Dr. Molly Fuentes is medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital. Dr. Fuentes is an assistant professor of rehabilitation medicine at the University of Medicine. She also is a pediatric physiatrist. She completed her undergraduate degree at Stanford University and is a graduate of the School of Medicine at the University of Michigan. She completed her residency at the University of Washington and later completed a pediatric fellowship at the Seattle Children’s Hospital. She then completed a research fellowship in pediatric injury at the Harborview Injury Prevention and Research Center at the University of Washington. She is the medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital.

Part 1

Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion.  Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion.  Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field.

Part 2

We call them psychobiotics because these specific probiotics actually are helping the targeting of treatment of things we are trying to do.) Next, we are going to discuss nutritional support of these patients. She discussed the role of nutritional supplements, such as Vitamin E. The brain requires high levels of Vitamin C after a traumatic brain injury, It is a potent antioxidant. Magnesium levels drop acutely right after a concussion. It reduces stress and promotes relaxation. It helps in sleeping. She identified which magnesium supplements should be used. She furnished information about jockeys who are at a high risk for experiencing concussions. Additionally, in order to meet requirements in competition, many of them starve themselves to arrive at their goal weight. They talk openly about their eating disorders. Another topic covered in her presentation is mitochondria and fatigue. She also indicated the use of various alternative and complementary substances.

Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion.  Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion.  Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field.

Part 1 

Today’s topic is something none of us got in medical school. What makes her successful in treating her patients is having this approach, sort of a 180-360 approach to nutritional status among the head-neck , vestibular balance, and everything else we do. When a concussion occurs, we often have disruption of the blood-brain barrier. There also is inflammation. Ultimately, there can be cell death. We have an opportunity for nutritional repair in concussions. There is an energy crisis in the brain. We need to increase the brain’s need for anti-inflammatory and antioxidant nutrients. We will discuss in this presentation how to get that into a person’s brain or diet and look at why diet matters.

Avery Menaker is a senior occupational therapist at NYU Rusk Rehabilitation. She is certified as both a stroke rehabilitation specialist and a brain injury specialist. She co-leads an initiative at NYU to bring high intensity practice to patients participating in occupational therapy.

The following topics were among those discussed in the interview: how high intensity training differs from traditional therapy approaches and what its benefits are; kinds of patients for whom high intensity training is appropriate; research to support high intensity training; equipment needed for this intervention; what a typical high intensity treatment session looks like in physical therapy and occupational therapy; implementation challenges; whether high intensity training is done in every therapy clinic and if all therapists know about it; and contents of an NYU continuing education course on high intensity training that will be offered on May 17-18, 2025.

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. 

Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services 

Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.

Part 2

Dr. Flemming described the functional results obtained from their intervention. They specifically chose the activity measure proposed for post-acute care, abbreviated as AM-PAC. It showed improvement over time and it allowed looking at specific subsections within rehabilitation, such as basic mobility, daily activity, and cognitive scores. An AM-PAC score is a recognized tool by Medicare used in multiple post-acute care settings. Dr. Cuccurullo indicated that according to an article published in 2011 in the journal Stroke, the all-cause mortality for stroke patients in the U.S. is 31%. In one year, the all-cause mortality in their program was 1.47%. Their results were published in the American Journal of Physical Medicine and Rehabilitation. The paper received the Excellence in Research Writing Award for the most impactful article of the year. Significantly, the manuscript attracted the attention of Medicare officials who asked them to present their findings. CMS wanted to know if it can be proved that the stroke recovery program saves money, can they validate their previous improvement in mortality with more patients, and can they replicate the results at other institutions nationally. Drs. Fleming and Cuccurullo described what they did in response to these questions.

A Question & Answer period followed.

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.

Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services 

Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.

Part 1

Dr. Cuccurullo began by discussing their stroke recovery program, specifically investigating and analyzing the effects of a comprehensive initiative on all-cause mortality, function, and readmissions. She listed the learning objectives for today’s grand round presentation. Strokes are the number one admission in their inpatient rehab facility. Twenty-two percent of their patients comply with going to the facility. Their patients have a finite resource for Medicare once they leave inpatient or the acute care setting. Payment caps compromise the ability to have outpatient therapies that prevent them from having a full recovery. Dr. Flemming pointed out that there is an overlap with patients who have neurologic disease after stroke as well as patients who have cardiac disease. So, they designed their program to combine both elements of neurorehabilitation and a modified cardiac rehabilitation program, which starts with an outpatient visit with a stroke physiatrist. Common challenges that need to be addressed are patients with: weakness on their one side versus the other, cognitive or attention deficits, poor safety awareness, and post-stroke fatigue. They decided that it would be important to collect medical and functional outcome data to see if the program could affect hospital readmissions, the recurrence of stroke, and overall mortality.