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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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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.
Oct 13, 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. 
 
 
 

 

Sep 29, 2021

PART TWO

In Part 1, Dr. Kim presented information about the historical and legal background for cannabis, variations in policies in the states, and the status of current research. In Part 2, she discussed cancer pain that is not neuropathic. She described the results of a study that involved opioid refractory cancer pain. Evidence currently shows that patients who have increased access to cannabis actually have higher rates of opioid overdose and deaths. She reviewed a case of one of her patients who had prostate cancer. This individual was not amenable to physical therapy and was weaned off opioids because they were not effective. Finally, they decided to try different types of cannabis for pain and sleep and he is doing quite well. He eventually used a combination of low and high THC capsules and was weaned off all other drugs. She and her colleagues also looked at how patients considered the use of cannabinoid therapy and found that overall they preferred it for their future chemo. Even though cannabis is a natural product, it is not true that it is free of side effects. There is some concern that it can have interactions on the heart, result in psychotic symptoms, affect psychomotor performance, and lead to an increase in tolerance, making it necessary to use higher and higher doses to achieve the same effect. A question-and-answer period followed her presentation. 

Sep 15, 2021

PART ONE

In Part 1 of a two-segment presentation, Dr. Kim discussed historical and legal background for medical cannabis and cannabis in general; mechanism of action; applications for pain and symptom management; the science behind cannabis for cancer care; relative safety issues; contraindications and monitoring; and some public health concerns. She defined cannabis, marijuana, hemp, and indicated various code names for recreational marijuana. Marijuana was criminalized and removed from the U.S. Pharmacopeia in 1941, Most recently, some states have legalized it both medically and recreationally. For medical purposes, there is a lot of variation in what states will allow. A concern has been about the presence of contaminants in many products. Based on current research, the science and the evidence are not where they could be ideally. She discussed marijuana and how it works, mentioning the endocannabinoid system. Different ways exist to act on that system. She described the entourage effect and how it functions.

 

D

Sep 1, 2021

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.

In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).

In Part 2 of his presentation, he continued describing the current state of research on the use of PNS, which to some degree is lacking, but certainly it potentially is increasing. He referred to a multi-center, randomized, double-blind investigation that looked at PNS technologies in a variety of pain conditions. He then described a product that was cleared by the FDA in July 2016. It involves the use of multiple electronic leads rather than using a single one. The implant used is of a temporary nature (60 days) rather than something permanently. He pointed out that because the technology is much smaller, no incision is necessary. The micro lead is much smaller in diameter and does not have to be as close to the nerve. He showed a video about a typical implant for a shoulder, involving the 60-day version of technology being used. While it played, he narrated some of the steps shown in the video regarding the implant of the electrode. Everything becomes stabilized as the electrode moves closer to the nerve. His presentation concluded with his fielding questions asked by participants at this event, including two by Dr. Steven Flanagan, Director of the Rusk Rehabilitation Institute at NYU Langone Health.

Aug 18, 2021

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology.

In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).

Aug 4, 2021
Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado.
 
Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University. 
 
In Part 2, we discussed: advanced surgical techniques employed for both hip and knee surgery; time after surgery when physical therapy interventions are initiated; other kinds of members of the health care team at NYU Langone Health involved both pre- and post-surgery to make possible same-day discharge; additional therapy provided once patients return home and when it is initiated; the role of telehealth in delivering home-based care; situations at home that may result in patients seeking emergency room care or requiring in-patient hospitalization; whether patients who undergo bilateral hip and knee surgery are suitable candidates for same-day discharge; and kinds of research being conducted at NYU involving same-day discharge
Jul 21, 2021
Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado.
 
Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University. 
 
In Part 1, we discussed: the effect of the COVID pandemic on performing hip and knee replacement surgery and providing post-operative care; typical hospital length of stay experienced by patients prior to implementing same-day discharge; number of these surgical procedures performed on a weekly basis; the proportion of these operations resulting in same day-discharge; kinds of factors used to identify patients who are excellent candidates for same-day discharge following hip and knee replacement surgery; factors indicating that certain patients should be excluded from participating in same-day discharge; and contents of a "playbook" used during the preoperative consultation phase. 
Jul 7, 2021

In Part 2 of his presentation on the topic of diversity and inclusion in medicine, Dr. Lopez continued describing the use of a holistic approach to interview candidates for admission to NYU’s PM&R residency program. Factors currently being  taken into account other than board scores, include socio economic hardship, commitment to the underserved, work experience, and fluency in other languages. A task force also was formed to review every candidate individually. Interviews  presently involve taking a closer look at structured behavioral interview questions, which can be used to measure factors, such as professionalism and teamwork. Interviewers also are blinded to board scores to eliminate a higher halo effect that might exist. Dr. Lopez then reviewed the results of the latest match and identified the kinds of efforts that should be undertaken to increase the proportion of underrepresented groups, including women and members of the LGBTQ community. More diversity is welcome at NYU. Change is not going to happen overnight. Current efforts are just the starting point. A question and answer session for several minutes followed his presentation, including comments made by Dr. Steven Flanagan, Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health.

 
 
 
 
 
Jun 23, 2021

In Part I, Dr. Lopez wanted to familiarize listeners in this grand rounds presentation with a history of minorities in medicine and to describe current trends in diversity and inclusion in medicine in general and specifically in PM&R.  He identified arguments for diversity and contrasted past, present, and future recruitment efforts at NYU. He also discussed this years’ match data results. Historically, there have been many challenges for minorities to gain a foothold in medicine. He wanted to furnish objective data about this situation. These individuals had a problem right from the beginning in obtaining admission to medical schools. He described enrollment data from the Association of American Medical Colleges (AAMC) and compared it to U.S. Census Bureau data. Over the last 50 years, Dr. Lopez noted how medical schools have tried to do something about increasing the proportion of students from underrepresented minority groups. Specific information entailed showing what has occurred in PM&R, involving students and faculty. Comparisons then were made with overall U.S. population trends. Reasons are provided for increasing diversity and inclusion in medicine, e.g., minority patients seek doctors who look like them and more minority physicians are likely to take care of minority patients

Jun 9, 2021

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 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis. 

In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers. 

A Q & A period followed.

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