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.

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.

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.

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.

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.

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. 

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. 

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.

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. 

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. 

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro. 

Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).

William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.

Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.

The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs

This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro. 

Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).

William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.

Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.

The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound.