2018 Featured Stories

Richard Wilson, MD, Director of the Division of Neurorehabilitation and Director of Stroke Rehabilitation, was awarded a 5-yr $3.3 million NIH grant to study the effectiveness of peripheral nerve stimulation (PNS) for the treatment of subacromial impingement syndrome (SIS), one of the most common causes of shoulder pain in the general population. 

This multisite, placebo-controlled trial will test the hypothesis that PNS of the axillary nerve with physical therapy (PT) is more effective than PT alone in the treatment of shoulder pain. The secondary objectives are to explore mechanisms of PNS for the treatment of SIS and to determine which characteristics can predict successful treatment outcomes. 

Outcome measures include pain, pain interference with activities of daily living, capacity for activities of daily living, quality of life, shoulder biomechanics and measures of central sensitization. Participants will be followed for 24 weeks after treatment has concluded. 

Trial sites include the MetroHealth Rehabilitation Institute, led by Richard Wilson, MD, and the Vanderbilt Health System, led by Nitin Jain, MD. Dr. Wilson is Associate Professor of PM&R at the Case Western Reserve University School of Medicine and Principal Investigator in the Cleveland Functional Electrical Stimulation (FES) Center. 

Jayme Knutson, PhD, Director of Research for the Department of Physical Medicine and Rehabilitation (PM&R) was awarded a $3.2 million grant from the NIH to evaluate the effectiveness of Contralaterally Controlled Functional Electrical Stimulation (CCFES) for hand recovery following stroke. The MetroHealth System is the lead site on this first multicenter clinical trial of CCFES, a technique developed by researchers at MetroHealth. 

CCFES applies electrical stimulation to weak finger and thumb extensor muscles through surface electrodes, and causes the weak hand to open, a function that is often lost in stroke survivors. The patient controls the intensity of stimulation to their weak hand by wearing a glove with sensors on their unaffected hand. When the patient opens their unaffected hand, a proportionate intensity of stimulation opens their weak hand. CCFES puts the patient back in control of their weak hand, and this may drive changes in the central nervous system that lead to better recovery of hand function. 

Other sites in the study include the Cleveland Clinic (Ela Plow, PT, PhD), the Kessler Institute for Rehabilitation (Anna Barrett, MD) and the Rusk Rehabilitation Institute of New York University (Preeti Raghavan, MD). Co-Investigators at The MetroHealth System include John Chae, MD and Doug Gunzler, PhD. 

Dr. Knutson is Associate Professor of PM&R at the Case Western Reserve University School of Medicine and Principal Investigator and Research Biomedical Engineer in the Cleveland FES Center of the Louis Stokes Cleveland VA Medical Center. 

Mary Vargo, MD, Director of Cancer Rehabilitation and Electrodiagnostic Medicine in the Department of Physical Medicine and Rehabilitation (PM&R), has been promoted to Professor of PM&R at Case Western Reserve University (CWRU). She is the first woman faculty in the department of PM&R to achieve this academic rank, the highest possible at the university.

Dr. Vargo received her bachelor's degree from the University of Pennsylvania and her medical degree from the University of Rochester. She completed her residency in PM&R at the University of Pittsburgh. Dr. Vargo initially joined the PM&R faculty in 1989. After three years at the National Institutes of Health (NIH) Clinical Center, she rejoined the PM&R faculty in 1994. 

Dr. Vargo is nationally recognized for her expertise in cancer rehabilitation. She has served as the Director of the region’s only PM&R based cancer rehabilitation and lymphedema clinic since 2001. In 2007, Dr. Vargo and a team of therapists initiated the breast protocol, where all postsurgical breast cancer patients are referred for rehabilitation services. She also advocated for specialized lymphedema certification for several of our therapists, which has greatly enhanced the quality of clinical services at The MetroHealth System. With improvements in early surveillance and interventions, cancer survival has increased dramatically. This has led to the greater appreciation for the necessity to improve the overall function and quality of life of our cancer survivors, especially with respect to the physical and cognitive sequela of chemo and radiation therapy, surgical interventions, and immobility. 

Dr. Vargo serves on the Cancer Committee, Breast Program Leadership Committee, and Cancer Survivorship Committee at MetroHealth. She also is board certified in Brain Injury Medicine, an expertise she applies to the care of individuals with brain tumor and other neurologic sequelae of cancer, as well as, separate from her cancer rehabilitation focus, to a busy concussion care clinical practice and educational activities within MetroHealth’s brain injury program.

Dr. Vargo’s participation on the Institute of Medicine committee on cancer survivorship led to the publication of “Lost in Transition: From Cancer Patient to Cancer Survivors (2006).” This highly influential work emphasized the importance of physical activity and the need for additional research in cancer rehabilitation. She was the only physiatrist and rehabilitation clinician among invited panelists at the Breast Health Global Initiative in Vienna, Austria, in 2012. The goal of this population health effort was to establish supportive care guidelines for breast cancer patients worldwide. Recommendations were published in 2013. In 2016, Dr. Vargo was an invited participant on a NIH-National Cancer Institute panel on employment issues in cancer survivors.

Greg Nemunaitis, MD, Director of Spinal Cord Injury (SCI) Rehabilitation in the Department of Physical Medicine and Rehabilitation (PM&R), was awarded a $181,000 Craig H. Neilsen Foundation Grant to support two MetroHealth/Case Western Reserve University SCI Medicine Fellows for the 2018-2019 Academic Year. The grant award will be used to produce well-trained physicians with advanced knowledge and competencies capable of addressing the prevention, diagnosis, treatment and management of persons with spinal cord dysfunction in acute, chronic and lifelong phases. The Northeast Ohio Regional Spinal Cord Injury System (NORSCIS) at The MetroHealth System, one of only 14 federally designated SCI Model Systems in the nation, serves as the primary training site. Other training sites include The Cleveland Clinic Foundation and The Louis Stokes VAMC. Dr. Nemunaitis has received nearly $600,000 from the Craig H. Neilsen Foundation since 2011 in support of the SCI Fellowship. Dr. Nemunaitis is Professor of PM&R at Case Western Reserve University and Director of NORSCIS at The MetroHealth System. 

Anthony DiMarco, MD, Professor of Physical Medicine and Rehabilitation, was awarded a 5-year, $2.8 million NIH grant entitled, “Spinal Cord Stimulation: A Novel Method to Restore Breathing in Spinal Cord Injury.” Many patients with spinal cord injuries are dependent on invasive mechanical ventilation to sustain life. These devices are uncomfortable, limit mobility, interfere with eating and sense of smell, and reduce quality of life. New methods are needed to restore breathing utilizing patient's own breathing muscles to address these limitations. Dr. DiMarco’s team will explore new electrical stimulation methods to restore more normal and natural breathing and improve the quality of life of patients with spinal cord injury.

John Chae, MD, Interim Vice President, Research and Chair of the Department of Physical Medicine and Rehabilitation, also serves as president of the Association of Academic Physiatrists (AAP). This nationwide organization is dedicated to advancing the field of physical medicine and rehabilitation (PM&R) through research and education.

The AAP recently honored Dr. Chae at its annual meeting. Attendees saw this video, which highlights his pioneering work and professional accomplishments, and received a copy of the MetroHealth Rehabilitation Institute’s current outcomes report.

Dr. Chae is Medical Director of Neuromusculoskeletal Service at MetroHealth; Director of the MetroHealth Rehabilitation Institute; and a professor of PM&R and biomedical engineering at Case Western Reserve University. He has been a member of the AAP since 1992.