What made you want to work in stroke?
I started my career as a neuropsychologist at the Rusk Institute of Rehabilitation Medicine, NYU Langone, in New York. There I worked with patients with acute illnesses to their brain, traumatic brain injury (TBI), and stroke. There is a lot of overlap between TBI and stroke, both in terms of the sudden onset of disability and in the recovery. In rehabilitation, the focus is always on improving functioning. It is rewarding to work in an area where people are getting better, and to help them maximise their skills as well as process and cope with any remaining disabilities.
What keeps you motivated working with stroke?
A stroke can affect everything in one’s life: physical abilities, cognition, behaviour, emotions, and one’s ability to work or perform daily functions. Further, it can happen to any one of us. Watching patients improve following a stroke and regain their independence is profound and keeps me motivated to work in this field.
What is the inspiration behind your research?
Right now, I am most interested in the capacity to make medical decisions, which I have written about before. The inspiration here is that stroke (and other illnesses and injuries) can affect one’s ability to make informed, reasoned decisions, and this needs to be carefully assessed both for the patient’s safety and so as not to inadvertently rob someone of their autonomy. Another area of interest are potential behavioural sequelae of stroke, such as apathy and abulia, and how these differ from depression. It is sometimes assumed that our patients with stroke are not participating in rehabilitation due to depression, when it may actually be a behavioural symptom due to the stroke itself. These involve distinct neurological mechanisms and are treated differently, so it is important to tease them apart.
What advice would you give to yourself at the start of your career?
This is a good question. I guess I would say that you cannot do everything you want to do all at the same time. I have a lot of interests, but when you spread yourself too thin then nothing gets accomplished, or accomplished well. Hopefully a career lasts a while, so you can take on different things serially, rather than simultaneously. The other thing I would tell myself is that you learn something from everybody, and every patient with whom you work. So, stay open and try to learn the lesson.
Have you had any setbacks in your time working with stroke, if so how did you deal with them?
Yes, I have encountered a couple of situations where the patient, due to their stroke, had some degree of expressive aphasia and I had tremendous difficulty understanding them. This was extremely frustrating for the patient and made my job next to impossible. I initially felt helpless, but learned in these situations to consult with the speech therapist, who could offer suggestions or alternative means of communication. The experts in stroke rehabilitation really work together as a care team, for the benefit of the patients.
What is something you have done in the field of stroke, that you are most proud of?
I have presented on the role of cognitive, functional, and social factors on discharge destination from inpatient rehabilitation for older stroke patients. The results of my studies showed that patients can be physically able to go home, but can still have residual cognitive deficits that preclude them from living independently, especially if they do not have support at home. Thus, these patients ultimately get discharged to another facility rather than to home. At least in the United States, this is a big problem because insurance often will not pay for rehabilitation that is strictly cognitive (meaning they do not require physical therapy), and yet there is a paucity of resources for patients and for families for dealing with neuropsychological deficits in the community. This kind of work is important to call attention to disparities in healthcare.
What is the best quality someone working with stroke can have?
I would say empathy is an important quality working with stroke; being able to really identify with what someone is experiencing. Having patience and good listening skills are essential as well, but they go along with empathy. If you can put yourself in the shoes of someone who suffered a stroke, these are the qualities you would want your treaters and therapists to have.
