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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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Apr 28, 2021

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.

Apr 14, 2021

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. 
Mar 31, 2021

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. 
 

 

Mar 17, 2021

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.

Mar 3, 2021

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.

Feb 17, 2021

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.

Feb 3, 2021

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.

Jan 20, 2021
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.
 

 

Jan 6, 2021

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.

 

Dec 23, 2020

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.

 

 

 

Dec 9, 2020
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.
 
 
Nov 25, 2020

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.

Nov 11, 2020

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.

Oct 28, 2020

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.

 

 

Oct 14, 2020

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.

 
 
 

 

Sep 30, 2020
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.
Sep 16, 2020
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.
 

 

Sep 2, 2020

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. 

Aug 26, 2020

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. 

Aug 19, 2020

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.

Aug 5, 2020
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 handshow 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.
Jul 22, 2020

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. 

Jul 8, 2020

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. 

Jun 24, 2020
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.

 

Jun 10, 2020
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?
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