May 2024

Spasticity 

John McGuire, MD, Professor

The past year for the comprehensive spasticity management program was one of transition, resilience, and celebration. As we look back on the past year, we have been continually adapting to change. Besides keeping busy in clinic and doing inpatient consults, we continue with our teaching and research efforts. 

We currently have three active clinical trials, five grant funded studies, five minimal risk enrolling studies, and one chart review study, totaling 15 different studies in our spasticity group. This past year, I completed data collection on a Phase II study sponsored by Saol Therapeutics in collaboration with TIRR on the use of a novel phenol product for the treatment of spasticity. Additionally, recruitment for my NIH R21 Wearable study has been completed and we are in the data analysis phase.

We celebrated the arrival of Drs. McGonigle and Ketchum’s beautiful baby boy, Conor. He was so excited to get started, that he was born seven weeks early. We look forward for Dr. McGonigle’s return. Dr. Ketchum will be pursing new challenges by joining former fellow, Dr. Chris Cronsell, in private practice. Dr. Ketchum is an exceptional clinician, teacher, researcher, and colleague who will be sorely missed, but we are grateful for all he did to help make our program an international leader in comprehensive spasticity management.

I unfortunately had to experience life on the other side of the stethoscope. Due to an unknown illness, I had to be out on medical leave for six weeks. Since it didn’t kill me, I am now almost fully recovered, and it will only make me stronger. Thank you everyone for chipping in and helping take care of my patients throughout my unexpected absence.

Dr. Goodfriend continues to see patients in the spasticity clinic and has increased her research efforts as Investigator in multiple clinical trials. This past year, Dr. Shah has spent between Spine Care Clinic and FMLH. Come July, Dr. Shah will be transitioning to main campus full time. Dr. Nelson-Biersach was nominated to the International Society of Physical and Rehabilitation Medicine’s WHO-Liaison Committee (ISPRM-WHO-LC). In June, she will head to Ghana to finish up data collection for a SCI registry.

As medicine advances, so do our treatment options. We plan to start working on a cryoneurolysis clinical trial this year, in addition to adding it to our clinic treatment options. This technique uses liquid nitrogen to freeze the targeted nerve to the spastic muscle. This is an exciting potential breakthrough treatment, as this is the first new spasticity treatment in 30 years.

Looking ahead to July, we look forward to welcoming two new additions to the team. Dr. Lauren Shuda, who is no stranger to the department, will start as an Assistant Professor specializing in spasticity management. Dr. Shuda is finishing up her SCI fellowship at MCW. Additionally, we will welcome our 16^th fellow into the program, Dr. Angela Taylor. Dr. Taylor is coming to us from Temple/Moss Rehab and is a native of Michigan.

 A Farwell to Dr. Oksana Sayko 

Dr. Oksana Sayko will be leaving MCW early May to pursue her career elsewhere. Dr. Sayko joined the MCW PM&R Department in 2004 and devoted much of her clinical and teaching career to the inpatient FH PM&R consult service, electrodiagnostic medicine and cancer rehabilitation. She also served as the director of undergraduate PM&R medical education from 2006-2014, and medical director of our PM&R clinic from 2017-2019. Her educational contributions include serving as the FH consult rotation director since 2017, leading PM&R resident didactics in “Cancer, Cardio-Pulmonary and Burn Didactics”, and teaching medical students. Since 2011, Dr. Sayko provided electrodiagnostic medicine and teaching at the VA once a week. Dr. Sayko served on the MCW Admissions Committee, MCW Faculty Council and MCW Global Health Committees. Dr. Sayko was promoted to Associate Professor rank in the Clinician Educator pathway in 2014. Her career at MCW facilitated the achievement of AANEM Electrodiagnostic Lab Accreditation for our FH EMG lab. Dr. Sayko has been involved nationally with AANEM by serving as a member of the Electrodiagnostic Lab Accreditation Committee and a member of the Scientific Abstracts committee. Internationally, Dr. Sayko recognized the tremendous need for rehabilitation in the Ukraine as a result of war. 

"Dr. Sayko,

We are grateful for your clinical care, teaching, education, and importantly, for teaching us about international rehabilitation needs in the Ukraine! Your dedication to international service is so evident by your leadership in global health prior to and during the current invasion of the Ukraine. We wish you the best and we will miss you!"

Sincerely,

Diane W. Braza, MD
Professor and Chair, Physical Medicine and Rehabilitation

Dr. Orr's Future Plans

After completing his internship at Saint Joseph’s Hospital Catholic Health Partners in Chicago, Il., he completed his PM&R residency at Medical College of Virginia. Dr. Orr then pursued a SCI fellowship at Hunter Holmes McGuire VAMC in Richmond, Virginia. He was recruited to MCW and joined the PM&R faculty in Sept. 2005, as Assistant Professor.  During his career at MCW, he worked clinically at FH and VAMC. Notably, Dr. Orr served as FH Medical Director Spinal Cord Injury Rehabilitation since 2017. Under his leadership, significant advancements were made to improve quality of care delivered to individuals sustaining spinal cord injury, including optimization of neurogenic bowel and bladder programs, and opioid weaning.  In July 2022, Dr. Orr was one of our inaugural PM&R faculty to work full-time at Froedtert Bluemound Rehabilitation Hospital.  

Dr. Orr served on MCW’s Diversity and Inclusion Advisory Committee since 2017 and was the PM&R department’s patient safety and quality officer (PSQO) since 2017. Between 2005-2010, Dr. Orr was the president of Victims of Intense Crimes Embracing Others, Inc. (VOICE).

I am very grateful to Dr. Orr for his many clinical, education, and administrative contributions to MCW, VAMC, FH and PM&R over his notable career here and wish him the very best in his future endeavors.

Jason and I will be working with Dr. Park and our PM&R faculty to develop a plan for interim inpatient coverage at FBRH, and also pursue faculty recruitment for this important subspecialty in PM&R."

 

Sincerely,

Diane W. Braza, MD
Professor and Chair, Physical Medicine and Rehabilitation

Congratulations to Dr. White on his Re-election! 

Celebrating our PM&R Department Administrators 

New Updates In Research

New staff:

Amanda Wietrzny joins the PM&R Department as a first-year PhD Candidate in Dr. Matt Durand’s laboratory. She recently graduated from Wisconsin Lutheran College with a B.S. in Biology. 

Presentations:

PM&R faculty were listed as authors on a number of recent presentations at national conferences:

Gill J, Ward A, Rogers K, Glad B, Lee K, Goodfriend K, Schindler-Ivens S, Nemanich, S. “Quantification of bilateral coordination patterns and relationship to ADL performance in children with hemiparetic cerebral palsy”. American Occupational Therapy Association Annual Meeting. Orlando, FL, March 20-22, 2024.

Durand MJ, Nguyen JN, Whitaker-Hilbig A, Jaramillo-Torres MJ, O’Connel E, Freed JK. High Intensity Interval Exercise Causes Acute Microvascular Dysfunction in Elderly Individuals with Low Cardiorespiratory Fitness - A Pilot Study. American Physiological Society Annual Summit. Long Beach, CA, April 4-7, 2024.

Zhou Z, Klevenow E, Adam M, Schmit BD, Durand MJ, Hunter S, and Hyngstrom AS. Ischemic Conditioning Reduces Neuromuscular Fatigability During Dynamic Exercise Post Stroke. American Physiological Society Annual Summit. Long Beach, CA, April 4-7, 2024.

Hughes W, Nguyen JN, Mcintosh JJ, Freed JK, Beyer AM, Durand MJ.  Divergent Vasodilator Mechanisms to Endothelial-Dependent Agonists with Advancing Age. American Physiological Society Annual Summit. Long Beach, CA, April 4-7, 2024.

Whitaker-Hilbig A, Nguyen JN, Hyngstrom AS, Durand MJ.  Ischemic Conditioning Improves the Microvascular Hyperemic Response to Passive Limb Movement in Young Adults. American Physiological Society Annual Summit. Long Beach, CA, April 4-7, 2024.

Kohen KE, Bordas-Murphy H, Durand MJ and Freed JK. Sphingosine-1-Phosphate Promotes Resiliency to External Stress in the Human Microvasculature. American Physiological Society Annual Summit. Long Beach, CA, April 4-7, 2024.

Publications:

Hyngstrom AS, Nguyen JN, Gutterman DD, Schmit BD, Klevenow EA, Durand MJ. Non-Invasive Estimation of Skeletal Muscle Oxygen Consumption Rate and Microvascular Reactivity in Chronic Stroke Survivors using Near Infrared Spectroscopy. J Appl Physiol (1985). 2024 Apr 11. doi: 10.1152/japplphysiol.00093.2024. Epub ahead of print. PMID: 38601999.

Featured Study of the Month:

The featured study for this month is the SPIO study “Assessing functional improvements with use of the SPIO® Core-MAX® Expedition TLSO”. The purpose of this study is to assess functional improvements with the use of SPIO® Core-MAX® Expedition thoracolumbosacral orthosis (TLSO) in subjects with neuromotor control issues. Subjects will complete baseline assessments and follow up assessments at 3, and 6 months. Stacy Stibb is the PI, and Sarah Golus is the lead coordinator on this project. PM&R started enrolling in this project in February 2024 and has enrolled in 6 subjects to date. The research team hopes to enroll 24 more participants in this study over the next year and a half. Currently this study is recruiting from PM&R peds outpatients, so if you see a patient aged 6 months to 18 months age corrected with abnormal muscle tone and you think might benefit from an orthotic vest (whether the family chooses to use one or not!), please send them our way! 

MCW/Marquette Research Earth Day MKE River Cleanup

Some of the research crew celebrated earth day with the Milwaukee Riverkeepers Cleanup on Saturday, April 20^th.  Overall, they had 4450 people come out to remove over 100,000lbs of trash.

Research Department Celebrates National Exercise Day

Above is a photo of the research crew. April 18^th was National Exercise Day. The research team went around the department and clinic, giving people the opportunity to spin the exercise wheel to encourage movement. Shout out to everyone who participated!  

PM&R National Pet Day Photos 

In honor of 'National Pet Day' on April 11th, we asked the PM&R Department to share photos of their pets! 

PM&R Philanthropy Case 

Please contact Meg Bilicki, Senior Director of Development  mbilicki@mcw.edu or Dr. Braza dbraza@mcw.edu for more information.

To support Physical Medicine and Rehabilitation click on this link!

Department Mascot's Outfit for the Month of May

For the month of May our department mascot 'Randy the Rhino' shares a photo of himself visiting his mother Rhonda on Mother's Day.

The answer to the riddle below will be provided in next month's newsletter. See if you can solve this following riddle:

Before Mt. Everest was discovered, what was the highest mountain in the world?

Answer to last month's riddle: The anwser is "SEE O DOUBLE YOU" 

Monthly Wellness Feature: Ways To Close The Door To Negative People

We may all encounter negative people from time to time. In some situations, reaching out to see if there are certain circumstances causing the negativity can be helpful. Sometimes, though, it can be better to create some space or simply walk away from the relationship for the time being. If that’s not possible, you might set healthy boundaries and model positive behavior. It can also be wise to take some time for introspection and to try not to take others’ negativity personally. A licensed therapist may be able to help you gain insight into the situation and cope with any challenging feelings you may be experiencing due to the negativity.

Reach out

The first, and perhaps most important, thing to do if you find that a friend has been overly negative lately may be to ask your friend what's going on. If this isn't typical behavior for them, or you've noticed this change over time, there is likely something behind the negativity. You may want to rule out any challenges that may be causing this individual to act out. This could include any mental health concerns, like depression, or other circumstantial elements contributing to persistent pessimism. Reaching out to your friend may help them feel comfortable opening up and could be the first step toward healing.

Be honest

If you plan to reach out, try to be gentle but honest about how this person’s actions are affecting you and others. While it can be hard to be so vulnerable with someone who is causing you pain (especially if you think they may react poorly), this type of honesty is often the best policy. To make the conversation less painful, try to use "I-statements" when talking to them. 

Walk away

If the above tactics aren't getting you anywhere, and you feel as though the friendship is bringing too much negativity to your life, it might be time to let it go. The easiest way to remove a negative person may be to simply walk away. By walking away, you may take away this person’s audience and remove yourself from their influence. This doesn’t necessarily have to be a permanent measure, either. However, if the negative person in your life is a parent, sibling, colleague, or someone else you simply cannot avoid, this tactic may not be an option.

Create space

Slowly distancing yourself from the negative person is often the least painful choice. Just walking away may create a rift and potentially lead to confrontation. By creating space between the two of you, you may no longer be affected by their negative energy or constant complaints. If you still feel the need to see them from time to time, you could try limiting your interactions.

Set boundaries

We usually teach people how to treat us. By accepting certain behaviors, you may be telling someone that you are okay with how they are acting toward you. Boundaries can be set in many ways. You can be honest and tell them that you are not willing to hear such negativity all the time, so in the future, you will simply walk away when they’re being negative. 

Model the desired behavior

Much like we can teach people how to treat us, we may also teach people how to behave through our own behavior. If you speak positively, refuse to gossip, and generally act upbeat and happy around your negative friend, you may find that they fall into step with your actions. Alternatively, they may become more aware of how negatively they are behaving by comparison and choose to actively adjust their behavior.

Take a look at yourself

If you have a friend who drags down every interaction you have, it might be worthwhile to take a look at yourself. Are you also being negative without realizing it? Are you surrounding yourself with angry, belligerent people? Take a moment to consider whether you could be part of the problem. As difficult as it may be, this self-reflection could be beneficial in the long run.

Don't take things personally

It can be easy to take negativity personally, but in all likelihood, it isn’t about you. Negative people can have many reasons for their negativity. Still, if they are always acting out in this manner when they’re around you, it can be important to remind yourself that it isn't your fault. Not being able to fix another person’s negativity usually isn't your fault, either. If you've tried to reach out before and they haven't accepted your help, you may need to accept that there is nothing more that can be done unless they want to work on it themselves.

Takeaway

It may be impossible to completely avoid negative people in life, so it can be helpful to know potential strategies to manage negativity. If you don’t necessarily have to be around a negative person, walking away can be a simple solution. However, if the negative person in your life is a friend or family member, you may wish to ask them if anything is bothering them. You could also model positive behavior, set healthy boundaries, or create a bit of space in the relationship. It may be worth considering whether you could be contributing to the negativity in any way as well. Working with a licensed therapist in person or online may help you manage the situation appropriately and provide support as you discuss your thoughts and feelings.

Healthy Recipie of the Month - Lemon Parmesan Kale Salad

INGREDIENTS:

• 4 cups curly kale
• 2 TBSP fresh lemon juice
• 2 TBSP extra virgin olive oil
• ¼ tsp fresh minced garlic
• ¼ tsp salt
• ⅛ tsp black pepper or to taste
• ½ cup croutons (homemade or store bought)
• ¼ cup freshly grated Parmesan cheese

DIRECTIONS:

• If starting with a bunch of curly kale, wash, dry, and remove leaves from stem.

• Finely chop kale leaves and add to a medium-large bowl.

• Whisk together dressing ingredients and drizzle a teeny bit (around 1/2 tsp) onto the kale leaves.

• Mix onto kale leaves thoroughly.

• Toss with remaining dressing and top with freshly grated parmesan cheese.

• Place croutons in a plastic bag or between two paper towels. Use the bottle of olive oil to crush into small panko-sized pieces to sprinkle over the kale salad. 

Recipe submitted by department Administration Assistant Sr. Rhiannon Shewczyk 

*If you would like to share a favorite healthy recipe in next month's newsletter please email Rhiannon Shewczyk at Rshewczyk@mcw.edu

May is ALS Awareness Month

ALS Awareness Month is a campaign to spread awareness of and raise funds for research for a cure for ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig’s Disease). ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. 

Month-long Observations:

• Haitian Heritage Month
• Indian Heritage Month
• Jewish-American Heritage Month
• Mental Health Awareness Month
• National Asian American and South Pacific Islander Heritage Month
• Older Americans Month
• South Asian American Heritage Month

Important May DE&I calendar dates:

• May 5 – Cinco de Mayo
• May 5 – Yom Hashoah (Jewish)
• May 12 – Mother’s Day
• May 17 – International Day Against Homophobia, Transphobia and Biphobia
• May 19 – Malcolm X Day (USA)
• May 20 – Victoria Day (Canada)
• May 20 – International Human Resources Day
• May 21 – World Day for Cultural Diversity for Dialogue and Development
• May 23 – Declaration of the Bab (Baha’i)
• May 26 – Arbor Day
• May 29 – Ascension of Baha’u’llah (Baha’i)
• May 27 – Memorial Day

PM&R Book Club 

If you have any questions please email Dr. Charlotte Ball at chball@mcw.edu. 

COVID-19 Guidelines 

Both Froedtert and MCW employees with an approved COVID-19 vaccination exemption are no longer required to wear masks at Froedtert & MCW facilities except when and where masks are required for all. To remain consistent within all adult clinical spaces, MCW clinics will follow this same guidance. Masks have not been required for unvaccinated individuals in MCW non-clinical spaces since October 2022.

The COVID-19 vaccine requirement was discontinued for employees effective on June 13, due to recent guidance from the CDC and Centers for Medicare and Medicaid Services (CMS). COVID-19 vaccinations and boosters will continue to be strongly recommended, but not required as a condition of employment with MCW.  Vaccination will continue to be required for students and learners who participate in clinical care due to many healthcare partners who have not yet lifted their COVID-19 vaccine requirement. This requirement is being actively re-evaluated as a high priority, and we will provide follow-up information as soon as feasible. Individuals who work in partner healthcare facilities that require vaccination must also continue to follow the guidance and requirements of those facilities. 

For additional information visit the COVID-19 page on infoscope. 

Medical College of Wisconsin |  8701 Watertown Plank Road  |  Milwaukee, WI 53226
You are receiving this email because you are subscribed to PM&R emails.
 © 2022 Medical College of Wisconsin. All rights reserved.

MCW.EDU     |     INFOSCOPE     |     CONTACT US

Connect to MCW on Social