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RUSK Insights on Rehabilitation Medicine

RUSK Insights on Rehabilitation Medicine is a top podcast featuring interviews with faculty and staff of RUSK Rehabilitation as well as leaders from other rehabilitation programs around the country. 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.
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Sep 28, 2022

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.

Sep 14, 2022

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.

 
 
 
Sep 1, 2022

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.

Aug 17, 2022

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?

 

Aug 3, 2022

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.

Jul 20, 2022

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.
Jul 6, 2022

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.

Jun 22, 2022

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. 

 

Jun 8, 2022
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.  

 

May 26, 2022

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. 

 

May 11, 2022

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.

Apr 27, 2022

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.

Apr 13, 2022
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.

Mar 30, 2022
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.

Mar 16, 2022

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. 

Mar 2, 2022

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. 

Feb 16, 2022
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.  

Feb 2, 2022
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.

Jan 19, 2022

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.

 

Jan 5, 2022

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.

Dec 22, 2021

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

 

Dec 8, 2021

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.  

 

Nov 24, 2021

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. 

Nov 10, 2021

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.

Oct 27, 2021

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.
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