Grand Rounds Part 1, Dr. Kathleen Martin Ginis: Education About Spinal Cord Injury (SCI) and Physical Activity

Dr. Kathleen Martin Ginis is a Distinguished University Scholar and a Professor in the Department of Medicine (Division of Physical Medicine and Rehabilitation) and in the School of Health and Exercise Sciences at The University of British Columbia. She holds the Reichwald Family Chair in Preventive Medicine and is a Fellow of the Royal Society of Canada, the Canadian Academy of Health Sciences, the Canadian Society for Psychomotor Learning and Sport Psychology, and as is an International Fellow of the National Academy of Kinesiology. The focus of Dr. Martin Ginis's research is placed on understanding and changing physical activity behaviour, particularly among people living with spinal cord injury. She is deeply committed to knowledge translation; specifically, the development and implementation of evidence-based best-practices to improve health and well-being among people with disabilities. By example, Dr. Martin Ginis spearheaded the formulation and knowledge translation of scientific exercise guidelines for adults with spinal cord injury. These guidelines have been translated into nearly 20 languages and are used worldwide in clinical and community settings. Part 1 One of her objectives is to present recent data showing the physical and mental health benefits of exercise for adults with spinal cord injury. She wants to introduce exercise guidelines for adults with SCI. Starting with the benefits of exercise from a mental and physical health perspective, probably the best two areas, best two outcomes for which there is evidence are improving insulin sensitivity and cardiovascular disease risk in this population. The fitness guideline stipulates that to improve cardiorespiratory fitness and muscle strength, adults with SCI should do at least 20 minutes of moderate to vigorous intensity, aerobic activity twice per week, and strength training exercises twice per week. The guideline for cardiometabolic health stipulates that a minimum of 30 minutes of moderate to vigorous intensity physical activity is required three times per week. She discussed how exercise improves well-being. She also talked about exercise in chronic pain. She described the Epic SCI trial, a pragmatic, randomized controlled trial, testing the effects of exercising according to the scientific SCI exercise guidelines on SCI chronic pain.

With over 20 years of extensive clinical experience, Dr. Kedzierska is a Board Certified Clinical Specialist in Neurologic Physical Therapy from the American Board of Physical Therapy Specialties. She serves as a faculty member of an Accredited Physical Therapy Neurology Residency Program. She mentors department staff on assessment/treatment for related diagnosis. She has presented in local and national conferences and is a published author in the ANPT newsletter and Brain Injury Journal. She received her Master's Degree in Physical Rehabilitation in Poland, Advanced Master's Degree from NYU and a doctorate degree from Northeastern University serving a variety of populations. Dr. Fay is a board certified Neurologic Clinical Specialist through the American Board of Physical Therapy Specialties and is a member of the faculty of the Neurological Residency program at Rusk Rehabilitation at NYU Langone Medical Center. She is an active member of the American Physical Therapy Association (APTA), and has served on the APTA's Vestibular EDGE Task Force; a select group of therapists chosen to review measures designed for assessment and treatment of patients with vestibular deficits. She has lectured at both local and national conferences on Vestibular Rehabilitation and is a published author in the Journal of Pediatric Physical Therapy. Her areas of special interest include vestibular rehabilitation in individuals with symptoms of dizziness. Part 1: The interview included the following topics: common vestibular disorders; challenges treating patients with vestibular disorders; other specialists involved in providing treatment; overlapping symptoms; advances in diagnosis; distinguishing between peripheral and central vestibular disorders; patient compliance; and involvement of family members in treatment.

Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45. Part 2 The discussion included the following topics: challenges that patients face during the recovery period; factors determining treatment outcomes; preventing concussions; composition of the interdisciplinary treatment team; and the role of technology in treatment interventions.    

Dr. Maria Janakos is a sports medicine physiatrist at NYU and a Clinical Assistant Professor at the NYU Grossman School of Medicine. She completed her residency at the University of Louisville and a Primary Care Sports Medicine Fellowship at Morristown Medical Center in New Jersey. Her clinical interests include concussion management, orthobiologics, musculoskeletal ultrasound, and event coverage. Dr. Janakos is actively involved in medical education at NYU, teaching medical students, residents, and fellows through lectures, hands-on training, and mentorship. At NYU, she is an active member of the NYU Concussion Center, where she regularly lectures on various concussion topics at both local and national levels. She specializes in the care of patients with acute concussions, treating individuals from adolescence through age 45.   Part 1 The discussion included the following topics: age groups of patients receiving treatment; types of cases treated; distinguishing medical terms for brain injuries; common symptomology; patient journey from initial assessment through recovery; and collaboration with patients' families.  

Dr. Zhu is a clinical assistant professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. Her clinical interests include the management of a range of symptoms associated with cancer and its treatment, including weakness, pain, neuropathy, and limited range of motion. Throughout her career, she has been dedicated to proactive healthcare engagement, working closely with a team to provide comprehensive care. Her practice emphasizes patient education, along with helping individuals understand the causes of their symptoms and the changes their bodies are undergoing. She received her medical degree from Rutgers New Jersey Medical School. She then went on to complete a PM&R Residency at NYU Grossman School of Medicine and a Cancer Rehabilitation Fellowship at the University of Miami.    Part 1 The discussion included the following topics: primary purpose of this offering, educational objectives. Summit format, target audience, topics to be covered, and expected outcomes for participants.

Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines. Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Part 2 The discussion included the following topics: quality measures used to determine if desired outcomes are being achieved; challenges or potential downsides associated with a transition from pediatric to adult care; integration of artificial intelligence into pediatric rehabilitation; and current pediatric research conducted at NYU.

Dr. Patricia Tan serves as Medical Director for Rusk Pediatrics Rehabilitation. Her Certification is from the American Board of Physical Medicine & Rehabilitation. She has been selected as a Fellow by the following organizations: American Academy of Physical Medicine and Rehabilitation; American Academy of Pediatrics; American Academy of Cerebral Palsy and Developmental Medicine; and the Association of Academic Physiatrists. Her medical degree is from the University of Santo Tomas in Manila, Philippines. Dr. Megan Conklin is Associate Director of Rusk Pediatric Therapy Services at NYU Langone. She works collaboratively with an interdisciplinary team across the spectrum of pediatric diagnoses from birth through the transition into adulthood. She has a Doctor of Physical Therapy degree, 20 years of clinical experience at NYU; and is certified as a clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Part 1 The discussion included the following topics: kinds of health problems and conditions treated; age range of patients; clinical guidelines and evidence-based treatment protocols used; holistic approaches to treatment; collaboration with families of patients; and composition of the health care team

Dr. Ira Rashbaum specializes in mind–body care and treatment of patients who have tension myoneural syndrome, previously known as tension myositis syndrome, a condition that causes pain and symptoms associated with tension and stress factors. His expertise is in diagnosing and treating individuals who have psychosomatic pain disorders. He has an extensive list of publications, national meeting presentations, and media appearances. As study guide committee chairperson of the American Academy of Physical Medicine and Rehabilitation, he led a project that compiled information on advances in rehabilitation medicine for more than 10,000 physicians worldwide. This position placed him at the forefront of all aspects of rehabilitation medicine. Dr. Samuel Mann is a physician and researcher, specializing in hypertension. He has spent the past 40 years as a specialist in this condition, combining patient care, research and teaching at his institution. As a researcher, he has published 65 articles in medical and psychology journals, along with 10 book chapters on hypertension, and three books. His most recent book is "Hidden Within Us; A Radical New Understanding of the Mind-Body Connection (2022). He emphasizes that in most patients, hypertension is not a mind/body disorder. But when it is, it is not related to emotions, such as anger and anxiety that patients report, but to powerful repressed emotions, often related to a past history of stress or trauma, that are completely hidden from conscious awareness. Part 2 The discussion included the following topics: accuracy of adults in recalling traumatic events that may have occurred in childhood, communicating with patients reluctant to discuss emotional aspects other than physical health ailments; possible distinctions among patients in different demographic groups, non-pharmacologic kinds of treatment, and status of research aimed at understanding the connection between emotions and physical health problems.

Dr. Ira Rashbaum specializes in mind–body care and treatment of patients who have tension myoneural syndrome, previously known as tension myositis syndrome, a condition that causes pain and symptoms associated with tension and stress factors. His expertise is in diagnosing and treating individuals who have psychosomatic pain disorders. He has an extensive list of publications, national meeting presentations, and media appearances. As study guide committee chairperson of the American Academy of Physical Medicine and Rehabilitation, he led a project that compiled information on advances in rehabilitation medicine for more than 10,000 physicians worldwide. This position placed him at the forefront of all aspects of rehabilitation medicine. Dr. Samuel Mann is a physician and researcher, specializing in hypertension. He has spent the past 40 years as a specialist in this condition, combining patient care, research and teaching at his institution. As a researcher, he has published 65 articles in medical and psychology journals, along with 10 book chapters on hypertension, and three books. His most recent book is "Hidden Within Us; A Radical New Understanding of the Mind-Body Connection (2022). He emphasizes that in most patients, hypertension is not a mind/body disorder. But when it is, it is not related to emotions, such as anger and anxiety that patients report, but to powerful repressed emotions, often related to a past history of stress or trauma, that are completely hidden from conscious awareness. Part 1 The discussion included the following topics: definitions of repressed and suppressed emotions; common emotions that patients tend to repress; extent to which the biomedical model may have to be augmented or replaced as a means of having a greater emphasis on emotions and their unrecognized relationship to some physical health conditions; strength of evidence supporting a connection between emotions and physical health conditions; and the role played by emotional trauma on the onset of various physical health conditions.

Dr. Ronald (James) Cotton who is an electrical engineer, neuroscientist, and physiatrist working as a physician scientist at Shirley Ryan Ability Lab, and assistant professor in the Northwestern University Department of Physical Medicine and Rehabilitation. We have this one paper where we can use diffusion models and generate a bunch of probabilistic samples of movements and they constrain them by what we see in the cameras and have shown that we can actually estimate the confidence and the uncertainty in a reliable way. He indicated that we can use something called the myoskeleton that allows us to track all joints in the body down to the individual fingers. Our Portable Biomechanics Laboratory is kind of a combination of a smartphone app that records the rotation and movement of the phone itself. He discussed how he would like to establish validity as a predictive biomarker. He asked what do we actually want and what do we mean by precision rehabilitation? In his mind, the best formalism of it is something called the optimal dynamic treatment regime, which essentially is some kind of function, probably a learned function that looks at all the health information, all the biomarkersof an individual at any point in rehabilitation, kind of condenses that into a phenotype, and then predicts what is the next intervention that should be given. He spoke briefly about a case studythat applies to another line of research in his lab, which is EMG-based biofeedback and also about Next Generation Brain Machine Interface Chips.