August 2023

VA General- Physical Medicine and Rehabilitation

Judith B. Kosasih, MD. Professor, Department of Physical Medicine and Rehabilitation

Accomplishments and Updates:

VA PM&R program accreditation: In March 2023, the Milwaukee VA Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) successfully completed a CARF survey, leading to another 3-year CARF reaccreditation. Kudos to the exceptional leadership and dedicated rehabilitation team for maintaining this accomplishment since the initial CARF accreditation in 2000.

Growth in virtual care delivery: Our commitment to enhancing care access and delivery is reflected in the continued expansion of virtual clinical services in the interdisciplinary Polytrauma/TBI and Amputation/Prosthetic Clinics. Notably, in the current fiscal year (2023), almost half of the Amputation Clinic appointments/assessments have been conducted virtually. This includes Clinical Video Telehealth (CVT) clinics with Iron Mountain VA, Madison VA and Tomah VA, as well as VA Video Connect (VVC) clinics to patient’s home, community vendors, and other community-based outpatient VA sites. These efforts have significantly facilitated timely prosthetic limb delivery and improved patient experiences.

VA PM&R research activities: Dr. Connelly and his research mentee, Dr. Sharma, have received VA IRB approval for their neuromuscular ultrasound study. They are evaluating the sonographic echo intensity of the APB muscle pre/post-carpal tunnel release surgery. They are actively enrolling patients and completing ultrasound evaluations.

Dr. England remains actively involved in a multicenter research study that examines differences in shoulder pathology using ultrasound among adult and pediatric manual wheelchair users with spinal cord injuries. Data collection is currently underway.

Growth in PM&R’s educational outreach and collaboration: Dr. Connelly and his team presented the “Interdisciplinary Team Approach to Treating Persistent Pain- Functional Rehabilitation Group (FRG) at the Milwaukee VAMC” in a VA grand rounds in April 2023.  This educational session received high praise from VA primary care and subspecialty providers. Dr. Connelly will represent PM&R in the upcoming subspecialty educational sessions for regional VA primary care partners, focusing on spinal stenosis.

VA PM&R faculty sustains commitment in the teaching mission as a primary VA PM&R education site across education levels and specialties including medical students, Geriatric Medicine residents and fellows, Pain Anesthesiology residents, and various Physician Assistant residents. A new initiative in 2023 includes collaboration with Internal Medicine for the VA Medicine Ambulatory Immersion (AI) rotation with Dr. Yacub Martin as a PM&R Point of Contact/Coordinator.

Dr. Yacub Martin was accepted to the 2023-2024 Kern Institute KinetiC3 Excellence in Teaching Track. KinetiC3 is a professional teaching program to enhance one’s professional practice by integrating Character, Caring and Competence.

Dr. Kotsonis has been honored with the 'Robert Boyle Teacher of the Year' award from the PM&R residency class of 2023, marking the eighth time he has received this recognition since 2010!

Updated Masking Guidelines: In response to the evolving Covid restriction, effective May 8, 2023, the Milwaukee VA has introduced new masking guidelines. Masks are now optional for most areas; however, they will continue to be required in high-risk areas, including the inpatient rehabilitation unit. We are pleased to witness the friendly smiles that had been hidden behind masks since 2020.

Karin Goodfriend, MD promoted to Associate Professor

Rounding with the Dean of the School of Medicine

"On Friday, June 9, 2023, I rounded in the Department of Physical Medicine & Rehabilitation. Diane Braza, MD, Chair and Professor, Physical Medicine and Rehabilitation, and her team hosted an inspiring visit at the Froedtert Bluemound Rehabilitation Hospital (10000 W Bluemound Rd, Wauwatosa, WI 53226). During our visit they led me on a tour of the new facility, discussed their upcoming goals and highlighted recent research initiatives."

- Joseph E. Kerschner, MD Provost and Executive Vice President, The Julia A. Uihlein, MA, Dean of the School of Medicine

Full highlights can be found here. 

VA Wheelchair Games in Portland, OR

The National Veterans Wheelchair Games were held in Portland, OR on July 4th-July 9th. Drs. Ken Lee, Beth Weinman, Vaishnavi Muqeet, Lauren Shuda, and Eric Bobel as well as MCW medical students Allyson Gorman and Jessica Liu provided medical coverage for the events while Dr. Christopher White attended as a classifier. Our Wisconsin veteran team (appropriately nicknamed "The Cows" thanks to the New Glarus sponsored shirts) brought home 19 gold, 10 silver and 4 bronze medals between its 14 members, half of which were competing for their first time. 

WASA Eagles take the Championship at Grand Junction

The WASA Eagles wheelchair lacrosse team brought home first place at the inaugural 1^st Annual Frenzy Fest Wheelchair Lacrosse Tournament in Grand Junction, MI, hosted by the Grand Rapids Frenzies and the Mary Free Bed Rehabilitation Hospital on July 15th and 16th. Drs. Ken Lee, Michiko Paschall and Lauren Shuda provided medical support for the team.

Dr. Mary Elizabeth Nelson Presentation at ISPRM in July 2023

Dr. Mary Elizabeth Nelson has been busy with Global health pursuits in her dual role as an MCW faculty and Board member of the International Rehabilitation Forum (IRF). She was recently elected the Vice President of the IRF, Dr. Nelson traveled in June to Cartagena, Colombia to the ISPRM annual meeting and was an organizer and presenter at the pre-conference. This meeting kicked off with a full day pre-conference workshop collaboration between the IRF and CARF.  The workshop goal was to enhance quality rehabilitation care in resource constrained settings and served as a dynamic platform for diverse PRM providers to learn how to develop multidisciplinary teams and develop academic programs to train providers in PRM medicine globally. Significant discussion was held regarding building functional teams, implementation of standards of care, academic capacity building and workforce development as well as the use of communication technology for advocacy.  A short article regarding the workshop is available at https://rehabforum.wpengine.com/news-media/irf-carf-at-isprm2023/ . Additionally, Dr. Nelson participated in a book launch of Author Tom Haig’s memoir "Global Nomad".

Dr. Nelson was again welcomed to the WHO liaison’s meeting during the conference where the team provided annual updates on WHO initiatives for rehabilitation, this year on the tails of the landmark resolution on strengthening rehabilitation in health systems in May!

This year’s ISPRM theme was “New perspectives in Physical Medicine and Rehabilitation for Global Health Challenges”. Keynote speeches addressed the challenges of healthy longevity, evidence in rehabilitation, PRM in low-to-middle income countries, new technology and treatments for peripheral nerve traumas as well as spasticity management, long COVID rehabilitation and the use of wearable devices for rehabilitation. It was a very diverse meeting! IF you have never attended the ISPRM it is a wonderful venue to learn different aspects of rehabilitation care, meet a diverse team of providers from around the globe and gain new perspectives on how to optimize patient outcomes.

In July Dr. Nelson had the honor of representing the IRF at two different meetings at the World Health Organization: The World Health Assembly 3^rd meeting of Rehabilitation 2030 and The World Rehabilitation Alliance (WRA) kick off meeting.  These back-to-back meetings in Geneva, Switzerland at WHO headquarters brought together over 120 rehabilitation professionals from all over the globe to further the work of Rehabilitation 2030 and promote rehabilitation FOR ALL at an international level.  During these meetings there was a focus on implementing Rehab 2030 and promoting rehabilitation as an essential health service. The WHO rolled out their new technical products for rehabilitation and there was work towards the promotion of health systems and policy research regarding rehabilitation, capacity building for rehabilitation services and provider training and inclusion of rehabilitation in disaster planning and integrating rehabilitation services into primary care initiatives. Multiple Ministries of health were present at the meeting and presented the successes and challenges of the initiatives in their countries (such as Ethiopia and Nepal). Dr. Nelson continued her role as representative to the Research Workstream in breakout sessions promoting work to integrate HSPR to enhance rehabilitation on a global level. Individually Dr. Nelson met with Ministry of health officials from Uganda, Tanzania, Ethiopia and Nepal to discuss initiatives in workforce capacity building and other ways to help promote programs in their respective countries.

Please be sure to congratulate Dr. Mary Elizabeth Nelson on this major accomplishment!

Progress in Clinical Motor Control II Conference

Dr. McGuire and his research study team presented on the feasibility, usability, efficacy and implementation of using wearable technology in an inpatient rehabilitation setting among survivors of stroke at the Progress in Clinical Motor Control II Conference on July 13th - July 15th.  It was hosted by the Physical Therapy and Human Movement Sciences Department in the Feinberg School of Medicine at Northwestern University in downtown Chicago. The Wearable team presented 4 posters related to the NICHD grant-funded inpatient study. Presenters were Kim Bassindale (Marquette study team), Sarah Golus (PM&R), Dr. John McGuire (PM&R) and Maureen Winkoski (MCW medical student). Viewers commented on the timeliness of the work given the needs of the field and the cohesive group messaging. Well done Wearable Team!

Posters Presented at PCMC II Conference 

Congratulations Sarah Golus on being promoted to CRC II! 

Thanks to Sarah for all of her dedication and hard work. Please be sure to congratulate her on this well-deserved promotion!

Save the Date - Spine Day 2023 - Friday, 9/22/2023

Please plan to join the Department of Neurosurgery for Spine Day 2023 taking place on Friday, September 22^nd, 2023. The theme for the conference will be “Caring for the Female Spine Patient”. Additional information on registration, additional speakers and their topics, and CME credits will be coming out on InfoScope soon!

July Medical Students

Please welcome the following medical students who joined us in July!

Save the Date - PM&R Summer Picnic - Saturday, August 19th 

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!

Congratulations Dr. Kosasih!

Dr. Kosasih and family are blessed to welcome their first grandchild, Micah Christopher on May 11th, 2023 to Andrew and Claire Kosasih. He is a precious bundle of joy!

PM&R July Photos

Interim Department Administrator Angela Dement's daughter Quinn joined her at Summerfest for MCW’s Employee Recognition event. And later she took her son Silas to his very first concert at Summerfest to see Imagine Dragons. 

The Sytsma family visited my parents in Tennessee on our vacation. We took in a Tennessee Lookouts game (nail bitter 11-10 score!) wearing the all-important Brewers and Milwaukee Milkmen hats. Wisconsin represent! We also visited a Buc’ees. Yes – Buc’ees is everything it is cracked up to be. It is a not-to-be-missed experience. My favorite Buc’ees t-shirt logo: I don’t remember the question, but the answer is Buc’ees.

Department Mascot's Outfit for the Month of August

In honor of the upcoming Wisconsin State Fair, Randy the Rhino shares a photo of his Wisconsin State Fair visit from last summer. 

The answer to the riddle below will be provided in next month's newsletter. This riddle is courtesy of Alan Young, Clinical Research Coordinator:

"What ball can you roll but cannot throw?"

Answer to last month's riddle:  "a choice"

Monthly Wellness Feature: Tips to Prevent Vision Loss

Your eyes are an important part of your health. You can do many things to keep them healthy and make sure you’re seeing your best. Follow these simple guidelines for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases, such as glaucoma, diabetic eye disease, and age-related macular degeneration, often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or widen, the pupil to allow more light to enter the eye—the same way an open door lets more light into a dark room. This process enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you’re seeing your best.

Maintain your blood sugar levels. 90% of blindness caused by diabetes is preventable. Ask your health care team to help you set and reach goals to manage your blood sugar, blood pressure, and cholesterol—also known as the ABCs of diabetes.

• A1c: The goal set for many people is less than 7% for this blood test, but your doctor might set different goals for you.
• Blood pressure: High blood pressure causes heart disease. The goal is less than 140/90 mmHg for most people, but your doctor might set different goals for you.
• Cholesterol: LDL or “bad” cholesterol builds up and clogs your blood vessels. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. Ask what your cholesterol numbers should be.

Know your family’s eye health history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with an eye disease or condition, since many are hereditary. This information will help to determine if you’re at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You’ve heard that carrots are good for your eyes. But eating a diet rich in fruits and vegetables—particularly dark leafy greens, such as spinach, kale, or collard greens—is important for keeping your eyes healthy, too.ⁱ Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you’re having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for the activity in which you’re engaged. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.^{ii, iii}

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This short exercise can help reduce eyestrain.

Clean your hands and your contact lenses—properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate. Learn more about keeping your eyes healthy while wearing contact lenses and listen to a podcast on keeping your eyes safe.

Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times, and encourage your coworkers to do the same!

To find more resources on here

August is National Civility Month, a time to celebrate and recognize the importance of civil behavior in our communities and workplace.

People being civil to other people is what makes the world a whole lot better and is the key focus of National Civility Month, which is held in August each year. This holiday was founded to help the world remember to treat others the way we wish to be treated ourselves — with kindness, empathy, and respect. This month follows a common theme like other similar awareness months centered around civility, including National Win With Civility Month, International Civility Awareness Month, and more.

Other August Celebrations:

• August 7 – Purple Heart Day
• August 9 – International Day of the World’s Indigenous People
• August 13 – Left-Handers Day
• August 17 – Marcus Garvey Day (Jamaican)
• August 19 – World Humanitarian Day
• August 21 – Senior Citizens Day
• August 22 – American Business Women’s Day
• August 26 – Women’s Equality Day

COVID-19 Updates

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, effective immediately. To remain consistent in with 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. 

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