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. 

Dr. Jeffrey Fine serves as Vice Chairman of NYU Langone Health Brooklyn Rehabilitation & Rusk Rehabilitation Network Development. He is a clinician educator and administrator who has been practicing in academic medicine at Level I Trauma Center teaching hospitals for over 20 years. Dr. Fine is chairperson of the VBM ICU early mobilization program at NYU Langone Hospital Brooklyn and also chairperson of the  Brooklyn brain injury outpatient care planning team. He holds four certifications from the American Board of Medical Specialties in the following areas: Physical Medicine & Rehabilitation; Spinal Cord Injury; Brain Injury Medicine; and Pain Medicine. He also has published several articles regarding patient safety during transitions of care including communication during handoffs, and identification/reconciliation of barriers to safe community discharge with resultant enhanced patient satisfaction. His medical degree is from New York Medical College and he completed his residency at Mount Sinai School of Medicine in New York City. Among his many prestigious awards, on more than one occasion he was honored as Best Teacher Of The Year in the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai.

In this interview, Dr. Fine discusses the following: kinds of patients he is treating for COVID-19; patient pathways to arrive for treatment; differential susceptibility of patients entering the health care setting on the basis of age, gender, socioeconomic factors, genetic variations and other characteristics, such as preexisting conditions like diabetes; whether accurate predictors are being employed, along with any kinds of measures or rating scales to help distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; access to all necessary therapies, including those considered still at an experimental stage of effectiveness; role of telehealth in treating COVID-19; possible impact on daily activities of wearing full-body PPE by clinicians in the hospital; and how as a health professional life may have changed since the appearance of COVID-19.

Dr. Brian Im serves as director of brain injury rehabilitation at the Rusk Rehabilitation Institute at NYU Langone Health. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.

In this episode, Dr Im discusses the kinds of patients he has been treating for COVID-19, after-effects that are caused or associated with the onset of coronavirus that might not have occurred in the absence of a COVID-19 infection; patterns that characterize these patients; when triage becomes necessary; whether any kinds of measures or rating scales are being used at Rusk as a means of helping to distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; whether accurate predictors exist to help determine whether a patient’s condition may be prone to deteriorate rapidly as opposed to achieving recovery eventually from what ails them; if Rusk has access to all necessary therapies, including those considered still at an experimental stage of effectiveness; if wearing full-body PPE in the hospital results in physical barriers that hinder personal activities; ways is which his life has changed since the appearance of COVID-19; and whether telehealth plays a role in treating either patients who have been discharged after being treated for COVID-19 or patients who already were being treated by Rusk clinicians prior to the outbreak of that disease.

Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement. 

Listeners to Part 1 of Dr. Gerber’s presentation will recall that she talked about fatigue in the context of proteomics, performance, and perception. In Part 2, she began by asking how do we separate central fatigue from depression? It is a difficult question and may be why the biosignatures are so important. From a clinical perspective, sad and despairing feelings, anhedonia, really is the hallmark of depression. It’s not the hallmark of central fatigue, which is a different pathway. Many important factors here originate in the liver. We need to be attentive to the way we measure the specifics of both peripheral and central fatigue. We have objective measures that are quantitative and we have self-reports. Both are needed, along with observer-recorded reports to obtain a full picture of what we mean by fatigue. A perfect fatigue instrument has not been found yet. She described the fatigue severity scale and indicated some of its deficiencies. She also described the kinds of procedures undertaken in her laboratory to obtain a fuller understanding of fatigue. She indicated who can be considered fatigued. It’s usually women, individuals who are less active, who are obese or overweight, who are smokers with more than moderate alcohol intake, often complaining of depressed symptomology, and they are anxious. In her view, metabolic issues are under appreciated by our specialty. 

Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement. 

In Part 1 of her presentation, Dr. Gerber’s aim is to decipher fatigue in the context of proteomics, performance, and perception. She wants to describe the construct that is beginning to be shaped to enable us to understand fatigue better and indicate how it is effectively measured both objectively and subjectively. She mentioned that the term biosignature is a more robust term than biomarker because it represents multiple domain measures to help us understand complex ideas, such as fatigue. When talking about fatigue, it is necessary for individuals to report what they are experiencing. Expectation plays a role in what a person is trying to accomplish. In order to treat fatigue effectively, it is necessary to know the parameters. Her presentation included the topics of cancer fatigue and liver fatigue, noting that if we do not study the liver better, an important concept in the rehabilitation world, we are not going to conquer this problem. She made a distinction between pathological and non-pathological (normal) fatigue and how to treat these conditions. She also discussed peripheral and central fatigue. There is confusion in the domain culture about these kinds of fatigue and an effort is underway to identify a biosignature that gives a mix of objective measures linked to perception. A portion of the tryptophan pathway is critical for understanding fatigue, both peripheral and central.

Dr. Bartels received his MD and MPH degrees from Columbia University College of Physicians & Surgeons and completed an internship and internal medicine and rehabilitation residencies at New York-Presbyterian/Columbia University Medical Center in New York.

Prior to becoming the Chairman of the Department of Physical Medicine and Rehabilitation at Montefiore Medical Center/Albert Einstein College of Medicine in September 2013, Dr. Bartels directed Cardiopulmonary Rehabilitation and the Human Performance Laboratory at Columbia Presbyterian Medical Center, where he has served as director of cardiopulmonary rehabilitation and founder and director of the Human Performance Laboratory.

Over the years, Dr. Bartels has also been recognized for his commitment to educating future physicians, including those outside of his specialty of rehabilitation medicine.  While at Columbia, he served as a clinical mentor to two first-year medical students each year and coordinated research teaching for the Rehabilitation residents. He also participated in lecture series events for fellows in the areas of Cardiology and Pulmonary Medicine, sharing the rehabilitation perspective for each specialty.

Dr. Bartels received his MD and MPH degrees from Columbia University College of Physicians & Surgeons and completed an internship and internal medicine and rehabilitation residencies at New York-Presbyterian/Columbia University Medical Center in New York.

Prior to becoming the Chairman of the Department of Physical Medicine and Rehabilitation at Montefiore Medical Center/Albert Einstein College of Medicine in September 2013, Dr. Bartels directed Cardiopulmonary Rehabilitation and the Human Performance Laboratory at Columbia Presbyterian Medical Center, where he has served as director of cardiopulmonary rehabilitation and founder and director of the Human Performance Laboratory.

Over the years, Dr. Bartels has also been recognized for his commitment to educating future physicians, including those outside of his specialty of rehabilitation medicine. While at Columbia, he served as a clinical mentor to two first-year medical students each year and coordinated research teaching for the Rehabilitation residents. He also participated in lecture series events for fellows in the areas of Cardiology and Pulmonary Medicine, sharing the rehabilitation perspective for each specialty.

Dr. Charla Fischer one of New York City’s top minimally invasive spine surgeons. She specializes in lumbar disc herniations, lumbar spinal stenosis, lumbar degenerative disc disease, instability, and cervical spine degeneration. She is also an expert in advanced minimally invasive spine surgery techniques such as minimally invasive microdiscetomy, MIS lumbar fusions, robotic-assisted spine surgery, and advanced MIS techniques.

Dr. Fischer completed her residency at Columbia after completing both medical school and undergraduate school on a full academic scholarship at University of Southern California. She spent a year specializing in spine surgery at NYU-Hospital for Joint Diseases.

As an associate professor of spine surgery at NYU Langone Medical Center, Dr. Fischer regularly teaches residents and medical students in the areas of compassionate patient care and minimally invasive spine surgery. She has received grants from the National Institutes of Health (NIH) and the Orthopedic Research and Education Foundation (OREF). The funding helps her pursuits in the advancement of minimally invasive surgical techniques, and quality of life improvements after spine surgery. She routinely publishes in the top peer-reviewed journals and presents her findings at internationally attended academic meetings. She serves on the SRS Research Committee and is an Associate Editor for the prestigious Journal of Bone and Joint Surgery.

Dr. Charla Fischer one of New York City’s top minimally invasive spine surgeons. She specializes in lumbar disc herniations, lumbar spinal stenosis, lumbar degenerative disc disease, instability, and cervical spine degeneration. She is also an expert in advanced minimally invasive spine surgery techniques such as minimally invasive microdiscetomy, MIS lumbar fusions, robotic-assisted spine surgery, and advanced MIS techniques.

Dr. Fischer completed her residency at Columbia after completing both medical school and undergraduate school on a full academic scholarship at University of Southern California. She spent a year specializing in spine surgery at NYU-Hospital for Joint Diseases.

As an associate professor of spine surgery at NYU Langone Medical Center, Dr. Fischer regularly teaches residents and medical students in the areas of compassionate patient care and minimally invasive spine surgery. She has received grants from the National Institutes of Health (NIH) and the Orthopedic Research and Education Foundation (OREF). The funding helps her pursuits in the advancement of minimally invasive surgical techniques, and quality of life improvements after spine surgery. She routinely publishes in the top peer-reviewed journals and presents her findings at internationally attended academic meetings. She serves on the SRS Research Committee and is an Associate Editor for the prestigious Journal of Bone and Joint Surgery.

Dr. JR Rizzo 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. This is a two-part Grand Rounds presentation.

In Part Two, Dr. Rizzo discusses assistive technology. There is lots of it for physical impairments, but what about for sensory impairments, such as mobility? Visually impaired patients may use a white cane while walking, but it misses large physical objects. So, they came up with something they called the Dragon Fly, which may become available commercially by the end of 2019. A form of push and clear technology, it should prove to be highly useful. He talked about advanced driver assist systems (ADAS), systems which, for example, help motor vehicle drivers by improving road safety. Rear end collisions are being reduced significantly. Why can’t we do this for falls experienced by patients with sensory impairments? This work is being done now and he gave examples of how visually impaired pedestrians are being assisted. He also described assistance devices that can help patients in their homes, such as reaching and grasping accurately.

Dr. JR Rizzo 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. This is a two-part Grand Rounds presentation. 

In Part One, Dr. Rizzo focuses on how hand-eye coordination is pervasive in rehabilitation. How do we actually build this hand-eye coordination? Every day, an individual experiences a quarter of a million eye movements. He asked how eye-hand coordination intersects with stroke. Patients who have had a stroke have to do a lot more work in conducting eye movements. It is exhausting to do a simple reach. A great deal of work is necessary to complete basic tasks. Hand-eye coordination is being impeded through interference. So good questions are what comes next and how do you actually deal with it? Currently, they are trying to understand the cognitive implications of what is happening. For example, what happens if we look at the way work is done by considering it as sequential steps, e.g., first look and then reach, first look and then reach. Improvement occurred. Instead of considering biofeedback of the limb, they began doing biofeedback of the eye.

Dr. Ryan Branski is an Associate Professor of Otolaryngology-Head and Neck Surgery and Pathology in the School of Medicine at NYU. He also has an affiliate appointment in Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. He is a licensed speech pathologist and serves as the Associate Director of the Voice Center at NYU Langone Health. In addition to maintaining a clinical practice, 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 a Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.

This is the second of a two-part interview with Dr Ryan Branski. 

In Part Two, Dr. Branski indicates that there are a lot of in-office procedures completed. Unlike cholesterol studies, looking at vocal fold function in humans is not the same as looking at it in other animals, such as rabbits. An area of great interest is a regenerative medicine approach to vocal fold injury. He indicates that in research, they are starting with new pre-clinical trials. 

Dr. Ryan Branski is an Associate Professor of Otolaryngology-Head and Neck Surgery and Pathology in the School of Medicine at NYU. He also has an affiliate appointment in Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. He is a licensed speech pathologist and serves as the Associate Director of the Voice Center at NYU Langone Health. In addition to maintaining a clinical practice, 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 a Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association.

This is the first of a two-part interview with Dr Ryan Branski. 

In Part One, Dr. Branski points out that voice loss is the most common communication disorder while the Institute for Deafness and Other Communication Disorders allocates only 6% of research dollars for voice disorders and 70% for hearing loss research. The impacts of voice disorders are broad and hard to characterize. Psychosocial implications also are profound. 

PART 2

Dr. Branski indicated that we do a ton of in-office procedures. We can put just about any therapeutic into a larynx. In our lab, we have spent a lot of time looking at steroids. We also do a fair amount of gene therapy. Unlike cholesterol studies, looking at vocal fold function in humans is not the same as looking at it in other animals, such as rabbits. We do a lot of tissue engineering. An area we are most interested in using a regenerative medicine approach to vocal fold injury. He indicated that in research, they are starting with new pre-clinical trials. They have new custom carriages and do not have to use connect. One problem is that pre-clinically, we did not know what to look at. So, we have become interested in biomechanical testing. 

Dr. Julie Silver has been an integral part of developing the new Spaulding Research Institute from conception to launch. Her research and clinical work have focused on improving gaps in the delivery of healthcare services, particularly cancer rehabilitation. She has published many scientific reports and is well-known for her ground-breaking work on “impairment-driven cancer rehabilitation.” She is the co-founder and co-director of the Cancer Rehabilitation Group for the American Congress of Rehabilitation Medicine, a research-focused interdisciplinary professional society. As a healthcare leader, Dr. Silver also is committed to supporting the healthcare workforce, and she is a researcher and nationally recognized expert on inclusion, diversity and equity. She has published multiple reports on bibliometrics—educating researchers about both conventional and alternative metrics—aimed at supporting both research dissemination and faculty promotion. Her work has been featured in several major print and broadcast media throughout the United States.

In Part 2 of this presentation on the topic of “How to Lead High Impact Strategic Initiatives in Health Care,” Dr. Silver specifies that you need to tell a compelling story and every story needs a story board. She tells faculty members, here is your story and here are the parts that are missing. She recognized that medical societies had to do more to equitably support our faculties so that we could be promoted and compensated better. She was able to show that women are under-represented in recognition awards. She also looked at elections. For example, one of her studies demonstrated that for 10 medical societies, they had zero leadership positions for women in the past decade. It also is useful to look at micro inequities. Women are not showing up in medical society newsletters, which means that it is not possible to hear about their work. Progress is underway because medical societies all around the U.S. are beginning to pass gender equity resolutions.

Dr. Julie Silver has been an integral part of developing the new Spaulding Research Institute from conception to launch. Her research and clinical work have focused on improving gaps in the delivery of healthcare services, particularly cancer rehabilitation. She has published many scientific reports and is well-known for her ground-breaking work on “impairment-driven cancer rehabilitation.” She is the co-founder and co-director of the Cancer Rehabilitation Group for the American Congress of Rehabilitation Medicine, a research-focused interdisciplinary professional society. As a healthcare leader, Dr. Silver also is committed to supporting the healthcare workforce, and she is a researcher and nationally recognized expert on inclusion, diversity and equity. She has published multiple reports on bibliometrics—educating researchers about both conventional and alternative metrics—aimed at supporting both research dissemination and faculty promotion. Her work has been featured in several major print and broadcast media throughout the United States.

In Part 1 of this presentation, Dr. Silver addresses the topic of “How to Lead High Impact Strategic Initiatives in Health Care” from the perspective of the traditional three hats worn in academic medicine: medical education, clinician, and researcher. When dealing with patients who had polio, she came to the realization that someone had to record their stories regarding what happened to them, which led to her creating an oral history project. When it comes to innovation, it is not enough to have a great idea, but to have a strategy around it, which means the necessity of developing an innovation engine that takes a great idea to enable others to understand it.Tipping points really matter and are the hardest part by being able to define what really makes a difference. Another key essential is to leverage your network. When you want to have divergent change, it helps to have a bridging network and to be able to leverage different groups to bring about big change.

Kathryn Schmitz is a Professor of Public Health Sciences at the Pennsylvania State University’s College of Medicine. She has led many exercise trials and her work has been translated into clinical practice. Dr. Schmitz has published more than 230 peer-reviewed scientific papers and has had $25 million dollars in funding for her research since 2001. She was the lead author of the first American College of Sports Medicine Roundtable on Exercise for Cancer Survivors, which published guidance for exercise testing and prescription for cancer survivors in July 2010. In June 2017, she became president-elect of that organization, assumed its presidency in June 2018, and became Immediate Past President in June 2019. While serving as chairperson in March 2018 of an International Multidisciplinary ACSM Roundtable on Exercise and Cancer Prevention and Control, participants agreed it is time for exercise oncology to go prime time. The question is how. Her professional mission is to answer that question. Her doctorate is from the University of Minnesota-Twin Cities.

She began Part Two of her presentation by indicating that as a result of the intervention described in Part 1, arm swelling among lymphedema patients was reduced by 70% among women with five or more nodes removed. A big question that arose was who was going to do all the things necessary that were part of a research study? Problems with sustainability and dissemination occurred. There also were safety concerns and costs that could not be met. She then described another initiative that was undertaken. Following a referral by an oncologist, physical therapy evaluation and education in a group setting occurred. Participation could occur in a YMCA setting or at home, but a challenge was to figure out how to pay for equipment in the home after the program ended. Subsequently, the program was renamed Strength After Breast Cancer, which is paid for by insurance. She described a series of lessons learned involving transportation, competing demands affecting patients with jobs, location, keeping up with training requirements, and cost. A need also exists for provider education on matters, such as progression of the weights used by patients. She concluded by noting that her mission and the Rusk mission are a shared mission.

This special panel presentation features three leaders in the space: 

This special panel presentation features three leaders in the space: 

Dr. Barr is an Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. He has over 30 years of experience in clinical practice, training, and research in the field of clinical neuropsychology. He has been on the editorial boards of multiple professional journals and has served as an officer and board member of a number of professional societies, including a term as President of the Society for Clinical Neuropsychology (Division 40) of the American Psychological Association (APA) in 2011.  He has an active clinical practice in neuropsychological assessment with ongoing research programs on cognitive and behavioral aspects of epilepsy in addition to other programs in mild traumatic brain injury and forensic neuropsychology. He also maintains an active social media presence on topics related to sports concussion and chronic traumatic encephalopathy (CTE). His doctorate in clinical psychology is from New School University.

This is the second of a two-part series of a live Grand Rounds presentation given at RUSK. 

In Part 1 of his presentation, Dr. Barr discussed how he takes a translational approach by applying findings from sports studies to clinical practice. Athletics provide a natural laboratory for studying concussion. Unlike other kinds of concussion injury, the motivation for patients is to return to the field of athletics rather than not to do so. Currently, no obvious concussion test exists. Neuropsychological assessment represents one means of documenting symptoms. A focus in this presentation is on subjective symptoms. Some athletes either fail to report their concussion symptoms or hide them in order to remain on the field while some patients may misreport symptoms that pertain to conditions, such as anxiety and depression rather than concussion. Perhaps not as much attention should be paid to cognitive symptoms (e.g., attention and memory), which may be short-lived, as to emotional symptoms that can persist over longer periods of time. He described how the Sports Laboratory Assessment Model (SLAM) is used. A transition then occurred in the battery of neuro psychological tests from paper and pencil to computer applications.

Part 2 involves a discussion of what has occurred in neuropsychological testing since 2001 and how the SLAM model was used to replicate other studies conducted in the early part of the 21st century. Batteries of different tests were administered to large numbers of college athletes to show natural recovery curves. The results show that sideline battery testing does a good enough job while neuropsychological testing added little to the results. Questions then arose regarding how various computerized tests work and which ones should be used. In addition to studies of athletes, research also was done as part of the translational process that involved emergency room patients. Poor test-retest reliability was found for all the different measures. The test lacked reliability to identify changes.  By 2012, it became apparent that baseline neuropsychological testing of athletes was not as important as originally envisioned. Some patients experience symptoms that last beyond one month and these are the individuals who end up in the offices of psychologists. He also discussed post-concussion persistent symptoms.

Dr. Barr is an Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. He has over 30 years of experience in clinical practice, training, and research in the field of clinical neuropsychology. He has been on the editorial boards of multiple professional journals and has served as an officer and board member of a number of professional societies, including a term as President of the Society for Clinical Neuropsychology (Division 40) of the American Psychological Association (APA) in 2011.  He has an active clinical practice in neuropsychological assessment with ongoing research programs on cognitive and behavioral aspects of epilepsy in addition to other programs in mild traumatic brain injury and forensic neuropsychology. He also maintains an active social media presence on topics related to sports concussion and chronic traumatic encephalopathy (CTE). His doctorate in clinical psychology is from New School University.

This is the first of a two-part series of a live Grand Rounds presentation given at RUSK. 

In Part 1 of his presentation, Dr. Barr discussed how he takes a translational approach by applying findings from sports studies to clinical practice. Athletics provide a natural laboratory for studying concussion. Unlike other kinds of concussion injury, the motivation for patients is to return to the field of athletics rather than not to do so. Currently, no obvious concussion test exists. Neuropsychological assessment represents one means of documenting symptoms. A focus in this presentation is on subjective symptoms. Some athletes either fail to report their concussion symptoms or hide them in order to remain on the field while some patients may misreport symptoms that pertain to conditions, such as anxiety and depression rather than concussion. Perhaps not as much attention should be paid to cognitive symptoms (e.g., attention and memory), which may be short-lived, as to emotional symptoms that can persist over longer periods of time. He described how the Sports Laboratory Assessment Model (SLAM) is used. A transition then occurred in the battery of neuro psychological tests from paper and pencil to computer applications.

Part 2 involves a discussion of what has occurred in neuropsychological testing since 2001 and how the SLAM model was used to replicate other studies conducted in the early part of the 21st century. Batteries of different tests were administered to large numbers of college athletes to show natural recovery curves. The results show that sideline battery testing does a good enough job while neuropsychological testing added little to the results. Questions then arose regarding how various computerized tests work and which ones should be used. In addition to studies of athletes, research also was done as part of the translational process that involved emergency room patients. Poor test-retest reliability was found for all the different measures. The test lacked reliability to identify changes.  By 2012, it became apparent that baseline neuropsychological testing of athletes was not as important as originally envisioned. Some patients experience symptoms that last beyond one month and these are the individuals who end up in the offices of psychologists. He also discussed post-concussion persistent symptoms.

Dr. Olesya Yevdayev is a Senior Physical Therapist in the Outpatient Physical Therapy Department at Rusk Rehabilitation, NYU Langone Health. She has a Bachelor of Science degree from Touro College and a Bachelor of Arts degree from Hunter College. She earned her Doctor of Physical Therapy degree from Touro College where she received an Outstanding Clinical Achievement award. She has 7.5 years of professional experience in orthopedics/ sports rehabilitation utilizing the Mulligan Method, McKenzie Method, and manual therapy with a concentration on pelvic floor, pregnancy, osteoporosis, oncology, and lymphedema rehabilitation. She also is involved in community services, patient education, and has presented lectures at NYU in Brooklyn and the 26thCancer Conference.

Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Health and private owner and founder of an office for pain management that will open in August 2019. She has a focus on interventions for spinal issues, joints/tendons, headache and also pelvic pain.  She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. She completed her residency in physical medicine and rehabilitation at Mount Sinai Medical Center, New York, NY.  Her fellowship training took place at the Beth Israel Medical Center.  She treats all types of pelvic pain disorders, including pelvic floor dysfunction, rectal pain, headache, jaw pain, along with spine and joint pain.

This is the second of a two-part series. In Part 1, the guests discuss: the kinds of pelvic floor disorders that women can experience; symptoms that patients can present with; whether only women experience pelvic floor problems;  causes of painful symptoms at the pelvic, rectal, or vaginal area and injections available to treat these kinds of pain; extent to which delivering children and growing older influence the occurrence of pelvic floor disorders; if the type of child delivery method, such as vaginal delivery, increases the probability a woman will develop a pelvic floor disorder later in life; how modalities other than surgery, such as physical therapy can contribute to positive outcomes; and the kinds of procedures involved in the administration of pelvic floor physical therapy and the basis on which  various approaches either singly or in combination are best suited for a particular patient?

In Part 2, they discuss: Periods of time, such as weeks or months when most rehabilitation interventions take place and whether it ever occurs that further treatment is not associated with additional improvements; if there are instances, such as the presence of a patient’s advanced old age or co-morbidities where watchful waiting may represent the best choice instead of any other kind of intervention; steps that can be taken to lower the percentages of women who experienced urinary incontinence, yet had not talked to a doctor about this problem;  pelvic floor muscle training to treat overactive bladder and who provides it; the role of botulinum toxin as a form of treatment for pelvic floor dysfunctions among elderly patients; extent to which patient education is involved in efforts to improve knowledge of, attitude towards, and practice of pelvic floor muscle exercise; frequency of urinary incontinence symptoms and other pelvic floor disorders among adolescent females; and pelvic floor muscle training as a means of primary prevention of urinary incontinence in asymptomatic women and secondary prevention for women with small muscle strength who are considered dysfunctional, but asymptomatic.

Dr. Olesya Yevdayev is a Senior Physical Therapist in the Outpatient Physical Therapy Department at Rusk Rehabilitation, NYU Langone Health. She has a Bachelor of Science degree from Touro College and a Bachelor of Arts degree from Hunter College. She earned her Doctor of Physical Therapy degree from Touro College where she received an Outstanding Clinical Achievement award. She has 7.5 years of professional experience in orthopedics/ sports rehabilitation utilizing the Mulligan Method, McKenzie Method, and manual therapy with a concentration on pelvic floor, pregnancy, osteoporosis, oncology, and lymphedema rehabilitation. She also is involved in community services, patient education, and has presented lectures at NYU in Brooklyn and the 26thCancer Conference.

Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Health and private owner and founder of an office for pain management that will open in August 2019. She has a focus on interventions for spinal issues, joints/tendons, headache and also pelvic pain.  She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. She completed her residency in physical medicine and rehabilitation at Mount Sinai Medical Center, New York, NY.  Her fellowship training took place at the Beth Israel Medical Center.  She treats all types of pelvic pain disorders, including pelvic floor dysfunction, rectal pain, headache, jaw pain, along with spine and joint pain.

This is the first of a two-part series. In Part 1, the guests discuss: the kinds of pelvic floor disorders that women can experience; symptoms that patients can present with; whether only women experience pelvic floor problems;  causes of painful symptoms at the pelvic, rectal, or vaginal area and injections available to treat these kinds of pain; extent to which delivering children and growing older influence the occurrence of pelvic floor disorders; if the type of child delivery method, such as vaginal delivery, increases the probability a woman will develop a pelvic floor disorder later in life; how modalities other than surgery, such as physical therapy can contribute to positive outcomes; and the kinds of procedures involved in the administration of pelvic floor physical therapy and the basis on which  various approaches either singly or in combination are best suited for a particular patient?

In Part 2, they discuss: Periods of time, such as weeks or months when most rehabilitation interventions take place and whether it ever occurs that further treatment is not associated with additional improvements; if there are instances, such as the presence of a patient’s advanced old age or co-morbidities where watchful waiting may represent the best choice instead of any other kind of intervention; steps that can be taken to lower the percentages of women who experienced urinary incontinence, yet had not talked to a doctor about this problem;  pelvic floor muscle training to treat overactive bladder and who provides it; the role of botulinum toxin as a form of treatment for pelvic floor dysfunctions among elderly patients; extent to which patient education is involved in efforts to improve knowledge of, attitude towards, and practice of pelvic floor muscle exercise; frequency of urinary incontinence symptoms and other pelvic floor disorders among adolescent females; and pelvic floor muscle training as a means of primary prevention of urinary incontinence in asymptomatic women and secondary prevention for women with small muscle strength who are considered dysfunctional, but asymptomatic.

Joan Gold is a clinical professor in the Department of Rehabilitation at Rusk Rehabilitation, NYU Langone Health. Her areas of specialization include the pediatric disorders cerebral palsy, and spina bifida. In her own words, she stated that she has had the pleasure of watching her patients and learning from their strengths for 45+ years. 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 Pediatrics. 

This is the second of a two-part series. In this Part 2, she discusses: pregnancy among patients with cerebral palsy, effect of pregnancy on balance and coordination if a motor functional impairment exists; challenges and resources available for patients who become parents; identification of the felt needs of patients; improvements needed in diagnosis and treatment; time period for adoption of rehabilitation treatment innovations; and key topics in rehabilitation research.

In Part 1, Dr. Gold discussed: number of adults in the U.S. with cerebral palsy; their life expectancy; challenges involved in the transition from pediatric to adult care for these patients; kinds of health problems adult patients experience; treatment for dystonia; the impact of additional physical deterioration on quality of life and mental health; and the ability to participate in physical activities, work, family, and recreational activities.