as professionalism and teamwork. Interviewers also are blinded to board scores to eliminate a higher halo effect that might exist. Dr. Lopez then reviewed the results of the latest match and identified the kinds of efforts that should be undertaken to increase the proportion of underrepresented groups, including women and members of the LGBTQ community. More diversity is welcome at NYU. Change is not going to happen overnight. Current efforts are just the starting point. A question and answer session for several minutes followed his presentation, including comments made by Dr. Steven Flanagan, Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health.
**In Part I**, Dr. Lopez wanted to familiarize listeners in this grand rounds presentation with a history of minorities in medicine and to describe current trends in diversity and inclusion in medicine in general and specifically in PM&R. He identified arguments for diversity and contrasted past, present, and future recruitment efforts at NYU. He also discussed this years’ match data results. Historically, there have been many challenges for minorities to gain a foothold in medicine. He wanted to furnish objective data about this situation. These individuals had a problem right from the beginning in obtaining admission to medical schools. He described enrollment data from the Association of American Medical Colleges (AAMC) and compared it to U.S. Census Bureau data. Over the last 50 years, Dr. Lopez noted how medical schools have tried to do something about increasing the proportion of students from underrepresented minority groups. Specific information entailed showing what has occurred in PM&R, involving students and faculty. Comparisons then were made with overall U.S. population trends. Reasons are provided for increasing diversity and inclusion in medicine, e.g., minority patients seek doctors who look like them and more minority physicians are likely to take care of minority patients
Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.
In Part 1 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis.
In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers.
A Q & A period followed.
Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.
In Part 1 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis.
In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers.
A Q & A period followed.
This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.
In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim.
In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.
This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.
In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim.
In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.
Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon.
Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory.
This is a two-part series. In Part 1, they discuss: how the ability to conduct research has been affected by the arrival of the coronavirus pandemic; possible reluctance of patients to be involved in research that occurs in a clinical setting because of a fear of contracting COVID-19 there; the extent to which delays and postponements have occurred because of disease resurgences; how COVID-19 limitations on touch and physical contact have led to unintended yet significant challenges to spatial perception, interpretation, and behavior for individuals who are blind or visually impaired; the effectiveness of gloves, hand sanitizers, and hand washing in reducing the risk of touching contaminated surfaces and what, if any downsides, would be associated with such practices; and how the the Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation operates. In Part 2, they discuss: research involving advanced wearables for sensory deprived patients; the use of other kinds of suitable assistive technology devices; the role of the cerebellum and the cortex regarding critical aspects of functional movement control; the results of a study to determine if native English speakers perform differently compared to non-native English speakers on a sideline-focused rapid number naming task and to characterize objective differences in eye movement behavior between these cohorts; the role of the long white cane as a mobility tool for individuals who have visual impairments and any shortcomings this assistive instrument may have; and any other current research not discussed in this interview, along with any projected vision research at NYU.
Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon.
Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory.
This is a two-part series. In Part 1, they discuss: how the ability to conduct research has been affected by the arrival of the coronavirus pandemic; possible reluctance of patients to be involved in research that occurs in a clinical setting because of a fear of contracting COVID-19 there; the extent to which delays and postponements have occurred because of disease resurgences; how COVID-19 limitations on touch and physical contact have led to unintended yet significant challenges to spatial perception, interpretation, and behavior for individuals who are blind or visually impaired; the effectiveness of gloves, hand sanitizers, and hand washing in reducing the risk of touching contaminated surfaces and what, if any downsides, would be associated with such practices; and how the the Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation operates. In Part 2, they discuss: research involving advanced wearables for sensory deprived patients; the use of other kinds of suitable assistive technology devices; the role of the cerebellum and the cortex regarding critical aspects of functional movement control; the results of a study to determine if native English speakers perform differently compared to non-native English speakers on a sideline-focused rapid number naming task and to characterize objective differences in eye movement behavior between these cohorts; the role of the long white cane as a mobility tool for individuals who have visual impairments and any shortcomings this assistive instrument may have; and any other current research not discussed in this interview, along with any projected vision research at NYU.
Dr. Robert Gordon is the Director of Intern Training and Associate Director of Postdoctoral Fellow Training at Rusk Rehabilitation Institute and Clinical Associate Professor at New York University Grossman School of Medicine. He has been the Director of Intern Training since 1995 and has trained over 270 psychology interns. He has specialties in the areas of neuropsychological and forensic testing and psychotherapy with children and adults with physical and learning disabilities and chronic illness. He has published in the areas of existential-humanistic and relational therapeutic approaches during COVID-19 with patients with preexisting conditions, ethics, supervision, relational psychoanalysis, dream interpretation, pain management, and the use of projective testing in neuropsychology. He received his doctorate from the Ferkauf Graduate School of Psychology, Yeshiva University in Child Clinical/School Psychology in 1985 and a Certificate in Psychoanalysis and Psychotherapy from Adelphi University in 1999.
This is a two part series. In **Part 1**, he discusses: his role at Rusk and the services his department provides and with what populations; the extent to which telehealth was used prior to the COVID-19 outbreak and how this usage compares to the aftermath of the appearance of this disease; what motivated him to write a recent article entitled “Existential-Humanistic and Relational Approaches During COVID with Patients with Preexisting Medical Conditions;” his description of the meaning of the term Existential-Humanistic Psychotherapy; who some major writers are in the field of Existential-Humanistic Therapy and how their ideas are relevant to dealing with COVID; some psychological challenges of dealing with COVID; and what constitutes relational psychotherapy and what major ideas there are in this approach. In **Part 2**, he discusses: some major techniques in applying Existential-Humanistic and Relational approaches with patients with preexisting medical conditions; what Posttraumatic Growth is and what strategies are used in exploring it in psychotherapy; major issues that patients with preexisting issues experience; kinds of therapeutic adjustments that must be made in treating patients with communication impairments; the nature of group work with patients and determining when it is advantageous to use it; and some implications of the paper he wrote regarding clinical practice and society in general.
Dr. Robert Gordon is the Director of Intern Training and Associate Director of Postdoctoral Fellow Training at Rusk Rehabilitation Institute and Clinical Associate Professor at New York University Grossman School of Medicine. He has been the Director of Intern Training since 1995 and has trained over 270 psychology interns. He has specialties in the areas of neuropsychological and forensic testing and psychotherapy with children and adults with physical and learning disabilities and chronic illness. He has published in the areas of existential-humanistic and relational therapeutic approaches during COVID-19 with patients with preexisting conditions, ethics, supervision, relational psychoanalysis, dream interpretation, pain management, and the use of projective testing in neuropsychology. He received his doctorate from the Ferkauf Graduate School of Psychology, Yeshiva University in Child Clinical/School Psychology in 1985 and a Certificate in Psychoanalysis and Psychotherapy from Adelphi University in 1999.
This is a two part series. In **Part 1**, he discusses: his role at Rusk and the services his department provides and with what populations; the extent to which telehealth was used prior to the COVID-19 outbreak and how this usage compares to the aftermath of the appearance of this disease; what motivated him to write a recent article entitled “Existential-Humanistic and Relational Approaches During COVID with Patients with Preexisting Medical Conditions;” his description of the meaning of the term Existential-Humanistic Psychotherapy; who some major writers are in the field of Existential-Humanistic Therapy and how their ideas are relevant to dealing with COVID; some psychological challenges of dealing with COVID; and what constitutes relational psychotherapy and what major ideas there are in this approach. In **Part 2**, he discusses: some major techniques in applying Existential-Humanistic and Relational approaches with patients with preexisting medical conditions; what Posttraumatic Growth is and what strategies are used in exploring it in psychotherapy; major issues that patients with preexisting issues experience; kinds of therapeutic adjustments that must be made in treating patients with communication impairments; the nature of group work with patients and determining when it is advantageous to use it; and some implications of the paper he wrote regarding clinical practice and society in general.
Dr. Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also in Pediatrics. Her area of specialization includes the pediatric disorders cerebral palsy and spina bifida.
This is a special two-part Grand Rounds series.
In Part 1 of her presentation, Dr. Gold contrasted a time 50 years ago when she made a presentation on the topic of spina bifida. Today, we have a change in attitude and a change in medical information since that earlier period and we also need to be aware of long-term care needs and the need for continuity of care of these patients, and all our patients who are aging out. She cited professional literature from 1971 that described many kinds of pediatric patients whose conditions were such that rather than try to treat them, they should be allowed to succumb. For example, comments made back then about these patients being incontinent and socially unacceptable were not true. By 1996, it was shown that most of the previous assumptions were wrong. A child in a wheelchair is worth living. Many surgical deformities that once were present can be corrected today. Incontinence is not inevitable and bowel function can be controlled. She discussed the role of folate in reducing the incidence of spina bifida. She mentioned the implications of providing care for these patients. Most of the surgical procedures undertaken today are neurosurgical. Various generalizations can be made. One is that adult spina bifida patients are likely to have fewer primary care visits than patients under the age of 18 and she explained reasons why it is so. She concluded Part 1 of her presentation by talking about the role that urinary complications may play in the death of many patients.
Listeners to Part 1 of Dr. Gold’s presentation will recall she indicated that it probably is the urinary complication that is the cause of death in most of these patients, which is critical. In Part 2, she began by asking what multilevel care elements should exist for patients with spina bifida? She mentioned that as a result of pushing wheelchairs, some patients experience rotator cuff injuries. Although therapeutic services do not have to be performed for all patients, she described some kinds of assistance that they may need. Some patients may experience functional regression. Once able to walk at ages five and 10, they no longer can do so. There is a higher incidence of neuroses. These patients need vocational, nutritional, and social work services. A problem for many patients is when they have to travel a considerable distance for hospital care, the facility they go to may lack the personnel necessary to provide appropriate kinds of spina bifida care. She indicated some surgical concerns. Most shunted patients have long term motor and cognitive behavioral deficits. She described urological issues that are most paramount and frequent. She asked what kinds of things should we do when we assess patients within a therapeutic realm? We should look at their transportation skills, perceptual motor skills to drive, be knowledgeable of their medical management and history, and try to establish some autonomy with money management, household skills, and community living skills. Also, there is a need to work on their parenting skills and on obtaining adequate health care for themselves and their children. There are issues with cardiovascular disease. Studies show that as many as 73% of spina bifida patients have chronic pain. A final portion of the presentation was on the topic of women with spina bifida giving birth.
Dr. Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also in Pediatrics. Her area of specialization includes the pediatric disorders cerebral palsy and spina bifida.
This is a special two-part Grand Rounds series.
In Part 1 of her presentation, Dr. Gold contrasted a time 50 years ago when she made a presentation on the topic of spina bifida. Today, we have a change in attitude and a change in medical information since that earlier period and we also need to be aware of long-term care needs and the need for continuity of care of these patients, and all our patients who are aging out. She cited professional literature from 1971 that described many kinds of pediatric patients whose conditions were such that rather than try to treat them, they should be allowed to succumb. For example, comments made back then about these patients being incontinent and socially unacceptable were not true. By 1996, it was shown that most of the previous assumptions were wrong. A child in a wheelchair is worth living. Many surgical deformities that once were present can be corrected today. Incontinence is not inevitable and bowel function can be controlled. She discussed the role of folate in reducing the incidence of spina bifida. She mentioned the implications of providing care for these patients. Most of the surgical procedures undertaken today are neurosurgical. Various generalizations can be made. One is that adult spina bifida patients are likely to have fewer primary care visits than patients under the age of 18 and she explained reasons why it is so. She concluded Part 1 of her presentation by talking about the role that urinary complications may play in the death of many patients.
Listeners to Part 1 of Dr. Gold’s presentation will recall she indicated that it probably is the urinary complication that is the cause of death in most of these patients, which is critical. In Part 2, she began by asking what multilevel care elements should exist for patients with spina bifida? She mentioned that as a result of pushing wheelchairs, some patients experience rotator cuff injuries. Although therapeutic services do not have to be performed for all patients, she described some kinds of assistance that they may need. Some patients may experience functional regression. Once able to walk at ages five and 10, they no longer can do so. There is a higher incidence of neuroses. These patients need vocational, nutritional, and social work services. A problem for many patients is when they have to travel a considerable distance for hospital care, the facility they go to may lack the personnel necessary to provide appropriate kinds of spina bifida care. She indicated some surgical concerns. Most shunted patients have long term motor and cognitive behavioral deficits. She described urological issues that are most paramount and frequent. She asked what kinds of things should we do when we assess patients within a therapeutic realm? We should look at their transportation skills, perceptual motor skills to drive, be knowledgeable of their medical management and history, and try to establish some autonomy with money management, household skills, and community living skills. Also, there is a need to work on their parenting skills and on obtaining adequate health care for themselves and their children. There are issues with cardiovascular disease. Studies show that as many as 73% of spina bifida patients have chronic pain. A final portion of the presentation was on the topic of women with spina bifida giving birth.
Holly Cohen is the Program Manager of the Assistive Technology Service at NYU Langone Health. Along with her clinical experience, she holds certification in assistive technology from the Rehabilitation and Engineering and Assistive Technology Society of North America, has a specialty certification in environmental modifications from the American Occupational Therapy Association, and is a Certified Driving Rehabilitation Specialist from the Association for Driver Rehabilitation Specialists. She founded the Assistive Technology Service and also started the Driving Rehabilitation program, serving as program manager of both services at NYU. She is an adjunct professor in the Department of the Occupational Therapy in the Steinhardt School at New York University. Her degree in Occupational Therapy is from the State University of New York and she has taken graduate level courses within the Interactive Telecommunications department at New York University. In this interview, she discusses how the coronavirus led to changes in how she works with patients, examples of low tech/high tech assistive devices, kinds of devices she uses most frequently, health problems of patients she treats, determining which forms of assistive technology to use, working with patients whose coronavirus symptoms persist, using telehealth to enable patients to use assistive devices at home, and helping patients to avoid abandoning the use of these devices.
Dr. Chelsea Schoen provides psychological and neuropsychological assessment and intervention services to a wide range of adults recovering from traumatic brain injury, stroke, other complex neurologic conditions, spinal cord injury, and orthopedic/musculoskeletal conditions. Her clinical and research interests include psychological factors associated with fear of falling. She received her PhD in Clinical Psychology with a Health Emphasis and specialization in neuropsychology from the Yeshiva (Yeshiva) University.
Dr. Philip J. Uy is a Senior Psychologist at Rusk Rehabilitation and works at Cardiopulmonary/Medically Complex on the Main Campus and at the Neurorehabilitation (Langone Orthopedic Hospital) acute inpatient rehabilitation. His clinical and research interests are in neurologic disorders, cardiopulmonary conditions, and adjustment to medical disability. He also has expertise in substance use disorders. He obtained his doctorate in Clinical Psychology from Fairleigh Dickinson University.
In Part 1, they discuss the following: kinds of patients treated involving COVID-19; possible after-effects either caused or associated with the onset of coronavirus symptoms; types of challenges treating coronavirus patients; mental health conditions that persist long-term; and mental health services provided for clinical colleagues. In Part 2, they discuss the following: work involving telehealth care of patients; Acceptance and Commitment Therapy; sleep disturbance or disorders experienced by patients; kinds of coronavirus patients at an increased risk for emotional disorders; and topics where more research could prove to be advantageous in improving patient care.
Dr. Chelsea Schoen provides psychological and neuropsychological assessment and intervention services to a wide range of adults recovering from traumatic brain injury, stroke, other complex neurologic conditions, spinal cord injury, and orthopedic/musculoskeletal conditions. Her clinical and research interests include psychological factors associated with fear of falling. She received her PhD in Clinical Psychology with a Health Emphasis and specialization in neuropsychology from the Yeshiva (Yeshiva) University.
Dr. Philip J. Uy is a Senior Psychologist at Rusk Rehabilitation and works at Cardiopulmonary/Medically Complex on the Main Campus and at the Neurorehabilitation (Langone Orthopedic Hospital) acute inpatient rehabilitation. His clinical and research interests are in neurologic disorders, cardiopulmonary conditions, and adjustment to medical disability. He also has expertise in substance use disorders. He obtained his doctorate in Clinical Psychology from Fairleigh Dickinson University.
In Part 1, they discuss the following: kinds of patients treated involving COVID-19; possible after-effects either caused or associated with the onset of coronavirus symptoms; types of challenges treating coronavirus patients; mental health conditions that persist long-term; and mental health services provided for clinical colleagues. In Part 2, they discuss the following: work involving telehealth care of patients; Acceptance and Commitment Therapy; sleep disturbance or disorders experienced by patients; kinds of coronavirus patients at an increased risk for emotional disorders; and topics where more research could prove to be advantageous in improving patient care.
Rebecca Missimer is a physical therapy clinical specialist in acute care at Tisch/Kimmel at NYU Langone. She has been a practicing clinician for seven years and is a board-certified clinical specialist in neurologic physical therapy. She works with patients with a variety of diagnoses, including individuals with respiratory, pulmonary, and cardiac issues on the acute floors and in the intensive care units. Mary Fischer is a clinical specialist in acute care at NYU Langone Rusk. She also is a faculty member of the Acute Care Physical Therapy Residence Program. With more than 30 years of experience in acute care, inpatient rehabilitation, outpatient, and home care physical therapy, she was the lead investigator and author of a fall risk study published in the Journal of Acute Care Physical Therapy in October 2020. She is a graduate of Columbia and Stony Brook Universities and is a board-certified Geriatric Clinical Specialist. In this interview, they discuss the kinds of patients treated who already were obtaining rehabilitation services and then subsequently contracted the coronavirus and another group that initially was not involved in rehabilitation, but later required it as a consequence of becoming infected; after-effects either caused or associated with the onset of coronavirus symptoms; conditions among patients that persist well beyond when they initially began to experience symptoms upon becoming infected; population subgroups that may be more prone to continue to experience long-term symptoms; patients that experience a loss of physical function in the form of deconditioning; kinds of respiratory support for patients hospitalized with COVID-19; and research topics for improving patient care.
Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine.
PART 1
In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim. It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum.
PART 2
Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.
Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine.
PART 1
In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim. It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum.
PART 2
Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.
Megan Conklin serves as Program Manager of Rusk Pediatric Therapy Services, which is part of Hassenfeld Children’s Hospital at NYU Langone Health. She earned her Doctor of Physical Therapy degree from the University of Scranton and has been practicing physical therapy for 15 years, all of them spent at NYU. In 2012, she was awarded the professional designation of board-certified clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Since 2017, she also has been a part-time faculty member at the University of Scranton teaching pediatric specialty for the doctoral physical therapy program.
In this interview, she discusses the following topics: the kinds of pediatric patients she and the rest of a health care team treat and the nature of health problems involved; how therapies provided in the hospital differ from therapies furnished in the early intervention or school settings; challenges for patients with long-term health problems who have to make the transition from pediatric to adult care; how telehealth differs from care provided in the clinical setting; how COVID-19 has affected how health care services are delivered; and description of a case study that was challenging, interesting, and rewarding for both patients and their caregivers.
Tami Altschuler is a Speech-Language Pathologist and Clinical Specialist in Patient-Provider Communication at NYU Langone Medical Center and the Rusk Rehabilitation Institute of Medicine in New York, NY. She is spearheading hospital wide initiatives to establish communication access for all patients throughout the continuum of care. Tami is a board member of the United States Society of Augmentative and Alternative Communication (USSAAC) and an active member of the Patient-Provider Communication Forum. She has presented nationally and internationally on the topic of patient-provider communication.
Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association. In Part 1, Dr Branski discusses: Barriers that had to be overcome to perform rigorous research on COVID-19 after the appearance of this disease among NYU patients; kinds of investigations either presently underway or expect to be undertaken this year at the Rusk Rehabilitation Institute and also within the broader NYU Langone Health system that involve both applied clinical research and disease-related basic research; NYU prioritization of research endeavors; whether any work is being done that entails using monoclonal antibodies in treating patients prior to the availability of vaccines; and time frames involved in anticipating the completion of studies that were described? The discussion in Part 2 included: conducting studies on mental health problems experienced by patients with COVID-19; any studies being done involving patients who experience long-term symptoms after becoming infected with this disease; how studies are being financed; ways in which treatment patterns may have undergone any changes sine coronavirus patients first began to arrive at the hospital; how to deal with the thousands of papers on the topic of coronavirus that have appeared in journals since early in 2020; and research that he currently is involved in conducting.
Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association. In Part 1, Dr Branski discusses: Barriers that had to be overcome to perform rigorous research on COVID-19 after the appearance of this disease among NYU patients; kinds of investigations either presently underway or expect to be undertaken this year at the Rusk Rehabilitation Institute and also within the broader NYU Langone Health system that involve both applied clinical research and disease-related basic research; NYU prioritization of research endeavors; whether any work is being done that entails using monoclonal antibodies in treating patients prior to the availability of vaccines; and time frames involved in anticipating the completion of studies that were described? The discussion in Part 2 included: conducting studies on mental health problems experienced by patients with COVID-19; any studies being done involving patients who experience long-term symptoms after becoming infected with this disease; how studies are being financed; ways in which treatment patterns may have undergone any changes sine coronavirus patients first began to arrive at the hospital; how to deal with the thousands of papers on the topic of coronavirus that have appeared in journals since early in 2020; and research that he currently is involved in conducting.
Dr. Pham is the Section Chief of Infectious Disease at NYU Langone Medical Center. In this interview, he discusses COVID-19 updates, testing, and precautions.
The interview is done by Dr. Lyn Weiss, Chair NYU Winthrop, Nocturnist on COVID + Medicine Unit.
Dr. Marcalee Alexander specializes in the treatment of patients with spinal cord injury. In 2019 she and her husband Craig took a break from full-time practice to educate people about climate change and disability by starting a walk from Canada to Key West to bring attention to issues of persons of disabilities in climate change by educating both professionals and communities. Along with being the first female president of the American Spinal Injury Association, Dr. Alexander has published more than 125 articles and chapters in professional journals and is currently the editor of the journal Spinal Cord Series and Cases. Throughout most of her career, her research has focused on sexuality and spinal cord injury and she is known for performing significant laboratory-based research outlining the impact of specific neurologic injuries on sexual responses. Over the past 15 years she also has had an interest in telemedicine, and she currently has a sexuality telehealth clinic at Spaulding rehabilitation hospital. At present, she also is working on a summit in 2021 to bring together leaders from the climate change and disabilities fields. In conjunction with this work, she started a nonprofit called Telerehabilitation International with a mission to bring attention to climate change and disability and to use telemedicine to start a volunteer network of physiatrists to provide consults for persons with disabilities in areas of disaster relief. A graduate of Jefferson Medical College, she completed her residency in physical medicine and rehabilitation there.
This is part 2 of a 2-part series, in which she discusses examples of the kinds of consequences from a health perspective that stem from weather-related events of varying lengths of time; ways in which climate change has the potential to result in the increased incidence of infectious diseases; whether climate change warrants any alterations in how rehabilitation health professionals are educated; kinds of core competencies that would serve as a suitable basis for such education; current status of efforts to educate rehabilitation professionals about the impact of climate change on health; kinds of mechanisms it would be advantageous to establish to advance educational efforts; and types of studies that would benefit the field of rehabilitation benefit on the topic of climate change.
Dr. Marcalee Alexander specializes in the treatment of patients with spinal cord injury. In 2019 she and her husband Craig took a break from full-time practice to educate people about climate change and disability by starting a walk from Canada to Key West to bring attention to issues of persons of disabilities in climate change by educating both professionals and communities. Along with being the first female president of the American Spinal Injury Association, Dr. Alexander has published more than 125 articles and chapters in professional journals and is currently the editor of the journal Spinal Cord Series and Cases. Throughout most of her career, her research has focused on sexuality and spinal cord injury and she is known for performing significant laboratory-based research outlining the impact of specific neurologic injuries on sexual responses. Over the past 15 years she also has had an interest in telemedicine, and she currently has a sexuality telehealth clinic at Spaulding rehabilitation hospital. At present, she also is working on a summit in 2021 to bring together leaders from the climate change and disabilities fields. In conjunction with this work, she started a nonprofit called Telerehabilitation International with a mission to bring attention to climate change and disability and to use telemedicine to start a volunteer network of physiatrists to provide consults for persons with disabilities in areas of disaster relief. A graduate of Jefferson Medical College, she completed her residency in physical medicine and rehabilitation there.
This is part 1 of a 2-part series in which she discusses what inspired her interest in how climate change influences individual and community health status; how individuals with spinal cord injury (SCI) might be at a heightened risk to experience adverse health impacts from climate change; the degree to which mental health impacts should be taken into account when discussing climate change; and how various sub-groups, such as individuals who are characterized by having low-income, being geographically isolated, living in poor housing conditions, and who differ on the basis of age, gender, level of frailty, and presence of chronic disease might be affected differently by climate change.
Dr. Natalia Ruiz is a senior physical therapist at the NYU Langone Orthopedic Center. She has been a physical therapist for 16 years and has worked at the hospital for 14 years in the areas of orthopedic rehabilitation, occupational health, and chronic pain. She currently works in the hand therapy department. She became an American Physical Therapy Association board-certified specialist in orthopedics in 2016 and a board certified hand therapist in 2018. In addition to physical therapy, she also collaborates with the NYU HR department addressing ergonomics for employees, as well as NYU Langone Hospitals Corporative Services with ergonomic consultations for other companies. She received her doctorate in physical therapy at Long Island University and has advanced degrees in Ergonomics from NYU and in hand and upper extremity rehabilitation from Drexel University. In this interview, she discusses how to go about making a workspace in the home more comfortable and some ways in which basic ergonomic principles can be applied; basic instruments and specific analytical tools used to diagnose conditions that require some form of remediation; the role of telehealth in being able to view an individual’s home workspace and also being able to demonstrate techniques involving physical exercise; addressing how to recognize bodily strain from prolonged sitting; health problems that can arise from sitting in an awkward position at a computer and having to incorporate speed and repetitive motions involved in frequent swipes of tabloid screens using one’s hands; how factors, such as age, gender, and body weight must be taken into account from an ergonomics perspective; importance of breathing exercises not only for stress control, but to improve oxygenation; taking active breaks; staying active when not employed; and ergonomic studies it may be worth launching as a means of improving the health status of individuals whose employment involves staying at home.
Join us for this special edition of a Grand Rounds given by multiple presenters entitled: Wounds after COVID-19: Understanding Pathophysiology, Assessment, Treatment and Nomenclature.
Join us for this special edition of a Grand Rounds given by multiple presenters entitled: Wounds after COVID-19: Understanding Pathophysiology, Assessment, Treatment and Nomenclature.
Dr. Julie Fernandes works as a clinical specialist coordinating the Hand Therapy Fellowship Program at NYU Langone Orthopedic Center program. Originally from South Africa, she received her occupational therapy degree from the University of Cape Town. She went on to specialize in hand therapy, honing her ability to fabricate splints and treat surgical patients. In 2009, Julie relocated to Chicago and then New York City where she has worked as a certified hand therapist for the past eight years. She has a post-professional clinical doctorate in Occupational Therapy and has published in the peer-reviewed American Journal of Occupational Therapy on “The Occupational Therapist’s Role in Perinatal Care: A Health Promotion Approach.” In this interview, she discusses the Hand Therapy Fellowship Program at NYU Langone Orthopedic Center program; range of services provided by occupational therapists, an article she recently had published; how the coronavirus has redefined how occupational therapists provide services to patients; stage when hand splinting occurs for post-operative patients; different stages when occupational therapy is most effective for hospitalized coronavirus patients; interactions with patients via telehealth; differences between providing hands-on care in a clinical setting and using a telehealth approach; challenges that must be addressed in dealing with patients who have different personal characteristics, such as age; occupational therapy studies it may be worth launching in order to enhance the care of patients who will be treated in the future; and possible additions to occupational therapy education programs.
Dr. Felicia Connor’s techniques integrate mindfulness-based interventions, cognitive-behavioral therapy and solution-focused therapy into her individual and group work. Her clinical interests include therapy with a spirituality focus, culturally informed therapy and assessment and concussion across the lifespan. In her daily practice, she provides individual and group cognitive rehabilitation, psychotherapy and neuropsychological assessment to those with neurological conditions. She has been trained in traditional therapy for depression, anxiety, adjustment to disability, grief/loss; pediatric neurological issues (e.g. concussion management) and couples and family therapy. Her research interests include: multiple sclerosis, cultural considerations for treatment, and cognitive remediation. She is Board Certified in Rehabilitation Psychology and licensed in New York, Delaware and Pennsylvania. Her doctorate in clinical psychology is from Argosy University. Dr. Caitlyn Arutiunov’s research focuses on identifying barriers to the neurorehabilitation process within an outpatient neurorehabilitation population, including factors such as psychosocial, environmental, institutional, and attitudinal barriers to treatment. The goal of this research is to document these barriers to treatment to aid in improving overall quality of care for neurorehabilitation patients. In addition to conducting research, she provides psychotherapy, cognitive remediation, and group therapy on an outpatient basis to neurorehabilitation patients at Rusk. She completed her doctoral internship at Rusk. She received her Psy.D. in Clinical Psychology from the Ferkauf Graduate School of Psychology at Yeshiva University, where she completed her dissertation on "The Ethics of Publicly Diagnosing Public Figures with Mental Disorders." In the interview, they discuss kinds of treatment for patients with a coronavirus infection; how such treatment might differ from typical treatment protocols; what a workday is like treating patients by telehealth; if interaction with patients differs compared to treating them directly in a clinical setting, and if so, in what ways; how telehealth group work and cognitive remediation present more challenges and require some creative solutions on the part of clinicians; whether the type of mental health condition aids in the determination of whether treatment on a one-to-one or group therapy basis is more appropriate; whether psychological services are being provided for other health personnel treating coronavirus patients in the clinical setting and for what kinds of mental health challenges; psychological studies it may be worth launching in order to enhance the mental health care of patients who will be treated in the future; and based on personal experiences working with coronavirus patients, what could be worth incorporating in psychology education programs?
This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City.
Questions from around the country are answered in this exciting and extremely important episode!
Please excuse any issues with sound.
This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City.
Questions from around the country are answered in this exciting and extremely important episode!
Please excuse any issues with sound.
This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro.
Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).
William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.
Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.
The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs
This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro.
Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).
William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.
Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.
The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs
This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City.
Questions from around the country are answered in this exciting and extremely important episode!
Please excuse any issues with sound.
This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City.
Questions from around the country are answered in this exciting and extremely important episode!
Please excuse any issues with sound.
Dr. Jeffrey Fine serves as Vice Chairman of NYU Langone Health Brooklyn Rehabilitation & Rusk Rehabilitation Network Development. He is a clinician educator and administrator who has been practicing in academic medicine at Level I Trauma Center teaching hospitals for over 20 years. Dr. Fine is chairperson of the VBM ICU early mobilization program at NYU Langone Hospital Brooklyn and also chairperson of the Brooklyn brain injury outpatient care planning team. He holds four certifications from the American Board of Medical Specialties in the following areas: Physical Medicine & Rehabilitation; Spinal Cord Injury; Brain Injury Medicine; and Pain Medicine. He also has published several articles regarding patient safety during transitions of care including communication during handoffs, and identification/reconciliation of barriers to safe community discharge with resultant enhanced patient satisfaction. His medical degree is from New York Medical College and he completed his residency at Mount Sinai School of Medicine in New York City. Among his many prestigious awards, on more than one occasion he was honored as Best Teacher Of The Year in the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai.
In this interview, Dr. Fine discusses the following: kinds of patients he is treating for COVID-19; patient pathways to arrive for treatment; differential susceptibility of patients entering the health care setting on the basis of age, gender, socioeconomic factors, genetic variations and other characteristics, such as preexisting conditions like diabetes; whether accurate predictors are being employed, along with any kinds of measures or rating scales to help distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; access to all necessary therapies, including those considered still at an experimental stage of effectiveness; role of telehealth in treating COVID-19; possible impact on daily activities of wearing full-body PPE by clinicians in the hospital; and how as a health professional life may have changed since the appearance of COVID-19.
Dr. Brian Im serves as director of brain injury rehabilitation at the Rusk Rehabilitation Institute at NYU Langone Health. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.
In this episode, Dr Im discusses the kinds of patients he has been treating for COVID-19, after-effects that are caused or associated with the onset of coronavirus that might not have occurred in the absence of a COVID-19 infection; patterns that characterize these patients; when triage becomes necessary; whether any kinds of measures or rating scales are being used at Rusk as a means of helping to distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; whether accurate predictors exist to help determine whether a patient’s condition may be prone to deteriorate rapidly as opposed to achieving recovery eventually from what ails them; if Rusk has access to all necessary therapies, including those considered still at an experimental stage of effectiveness; if wearing full-body PPE in the hospital results in physical barriers that hinder personal activities; ways is which his life has changed since the appearance of COVID-19; and whether telehealth plays a role in treating either patients who have been discharged after being treated for COVID-19 or patients who already were being treated by Rusk clinicians prior to the outbreak of that disease.
Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement.
Listeners to Part 1 of Dr. Gerber’s presentation will recall that she talked about fatigue in the context of proteomics, performance, and perception. In Part 2, she began by asking how do we separate central fatigue from depression? It is a difficult question and may be why the biosignatures are so important. From a clinical perspective, sad and despairing feelings, anhedonia, really is the hallmark of depression. It’s not the hallmark of central fatigue, which is a different pathway. Many important factors here originate in the liver. We need to be attentive to the way we measure the specifics of both peripheral and central fatigue. We have objective measures that are quantitative and we have self-reports. Both are needed, along with observer-recorded reports to obtain a full picture of what we mean by fatigue. A perfect fatigue instrument has not been found yet. She described the fatigue severity scale and indicated some of its deficiencies. She also described the kinds of procedures undertaken in her laboratory to obtain a fuller understanding of fatigue. She indicated who can be considered fatigued. It’s usually women, individuals who are less active, who are obese or overweight, who are smokers with more than moderate alcohol intake, often complaining of depressed symptomology, and they are anxious. In her view, metabolic issues are under appreciated by our specialty.
Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement.
In Part 1 of her presentation, Dr. Gerber’s aim is to decipher fatigue in the context of proteomics, performance, and perception. She wants to describe the construct that is beginning to be shaped to enable us to understand fatigue better and indicate how it is effectively measured both objectively and subjectively. She mentioned that the term biosignature is a more robust term than biomarker because it represents multiple domain measures to help us understand complex ideas, such as fatigue. When talking about fatigue, it is necessary for individuals to report what they are experiencing. Expectation plays a role in what a person is trying to accomplish. In order to treat fatigue effectively, it is necessary to know the parameters. Her presentation included the topics of cancer fatigue and liver fatigue, noting that if we do not study the liver better, an important concept in the rehabilitation world, we are not going to conquer this problem. She made a distinction between pathological and non-pathological (normal) fatigue and how to treat these conditions. She also discussed peripheral and central fatigue. There is confusion in the domain culture about these kinds of fatigue and an effort is underway to identify a biosignature that gives a mix of objective measures linked to perception. A portion of the tryptophan pathway is critical for understanding fatigue, both peripheral and central.
Dr. Bartels received his MD and MPH degrees from Columbia University College of Physicians & Surgeons and completed an internship and internal medicine and rehabilitation residencies at New York-Presbyterian/Columbia University Medical Center in New York.
Prior to becoming the Chairman of the Department of Physical Medicine and Rehabilitation at Montefiore Medical Center/Albert Einstein College of Medicine in September 2013, Dr. Bartels directed Cardiopulmonary Rehabilitation and the Human Performance Laboratory at Columbia Presbyterian Medical Center, where he has served as director of cardiopulmonary rehabilitation and founder and director of the Human Performance Laboratory.
Over the years, Dr. Bartels has also been recognized for his commitment to educating future physicians, including those outside of his specialty of rehabilitation medicine. While at Columbia, he served as a clinical mentor to two first-year medical students each year and coordinated research teaching for the Rehabilitation residents. He also participated in lecture series events for fellows in the areas of Cardiology and Pulmonary Medicine, sharing the rehabilitation perspective for each specialty.
Dr. Bartels received his MD and MPH degrees from Columbia University College of Physicians & Surgeons and completed an internship and internal medicine and rehabilitation residencies at New York-Presbyterian/Columbia University Medical Center in New York.
Prior to becoming the Chairman of the Department of Physical Medicine and Rehabilitation at Montefiore Medical Center/Albert Einstein College of Medicine in September 2013, Dr. Bartels directed Cardiopulmonary Rehabilitation and the Human Performance Laboratory at Columbia Presbyterian Medical Center, where he has served as director of cardiopulmonary rehabilitation and founder and director of the Human Performance Laboratory.
Over the years, Dr. Bartels has also been recognized for his commitment to educating future physicians, including those outside of his specialty of rehabilitation medicine. While at Columbia, he served as a clinical mentor to two first-year medical students each year and coordinated research teaching for the Rehabilitation residents. He also participated in lecture series events for fellows in the areas of Cardiology and Pulmonary Medicine, sharing the rehabilitation perspective for each specialty.
Dr. Charla Fischer one of New York City’s top minimally invasive spine surgeons. She specializes in lumbar disc herniations, lumbar spinal stenosis, lumbar degenerative disc disease, instability, and cervical spine degeneration. She is also an expert in advanced minimally invasive spine surgery techniques such as minimally invasive microdiscetomy, MIS lumbar fusions, robotic-assisted spine surgery, and advanced MIS techniques.
Dr. Fischer completed her residency at Columbia after completing both medical school and undergraduate school on a full academic scholarship at University of Southern California. She spent a year specializing in spine surgery at NYU-Hospital for Joint Diseases.
As an associate professor of spine surgery at NYU Langone Medical Center, Dr. Fischer regularly teaches residents and medical students in the areas of compassionate patient care and minimally invasive spine surgery. She has received grants from the National Institutes of Health (NIH) and the Orthopedic Research and Education Foundation (OREF). The funding helps her pursuits in the advancement of minimally invasive surgical techniques, and quality of life improvements after spine surgery. She routinely publishes in the top peer-reviewed journals and presents her findings at internationally attended academic meetings. She serves on the SRS Research Committee and is an Associate Editor for the prestigious Journal of Bone and Joint Surgery.
Dr. Charla Fischer one of New York City’s top minimally invasive spine surgeons. She specializes in lumbar disc herniations, lumbar spinal stenosis, lumbar degenerative disc disease, instability, and cervical spine degeneration. She is also an expert in advanced minimally invasive spine surgery techniques such as minimally invasive microdiscetomy, MIS lumbar fusions, robotic-assisted spine surgery, and advanced MIS techniques.
Dr. Fischer completed her residency at Columbia after completing both medical school and undergraduate school on a full academic scholarship at University of Southern California. She spent a year specializing in spine surgery at NYU-Hospital for Joint Diseases.
As an associate professor of spine surgery at NYU Langone Medical Center, Dr. Fischer regularly teaches residents and medical students in the areas of compassionate patient care and minimally invasive spine surgery. She has received grants from the National Institutes of Health (NIH) and the Orthopedic Research and Education Foundation (OREF). The funding helps her pursuits in the advancement of minimally invasive surgical techniques, and quality of life improvements after spine surgery. She routinely publishes in the top peer-reviewed journals and presents her findings at internationally attended academic meetings. She serves on the SRS Research Committee and is an Associate Editor for the prestigious Journal of Bone and Joint Surgery.
Dr. JR Rizzo is a physician scientist at Rusk Rehabilitation. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury. Dr. Rizzo has been recognized as a Top 40 under 40 by Crain’s for his industry-leading innovation and dedication to transforming the lives of those with vision deficiencies worldwide. This is a two-part Grand Rounds presentation.
In Part Two, Dr. Rizzo discusses assistive technology. There is lots of it for physical impairments, but what about for sensory impairments, such as mobility? Visually impaired patients may use a white cane while walking, but it misses large physical objects. So, they came up with something they called the Dragon Fly, which may become available commercially by the end of 2019. A form of push and clear technology, it should prove to be highly useful. He talked about advanced driver assist systems (ADAS), systems which, for example, help motor vehicle drivers by improving road safety. Rear end collisions are being reduced significantly. Why can’t we do this for falls experienced by patients with sensory impairments? This work is being done now and he gave examples of how visually impaired pedestrians are being assisted. He also described assistance devices that can help patients in their homes, such as reaching and grasping accurately.
Dr. JR Rizzo is a physician scientist at Rusk Rehabilitation. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury. Dr. Rizzo has been recognized as a Top 40 under 40 by Crain’s for his industry-leading innovation and dedication to transforming the lives of those with vision deficiencies worldwide. This is a two-part Grand Rounds presentation.
In Part One, Dr. Rizzo focuses on how hand-eye coordination is pervasive in rehabilitation. How do we actually build this hand-eye coordination? Every day, an individual experiences a quarter of a million eye movements. He asked how eye-hand coordination intersects with stroke. Patients who have had a stroke have to do a lot more work in conducting eye movements. It is exhausting to do a simple reach. A great deal of work is necessary to complete basic tasks. Hand-eye coordination is being impeded through interference. So good questions are what comes next and how do you actually deal with it? Currently, they are trying to understand the cognitive implications of what is happening. For example, what happens if we look at the way work is done by considering it as sequential steps, e.g., first look and then reach, first look and then reach. Improvement occurred. Instead of considering biofeedback of the limb, they began doing biofeedback of the eye.
Dr. Ryan Branski is an Associate Professor of Otolaryngology-Head and Neck Surgery and Pathology in the School of Medicine at NYU. He also has an affiliate appointment in Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. He is a licensed speech pathologist and serves as the Associate Director of the Voice Center at NYU Langone Health. In addition to maintaining a clinical practice, Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named a Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.
This is the second of a two-part interview with Dr Ryan Branski.
In Part Two, Dr. Branski indicates that there are a lot of in-office procedures completed. Unlike cholesterol studies, looking at vocal fold function in humans is not the same as looking at it in other animals, such as rabbits. An area of great interest is a regenerative medicine approach to vocal fold injury. He indicates that in research, they are starting with new pre-clinical trials.
Dr. Ryan Branski is an Associate Professor of Otolaryngology-Head and Neck Surgery and Pathology in the School of Medicine at NYU. He also has an affiliate appointment in Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. He is a licensed speech pathologist and serves as the Associate Director of the Voice Center at NYU Langone Health. In addition to maintaining a clinical practice, Dr. Branski runs a productive research enterprise encompassing both clinical and laboratory initiatives. His NIH-funded laboratory primarily focuses on wound healing and regenerative approaches to optimized healing in the upper aerodigestive track. Dr. Branski is one of only a few investigators to be named a Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.
This is the first of a two-part interview with Dr Ryan Branski.
In Part One, Dr. Branski points out that voice loss is the most common communication disorder while the Institute for Deafness and Other Communication Disorders allocates only 6% of research dollars for voice disorders and 70% for hearing loss research. The impacts of voice disorders are broad and hard to characterize. Psychosocial implications also are profound.
PART 2
Dr. Branski indicated that we do a ton of in-office procedures. We can put just about any therapeutic into a larynx. In our lab, we have spent a lot of time looking at steroids. We also do a fair amount of gene therapy. Unlike cholesterol studies, looking at vocal fold function in humans is not the same as looking at it in other animals, such as rabbits. We do a lot of tissue engineering. An area we are most interested in using a regenerative medicine approach to vocal fold injury. He indicated that in research, they are starting with new pre-clinical trials. They have new custom carriages and do not have to use connect. One problem is that pre-clinically, we did not know what to look at. So, we have become interested in biomechanical testing.
Dr. Julie Silver has been an integral part of developing the new Spaulding Research Institute from conception to launch. Her research and clinical work have focused on improving gaps in the delivery of healthcare services, particularly cancer rehabilitation. She has published many scientific reports and is well-known for her ground-breaking work on “impairment-driven cancer rehabilitation.” She is the co-founder and co-director of the Cancer Rehabilitation Group for the American Congress of Rehabilitation Medicine, a research-focused interdisciplinary professional society. As a healthcare leader, Dr. Silver also is committed to supporting the healthcare workforce, and she is a researcher and nationally recognized expert on inclusion, diversity and equity. She has published multiple reports on bibliometrics—educating researchers about both conventional and alternative metrics—aimed at supporting both research dissemination and faculty promotion. Her work has been featured in several major print and broadcast media throughout the United States.
In Part 2 of this presentation on the topic of “How to Lead High Impact Strategic Initiatives in Health Care,” Dr. Silver specifies that you need to tell a compelling story and every story needs a story board. She tells faculty members, here is your story and here are the parts that are missing. She recognized that medical societies had to do more to equitably support our faculties so that we could be promoted and compensated better. She was able to show that women are under-represented in recognition awards. She also looked at elections. For example, one of her studies demonstrated that for 10 medical societies, they had zero leadership positions for women in the past decade. It also is useful to look at micro inequities. Women are not showing up in medical society newsletters, which means that it is not possible to hear about their work. Progress is underway because medical societies all around the U.S. are beginning to pass gender equity resolutions.
Dr. Julie Silver has been an integral part of developing the new Spaulding Research Institute from conception to launch. Her research and clinical work have focused on improving gaps in the delivery of healthcare services, particularly cancer rehabilitation. She has published many scientific reports and is well-known for her ground-breaking work on “impairment-driven cancer rehabilitation.” She is the co-founder and co-director of the Cancer Rehabilitation Group for the American Congress of Rehabilitation Medicine, a research-focused interdisciplinary professional society. As a healthcare leader, Dr. Silver also is committed to supporting the healthcare workforce, and she is a researcher and nationally recognized expert on inclusion, diversity and equity. She has published multiple reports on bibliometrics—educating researchers about both conventional and alternative metrics—aimed at supporting both research dissemination and faculty promotion. Her work has been featured in several major print and broadcast media throughout the United States.
In Part 1 of this presentation, Dr. Silver addresses the topic of “How to Lead High Impact Strategic Initiatives in Health Care” from the perspective of the traditional three hats worn in academic medicine: medical education, clinician, and researcher. When dealing with patients who had polio, she came to the realization that someone had to record their stories regarding what happened to them, which led to her creating an oral history project. When it comes to innovation, it is not enough to have a great idea, but to have a strategy around it, which means the necessity of developing an innovation engine that takes a great idea to enable others to understand it.Tipping points really matter and are the hardest part by being able to define what really makes a difference. Another key essential is to leverage your network. When you want to have divergent change, it helps to have a bridging network and to be able to leverage different groups to bring about big change.
Kathryn Schmitz is a Professor of Public Health Sciences at the Pennsylvania State University’s College of Medicine. She has led many exercise trials and her work has been translated into clinical practice. Dr. Schmitz has published more than 230 peer-reviewed scientific papers and has had $25 million dollars in funding for her research since 2001. She was the lead author of the first American College of Sports Medicine Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. In June 2017, she became president-elect of that organization, assumed its presidency in June 2018, and became Immediate Past President in June 2019. While serving as chairperson in March 2018 of an International Multidisciplinary ACSM Roundtable on Exercise and Cancer Prevention and Control, participants agreed it is time for exercise oncology to go prime time. The question is how. Her professional mission is to answer that question. Her doctorate is from the University of Minnesota-Twin Cities.
She began Part Two of her presentation by indicating that as a result of the intervention described in Part 1, arm swelling among lymphedema patients was reduced by 70% among women with five or more nodes removed. A big question that arose was who was going to do all the things necessary that were part of a research study? Problems with sustainability and dissemination occurred. There also were safety concerns and costs that could not be met. She then described another initiative that was undertaken. Following a referral by an oncologist, physical therapy evaluation and education in a group setting occurred. Participation could occur in a YMCA setting or at home, but a challenge was to figure out how to pay for equipment in the home after the program ended. Subsequently, the program was renamed Strength After Breast Cancer, which is paid for by insurance. She described a series of lessons learned involving transportation, competing demands affecting patients with jobs, location, keeping up with training requirements, and cost. A need also exists for provider education on matters, such as progression of the weights used by patients. She concluded by noting that her mission and the Rusk mission are a shared mission.
Dr. Kathryn Schmitz is a Professor of Public Health Sciences at the Pennsylvania State University’s College of Medicine. She has led many exercise trials and her work has been translated into clinical practice. Dr. Schmitz has published more than 230 peer-reviewed scientific papers and has had $25 million dollars in funding for her research since 2001. She was the lead author of the first American College of Sports Medicine Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. In June 2017, she became president-elect of that organization, assumed its presidency in June 2018, and became Immediate Past President in June 2019. While serving as chairperson in March 2018 of an International Multidisciplinary ACSM Roundtable on Exercise and Cancer Prevention and Control, participants agreed it is time for exercise oncology to go prime time. The question is how. Her professional mission is to answer that question. Her doctorate is from the University of Minnesota-Twin Cities.
She began Part One of her presentation by indicating that only a miniscule proportion of patients who begin cardiac rehabilitation complete the entire number of sessions, even though it is clear that such rehabilitation works effectively. Patients are not being referred, they are not coming and they are not staying once referred. The first thing to do to fix the problem is to ask if there is evidence and the answer is yes. From there it is necessary to look at the referral base to see if there are clinicians who will make the referrals, whether 3rd party coverage is available for your program, and if there are acceptable co-pays. Flexibility is necessary regarding when patients can obtain services and a lot of training is required, not only for the clinicians, but also for the rehab providers. Research should be conducted on what is necessary to fix problems and the results disseminated so that more than just a single rehab facility is implementing correct procedures. Based on her research, she described an example involving breast cancer care. She discussed the risks of lymphedema for women undergoing treatment. Unfortunately, the advice patients receive places them at even greater risk of a condition they want to avoid. She described a weight training intervention.
Liz Donroe is a Senior Placement and Rehabilitation Counselor in Rusk’s Vocational Rehabilitation Department at NYU Langone Health. With over 17 years’ experience in the field of rehabilitation, she has expertise in counseling individuals with complex medical conditions including traumatic brain injury, spinal cord injury, and amputation in returning to work. Her focus is on career counseling, work readiness, job placement and employment retention. Liz served on NYU Langone Medical Center’s Accessibility Committee and is an active member of the New York City Placement Consortium Network. She has presented at multiple national rehabilitation association annual conferences reporting on evidence based return to work methodologies. She currently is employed as a contractor for the U.S. Department of Labor, Office of Workers Compensation, assisting with return to work goals for injured workers. She holds a Master of Science in Rehabilitation Counseling from Hofstra University and is a Certified Rehabilitation Counselor (CRC).
In this interview, Liz discusses: how old age is being defined when referring to older workers with disabilities who are trying to obtain jobs; kinds of personal factors of a positive nature associated with enabling rehabilitation patients to be active in the workforce and any possible deterrent factors; impact of the overall state of the economy on the prospects of finding suitable jobs; barriers and facilitators viewed by potential employers that may distinguish various health conditions from one another; the role of family support; possible stigma by employers that could play a role in producing a wariness or unwillingness to hire individuals with various kinds of health problems; challenges involved in providing vocational rehabilitation services for individuals with physical or mental impairments; workplace accommodations made by employers; proportion of patients who want to return to an existing job and the proportion who may end up being employed in something different; and ways in which the field of vocational rehabilitation could benefit from additional research.
This special panel presentation features three leaders in the space:
Tara Denham, supervisor of vestibular physical therapy, is a leading expert in the field of vestibular therapy and founder of the Vestibular Physical Therapy Center at Rusk. As an American Physical Therapy Association certified vestibular clinician, she lectures extensively to a wide range of audiences. Eva Mihovich has served as a Senior Psychologist at Rusk Rehabilitation, NYU Langone Health Centers for over 20 years, and is a clinical instructor at the NYU School of Medicine. She currently coordinates Psychological Services at the Vestibular Rehabilitation Department at Rusk Rehabilitation. Her Ph.D. is from New York University. Dr. Jennifer Fay is a board-certified clinical specialist in Neurologic Physical Therapy through the American Board of Physical Therapy Specialties and is a clinical instructor in the Department of Physical Medicine and Rehabilitation in the NYU School of Medicine. Artmis Youssefnia is Senior Level II in the vestibular therapy department at Rusk Institute: NYU Langone Health System. She has over 20 years of experience working with patients with pulmonary disease and vestibular dysfunction and does extensive community outreach/education. She also is adjunct professor for Cardiovascular Pulmonary Examination at NYU Physical Therapy school. This is the second of a two-part series. In this episode, the panel covers: whether any patients report out-of-body experiences associated with 3PD, evaluation techniques used in developing treatment plans for patients; dominant treatment approaches; roles played by gait training and gaze stabilization; status of clinical practice guidelines and evidence-based treatments; research gaps where more studies may be necessary; factors that may characterize patients, such as fear of the future or threats to self-image that possibly could detract from the success of rehabilitation kinds of interventions; major components of a cognitive-behavioral approach to treating 3PD; whether plateaus ever occur where further treatment is not associated with additional improvements; and current research and proposed studies on the drawing board aimed at shedding additional light on 3PD.
This special panel presentation features three leaders in the space:
Tara Denham, supervisor of vestibular physical therapy, is a leading expert in the field of vestibular therapy and founder of the Vestibular Physical Therapy Center at Rusk. As an American Physical Therapy Association certified vestibular clinician, she lectures extensively to a wide range of audiences. Eva Mihovich has served as a Senior Psychologist at Rusk Rehabilitation, NYU Langone Health Centers for over 20 years, and is a clinical instructor at the NYU School of Medicine. She currently coordinates Psychological Services at the Vestibular Rehabilitation Department at Rusk Rehabilitation. Her Ph.D. is from New York University. Dr. Jennifer Fay is a board-certified clinical specialist in Neurologic Physical Therapy through the American Board of Physical Therapy Specialties and is a clinical instructor in the Department of Physical Medicine and Rehabilitation in the NYU School of Medicine. Artmis Youssefnia is Senior Level II in the vestibular therapy department at Rusk Institute: NYU Langone Health System. She has over 20 years of experience working with patients with pulmonary disease and vestibular dysfunction and does extensive community outreach/education. She also is adjunct professor for Cardiovascular Pulmonary Examination at NYU Physical Therapy school. This is the first of a two-part series. In this episode, the panel covers: why terms previously used were abandoned and how the classification 3PD represents an improvement over them; core symptoms of 3PD; kinds of health professionals involved in making an accurate differential diagnosis; specific clinical tests to detect the presence of 3PD; how well patients perform in describing their symptoms in constructive ways that aid in arriving at a correct diagnosis; what is known about the exact etiology of 3PD from the standpoint of any common initial events that might precede its development; whether 3PD can co-exist with other kinds of dizziness problems; if onset of 3PD associated in any way with certain demographic factors; and episodes that can trigger the onset of 3PD, such as a panic attack or generalized anxiety disorders
Dr. Barr is an Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. He has over 30 years of experience in clinical practice, training, and research in the field of clinical neuropsychology. He has been on the editorial boards of multiple professional journals and has served as an officer and board member of a number of professional societies, including a term as President of the Society for Clinical Neuropsychology (Division 40) of the American Psychological Association (APA) in 2011. He has an active clinical practice in neuropsychological assessment with ongoing research programs on cognitive and behavioral aspects of epilepsy in addition to other programs in mild traumatic brain injury and forensic neuropsychology. He also maintains an active social media presence on topics related to sports concussion and chronic traumatic encephalopathy (CTE). His doctorate in clinical psychology is from New School University.
This is the second of a two-part series of a live Grand Rounds presentation given at RUSK.
In Part 1 of his presentation, Dr. Barr discussed how he takes a translational approach by applying findings from sports studies to clinical practice. Athletics provide a natural laboratory for studying concussion. Unlike other kinds of concussion injury, the motivation for patients is to return to the field of athletics rather than not to do so. Currently, no obvious concussion test exists. Neuropsychological assessment represents one means of documenting symptoms. A focus in this presentation is on subjective symptoms. Some athletes either fail to report their concussion symptoms or hide them in order to remain on the field while some patients may misreport symptoms that pertain to conditions, such as anxiety and depression rather than concussion. Perhaps not as much attention should be paid to cognitive symptoms (e.g., attention and memory), which may be short-lived, as to emotional symptoms that can persist over longer periods of time. He described how the Sports Laboratory Assessment Model (SLAM) is used. A transition then occurred in the battery of neuro psychological tests from paper and pencil to computer applications.
Part 2 involves a discussion of what has occurred in neuropsychological testing since 2001 and how the SLAM model was used to replicate other studies conducted in the early part of the 21st century. Batteries of different tests were administered to large numbers of college athletes to show natural recovery curves. The results show that sideline battery testing does a good enough job while neuropsychological testing added little to the results. Questions then arose regarding how various computerized tests work and which ones should be used. In addition to studies of athletes, research also was done as part of the translational process that involved emergency room patients. Poor test-retest reliability was found for all the different measures. The test lacked reliability to identify changes. By 2012, it became apparent that baseline neuropsychological testing of athletes was not as important as originally envisioned. Some patients experience symptoms that last beyond one month and these are the individuals who end up in the offices of psychologists. He also discussed post-concussion persistent symptoms.
Dr. Barr is an Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. He has over 30 years of experience in clinical practice, training, and research in the field of clinical neuropsychology. He has been on the editorial boards of multiple professional journals and has served as an officer and board member of a number of professional societies, including a term as President of the Society for Clinical Neuropsychology (Division 40) of the American Psychological Association (APA) in 2011. He has an active clinical practice in neuropsychological assessment with ongoing research programs on cognitive and behavioral aspects of epilepsy in addition to other programs in mild traumatic brain injury and forensic neuropsychology. He also maintains an active social media presence on topics related to sports concussion and chronic traumatic encephalopathy (CTE). His doctorate in clinical psychology is from New School University.
This is the first of a two-part series of a live Grand Rounds presentation given at RUSK.
In Part 1 of his presentation, Dr. Barr discussed how he takes a translational approach by applying findings from sports studies to clinical practice. Athletics provide a natural laboratory for studying concussion. Unlike other kinds of concussion injury, the motivation for patients is to return to the field of athletics rather than not to do so. Currently, no obvious concussion test exists. Neuropsychological assessment represents one means of documenting symptoms. A focus in this presentation is on subjective symptoms. Some athletes either fail to report their concussion symptoms or hide them in order to remain on the field while some patients may misreport symptoms that pertain to conditions, such as anxiety and depression rather than concussion. Perhaps not as much attention should be paid to cognitive symptoms (e.g., attention and memory), which may be short-lived, as to emotional symptoms that can persist over longer periods of time. He described how the Sports Laboratory Assessment Model (SLAM) is used. A transition then occurred in the battery of neuro psychological tests from paper and pencil to computer applications.
Part 2 involves a discussion of what has occurred in neuropsychological testing since 2001 and how the SLAM model was used to replicate other studies conducted in the early part of the 21st century. Batteries of different tests were administered to large numbers of college athletes to show natural recovery curves. The results show that sideline battery testing does a good enough job while neuropsychological testing added little to the results. Questions then arose regarding how various computerized tests work and which ones should be used. In addition to studies of athletes, research also was done as part of the translational process that involved emergency room patients. Poor test-retest reliability was found for all the different measures. The test lacked reliability to identify changes. By 2012, it became apparent that baseline neuropsychological testing of athletes was not as important as originally envisioned. Some patients experience symptoms that last beyond one month and these are the individuals who end up in the offices of psychologists. He also discussed post-concussion persistent symptoms.
Dr. Olesya Yevdayev is a Senior Physical Therapist in the Outpatient Physical Therapy Department at Rusk Rehabilitation, NYU Langone Health. She has a Bachelor of Science degree from Touro College and a Bachelor of Arts degree from Hunter College. She earned her Doctor of Physical Therapy degree from Touro College where she received an Outstanding Clinical Achievement award. She has 7.5 years of professional experience in orthopedics/ sports rehabilitation utilizing the Mulligan Method, McKenzie Method, and manual therapy with a concentration on pelvic floor, pregnancy, osteoporosis, oncology, and lymphedema rehabilitation. She also is involved in community services, patient education, and has presented lectures at NYU in Brooklyn and the 26thCancer Conference.
Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Health and private owner and founder of an office for pain management that will open in August 2019. She has a focus on interventions for spinal issues, joints/tendons, headache and also pelvic pain. She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. She completed her residency in physical medicine and rehabilitation at Mount Sinai Medical Center, New York, NY. Her fellowship training took place at the Beth Israel Medical Center. She treats all types of pelvic pain disorders, including pelvic floor dysfunction, rectal pain, headache, jaw pain, along with spine and joint pain.
This is the second of a two-part series. In Part 1, the guests discuss: the kinds of pelvic floor disorders that women can experience; symptoms that patients can present with; whether only women experience pelvic floor problems; causes of painful symptoms at the pelvic, rectal, or vaginal area and injections available to treat these kinds of pain; extent to which delivering children and growing older influence the occurrence of pelvic floor disorders; if the type of child delivery method, such as vaginal delivery, increases the probability a woman will develop a pelvic floor disorder later in life; how modalities other than surgery, such as physical therapy can contribute to positive outcomes; and the kinds of procedures involved in the administration of pelvic floor physical therapy and the basis on which various approaches either singly or in combination are best suited for a particular patient?
In Part 2, they discuss: Periods of time, such as weeks or months when most rehabilitation interventions take place and whether it ever occurs that further treatment is not associated with additional improvements; if there are instances, such as the presence of a patient’s advanced old age or co-morbidities where watchful waiting may represent the best choice instead of any other kind of intervention; steps that can be taken to lower the percentages of women who experienced urinary incontinence, yet had not talked to a doctor about this problem; pelvic floor muscle training to treat overactive bladder and who provides it; the role of botulinum toxin as a form of treatment for pelvic floor dysfunctions among elderly patients; extent to which patient education is involved in efforts to improve knowledge of, attitude towards, and practice of pelvic floor muscle exercise; frequency of urinary incontinence symptoms and other pelvic floor disorders among adolescent females; and pelvic floor muscle training as a means of primary prevention of urinary incontinence in asymptomatic women and secondary prevention for women with small muscle strength who are considered dysfunctional, but asymptomatic.
Dr. Olesya Yevdayev is a Senior Physical Therapist in the Outpatient Physical Therapy Department at Rusk Rehabilitation, NYU Langone Health. She has a Bachelor of Science degree from Touro College and a Bachelor of Arts degree from Hunter College. She earned her Doctor of Physical Therapy degree from Touro College where she received an Outstanding Clinical Achievement award. She has 7.5 years of professional experience in orthopedics/ sports rehabilitation utilizing the Mulligan Method, McKenzie Method, and manual therapy with a concentration on pelvic floor, pregnancy, osteoporosis, oncology, and lymphedema rehabilitation. She also is involved in community services, patient education, and has presented lectures at NYU in Brooklyn and the 26thCancer Conference.
Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Health and private owner and founder of an office for pain management that will open in August 2019. She has a focus on interventions for spinal issues, joints/tendons, headache and also pelvic pain. She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. She completed her residency in physical medicine and rehabilitation at Mount Sinai Medical Center, New York, NY. Her fellowship training took place at the Beth Israel Medical Center. She treats all types of pelvic pain disorders, including pelvic floor dysfunction, rectal pain, headache, jaw pain, along with spine and joint pain.
This is the first of a two-part series. In Part 1, the guests discuss: the kinds of pelvic floor disorders that women can experience; symptoms that patients can present with; whether only women experience pelvic floor problems; causes of painful symptoms at the pelvic, rectal, or vaginal area and injections available to treat these kinds of pain; extent to which delivering children and growing older influence the occurrence of pelvic floor disorders; if the type of child delivery method, such as vaginal delivery, increases the probability a woman will develop a pelvic floor disorder later in life; how modalities other than surgery, such as physical therapy can contribute to positive outcomes; and the kinds of procedures involved in the administration of pelvic floor physical therapy and the basis on which various approaches either singly or in combination are best suited for a particular patient?
In Part 2, they discuss: Periods of time, such as weeks or months when most rehabilitation interventions take place and whether it ever occurs that further treatment is not associated with additional improvements; if there are instances, such as the presence of a patient’s advanced old age or co-morbidities where watchful waiting may represent the best choice instead of any other kind of intervention; steps that can be taken to lower the percentages of women who experienced urinary incontinence, yet had not talked to a doctor about this problem; pelvic floor muscle training to treat overactive bladder and who provides it; the role of botulinum toxin as a form of treatment for pelvic floor dysfunctions among elderly patients; extent to which patient education is involved in efforts to improve knowledge of, attitude towards, and practice of pelvic floor muscle exercise; frequency of urinary incontinence symptoms and other pelvic floor disorders among adolescent females; and pelvic floor muscle training as a means of primary prevention of urinary incontinence in asymptomatic women and secondary prevention for women with small muscle strength who are considered dysfunctional, but asymptomatic.
Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her areas of specialization include the pediatric disorders cerebral palsy, and spina bifida. In her own words, she stated that she has had the pleasure of watching her patients and learning from their strengths for 45+ years. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board-certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also Pediatrics.
This is the second of a two-part series. In this Part 2, she discusses: pregnancy among patients with cerebral palsy, effect of pregnancy on balance and coordination if a motor functional impairment exists; challenges and resources available for patients who become parents; identification of the felt needs of patients; improvements needed in diagnosis and treatment; time period for adoption of rehabilitation treatment innovations; and key topics in rehabilitation research.
In Part 1, Dr. Gold discussed: number of adults in the U.S. with cerebral palsy; their life expectancy; challenges involved in the transition from pediatric to adult care for these patients; kinds of health problems adult patients experience; treatment for dystonia; the impact of additional physical deterioration on quality of life and mental health; and the ability to participate in physical activities, work, family, and recreational activities.
Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her areas of specialization include the pediatric disorders cerebral palsy, and spina bifida. In her own words, she stated that she has had the pleasure of watching her patients and learning from their strengths for 45+ years. Her medical degree is from the State University of New York Downstate Medical Center. She completed her residency in physical medicine and rehabilitation at the NYU Medical Center and her residency in pediatrics at Beth Israel Medical Center. She is board-certified in the following three areas: Pediatric Rehabilitation Medicine, Physical Medicine & Rehabilitation, and also Pediatrics.
This is the first of a two-part series. In Part 1, Dr. Gold discusses: number of adults in the U.S. with cerebral palsy; their life expectancy; challenges involved in the transition from pediatric to adult care for these patients; kinds of health problems adult patients experience; treatment for dystonia; the impact of additional physical deterioration on quality of life and mental health; and the ability to participate in physical activities, work, family, and recreational activities.
In Part 2, she discusses: pregnancy among patients with cerebral palsy, effect of pregnancy on balance and coordination if a motor functional impairment exists; challenges and resources available for patients who become parents; identification of the felt needs of patients; improvements needed in diagnosis and treatment; time period for adoption of rehabilitation treatment innovations; and key topics in rehabilitation research.
Dr. Joel Stein is Physiatrist-in-Chief at New York-Presbyterian Hospital, as well as Professor and Chairman of the Department of Rehabilitation Medicine at the Columbia University College of Physicians and Surgeons, and Professor and Chairman of the Department of Rehabilitation Medicine at Weill Cornell Medical College. His clinical and research interests are in the area of stroke rehabilitation. He has had a particular focus on the use of exercise as a treatment, and on the use of robotic and other technologies to facilitate recovery of motor function after stroke. He has authored or co-authored two books on stroke recovery and rehabilitation for stroke survivors and their families, and edited a multi-authored medical textbook on this subject entitled “Stroke Recovery and Rehabilitation.” His undergraduate degree is from Columbia University and his medical degree is from the Albert Einstein College of Medicine. He completed a residency in Internal Medicine at Montefiore Hospital in the Bronx, followed by a residency in Physical Medicine and Rehabilitation at New York-Presbyterian Hospital. He is board certified in both internal medicine and physical medicine & rehabilitation.
This is part 2 of a 2-part series. In this episode, Dr. Stein discusses: measures to predict neurological recovery and stages when they are applied most effectively; periods of time when most rehabilitations interventions take place; success of efforts to achieve the translation of clinical findings and evidence-based research to the bedside in a timely manner; and many other exciting topics.
Dr. Joel Stein is Physiatrist-in-Chief at New York-Presbyterian Hospital, as well as Professor and Chairman of the Department of Rehabilitation Medicine at the Columbia University College of Physicians and Surgeons, and Professor and Chairman of the Department of Rehabilitation Medicine at Weill Cornell Medical College. His clinical and research interests are in the area of stroke rehabilitation. He has had a particular focus on the use of exercise as a treatment, and on the use of robotic and other technologies to facilitate recovery of motor function after stroke. He has authored or co-authored two books on stroke recovery and rehabilitation for stroke survivors and their families, and edited a multi-authored medical textbook on this subject entitled “Stroke Recovery and Rehabilitation.” His undergraduate degree is from Columbia University and his medical degree is from the Albert Einstein College of Medicine. He completed a residency in Internal Medicine at Montefiore Hospital in the Bronx, followed by a residency in Physical Medicine and Rehabilitation at New York-Presbyterian Hospital. He is board certified in both internal medicine and physical medicine & rehabilitation.
This is part 1 of a 2-part series. In this part of the discussion, Dr. Stein discusses: estimates of stroke incidence and prevalence in the U.S.; stroke occurrence among young individuals; impairments commonly resulting from a stroke; factors such as age that can affect the degree and speed of recovery; sleep apnea as a possible risk factor for stroke; relationship between sleep disorders and stroke recovery and possible contributions to cognitive decline post-stroke; whether screening for post-stroke depression and cognitive impairment can predict long-term patient outcomes; and whether persistent symptoms of anxiety can develop after a stroke.
Dr. Susan Maltser is Director of Cancer Rehabilitation and oversees the comprehensive Cancer Rehabilitation program for Northwell health. She is a practicing physiatrist and an assistant professor of Physical Medicine and Rehabilitation at Zucker School of Medicine. She also serves as Chief, Physical Medicine and Rehabilitation at Long Island Jewish Hospital. A graduate of the New York College of Osteopathic medicine, her residency in Physical Medicine and Rehabilitation was completed at the Rusk Institute at NYU Langone Medical Center. She is a fellow of the American Board of Physical Medicine and Rehabilitation, and holds membership in both the American Academy of Physical Medicine and Rehabilitation and the National Cancer Rehabilitation Physician Consortium.
This interview is a two-part series. In Part 2, Dr. Maltser discusses: the extent of post-surgical care aimed at social and emotional functions; from the perspective of patient-reported outcomes, steps taken to identify the felt needs of patients in conjunction with the needs identified by the health care team; whether demographic factors, such as age influence whether a woman wants to remain in the labor force and what can be done to assist women in this aspect of their lives; the degree to which sexual function affected by breast cancer treatment is discussed with patients; whether older women who undergo treatment for breast cancer are vulnerable to experiencing a balance problem that increases the risk of falling; if technological approaches, such as the development of wearable sensors and cloud-based apps are being used after patients leave the clinical setting to enable them to provide daily feedback on their condition and successes they are experiencing in self-care; and areas where improvements in diagnostic measures and rehabilitation treatment would be warranted.
Dr. Susan Maltser is Director of Cancer Rehabilitation and oversees the comprehensive Cancer Rehabilitation program for Northwell health. She is a practicing physiatrist and an assistant professor of Physical Medicine and Rehabilitation at Zucker School of Medicine. She also serves as Chief, Physical Medicine and Rehabilitation at Long Island Jewish Hospital. A graduate of the New York College of Osteopathic medicine, her residency in Physical Medicine and Rehabilitation was completed at the Rusk Institute at NYU Langone Medical Center. She is a fellow of the American Board of Physical Medicine and Rehabilitation, and holds membership in both the American Academy of Physical Medicine and Rehabilitation and the National Cancer Rehabilitation Physician Consortium.
This interview is a two-part series. In Part 1, Dr. Maltser discusses: what cancer rehabilitation is and some conditions that commonly are treated in breast cancer patients; measures employed to assess patients who have undergone breast surgery regarding the scope of rehabilitation interventions to pursue; the adverse effect of reconstructive surgery for breast cancer on shoulder function and the kinds of rehabilitation that prove effective in dealing with this problem; debilitating side effects, such as difficulty sleeping and fatigue, associated with breast cancer surgery; the risk of developing lymphedema after undergoing surgery for breast cancer; the role of self-care in treating lymphedema; and the role that physical exercise might play and when it should occur pre- and post-surgery.
Dr. Mitchell Elkind is a Professor of neurology at Columbia University College of Physicians and Surgeons as well as an attending neurologist in the stroke service at New York Presbyterian Hospital. His areas of expertise are cerebrovascular disease and stroke. He completed his medical school training at Harvard Medical School. His internship was at Brigham and Women’s Hospital in Boston, MA and was followed by a residency in neurology at the Massachusetts General Hospital where he served as chief resident. Dr. Elkind subsequently obtained a master’s degree in epidemiology at the Columbia University School of Public Health and also completed fellowship training in cerebrovascular diseases.
In the second of a two-part Grand Rounds, Dr. Elkind reviews occult atrial fibrillation, monitoring devices, and other relevant areas after which there is a Q&A.
Dr. Mitchell Elkind is a Professor of neurology at Columbia University College of Physicians and Surgeons as well as an attending neurologist in the stroke service at New York Presbyterian Hospital. His areas of expertise are cerebrovascular disease and stroke. He completed his medical school training at Harvard Medical School. His internship was at Brigham and Women’s Hospital in Boston, MA and was followed by a residency in neurology at the Massachusetts General Hospital where he served as chief resident. Dr. Elkind subsequently obtained a master’s degree in epidemiology at the Columbia University School of Public Health and also completed fellowship training in cerebrovascular diseases. In Part 1, Dr. Elkind focuses on unexplained stroke and potentially how to prevent it, especially based on some new developments; cryptogenic stroke and embolic stroke of undetermined source; various cardiac sources of stroke and PFO (patent foramen ovale) closure; and how RoPE (Risk of Paradoxical Embolism) scores are used.
Dr. J.R. Rizzo is a physician scientist at NYU Langone Medical Center’s Rusk Rehabilitation Institute, where he is an Assistant Professor of Physical Medicine and Rehabilitation with a cross-appointment in the Department of Neurology. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury and the Technology Translation in Medicine Laboratory, where the focus is on assistive technology for the visually impaired and benefits from his own personal experiences with vision loss. He recently completed an R03 grant through the National Institute of Aging, as a GEMSSTAR Scholar, focusing his research goals on eye-hand coordination in elderly stroke, and is completing a K12 award, as an RMSTP Fellow, focusing on visuomotor integration in brain injury. He has funding at the federal, state, municipal and foundational levels. He has numerous peer-reviewed publications and book chapters, in addition to domestic and international patents filed for his rehabilitation tools. An honors graduate in neuroscience at NYU, he completed medical school on scholarship at New York Medical College and was elected to the Alpha Omega Alpha Honor’s Society Iota Chapter. He completed his residency, including a chief year, at NYU’s Physical Medicine & Rehabilitation Program where he subsequently was awarded funding to complete a clinical research fellowship at Rusk.
In the second part of this Grand Rounds presentation Dr. Rizzo continues his description of a pilot research project involving chronic stroke patients who were recruited from outpatient clinics. The investigation included eye tracking while simultaneously recording motion capture of patients’ limbs. He indicates how eye errors correlate with limb errors in this study and mentioned some cognitive implications derived from the project. A question and answer period followed his presentation.
Dr. J.R. Rizzo is a physician scientist at NYU Langone Medical Center’s Rusk Rehabilitation Institute, where he is an Assistant Professor of Physical Medicine and Rehabilitation with a cross-appointment in the Department of Neurology. He leads the Visuomotor Integration Laboratory where his team focuses on eye-hand coordination as it relates to acquired brain injury and the Technology Translation in Medicine Laboratory, where the focus is on assistive technology for the visually impaired and benefits from his own personal experiences with vision loss. He recently completed an R03 grant through the National Institute of Aging, as a GEMSSTAR Scholar, focusing his research goals on eye-hand coordination in elderly stroke, and is completing a K12 award, as an RMSTP Fellow, focusing on visuomotor integration in brain injury. He has funding at the federal, state, municipal and foundational levels. He has numerous peer-reviewed publications and book chapters, in addition to domestic and international patents filed for his rehabilitation tools. An honors graduate in neuroscience at NYU, h**e** completed medical school on scholarship at New York Medical College and was elected to the Alpha Omega Alpha Honor’s Society Iota Chapter. He completed his residency, including a chief year, at NYU’s Physical Medicine & Rehabilitation Program where he subsequently was awarded funding to complete a clinical research fellowship at Rusk.
In the first part of a grand rounds presentation, Dr. Rizzo discussses eye-hand coordination or what is known as the eye-hand mystique. He describes perception, the ocular motor system, perception to action, and eye-hand control deficits as they relate to visual motor integration. He discusses visual crowding as it pertains to peripheral vision and the importance of material categorization. He also describes research involving chronic stroke patients recruited from outpatient clinics using eye tracking and simultaneously recording motion capture of their actual limbs. The session includes questions from attendees at the presentation and his responses.
In the second part of a grand rounds presentation by Dr. John Ross Rizzo on December 12, 2018 at the Rusk Institute of Rehabilitation at NYU Langone Health, he continued his description of a pilot research project involving chronic stroke patients who were recruited from outpatient clinics. The investigation included eye tracking while simultaneously recording motion capture of patients’ limbs. He indicated how eye errors correlated with limb errors in this study and mentioned some cognitive implications derived from the project. For example, in reaching for a cup of tea there could be an eye movement that has some computational load, meaning what is the cerebral load to complete that task and what is involved if the reaching is done using peripheral vision? In this context, it is worth considering what is occurring in the presence of an impaired brain, such as after a stroke. A central idea is that stroke interferes with cognitive resource sharing between eye and hand movement during eye-hand coordination. A question and answer period followed his presentation.
Rondel King is a certified strength and conditioning specialist and corrective exercise specialist. His programming aims to bring out the best in a person’s health and performance. He has a strong interest in postural asymmetries and the nervous system as it relates to biomechanics, human performance, and general health. Mr.King leads group fitness classes at NYU Langone Orthopedic Center and is a clinician with the Running Lab and the Golf Lab.
In his interview, Rondel discusses: the relationship between gaining muscle mass versus strength and stability and the topic of weight loss; kinds of patients who can benefit from losing weight; extent of eating disorders; influence of demographic factors on the attainment of successful outcomes; role of diet in weight loss reduction; kinds of lifestyle interventions that prove to be effective in achieving weight loss; role that wearable devices play in contributing to weight loss; whether poor nutrition can be out-trained; if crunches can produce flat abs; whether more sweat burns more calories; effect of running and squats on the knees; if more gym time always is better than less; the notion of No Pain, No Gain; whether yoga can help with back pain; if lifting heavy weights can make women “bulky;" and whether machines are better than free weights.
Heather Milton leads group fitness classes at NYU Langone Orthopedic Center and is a clinician with the Running Laboratory and Golf Laboratory. She is a board-certified exercise physiologist and strength and conditioning specialist. She is certified in Functional Movement Systems® and by the Titleist Performance Institute. She develops specialized programs to help athletes reach their maximum potential and ability. Ms. Milton creates unique and motivational programs to inspire health and fitness clients and designs injury prevention programs for at-risk athletes and youth sports teams. She also identifies limitations that may affect sport performance, including gait faults in running, swing faults in golf, and swing, kick, and throw patterns in rotational sports. Her undergraduate degree in cardiopulmonary science and her master’s degree in clinical exercise physiology are from Northeastern University.
In this interview, she discusses: kinds of patients who can benefit from building stability, strength, and muscle; measures to assess current physical abilities of patients; conditions where building stability, strength, and muscle can produce a preventive effect; impact of strength training on other abilities, such as improved balance and mobility; influence of demographic factors on the attainment of successful outcomes; the difference between stability and strength; progression of building stability, strength and muscle; difference between strength and mass; key components of a program to build stability, strength, and hypertrophy/muscle mass; common mistakes individuals make in their training programs; whether individuals naturally bulk up; gaining strength and avoidance of adding muscle mass; what to say when efforts to gain muscle for years fail; and who benefits from each type of training.
David Biderman is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Langone Health and serves as supervisor of the Brain Injury Day Treatment Program. He joined Rusk Rehabilitation, NYU Langone Health in 1996 as a research assistant and started working at the Brain Injury Day Treatment Program in 1999, becoming the supervisor in 2010. A New York City native, he earned his Doctoral Degree in Health Psychology from the Albert Einstein College of Medicine. Prior to coming to Rusk, he worked in research at other major medical centers in New York. Most recently he has presented and published on the role of significant others in the rehabilitation of individuals with a brain injury. He currently is working on cognitive retraining software to improve attention functions and continues his efforts to educate Brain Injury fellows, Psychology Doctoral Interns, and other professionals interested in learning about the comprehensive neuropsychological rehabilitation of individuals with an acquired brain injury. This discussion includes: assessments performed to determine if cognitive remediation is an appropriate intervention for patients who experienced a traumatic brain injury; aims pursued when engaging in cognitive remediation; the effect of TBI level of severity on kind of treatment and anticipated outcomes; the influence of demographic factors such as age, gender, and race/ethnicity on the attainment of successful outcomes; the role music can play in cognitive remediation; ways in which cognitive remediation could be enhanced through the use of existing and emerging kinds of social media platforms, along with other modalities, such as apps, wearable devices, and virtual reality technology; self- or family caregiver-treatment plans outside the clinical setting; and current research and proposed studies at NYU aimed at producing a greater understanding of the effectiveness of cognitive remediation kinds of intervention.
Dr. Steven Flanagan is the Chair, Department of Rehabilitation Medicine and Howard A. Rusk Professor of Rehabilitation Medicine at Rusk Rehabilitation. He is highly recognized, nationally and internationally, as one of the leading experts in the area of brain injury rehabilitation. He serves on numerous medical advisory boards, including the Brain Trauma Foundation and is a peer reviewer for several scientific journals. He currently is chairperson of the Medical Education Committee and sits on the Board of Governors of the American Academy of Physical Medicine and Rehabilitation Medicine. The author of numerous chapters and peer-reviewed publications, he has received awards from several organizations and been continually listed as one of America’s Top Doctors by Castle Connolly.
Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Medical Center. As a post-traumatic headache specialist, she has a focus on interventional pain management of chronic headache. She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. Her medical degree is from the Nova Southeastern University College of Osteopathic Medicine. She completed her residency in physical medicine and rehabilitation at the Broward General Medical Center in Fort Lauderdale, FL. Post-doctoral training took place at the Beth Israel Medical Center in New York City. Dr.Sackheim also had an anesthesia-based fellowship in interventional pain medicine, hospice & palliative care at the Mount Sinai School of Medicine in New York City. In Part 2 of this two part series, she discusses: the extent to which patient health behaviors can be targeted routinely to improve headache management; new headache medications that are effective for treatment; demographic factors that could affect both the degree and the speed of recovery from headaches when they occur; the importance of patient involvement in medical decision-making; use of complementary, alternative, and integrative medicine by patients; the role of in-home telehealth therapy programs; if there is a need for improved diagnostic measures and treatment; and key topics within the realm of rehabilitation research aimed at improving the care of patients who suffer from headaches and any possible emerging areas.
Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Medical Center. As a post-traumatic headache specialist, she has a focus on interventional pain management of chronic headache. She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. Her medical degree is from the Nova Southeastern University College of Osteopathic Medicine. She completed her residency in physical medicine and rehabilitation at the Broward General Medical Center in Fort Lauderdale, FL. Post-doctoral training took place at the Beth Israel Medical Center in New York City. Dr.Sackheim also had an anesthesia-based fellowship in interventional pain medicine, hospice & palliative care at the Mount Sinai School of Medicine in New York City. In Part 1 of this two part series, Dr. Sackheim discusses: headache forecasting models in accurately predicting future headache activity; situations in a patient’s life that serve as useful forecasts of the onset of headache; the degree to which preexisting conditions, such as mood disorders influence the onset of a headache; diagnostic challenges involved when patients present with both headache and neck pain; whether individuals hospitalized due to a head injury are more likely to have a new onset of headaches and a worsening of pre-existing headache and persistent headache; and the role depression and anxiety play in the development of headaches.
Dr. Armando Fuentes recently completed his ARRT fellowship at NYU Rusk Rehabilitation. While doing so, he focused on racial and cultural health disparities in traumatic brain injury. In October 2018, he began working as a clinician at the World Trade Center Survivors Clinic in Elmhurst Hospital, where he hopes to build a culturally informed mental health and clinical training program. He graduated with his PhD in clinical psychology from Fordham University where his research focused on culture, health beliefs, and neurocognition among Latinx patients living with HIV.
In this interview, Dr. Fuentes discusses: his presentation at a Rusk course on October 20 and 21, 2018 to highlight some of the latest evidence in complex TBI rehabilitation; clinical practice guidelines in general and for TBI patients from racial and ethnic groups in particular; outcomes in overall functioning by members of minority groups compared to whites; and lower retention rates in TBI research by Hispanics one to two years post-injury.
Tara Denham is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Langone and a Program Manager in Physical Therapy. She is a leading expert in the field of vestibular therapy and is the founder of the Vestibular Physical Therapy Center at Rusk. As an American Physical Therapy Association certified vestibular clinician, she lectures extensively to a wide range of audiences. Joseph Adams is a Senior Physical Therapist and Clinical Instructor of Rehabilitation Medicine at the NYU School of Medicine. He is a board-certified clinical specialist in Neurologic Rehabilitation with advanced training in Vestibular Rehabilitation. He is a faculty member at Rusk's Neurologic Residency program and also an adjunct professor at Touro College. Dr. Eva Mihovich is a Senior Psychologist and a clinical instructor at the NYU School of Medicine. She has done research and made professional presentations on the psychological assessment and treatment of vestibular patients. She is an integral part of the multidisciplinary care team at Rusk treating patients with vestibular disorders in individual and group therapy settings. This special interview with these three leaders explores a course on November 3-4, 2018 being offered at Rusk on the topic of vestibular evaluation and treatment of the dizzy patient; the association of vestibular dysfunction associated with certain demographic factors; the contribution of polypharmacy to creating bouts of dizziness; psychological aspects associated with vestibular disorders; conditions besides anxiety that lead to vestibular disorders; common central and peripheral disorders; how patients' lives are affected by benign paroxysmal positional vertigo (BPPV) and how this condition is tested for; the extent to which problems involving vestibular systems affect vision; evaluation techniques used in developing treatment plans for patients; the status of clinical practice guidelines and the evidence base for treatments; and current research and proposed studies on the drawing board at Rusk that are aimed at shedding additional light on vestibular disorders.
Dr. Estelle Gallo is a Clinical Specialist at the Rusk Rehabilitation NYU Langone Ambulatory Care Center. She is a certified clinical specialist in Neurology from the American Board of Physical Therapy Specialties who specializes in adult neurological rehabilitation. She serves as a faculty member of the accredited physical therapy neurology residency program and holds a faculty position as a Research Assistant Professor in the Physical Medicine and Rehabilitation Department at NYU School of Medicine. She has received internal funding for her research. Dr. Gallo has published her work in several peer-reviewed journals as well as presented at both national and international conferences. Currently, she is conducting a feasibility and safety study on high level mobility training in patients with non-progressive acquired central neurological injuries. She also serves as a member of the Locomotor Training Clinical Practice Guidelines Knowledge Translation Task Force for the Academy of Neurologic Physical Therapy. She received her doctorate degree from New York University.
In this interview, Dr. Gallo discusses: the ability to run a short distance in the rehabilitation of patients with acquired brain injury; existing evidence to make recommendations about the examination and intervention for high level mobility and to facilitate a return to running; examination techniques and outcome measures that are used; objective criteria used to guide initiation of high-level mobility training; recent developments in clinical practice guidelines on outcome measures for the neurologic population; upcoming recommendations about locomotor training, research being done in the physical therapy department to test the feasibility and safety of high-level mobility training; and some key rehabilitation research topics in physical therapy and some emerging areas.
Liat Rabinowitz is the Program Manager of Speech Language Pathology at Rusk. Her experience has been in evaluation and treatment of adults with acquired brain injury with a specific area of interest in cognitive communication impairments and working with patients in disorder of consciousness. Most of her current work involves managing the Speech Language Pathology department, along with supervising and training staff. A native of South Africa, she trained as a therapist at the University of Cape Town. Her master’s degree in speech-language pathology is from Columbia University. She currently teaches as an adjunct faculty member at NYU-Steinhardt school on language disorders in adults and has taught cognitive disorders at Columbia University.
In this interview, she discusses: meaning of the term post-confusional state and kinds of available treatment for it; interventions to treat acquired stuttering; language, cognitive communication, or swallowing disorders associated with the occurrence of a TBI and what can be done from the perspective of speech-language pathology; impairment of conversational ability following a brain injury; key topics within the realm of rehabilitation research in speech-language therapy; and the most common kinds of symptoms involved in post-traumatic amnesia.
Dr. Brian Im is the medical director for the NYU Rusk brain injury rehabilitation program and program director for the ACGME accredited brain injury medicine fellowship at NYU School of Medicine. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. In this interview, Dr. Im discusses some of the medical complexities associated with complex TBI. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. In Part 2, we discussed: becoming overweight as a risk following a TBI, whether a preexisting endocrine dysfunction can trigger a thyroid dysfunction, gait abnormalities that might stem from a TBI, the status of pharmacological treatment of a brain injury, and research on TBI being conducted at Rusk, along with any system enhancements either underway or being planned.
Dr. Brian Im is the medical director for the NYU Rusk brain injury rehabilitation program and program director for the ACGME accredited brain injury medicine fellowship at NYU School of Medicine. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. In this interview, Dr. Im discusses some of the medical complexities associated with complex TBI. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. In Part 1, we discussed: an October 20-21, 2018 program at Rusk on the topic of complex TBI rehabilitation, paths that patients take to arrive at Rusk for treatment, measures used to determine recovery, whether treatment plateaus are reached, and differences in how patients experience a TBI and living with its aftermath.
Until this interview, this podcast series has focused on healthcare professionals and researchers and the myriad activities in which they all engage. We are very excited that, for this interview, listeners have an opportunity to hear the views of an individual who was on the other side. Mr. Pierre Lucien is an individual who had both legs amputated above the knee. In 2008, while on a training run with the Atlanta, Georgia Police Department, he fell to the ground unconscious when he experienced massive organ failure. In an effort to save his life, doctors had to amputate both of his legs above the knees. He later was transferred to the Rusk Rehabilitation Institute at NYU Langone where he underwent additional surgery and began rehabilitation. Today, he is married and the father of two children and earns a living while employed at a police department in Marietta, Georgia. The interview with him consists of three parts.
In Part 3 we discussed: experience of phantom pain in missing limbs and how to treat it; a sensation of feeling the presence of missing limbs; what he does to stay physically active; his family life and what he does for a living; providing assistance to new patients who undergo an amputation; additional activities in which he is engaged to inspire other individuals to cope with life’s challenges successfully; and thoughts or recommendations important to convey to health professionals.
Until today, this podcast series has focused on healthcare professionals and researchers and the myriad activities in which they all engage. We are very excited that, for this interview, listeners have an opportunity to hear the views of an individual who was on the other side. Mr. Pierre Lucien is an individual who had both legs amputated above the knee. In 2008, while on a training run with the Atlanta, Georgia Police Department, he fell to the ground unconscious when he experienced massive organ failure. In an effort to save his life, doctors had to amputate both of his legs above the knees. He later was transferred to the Rusk Rehabilitation Institute at NYU Langone where he underwent additional surgery and began rehabilitation. Today, he is married and the father of two children and earns a living while employed at a police department in Marietta, Georgia. The interview with him consists of three parts.
In Part 2 Pierre discusses: from the perspective of an amputee what is considered both a good day and a bad day; amount of time elapsed from time of surgery before prostheses were prescribed and use of them began; length of time to accommodate to having prosthetic limbs; kinds of problems that can develop when a prosthetic device exerts pressure on a limb’s soft tissue and how to deal with them; once prosthetics are fitted and used how much maintenance of them is involved; and adjustments in prostheses necessary to carry anything heavy or in trying to navigate uneven ground or a flight of stairs and the kinds of challenges involved, such as feeling a loss of balance.
Until today, this podcast series has focused on healthcare professionals and researchers and the myriad activities in which they all engage. We are very excited that, for this interview, listeners have an opportunity to hear the views of an individual who was on the other side. Mr. Pierre Lucien is an individual who had both legs amputated above the knee. In 2008, while on a training run with the Atlanta, Georgia Police Department, he fell to the ground unconscious when he experienced massive organ failure. In an effort to save his life, doctors had to amputate both of his legs above the knees. He later was transferred to the Rusk Rehabilitation Institute at NYU Langone where he underwent additional surgery and began rehabilitation. Today, he is married and the father of two children and earns a living while employed at a police department in Marietta, Georgia. The interview with him consists of three parts.
In Part 1 we discussed: if there had been any signs or symptoms prior to his collapse and loss of consciousness; where he obtained treatment; his age when his legs were amputated; length of time as both an inpatient and an outpatient; time elapsed from time of surgery to rehabilitation; kinds of health and other kinds of professionals who provided care; amputation as a life changing event; adjustments that had to be made in various aspects of daily living and functioning; and for a single person who experienced amputation, how dating was affected.
Nathan Zasler is CEO and Medical Director of the Concussion Care Centre of Virginia as well as Tree of Life Services, Inc., a living assistance and transitional neurorehabilitation program for persons with acquired brain injury in Richmond, Virginia. He is board certified in Physical Medicine and Rehabilitation, fellowship trained in brain injury and subspecialty certified in Brain Injury Medicine. He has lectured and written extensively on neurorehabilitation issues related to acquired brain injury. He has won numerous awards for his work in traumatic brain injury research, clinical care, and advocacy. Along with serving as chief editor of the international scientific publications, “Brain Injury” and “NeuroRehabilitation,” he also has edited seven books and currently serves as a reviewer for over 10 peer-reviewed scientific journals. Dr. Zasler is an affiliate professor in the Department of Physical Medicine and Rehabilitation at Virginia Commonwealth University in Richmond, Virginia, and associate professor, adjunct, in the Department of Physical Medicine and Rehabilitation at the University of Virginia. Dr. Zasler also is a fellow of the International Academy of Independent Medical Evaluators, as well as the American Congress of Rehabilitation Medicine and a diplomate of the Academy of Integrative Pain Management. In Part 2 to this two-part interview, Dr. Zasler discusses: conservative management of post-traumatic headache and concerns about the need for surgical intervention; overuse of pain medication; when appropriate treatments may be beyond the financial reach of segments of the population with inadequate third-party insurance coverage; importance of patient involvement in medical decision-making; patient resilience and maintenance of an engaged participation in their rehabilitation; use of complementary and alternative medicine; leveraging existing and emerging kinds of social media platforms and other modalities; role of in-home telehealth therapy programs; age, gender, race, and ethnicity as factors that could affect the degree and speed of recovery from headaches; need for developing improved clinical care guidelines; need for improved assessment techniques, diagnostic measures, treatments, and/or modifications to the current classification systems; primary deficiencies in the currently available research; and the best way to avoid persistent symptoms of post traumatic headache?