Traditional rehabilitation models often do not incorporate aerobic exercise as a core component. Jonathan H. Whiteson, MD, associate professor of medicine and rehabilitation medicine, vice chair of clinical operations, and medical director of Cardiac Rehabilitation, believes models that do can yield dramatic improvements even in highly complex cases.
In one such case, doctors at NYU Langone Health initially diagnosed a 32-year-old woman with viral cardiomyopathy. Her deteriorating condition led to heart failure, and doctors listed her for a heart transplant. In the interim, cardiologists decided to implant a defibrillator and a left ventricular assist device (LVAD).
Rusk Rehabilitation was involved with the patient’s inpatient care every step of the way, including providing bedside physical therapy and occupational therapy to help her gain strength before the LVAD placement.
Her case was further complicated when she had a significant right middle cerebral artery stroke before her transplant.
In April 2018, after the patient’s post-stroke condition had stabilized, Nader Moazami, MD, professor of cardiothoracic surgery and surgical director of heart transplantation and mechanical circulatory support at NYU Langone’s Transplant Institute, successfully performed a heart transplant.
One month later, the patient was referred to Rusk Rehabilitation and enrolled in its inpatient cardiac rehabilitation program. She received speech and cognitive therapy and basic range of motion and strength therapy, and eventually graduated to treadmill- and bicycle-based aerobic exercise as a key element of her rehabilitation.
This exercise regimen can do far more than strengthen weak muscles and improve endurance after a disease or injury, Dr. Whiteson says. “At a neurochemical level and a cellular level, aerobic exercise enhances the traditional rehabilitation recovery rate,” he says.
It also provides significant cognitive benefits. Accordingly, he and his colleagues are working to expand the role of aerobic exercise not just in cardiac and pulmonary rehabilitation but also in rehabilitation across the disease spectrum. “There’s a growing amount of evidence that from a cellular level to an organ system and physiological level, aerobic exercise is key to a patient’s rehabilitation and may make a tremendous difference in the course of disease: in cancer, in brain injury, in stroke, and so on,” he says.
Engaging Rehabilitation Patients for Long-Term Recovery
Dr. Whiteson says the inpatient referral to Rusk Rehabilitation has played a major role in the patient’s impressive recovery. The heart transplant had left her with generalized weakness, and the stroke had left her with left-sided weakness and mild to moderate confusion and agitation.
Cardiac rehabilitation improved her general weakness, and stroke rehabilitation improved her left-sided strength and coordination. She also received cognitive rehabilitation through psychological, speech, occupational, and physical therapy.
In particular, though, the patient made significant strides in her cognitive, focal, and generalized weakness through daily aerobic exercise, which was gradually increased in both duration and intensity, Dr. Whiteson says. “She did so well that she was able to continue her rehabilitation as an outpatient.”
Discharged in September 2018, the patient is still enrolled in Rusk’s outpatient cardiac rehabilitation program, where she is working to fully regain her strength and cognitive abilities. She has markedly improved her physical aerobic conditioning and endurance on a bicycle, a treadmill, and other aerobic machines. Dr. Whiteson says she has done so well that she is now considered independent and ready to resume a normal life.
In an effort to keep patients engaged well beyond their graduation from cardiac rehabilitation, Dr. Whiteson and his colleagues are developing an online educational program designed to help physiatrists maintain a post-rehabilitation relationship with their patients.
Physiatrists plan to send their patients regular advice, videos, and articles on nutrition, exercise, stress management, and other facets of a sustainable, heart-healthy lifestyle.
To create this program, the team is collaborating with The Monday Campaigns, a nonprofit public health initiative that delivers messages and encouragement every Monday morning.
Kimberly S. Glassman, PhD, RN, NEA-BC, Lerner Director for Health Promotion, is spearheading the initiative at NYU Langone, which has begun with cardiac rehabilitation patients and includes a study to examine both the uptake and impact of the initiative.
NYU Langone’s integrated team approach to rehabilitation, representing multiple specialties and disciplines, is helping the medical center deliver exemplary outcomes for the most vulnerable patients, says Dr. Whiteson.
NYU Langone’s involvement in the patient’s remarkable recovery after a stroke and heart transplant did not end with just her physical improvements. A Rusk Rehabilitation vocational counselor is now helping to prepare her to reenter the workforce.