Dr. Ronald (James) Cotton Grand Rounds: Opportunities of AI Powered Gait Analysis for Rehabilitation, Part 1

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.

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. PART 1 All of us probably believe and understand that how someone moves and walks is hugely informative. People are exuding all this information about their health status, but we don't measure it and obviously a core treatment of rehabilitation is how people move. We don't actually routinely measure that and the reason is that we need better, more clinically accessible tools to measure the clinically meaningful things about movement and then use those to guide our treatment programs. We've never really had the tools. So, I'm going to discuss a plurality of methods we've been developing in my lab, including tools that use multi-view video, monocular video from a smartphone, for example, as well as sensor technology and then how we're trying to extract clinically meaningful metrics from these methods. A challenge we've been addressing in the lab is that the tools developed by the AI community don't necessarily solve the problems that we need or produce clinically relevant outputs. It's really important to have confidence intervals on what you measure. If we're going to use anything for decision making, we have to know we can trust it. A problem with a lot of computer vision algorithms is they don't provide anything like confidence intervals. Even if they pretend to, they're often uncalibrated and unreliable.

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 3 The discussion covered the following topics: social prescribing, artificial intelligence, reducing length of hospital stay, hospital readmission of patients, and implications of an obesity epidemic.

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 2 The discussion covered the following topics: Rusk’s interprofessional approach to patient care, future hiring needs, health promotion efforts to enhance health of staff, preparing Rusk residents for the future in health care, and putting patients first.  

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.