Dr. Sara Cuccurullo and Dr. Talya Flemming: Investigating and Analyzing the Effect of a Comprehensive Stroke Recovery Program, Part 2

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.

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services  Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine. Part 1 Dr. Cuccurullo began by discussing their stroke recovery program, specifically investigating and analyzing the effects of a comprehensive initiative on all-cause mortality, function, and readmissions. She listed the learning objectives for today’s grand round presentation. Strokes are the number one admission in their inpatient rehab facility. Twenty-two percent of their patients comply with going to the facility. Their patients have a finite resource for Medicare once they leave inpatient or the acute care setting. Payment caps compromise the ability to have outpatient therapies that prevent them from having a full recovery. Dr. Flemming pointed out that there is an overlap with patients who have neurologic disease after stroke as well as patients who have cardiac disease. So, they designed their program to combine both elements of neurorehabilitation and a modified cardiac rehabilitation program, which starts with an outpatient visit with a stroke physiatrist. Common challenges that need to be addressed are patients with: weakness on their one side versus the other, cognitive or attention deficits, poor safety awareness, and post-stroke fatigue. They decided that it would be important to collect medical and functional outcome data to see if the program could affect hospital readmissions, the recurrence of stroke, and overall mortality.

Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company. Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years.  Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York.  Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt. Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health.  Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists.  She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT). Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases.  She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University.  Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field.  The discussion covered the following topics: influence of artificial intelligence, and research endeavors pertaining to occupational therapy, physical therapy, and speech-language pathology.

Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company. Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years.  Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York.  Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt. Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health.  Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists.  She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT). Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases.  She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University.  Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field. The discussion covered the following topics: involvement of informal caregivers in treatment, staying on top of new developments, use of assistive technology, provision of care via telehealth, and impact of Long Covid on patient care.

Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company. Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years.  Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York.  Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt. Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health.  Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists.  She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT). Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases.  She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University.  Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field. The discussion in Part Two covered the following topics: types of patients treated, impact of health care disparities, and patient cooperation in health care interventions by providers.

Catherine Parkin serves as Clinical Assistant Professor, Department of Rehabilitation Medicine at NYU Grossman School of Medicine, She co-authored the book, Medical aspects of disability for the rehabilitation professionals in 2017 by the Springer Publishing Company. Mary Regina Reilly has served as the Clinical Director of Speech Language Pathology at Rusk Rehabilitation, NYU Langue Health for the last ten years.  Her Master’s Degree is from Columbia University and she did her fellowship at Montefiore Medical Center in the Bronx, New York.  Clinical concentration has focused on pediatric dysphagia with medically complex infants with additional efforts in developing specialty programs for adults with acquired neurogenic disorders. She was instrumental in assisting in the development of the Masters of Science Program in Communication Sciences at Yeshiva University and has served as an adjunct professor at both Mercy College and NYU Steinhardt. Dr. Angela Stolfi is the Director of Physical Therapy, Director of Therapy Services at Rusk Ambulatory Satellite Locations, Site Coordinator of PT Clinical Education, and Director of PT Residency and Fellowship Programs at Rusk Rehabilitation, NYU Langone Health.  Dr. Stolfi holds a faculty appointment in the Department of Rehabilitation at NYU School of Medicine and regularly lectures in the physical therapy programs at both NYU and the University of Scranton. The focus of much of her current and recent research relates to mentoring and education of student physical therapists.  She is also an Associate Editor of the Journal of Clinical Education in Physical Therapy (JCEPT). Maria Cristina Tafurt is the Site Director at the Rusk Institute NYU Langone Medical Center, Hospital for Joint Diseases.  She has been a licensed occupational therapist for over 30 years receiving her Bachelor’s degree from the University of Rosario in Bogata Colombia, and her Advance Master’s degree from NYU University.  Her clinical experience has varied with an emphasis on brain injury rehabilitation, pain management, hand therapy, and orthopedics. She holds a faculty appointment in the Department of Rehabilitation Medicine as a Clinical Instructor and has authored or co-authored sixteen articles, abstracts and international presentations in her field. The discussion covered the following topics in Part One: a description of each of the three professions, educational requirements to become practitioners, and recruitment and retention of clinicians. 

Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation. Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program.  She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness.  Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals. Part 3 The discussion covered the following topics: phases of treatment when mindfulness and self-compassion can be introduced to achieve optimal effectiveness; the role of telehealth; extent to which a group-based approach is used; availability of commercialized digital resources on the Internet, such as apps; use of wearable devices by patients; and the impact of artificial intelligence on patient care.  

Dr. Heidi Fusco is an assistant professor of Rehabilitation Medicine at NYU LANGONE Health and the Rusk Rehabilitation hospital. She is the Assistant Director of the Traumatic Brain Injury Program at Rusk and the Medical Director of the Brain Injury Unit at Queens Nassau Nursing and Rehabilitation. She completed a fellowship in Brain injury Rehab in 2013 at the Rusk Institute and is board certified in Brain Injury medicine and Physical Medicine and Rehabilitation. Alaina B. Hammond is a board certified rehabilitation psychologist and currently serves as Clinical Assistant Professor and Staff Psychologist in the NYU Langone Rusk Adult Inpatient - Brain Injury Rehabilitation Program.  She provides psychological and neuropsychological intervention and assessment to patients and families with acquired brain injury, stroke, spinal cord injury and other illness/injuries. In addition, she supervises psychology interns and enjoys researching family/caregiver adjustment to medical illness.  Dr. Jessica Rivetz is the current Brain Injury Medicine Fellow at NYU Rusk Rehabilitation. She recently completed her residency in physical medicine and rehabilitation at NYU Rusk. She received her MD degree at Albany Medical College, and also has a Master's of Science in health care management. Extracurricular activities include serving as co-chairperson of the NYU GME House Staff Patient Safety Council. Within brain injury medicine, she has a special interest managing patients with moderate to severe traumatic brain injury and helping them and their caregivers navigate life after brain injury and achieve their functional and quality of life goals. Part 2 The discussion covered the following topics: persistence of sleep disorders and the role of physical exercise in treating them; definition of mindfulness; kinds of interventions included under the heading of mindfulness; examples of how it aims to address the severity of various TBI-related health problems; duration of mindfulness treatment; and self-compassion as another type of non-pharmacological intervention.