400th Rusk Rehabilitation Podcast Anniversary: Dr Steven Flanagan, Part 1

Dr. Steven Flanagan, a nationally renowned expert in the field of traumatic brain injury (TBI), has worked at the Rusk Rehabilitation Institute at NYU Langone Health since 2008. He serves as the Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. A former President of the American Academy of Physical Medicine & Rehabilitation (PM&R), he is certified by the American Board of PM&R (Brain Injury Medicine). A graduate of the University of Medicine & Dentistry of New Jersey, he completed his medical residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation. Part 1 The discussion covered the following topics: his involvement at Rusk in patient care, research, and professional organizations; impact of COVID on Rusk; traumatic brain injury biomarkers; and recruitment and retention of health professionals.      

Dr. Molly Fuentes is medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital. Dr. Fuentes is an assistant professor of rehabilitation medicine at the University of Medicine. She also is a pediatric physiatrist. She completed her undergraduate degree at Stanford University and is a graduate of the School of Medicine at the University of Michigan. She completed her residency at the University of Washington and later completed a pediatric fellowship at the Seattle Children’s Hospital. She then completed a research fellowship in pediatric injury at the Harborview Injury Prevention and Research Center at the University of Washington. She is the medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital.   Part 2 She indicated that the Indian Health Service per capita receives half of what Medicaid receives. Treaty-bound trusts for providing health care are chronically underfunded. The Indian Health Service operates under a funding cap, which is annually appropriated. In contrast, Medicare and Medicaid are entitlement programs. She then returned to looking back at the injury-equity framework. She wanted to dive into the pre-event phase factors for native children and teens. An example pertains to motor vehicle injuries. Tribal sovereignty means that tribal laws are what is important to safety on reservations roads, e.g., speed limits and seat belt use. She described various programs that aim to improve safety on tribal roads. She then discussed the post-event phase involving rehabilitation and the golden hour that affects health outcomes. Where native people mostly reside in the U.S., there are fewer trauma centers. A related topic is models of access to health care services. The acceptability of these services by patients is a key element in the quality of health care provided.  High rates of health uninsurance affect this population negatively.

Dr. Molly Fuentes is medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital. Dr. Fuentes is an assistant professor of rehabilitation medicine at the University of Medicine. She also is a pediatric physiatrist. She completed her undergraduate degree at Stanford University and is a graduate of the School of Medicine at the University of Michigan. She completed her residency at the University of Washington and later completed a pediatric fellowship at the Seattle Children’s Hospital. She then completed a research fellowship in pediatric injury at the Harborview Injury Prevention and Research Center at the University of Washington. She is the medical director at the inpatient rehabilitation unit at the Seattle Children’s Hospital.   Part 1 Dr. Fuentes described her life experiences that influenced her choice of a career in the area of pediatric disability. In this presentation, she wanted to: review the injury epidemiology literature for American Indian and Alaska Native children and teens, identify some historical traumas that impact native people, recognize the utility of the injury-equity framework, the international classification of functioning disability and health model, conceptualize rehabilitative care, and describe some barriers to rehabilitation care. A health disparity is just that difference in health status between population groups. A health disparity becomes an inequity when that disparity is due to systematic differences in social, economic, environmental, or health care resources. There is a health care inequity when there is a difference in access to health care utilization or receipt of health care services. Looking specifically at disability and functional difference among American Indian and Alaska Native children, there really is not that much published literature on the prevalence of disability in this population. Dr. Fuentes concluded Part 1 by discussing historical relationships between Native American tribes and the federal government, which have had a significant deleterious impact on individual and community health status of these individuals. For example, boarding schools or residence schools represent another kind of push in the direction of forced assimilation where traditional practices were punished.

Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion.  Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion.  Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field. Part 2 We call them psychobiotics because these specific probiotics actually are helping the targeting of treatment of things we are trying to do.) Next, we are going to discuss nutritional support of these patients. She discussed the role of nutritional supplements, such as Vitamin E. The brain requires high levels of Vitamin C after a traumatic brain injury, It is a potent antioxidant. Magnesium levels drop acutely right after a concussion. It reduces stress and promotes relaxation. It helps in sleeping. She identified which magnesium supplements should be used. She furnished information about jockeys who are at a high risk for experiencing concussions. Additionally, in order to meet requirements in competition, many of them starve themselves to arrive at their goal weight. They talk openly about their eating disorders. Another topic covered in her presentation is mitochondria and fatigue. She also indicated the use of various alternative and complementary substances.

Shae Datta, MD is a Sports Neurologist with special interest in post-concussion syndrome, vestibulo-ocular dysfunction and the relation of integrative medicine on brain health. Her specific training allows for a variety of treatment modalities in the identification of mild traumatic brain injury and sideline concussion diagnosis. She has written a book chapter on the gut microbiome and its relation to headache syndromes in concussion.  Her primary research interests include identifying predictors of concussion recovery, examining the role of sleep during concussion recovery, and investigating the cognitive implications of concussion.  Dr. Datta serves as Vice Chair of the American Academy of Neurology's Sports Neurology Section to further awareness and develop new education initiatives in the field. Part 1  Today’s topic is something none of us got in medical school. What makes her successful in treating her patients is having this approach, sort of a 180-360 approach to nutritional status among the head-neck , vestibular balance, and everything else we do. When a concussion occurs, we often have disruption of the blood-brain barrier. There also is inflammation. Ultimately, there can be cell death. We have an opportunity for nutritional repair in concussions. There is an energy crisis in the brain. We need to increase the brain’s need for anti-inflammatory and antioxidant nutrients. We will discuss in this presentation how to get that into a person’s brain or diet and look at why diet matters.

Avery Menaker is a senior occupational therapist at NYU Rusk Rehabilitation. She is certified as both a stroke rehabilitation specialist and a brain injury specialist. She co-leads an initiative at NYU to bring high intensity practice to patients participating in occupational therapy. Faye Bronstein is the inpatient rehabilitation clinical specialist at Rusk Rehabilitation. She is board certified in neurology, geriatrics, and physical therapy, and has led initiatives to bring high intensity training practice into the NYU inpatient setting over the past three years. The following topics were among those discussed in the interview: how high intensity training differs from traditional therapy approaches and what its benefits are; kinds of patients for whom high intensity training is appropriate; research to support high intensity training; equipment needed for this intervention; what a typical high intensity treatment session looks like in physical therapy and occupational therapy; implementation challenges; whether high intensity training is done in every therapy clinic and if all therapists know about it; and contents of an NYU continuing education course on high intensity training that will be offered on May 17-18, 2025.      

Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist.  He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation.  He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology. Part 3 The discussion covered the following topics: spiritual aspects of health care, use of wearable devices by patients, role of physical exercise in the care of patients, influence of dietary practices on patients’ health status, and personal research underway and expected to begin in the near term.  

Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist.  He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation.  He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology.   Part 2 The discussion covered the following topics: launching new program initiatives, professionals involved in holistic neuropsychological rehabilitation, addressing health care disparities, willingness of patients to cooperate in their care, role of informal caregivers, and use of telehealth as an intervention.

Dr. Andrew Bateman has worked in clinical rehabilitation and research since 1990 as a chartered physiotherapist.  He was fascinated by the problem of patients with neurological conditions not doing what he expected. So, he went off to learn more about neuropsychology and did so by completing a PhD in Neuropsychology in 1997. He was at the National Health Service until 2019 when he left to take up his current academic role as a full professor of rehabilitation.  He is a Past President and currently Treasurer of The Society for Research in Rehabilitation; and Chair of the charity “United Kingdom Acquired Brain Injury Forum” and was recently appointed President of the Association of Chartered Physiotherapists in Neurology. Part 1 The discussion covered the following topics: diagnosing acquired brain injuries; biomarkers for neurological impairments; Long COVID and neurological symptoms; recruitment and retention of health personnel; and composition of the health care team.      

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.  Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services  Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine. Part 2 Dr. Flemming described the functional results obtained from their intervention. They specifically chose the activity measure proposed for post-acute care, abbreviated as AM-PAC. It showed improvement over time and it allowed looking at specific subsections within rehabilitation, such as basic mobility, daily activity, and cognitive scores. An AM-PAC score is a recognized tool by Medicare used in multiple post-acute care settings. Dr. Cuccurullo indicated that according to an article published in 2011 in the journal Stroke, the all-cause mortality for stroke patients in the U.S. is 31%. In one year, the all-cause mortality in their program was 1.47%. Their results were published in the American Journal of Physical Medicine and Rehabilitation. The paper received the Excellence in Research Writing Award for the most impactful article of the year. Significantly, the manuscript attracted the attention of Medicare officials who asked them to present their findings. CMS wanted to know if it can be proved that the stroke recovery program saves money, can they validate their previous improvement in mortality with more patients, and can they replicate the results at other institutions nationally. Drs. Fleming and Cuccurullo described what they did in response to these questions. A Question & Answer period followed.