 Dr. Jonas Sokolof is Director of the Division of Oncological Rehabilitation and Clinical Associate Professor in the Department of Rehabilitation Medicine at NYU Grossman School of Medicine. He is certified by the American Board of PM&R both in Sports Medicine and in Physical Medicine & Rehabilitation. His doctor of osteopathy degree is from the New York Institute Of Technology. His Residency occurred at the Harvard Medical School and the Spaulding Rehabilitation Hospital in Boston. He also had a fellowship in sports medicine from Rutgers New Jersey Medical School. Prior to arriving at NYU Langone Health in 2018, he was at the Memorial Sloan Kettering Cancer Center in New York City. In Part 1, we discussed the following:  if the recent COVID resurgence affected his ability to furnish care for patients with cancer; the types of cancer in which most of his patients can be found; what manual medicine entails; assessment of patients' emotional needs; supportive needs of patients of an informational, spiritual, or social nature;  whether patients are requested to produce autobiographical accounts of how they experience life as a cancer patient and the treatment they receive; and efforts to enable patients to become adept as self-managers of cancer so that they can be effective in self-monitoring, recognizing and reporting symptoms, and treating side effects.         

RUSK Insights on Rehabilitation Medicine

Dr. Jonas Sokolof: Oncological Rehabilitation Medicine, Part 1

PART TWO In Part 1, Dr. Kim presented information about the historical and legal background for cannabis, variations in policies in the states, and the status of current research. In Part 2, she discussed cancer pain that is not neuropathic. She described the results of a study that involved opioid refractory cancer pain. Evidence currently shows that patients who have increased access to cannabis actually have higher rates of opioid overdose and deaths. She reviewed a case of one of her patients who had prostate cancer. This individual was not amenable to physical therapy and was weaned off opioids because they were not effective. Finally, they decided to try different types of cannabis for pain and sleep and he is doing quite well. He eventually used a combination of low and high THC capsules and was weaned off all other drugs. She and her colleagues also looked at how patients considered the use of cannabinoid therapy and found that overall they preferred it for their future chemo. Even though cannabis is a natural product, it is not true that it is free of side effects. There is some concern that it can have interactions on the heart, result in psychotic symptoms, affect psychomotor performance, and lead to an increase in tolerance, making it necessary to use higher and higher doses to achieve the same effect. A question-and-answer period followed her presentation. 

Dr. Arum Kim: Exploring Medical Cannabis, Part 2

PART ONE In Part 1 of a two-segment presentation, Dr. Kim discussed historical and legal background for medical cannabis and cannabis in general; mechanism of action; applications for pain and symptom management; the science behind cannabis for cancer care; relative safety issues; contraindications and monitoring; and some public health concerns. She defined cannabis, marijuana, hemp, and indicated various code names for recreational marijuana. Marijuana was criminalized and removed from the U.S. Pharmacopeia in 1941, Most recently, some states have legalized it both medically and recreationally. For medical purposes, there is a lot of variation in what states will allow. A concern has been about the presence of contaminants in many products. Based on current research, the science and the evidence are not where they could be ideally. She discussed marijuana and how it works, mentioning the endocannabinoid system. Different ways exist to act on that system. She described the entourage effect and how it functions.   D

Dr. Arum Kim: Exploring Medical Cannabis, Part 1

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology. In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS). In Part 2 of his presentation, he continued describing the current state of research on the use of PNS, which to some degree is lacking, but certainly it potentially is increasing. He referred to a multi-center, randomized, double-blind investigation that looked at PNS technologies in a variety of pain conditions. He then described a product that was cleared by the FDA in July 2016. It involves the use of multiple electronic leads rather than using a single one. The implant used is of a temporary nature (60 days) rather than something permanently. He pointed out that because the technology is much smaller, no incision is necessary. The micro lead is much smaller in diameter and does not have to be as close to the nerve. He showed a video about a typical implant for a shoulder, involving the 60-day version of technology being used. While it played, he narrated some of the steps shown in the video regarding the implant of the electrode. Everything becomes stabilized as the electrode moves closer to the nerve. His presentation concluded with his fielding questions asked by participants at this event, including two by Dr. Steven Flanagan, Director of the Rusk Rehabilitation Institute at NYU Langone Health.

Dr. Charles Kim: Peripheral Nerve Stimulation 2.0, Part 2

Dr. Kim received his medical degree from SUNY Brooklyn and he completed a residency in both physical medicine and rehabilitation, along with a fellowship in anesthesiology and pain management at Mt. Sinai. He is board certified in both PM&R and anesthesiology. In Part 1 of his presentation, he indicated that he would mention some specific products and companies, but he does not have a financial relationship with them. One of his objectives is to provide background information about PNS. Currently, there is an increase in this kind of technology and also in the demand for non-opioid pain management. PNS can be fitted into the specialty of neuro modulation, a field that touches upon multiple specialties, including PM&R. The basic goal in PNS is to stimulate the nerve and reduce unwanted pain. PNS has been around since the early 1960s.  Pain is the most common indicator for employing its usage. Dr. Kim has a specific interest in post-stroke shoulder pain, which is a difficult condition to treat. Post-surgical pain in general and post-amputation pain have led to the increased demand for PNS. Complications of this kind of treatment include the risk of infection and scarring around the nerve. Modern implantables show why PNS has increased in demand because technology has led to more miniaturization of these stimulators, which significantly has decreased the amount of invasiveness. Based on work performed at Rusk, he mentioned how research findings have been shared with professional organizations, such as the North American Neuromodulation Society (NANS).

Dr. Charles Kim: Peripheral Nerve Stimulation 2.0, Part 1

Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado.   Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University.    In Part 2, we discussed: advanced surgical techniques employed for both hip and knee surgery; time after surgery when physical therapy interventions are initiated; other kinds of members of the health care team at NYU Langone Health involved both pre- and post-surgery to make possible same-day discharge; additional therapy provided once patients return home and when it is initiated; the role of telehealth in delivering home-based care; situations at home that may result in patients seeking emergency room care or requiring in-patient hospitalization; whether patients who undergo bilateral hip and knee surgery are suitable candidates for same-day discharge; and kinds of research being conducted at NYU involving same-day discharge.  

Dr. Joshua Rozell and Dr. Manuel Wilfred: Joint Replacement, Part 2

 Dr. Joshua Rozell is a hip and knee replacement surgeon at NYU Langone with practices in Brooklyn and Manhattan. He specializes in anterior approach hip replacement, computer-navigated and robotic knee replacements, and outpatient joint replacement surgery. Many of the techniques he uses allow patients to recover more quickly and improve their function and strength after surgery. He did his undergraduate training at Emory University, went to medical school at Drexel University, and had his orthopaedic surgery residency at the University of Pennsylvania, along with a hip and knee replacement fellowship at the prestigious Steadman Clinic in Vail, Colorado.   Dr. Manuel Wilfred is a physical therapist who provides care for joint replacement patients at NYU Langone-Brooklyn. He has worked with orthopedic patients both inpatient and outpatient throughout his 19 years in the profession. Prior to being at NYU Langone-Brooklyn, he received his bachelor's degree in physical therapy from India and then he left that country to study at University College London and work in the National Health Service's Middlesex Hospital. He has a doctor of physical therapy degree from the University of Montana and completed his PhD degree from Seton Hall University.    n Part 1, we discussed: the effect of the COVID pandemic on performing hip and knee replacement surgery and providing post-operative care; typical hospital length of stay experienced by patients prior to implementing same-day discharge; number of these surgical procedures performed on a weekly basis; the proportion of these operations resulting in same day-discharge; kinds of factors used to identify patients who are excellent candidates for same-day discharge following hip and knee replacement surgery; factors indicating that certain patients should be excluded from participating in same-day discharge; and contents of a "playbook" used during the preoperative consultation phase. 

Dr. Joshua Rozell and Dr. Manuel Wilfred: Joint Replacement, Part 1

 In Part 2 of his presentation on the topic of diversity and inclusion in medicine, Dr. Lopez continued describing the use of a holistic approach to interview candidates for admission to NYU’s PM&R residency program. Factors currently being  taken into account other than board scores, include socio economic hardship, commitment to the underserved, work experience, and fluency in other languages. A task force also was formed to review every candidate individually. Interviews  presently involve taking a closer look at structured behavioral interview questions, which can be used to measure factors, such as professionalism and teamwork. Interviewers also are blinded to board scores to eliminate a higher halo effect that might exist. Dr. Lopez then reviewed the results of the latest match and identified the kinds of efforts that should be undertaken to increase the proportion of underrepresented groups, including women and members of the LGBTQ community. More diversity is welcome at NYU. Change is not going to happen overnight. Current efforts are just the starting point. A question and answer session for several minutes followed his presentation, including comments made by Dr. Steven Flanagan, Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health.          

Dr. Francis Lopez: Diversity in Residency Part 2

 In Part I, Dr. Lopez wanted to familiarize listeners in this grand rounds presentation with a history of minorities in medicine and to describe current trends in diversity and inclusion in medicine in general and specifically in PM&R.  He identified arguments for diversity and contrasted past, present, and future recruitment efforts at NYU. He also discussed this years’ match data results. Historically, there have been many challenges for minorities to gain a foothold in medicine. He wanted to furnish objective data about this situation. These individuals had a problem right from the beginning in obtaining admission to medical schools. He described enrollment data from the Association of American Medical Colleges (AAMC) and compared it to U.S. Census Bureau data. Over the last 50 years, Dr. Lopez noted how medical schools have tried to do something about increasing the proportion of students from underrepresented minority groups. Specific information entailed showing what has occurred in PM&R, involving students and faculty. Comparisons then were made with overall U.S. population trends. Reasons are provided for increasing diversity and inclusion in medicine, e.g., minority patients seek doctors who look like them and more minority physicians are likely to take care of minority patients. In Part 2 of his presentation on the topic of diversity and inclusion in medicine, Dr. Lopez continued describing the use of a holistic approach to interview candidates for admission to NYU’s PM&R residency program. Factors currently being  taken into account other than board scores, include socio economic hardship, commitment to the underserved, work experience, and fluency in other languages. A task force also was formed to review every candidate individually. Interviews  presently involve taking a closer look at structured behavioral interview questions, which can be used to measure factors, such as professionalism and teamwork. Interviewers also are blinded to board scores to eliminate a higher halo effect that might exist. Dr. Lopez then reviewed the results of the latest match and identified the kinds of efforts that should be undertaken to increase the proportion of underrepresented groups, including women and members of the LGBTQ community. More diversity is welcome at NYU. Change is not going to happen overnight. Current efforts are just the starting point. A question and answer session for several minutes followed his presentation, including comments made by Dr. Steven Flanagan, Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health.           

Dr. Francis Lopez: Diversity in Residency, Part 1

 Dr. Ryan Branski is the Howard A. Rusk Associate Professor of Rehabilitation Research and the Vice Chair for Research in Rehabilitation Medicine at the NYU Grossman School of Medicine. He also has appointments in Otolaryngology-Head and Neck Surgery in the school of medicine and Communicative Sciences and Disorders in the Steinhardt School of Culture, Education, and Human Development. 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 Fellow of the American Academy of Otolaryngology-Head and Neck Surgery, the American Speech Language Hearing Association, and the American Laryngological Association. In Part 1 of his presentation, Dr. Branski discussed how efforts are underway to push research over the top in productivity at NYU. It is important to consider the economic implications of research. Obtaining external support is not easy and we should celebrate those accomplishments when funding is obtained. Voice disorders are the single most common communication disorder across the lifespan. He mentioned the importance of Reinke’s space and his contributions in describing the layered structure of the vocal folds. He indicated how challenging it is to deal with the problem of vocal fold necrosis.  In Part 2 of his presentation, Dr. Branski discussed voice research, an area of investigation that not only poses the most opportunities, but also the most obstacles. He also mentioned developments in addressing tissue deficits in the airway. He closed on the theme that research needs to be opportunistic and that what is of value in this institution is to enhance communication between the thousand clinicians at NYU and the researchers.  A Q & A period followed.

Dr. Ryan Branski: Therapeutics for the Vocal Cords, Part 2

Dr. Ryan Branski: Therapeutics For The Vocal Chords

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.  In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim. In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.  

Dr. Steven Flanagan: Where We Have Been, Where We Are, and Where we Need to Go, Part 2

This is a special two-part Grand Rounds series with Dr. Steven Flanagan, Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation.  In Part 1 of his presentation, Dr. Flanagan discusses the contributions of Dr. Howard Rusk, the father of rehabilitation medicine. He brought it to the forefront as a recognized specialty by showing that rehabilitation contributed to improving the lives of patients with disabilities. Dr. Flanagan referred to various efforts over the decades to manage health care costs through managed care and other means. Even today when it is evident that a inpatient care is necessary, barriers can offer resistance because of the costs involved. What makes the case of inpatient care more challenging is the need to have more data to justify the decision to provide care at that level. He predicts that cost containment will continue well into the future. Our aims are to improve health care outcomes and increase efficiency. He concluded Part 1 of his presentation by stating that PM&R has a critical role to play in attaining the Triple Aim. In Part 2 of his presentation, Dr. Flanagan discusses challenges involved in justifying the need for the provision of inpatient rehabilitation care in the context of controlling expenditures and the critical role that physical medicine and rehabilitation play in attaining the Triple Aim. We know that the intensity of some of our rehabilitation therapies are associated with better outcomes, for example, aphasia therapy. Early mobilization results in better outcomes with cost savings. Nonetheless, we still need more data to show that what we do is important. Mention was made of expansions at Rusk, such as a new division on Technology and Innovation to advance rehabilitation science. Health care is changing and education must change with it.

Dr. Steven Flanagan: Where We Have Been, Where We Are, and Where we Need to Go, Part 1

 Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with  the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon. Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory. This is a two-part series. In Part 1, they discuss: how the ability to conduct research has been affected by the arrival of the coronavirus pandemic; possible reluctance of patients to be involved in research that occurs in a clinical setting because of a fear of contracting COVID-19 there; the extent to which delays and postponements have occurred because of disease resurgences; how COVID-19 limitations on touch and physical contact have led to unintended yet significant challenges to spatial perception, interpretation, and behavior for individuals who are blind or visually impaired;  the effectiveness of gloves, hand sanitizers, and hand washing in reducing the risk of touching contaminated surfaces and what, if any downsides, would be associated with such practices; and how the the Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation operates.    In Part 2, they discuss: research involving advanced wearables for sensory deprived patients; the use of other kinds of suitable assistive technology devices; the role of the cerebellum and the cortex regarding critical aspects of functional movement control; the results of a study to determine if native English speakers perform differently compared to non-native English speakers on a sideline-focused rapid number naming task and to characterize objective differences in eye movement behavior between these cohorts; the role of the long white cane as a mobility tool for individuals who have visual impairments and any shortcomings this assistive instrument may have; and any other current research not discussed in this interview, along with any projected vision research at NYU. 

Dr. Rizzo and Dr. Beheshti Part 2: COVID-19 and Visual Disability: Can't Look and Now Don't Touch

 Dr. Mahya Beheshti is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. She has been working at the Visuomotor Integration Laboratory with the focus on eye-hand coordination research as it relates to acquired brain injury. She also collaborates with  the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory where her research involves advanced wearables for sensory deprived patients. Additionally, she is a Mechanical and Aerospace Engineering PhD student at NYU-Tandon. Dr. J.R. Rizzo also is a physician scientist at NYU Langone Health’s Rusk Rehabilitation Institute. He serves as Director of Innovation and Technology for Physical Medicine and Rehabilitation with cross-appointments in the Department of Neurology and the Departments of Biomedical & Mechanical and Aerospace Engineering at NYU-Tandon. He also is the Associate Director of Healthcare for the renowned NYU Wireless Laboratory in the Department of Electrical and Computer Engineering at NYU-Tandon. He leads both the Visuomotor Integration Laboratory and the Rehabilitation Engineering Alliance and Center Transforming Low Vision Laboratory. This is a two-part series. In Part 1, they discuss: how the ability to conduct research has been affected by the arrival of the coronavirus pandemic; possible reluctance of patients to be involved in research that occurs in a clinical setting because of a fear of contracting COVID-19 there; the extent to which delays and postponements have occurred because of disease resurgences; how COVID-19 limitations on touch and physical contact have led to unintended yet significant challenges to spatial perception, interpretation, and behavior for individuals who are blind or visually impaired;  the effectiveness of gloves, hand sanitizers, and hand washing in reducing the risk of touching contaminated surfaces and what, if any downsides, would be associated with such practices; and how the the Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation operates.    In Part 2, they discuss: research involving advanced wearables for sensory deprived patients; the use of other kinds of suitable assistive technology devices; the role of the cerebellum and the cortex regarding critical aspects of functional movement control; the results of a study to determine if native English speakers perform differently compared to non-native English speakers on a sideline-focused rapid number naming task and to characterize objective differences in eye movement behavior between these cohorts; the role of the long white cane as a mobility tool for individuals who have visual impairments and any shortcomings this assistive instrument may have; and any other current research not discussed in this interview, along with any projected vision research at NYU.      

Dr. Rizzo and Dr. Beheshti Part 1: COVID-19 and Visual Disability: Can't Look and Now Don't Touch

RUSK Insights on Rehabilitation Medicine is a top podcast featuring interviews with faculty and staff of RUSK Rehabilitation at NYU Langone Medical Center. These podcasts are being offered by RUSK, one of the top rehabilitation centers in the world. Your host for these interviews is Dr. Tom Elwood. He will take you behind the scenes to look at what is transpiring in the exciting world of rehabilitation research and clinical services through the eyes of those involved in making dynamic breakthroughs in health care.

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RUSK Insights on Rehabilitation Medicine

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