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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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Now displaying: 2022
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.

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