Dr. Tamara Wexler is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at NYU Langone Medical Center. Dr. Wexler established the Endocrine Patient Registry to support clinical research, and multidisciplinary and inter-institute research collaboration to further investigate the importance of pituitary dysfunction, and its treatment. She serves as principal investigator of the TBI/Pituitary Registry and the lead site investigator for a multisite neuroendocrine tumor study. Her research interests are focused on neuroendocrine and reproductive endocrine changes that may occur, including after traumatic brain injury. Her medical degree and PhD are from the University of Pennsylvania. She did her residency in Internal Medicine at the Massachusetts General Hospital. Dr. Wexler also had a fellowship at MGH involving Endocrinology, Diabetes, and Metabolism.
This is the first of a two-part interview. In Part One, Dr. Wexler discusses collaborations she established to further research and patient care; how the pituitary responds to different kinds of TBI and whether the injury stems from a one-time event or a series of repetitive events; how a TBI affects the anterior and posterior pituitary lobes; and whether genetic disposition plays a role in pituitary dysfunction after a TBI.
This interview is with a panel of three Rusk leaders: Dr. Tamara Bushnik, Dr. Brian Im, and Michelle Smith.
Dr. Tamara Bushnik is an Associate Professor and Director of Inter-Hospital Research and Knowledge Translation at Rusk Rehabilitation. She is is the Project Director of the current RuskTraumatic Brain Injury Model Systems (TBIMS) at NYU. She has over 50 peer-reviewed manuscripts since joining the project. She has been the Chair of the TBIMS Knowledge Translation Committee since 1999 and has led the selection of topics for the popular traumatic brain injury Fact Sheets and end-of-grant-cycle special issues/sections highlighting TBIMS research.
Dr. Brian Im is the director of brain injury rehabilitation at Rusk where he treats both inpatients and outpatients in the brain injury rehabilitation program. He is heavily involved in program development and academic medicine. He is the program director for the ACGME accredited brain injury medicine fellowship at NYU School of Medicine, has an active role in TBI research, and in the TBIMS projects. His research focus of interest is in studying the health care disparities and differences that exist in TBI care for different populations.
Michelle Smith is an Assistant Research Scientist where she manages day-to-day activities of studies, including the TBIMS National Database. She has a professional background and interests in health communications with the goal of providing vital information to patients to help improve their health through increasing health literacy. Prior to her current role, she managed the development and implementation of research studies to improve health in the underserved community of Harlem by developing and maintaining a website and a randomized-controlled trial to reduce hypertension.
During the interview, the three discuss: treatment of older patients who sustained a traumatic brain injury; interventions necessary when patients' health literacy levels are low; addressing patients’ treatment preferences when they have different beliefs about the nature of health problems; and how patients' level of emotional functioning can affect treatment outcomes.
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 and Pulmonary Rehabilitation. His research interests include: cardiac rehabilitation for patients with advanced congestive heart failure and after left ventricular assist device placement, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. His medical degree is from the University of London and he completed his residency at NYU Medical Center in Physical Medicine and Rehabilitation where he also completed a fellowship in cardiac and pulmonary rehabilitation. He is certified by the American Board of Physical Medicine and Rehabilitation.
This is the second of a two-part series with Dr. Whiteson in which he discusses many topics including: conditions such as medically complex, cardio-pulmonary, stroke, or TBI that make it more likely that a patient could become a candidate for readmission within 30 days of being discharged; challenges in treating frail patients; a pilot program at Rusk that involves patient needs assessment, medication reconciliation, patient education, making arrangements for out-patient/home-based services, and telephone follow-up; what is being done at Rusk from the standpoint of educating family caregivers and viewing them as valuable members of the health care team; how the Rusk team does an assessment of the safety of a patient's home to lower the risk of falls; and problems associated with polypharmacy that need to be taken into account when providing rehabilitation care.
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 and Pulmonary Rehabilitation. His research interests include: cardiac rehabilitation for patients with advanced congestive heart failure and after left ventricular assist device placement, pulmonary rehabilitation of individuals exposed to world trade center dust, and recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting. His medical degree is from the University of London and he completed his residency at NYU Medical Center in Physical Medicine and Rehabilitation where he also completed a fellowship in cardiac and pulmonary rehabilitation. He is certified by the American Board of Physical Medicine and Rehabilitation.
This is the first of a two-part series with Dr. Whiteson in which he discusses many topics including: conditions such as medically complex, cardio-pulmonary, stroke, or TBI that make it more likely that a patient could become a candidate for readmission within 30 days of being discharged; challenges in treating frail patients; a pilot program at Rusk that involves patient needs assessment, medication reconciliation, patient education, making arrangements for out-patient/home-based services, and telephone follow-up; what is being done at Rusk from the standpoint of educating family caregivers and viewing them as valuable members of the health care team; how the Rusk team does an assessment of the safety of a patient's home to lower the risk of falls; and problems associated with polypharmacy that need to be taken into account when providing rehabilitation care.
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.
In this interview, he discusses: the kinds of patients treated for TBI at Rusk, if a TBI sustained during early adulthood or mid-adulthood can pose a risk for dementia and other neurodegenerative diseases associated with aging, the role of brain reserve in developing an understanding of the interplay between TBI and neurodegenerative diseases associated with aging, treatment of chronic cognitive impairment in TBI, TBI and sleep disorders, inclusion of family members in the care giver team, the use of technological innovations in rehabilitation, and research on TBI being conducted at Rusk, along with any system enhancements underway or being planned.
This interview is a continuation of a panel discussion on TBI. This is the second of a two-part series featuring Dr. Prin Amorapanth and Dr. Brian Im.
Dr. Prin Amorapanth is a clinical instructor and a member of the research faculty at Rusk. His fellowship at NYU Langone Health focuses on brain injury medicine. His current research interests include identifying markers of visuospatial impairment following acquired brain injury as well as the use of non-invasive brain stimulation as both a therapeutic and investigational tool for maximizing rehabilitation and better understanding mechanisms of recovery following brain injury. He is certified by the American Board of Physical Medicine & Rehabilitation. His medical degree and PhD are from the University of Pennsylvania. He completed his residency training in rehabilitation medicine at the Rehabilitation Institute of Chicago.
Dr. Brian Im is Associate Director of Brain Injury Rehabilitation at Rusk. He also is program director for the ACGME-accredited brain injury medicine fellowship at NYU School of Medicine. Following medical school at SUNY, Syracuse, rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and fellowship in BI rehabilitation medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent 5-year tenure at NYU Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. He has an active role in TBI research at NYU and the TBI Model Systems Project at Rusk Rehabilitation, specifically as co-director of the Bellevue program. His primary research interest is in disparities in TBI health care for different U.S. populations.
In Part 2, the discussion includes: kinds of tests employed to assess patient emotions and the possibility of the results being compromised; differences between male and female athletes in TBI injuries; key rehabilitation research topics involving TBI where it would be beneficial to conduct more investigations; and changes that may occur as more patient care services occur mostly outside the hospital setting
This interview is a continuation of a panel discussion on TBI. This is the first of a two-part series featuring Dr. Prin Amorapanth and Dr. Brian Im.
Dr. Prin Amorapanth is a clinical instructor and a member of the research faculty at Rusk. His fellowship at NYU Langone Health focuses on brain injury medicine. His current research interests include identifying markers of visuospatial impairment following acquired brain injury as well as the use of non-invasive brain stimulation as both a therapeutic and investigational tool for maximizing rehabilitation and better understanding mechanisms of recovery following brain injury. He is certified by the American Board of Physical Medicine & Rehabilitation. His medical degree and PhD are from the University of Pennsylvania. He completed his residency training in rehabilitation medicine at the Rehabilitation Institute of Chicago.
Dr. Brian Im is Associate Director of Brain Injury Rehabilitation at Rusk. He also is program director for the ACGME-accredited brain injury medicine fellowship at NYU School of Medicine. Following medical school at SUNY, Syracuse, rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and fellowship in BI rehabilitation medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent 5-year tenure at NYU Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations. He has an active role in TBI research at NYU and the TBI Model Systems Project at Rusk Rehabilitation, specifically as co-director of the Bellevue program. His primary research interest is in disparities in TBI health care for different U.S. populations.
In Part 1, the discussion includes: whether different patterns of outcomes occur upon discharge of different racial and ethnic TBI patients from inpatient rehabilitation facilities; challenges involved in predicting the degree of cognitive, motor, and psychological recovery and the timeline of such recovery after sustaining a TBI; diagnostic tools to explore chronic traumatic encephalopathy pathophysiology; progress being made in identifying suitable biomarkers; kinds of emotional impairment among TBI patients; and the usefulness of incorporating patient self-reports in assessments of their emotional state.
This episode is part two of a panel discussion on TBI with Dr. Steven Flanagan and Dr. Erika Trovato.
Dr. Steven Flanagan is Director of the Rusk Rehabilitation Institute. 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. Erika Trovato recently completed her fellowship in Traumatic Brain Injury Rehabilitation at Rusk. She obtained her medical degree from New York College of Osteopathic Medicine and completed her residency in Physical Medicine and Rehabilitation at Rusk Rehabilitation before beginning her fellowship. Her current research interest involves sleep dysfunction after traumatic brain injury. She has accepted a TBI attending physician position at Burke Rehabilitation in White Plains, NY and will begin working there in October 2017.
In this interview, the two discuss: how to deal with situations when a patient’s resilience and positive willingness to want to participate actively in all aspects of rehabilitation are not present; long-term motor dysfunction and movement disorders in the kinds of research being conducted; progress being made in the incorporation of advances in technology to patient care; availability of prognostic tools to predict and define outcomes after a TBI; ways in which the rehabilitation of TBI patients could benefit from the development of more innovations of a non-technology nature; breaking bad news to patients and their family members about reduced chances for significant recovery; and kinds of interventions effective in dealing with fatigue.
This episode is part of a panel discussion on TBI with Dr. Steven Flanagan and Dr. Erika Trovato.
Dr. Steven Flanagan is Director of the Rusk Rehabilitation Institute. 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. Erika Trovato recently completed her fellowship in Traumatic Brain Injury Rehabilitation at Rusk. She obtained her medical degree from New York College of Osteopathic Medicine and completed her residency in Physical Medicine and Rehabilitation at Rusk Rehabilitation before beginning her fellowship. Her current research interest involves sleep dysfunction after traumatic brain injury. She has accepted a TBI attending physician position at Burke Rehabilitation in White Plains, NY and will begin working there in October 2017.
In this interview, the two discuss: the TBI Model System at Rusk; activities undertaken in the Rusk Fellowship Program; advice for incoming Rusk Fellows; when a patient is ill, how decisions are made regarding which different kinds of therapy should commence and when; and use of family caregivers to assist in the pain assessment of TBI patients.
Samantha Muscato is a clinical specialist in pediatric occupational therapy acute care at Rusk Rehabilitation, where she has been for nine years. She has worked in all pediatric rehabilitation departments including: outpatient, the former preschool program, inpatient acute rehabilitation, and acute care. Her experience includes assessing needs regarding assistive technology, seating and mobility, splinting, as well as standard occupational therapy assessment of fine motor, visual motor, sensory processing, cognitive skills, and activities of daily living. Her current work primarily is in the neonatal intensive care unit, the congenital cardiovascular care unit, and the acute care unit providing feeding therapy to infants born prematurely and babies with complex medical/surgical histories. Her Bachelor’s and a Master’s degree in Occupational therapy are from D’Youville College in Buffalo, NY. She has taken certification courses for Kinesiotaping, neonatal oral motor assessment scale, and she is a Certified Lactation Counselor.
In this interview, Samantha discusses: the ages of her patients and the kinds of conditions they have that necessitate the provision of occupational therapy services; feeding therapy to infants born prematurely and babies with complex medical and surgical histories; what specifically distinguishes the work of an occupational therapist in the pediatric intensive care unit; whether certification is necessary for an occupational therapist to work in that unit; tools for conducting assessments; occupational therapy strategies employed when addressing the complex health care needs of children at different ages; the role of assistive technology; mentoring and training new pediatric occupational therapists for all aspects of acute care; and developing programs and providing education for staff in other health professions.
Dr. Camille Magsombol is an occupational therapy clinical specialist at Rusk. She currently is involved in the development and promotion of self-management programs for patients with diabetes, low vision, and COPD. Her capstone project for her doctorate was about low vision, its effect on function, and incorporating low vision assessment and management within the inpatient rehabilitation setting. Her occupational therapy Bachelor's degree is from the University of the Philippines Manila and her Doctorate degree in Occupational Therapy is from Quinnipiac University.
Christina Marino is a senior occupational therapist on the adult inpatient unit at Rusk. She has specialized in treating patients with cognitive-perceptual deficits and visual deficits and she also provides mentoring for staff therapists in these areas. She leads the occupational therapy Vision Team which focuses on providing in-services for new staff and looking into evidenced based practice for treatment of vision problems. Her degree in occupational therapy as well as a bachelors in Hispanic Studies are from the University of Scranton.
In this interview, they discuss the kinds of disorders encountered that necessitate doing neurological and low vision assessments; how conditions, such as health problems, head injuries, or being sedated have an impact on the ability to obtain accurate assessments; given that neglect can restrict independence in activities of daily living, such as dressing and instrumental activities of daily living, such as cooking, how neglect is measured and what is done with the results; approach used to assess declines in cognitive capacity, vision, and physical abilities that may impair an individual's ability to drive safely; the role of occupational therapy in identifying and addressing visual impairments; and strategies used for patients with visual impairments.
Dr. Olga Kalandova is the supervisor of the Outpatient Physical Therapy Unit at Rusk Institute, NYU Langone Health. A wide spectrum of outpatient physical therapy programs have developed under her guidance, including orthopedic, neurological and the woman’s health patient population. She has been at Rusk Institute for 29 years and has extensive expertise in the treatment of spinal and neurological disorders. She also frequently teaches and gives professional and community lectures presenting on various topics and conditions. She received her graduate degree in orthopedics, a doctorate degree in physical therapy, completed internationally recognized certification in mechanical diagnosis and therapy, and holds a number of certifications in manual and alternative therapies.
In this interview, Dr. Kalandova discusses the kinds of patients she treats; the importance of posture and postural alignment;how posture affects function and daily performance;consequences of poor posture; correlations between posture and pain; how postural alignment affects exercise and conditioning; and the role education plays in treatment as a way of enabling patients to obtain skills necessary to manage pain and also as a way of either preventing or self-treating future occurrences outside of the clinical setting.
Steven has more than 35 years’ experience in Vocational Rehabilitation. He has worked in a variety of settings, including New York State Vocational Rehabilitation, as a Rusk Supervisor in Vocational Rehabilitation, as Associate Executive Director at a Not for Profit mental health agency, and 14 years at the Veterans Administration, including 5 years in the New York Regional Office. He supervises counselors and a support staff who serve 2,300 disabled Veterans in Eastern New York State. He obtained a Masters’ Degree in Vocational Rehabilitation at New York University and another Masters’ Degree in public Administration from John Jay College.
In this interview, Jennifer and Steven discuss vocational rehabilitation for veterans, the use of assistive technologies to accommodate more complex medical conditions experienced such as PTSD, vocational assessments, kinds of activities funded, and differences in providing services for veterans from the Gulf War/Afghanistan and the Vietnam conflict.
Matthew Wichrowski is a Senior Horticultural Therapist and Clinical Assistant Professor at Rusk. His primary responsibility at the Medical Center is as a clinician where he provides horticultural therapy services to patients in a cardiac/medically complex unit, a psychiatry unit, and an Epilepsy unit. His research interests center around the effects of nature on human health and wellness. He has completed performance improvement projects assessing the benefits that patients perceived as a result of participating in horticultural therapy sessions, as an inpatient, and then post discharge. His study assessing the effects of horticultural therapy on mood and heart rate in cardiopulmonary rehabilitation patients was published in the Journal of Cardiac Rehabilitation. He also has been involved with environmental improvement projects. He has been teaching in the Horticultural Therapy Certificate Program at New York Botanical Garden for 20 years and is Editor-In-Chief of The Journal of Therapeutic Horticulture. His bachelor’s degree is from SUNY Stony Brook and he has a master’s degree in social work from that institution.
Dr. Kristine Josef is a Neurologic Clinical Specialist with experience working in various areas including adult inpatient rehabilitation and acute care. While working in acute care, she was involved in the Early Mobility project in the intensive care unit that resulted in patient decreased length of stay, decreased hospital costs, and increased incidence of patient discharge home vs post-acute facilities. She has given multiple presentations on the topic of delirium. Recently, she co-authored a poster that was presented at the 2017 Combined Sections Meeting in San Antonio, TX that was titled “Delirium in patients with cerebrovascular accident: increasing treatment team awareness.” Her doctorate in physical therapy is from the University of Medicine & Dentistry of New Jersey, which now is Rutgers University. She is a board certified neurologic clinical specialist through the American Board of Physical Therapy Specialties.
In this interview, she discusses: distinguishing delirium from encephalopathy; tools for accurate delirium screening and diagnosis in critically ill patients; the role physical therapy plays in dealing with the problem of patients with delirium from the standpoint of diagnosis and treatment; if anything can be done pre-surgically to prevent the occurrence of delirium; aging and co-morbidities in relation to delirium; the role of family members in changing the course of delirium in a patient; and the advantages and disadvantages of using physical restraints to manage behavioral symptoms of hospitalized patients.
Kaitlin Hanley works as a speech-language pathologist in acute care and Rehabilitation at NYU Langone Medical Center and Christina Marino is an occupational therapist who works on that same unit. Kaitlin has cross-covered acute care and acute rehabilitation for her entire career with a focus on functional therapy for enabling patients to return to the community as it pertains to cognitive, speech, and language therapy. She completed her graduate work in Speech Language Pathology at MGH Institute of Health Professions in Boston. Christina has worked in a variety of settings, including Rusk and the Tisch Hospital acute care service at NYU Langone. Along with treating cardiopulmonary patients with cognitive deficits, another specialty includes working with limb loss patients. Her undergraduate and graduate degrees are from the University of Scranton.
In this interview, Kaitlin and Christina discuss the kinds of patients they treat and problems regarding how cognitive impairments affect cardiopulmonary patients; occupational therapy and speech-language pathology tools available to arrive at an accurate diagnosis; factors involved in making a determination of which types of interventions would be most appropriate for patients who may differ by age, frailty, and extent of their problems; activities that are aimed at preventing a recurrence of problems; and areas where further research might provide guidance for making additional improvements in patient care.
Sharon Matsos has been a physical therapist for 11 years and has experience in treating patients with cardiopulmonary diseases in acute care, inpatient, and outpatient cardiopulmonary rehabilitation. She helped develop and implement the diabetes education management program on the HCC-9 unit and is part of the cardiopulmonary strategic planning group, in the clinical subcommittee. Her doctorate in physical therapy is from Stony Brook University. Camille Magsombol currently is involved in the development and promotion of self-management programs for patients with diabetes, low vision, and COPD. She also is part of the cardiopulmonary strategic planning group, in the clinical subcommittee. Her Bachelor's degree in occupational therapy is from the University of the Philippines Manila and her Occupational Therapy doctorate is from Quinnipiac University. Shaparak Shadravan who is called “Shap” is part of the team treating cardiopulmonary and medically complex patients with communication, swallowing, and cognitive impairments. She also participates in the clinical brain injury strategic planning group, with a focus on stroke. Her bachelor’s and master’s degree in Communication Disorders are from the University of Texas at Dallas.
Sharon Matsos has been a physical therapist for 11 years and has experience in treating patients with cardiopulmonary diseases in acute care, inpatient, and outpatient cardiopulmonary rehabilitation. She helped develop and implement the diabetes education management program on the HCC-9 unit and is part of the cardiopulmonary strategic planning group, in the clinical subcommittee. Her doctorate in physical therapy is from Stony Brook University. Camille Magsombol currently is involved in the development and promotion of self-management programs for patients with diabetes, low vision, and COPD. She also is part of the cardiopulmonary strategic planning group, in the clinical subcommittee. Her Bachelor's degree in occupational therapy is from the University of the Philippines Manila and her Occupational Therapy doctorate is from Quinnipiac University. Shaparak Shadravan who is called “Shap” is part of the team treating cardiopulmonary and medically complex patients with communication, swallowing, and cognitive impairments. She also participates in the clinical brain injury strategic planning group, with a focus on stroke. Her bachelor’s and master’s degree in Communication Disorders are from the University of Texas at Dallas.
Part 1 of this interview involves a discussion of: a definition of cardiopulmonary rehabilitation, how patients qualify to be part of the program, kinds of patients treated based on their health problems, members of the treatment team, roles played by occupational therapy/physical therapy. speech-language pathology, and the kinds of tests used to determine appropriate treatment interventions.
Dr. Greg Sweeney is the Program Manager of the Joan and Joel Smilow Cardiac Prevention & Rehabilitation Center at Rusk Rehabilitation. He has close to 20 years of experience in cardiopulmonary rehabilitation, spanning a continuum of care that includes acute care, inpatient rehabilitation, home care, and outpatient settings. He is an American Physical Therapy Association board-certified cardiopulmonary clinical specialist. A Past President of the New York State Chapter of the American Association of Cardiovascular and Pulmonary Rehabilitation Program, he has a strong interest in research related to the population with cardiopulmonary disorders. He has produced several publications, including a book chapter and peer-reviewed journal articles. His bachelor’s degree is from Manhattan College. He has a Master's Degree in Physical Therapy from Long Island University and his doctorate in physical therapy is from the University of Scranton.
In this interview, Greg discusses settings where cardiopulmonary rehabilitation is provided, the role of physical therapy in cardiopulmonary rehabilitation, types of patients treated, tests involving cardiorespiratory fitness used to aid in a determination of the most effective physical therapy forms of treatment to employ, special challenges involved in treating patients who have implanted left-ventricular assistive devices, responding to situations where a patient may be concerned about the safety of engaging in a program involving physical activity, and key topics in rehabilitation research pertaining to physical therapy aspects of cardiopulmonary care.