Stroke rehabilitation, we spend a lot of time thinking about what the brain can do and how
the brain controls movement, but then once people move into their everyday lives, we
have to think about personal and environmental factors that might affect whether you actually
move or don't move.
Hi, I'm Jeff Kozlowski, host of the Next Step podcast at University of Rochester School
of Medicine and Dentistry, sitting in today for Dr. John Fox.
Welcome to another episode of Neuroscience Perspectives.
I'm thrilled to be joined by Dr. Katherine Lange, the Barbara J. Norton Professor of
Physical Therapy, Professor of Neurology and Occupational Therapy at Washington University
in St. Louis.
She is a motor systems neuroscientist and expert physical therapist dedicated to bettering
the lives of people with stroke and neurological and neurodevelopmental conditions by developing
effective and efficient rehabilitation.
She studied the brain as a graduate student and postdoc and its role in motor control
and upper extremity movement.
She has a passion for helping people move forward in their career and has been recognized
for her contributions as a fellow for both the American Society of Neurorehabilitation
and the American Physical Therapy Association.
Thank you, Dr. Lange, for taking the time to join us today.
How are you?
Thank you for having me.
Absolutely.
Welcome back to Rochester.
So, first, let's start with your research.
Can you just talk to us a little bit about what you're currently investigating?
Sure.
So, I've spent, you know, 25 years studying upper extremity, upper limb movement, looking
at recovery after stroke and how we can optimize rehabilitation.
And during this kind of journey, we stumbled on wearable sensors.
And we started using wearable sensors because we wanted to know what people were doing when
they weren't in the clinic, when they were outside of the laboratory or the clinic spaces.
And it turns out that by putting these sensors on people, we're able to measure their movement
out in the real world.
And we ended up with a lot more questions than we have answers.
And so, one of the things that we discovered after running a clinical trial where lots
of people in the clinical trial got better, it turns out they got better on the tests
that we gave them in the clinic, but they did not actually use their limb more at home
as measured with the wearable sensors.
And that opened up this kind of overwhelming set of questions.
Like we'd always assumed that because you got better on our in-clinic tests, you would
get better at home.
And in fact, as a professor, a person who teaches physical and occupational therapy
students, I've taught that for a long time.
And so, this was a real eye-opener.
And so, we then started a series of investigations asking whether it was just something that
just happened in our research study.
Was this unique to the upper limb?
If we were doing a rehabilitation for the lower limb, like walking training, would we
see this kind of discrepancy between what people can do in the clinic versus what they
actually do out in the real world?
And then, is this unique to stroke?
So, is this something that just happens with people with stroke or does it happen to other
neurorehabilitation populations?
And so, we embarked on a study where we enrolled people that were receiving outpatient physical
and occupational therapy.
We tested their abilities in the clinic, and then we tested their abilities outside the
clinic as they were moving through their episode of care.
And what we showed was that only about 20 percent actually improved in both how they
did in the clinic and how they did at home.
About 80 percent improved in how they did in the clinic.
And so, we have this discrepancy where we think that we're providing services to help
people get better, but some of those improvements may not be translating into people's everyday
lives.
And so, that was a real eye-opener for us.
And so, it's not necessarily something that people are not doing when they get home.
It's just that they're more equipped to do it better in the clinic?
Well, you can think about it as what you can do versus what you do do.
So, I could have gotten up this morning, and I could have gone to the U of R track and
run intervals, an interval workout.
But I didn't do that.
And you probably didn't do that either.
And so, I think what we have to consider is that there, at least with stroke rehabilitation,
we spend a lot of time thinking about what the brain can do and how the brain controls
movement.
But then, once people move into their everyday lives, we have to think about personal and
environmental factors that might affect whether you actually move or don't move.
And so, a good example of that would be I can help somebody rehabilitate their walking
in my clinic that has an even floor, and it's a safe place to walk.
But if they go home and they don't have a space to walk, either it's unsafe because
it's a broken sidewalk, or there's too many cars, or there's no sidewalk, or unsafe for
other reasons, then the services that I've delivered might not be translating out into
their lives.
So, these sensors, what else can they be used for?
So, the beauty of the sensors is they can be used to answer all kinds of questions.
So, for example, we have a collaboration with Child Psychiatry, and we are putting the sensors
on infants, and we're looking to characterize motor behavior within the first year of life
as a potential predictor to the development of autism spectrum disorder.
When you think about autism, it's actually a collection of kind of endophenotypes that
go on to be the clinical syndrome.
And one of those that seems to be very important is actually motor capabilities.
And so, we've got sensors on infant, six-month-old infant wrists, and it's actually a twin cohort
design.
So, we're examining the heritability, the monozygotic twin-twin correlation versus the
dizygotic twin-twin correlation, and then the stability of those measures over time
and their ultimate predictive ability for the development of autism or autistic traits.
So, can you talk a little bit then about sort of the relationship and how physical therapy
and neuroscience together have sort of helped you in career development or building your
career?
Sure.
So, I think it's helped in a number of ways.
Having trained first as a physical therapist, as I moved into the neuroscience world, I
had the perspective of what people with different physical therapy injuries or brain damage
look like and what the rehabilitation experience was.
And I think that's a really important, has been a really important factor in helping
me ask questions as well as communicating to my neuroscience peers about the human
experience of the conditions that people are studying.
Likewise, I think as I move in the physical therapy community, having a deep understanding
of how the brain controls movement, at least what we know so far, and the limits and possibilities
of that in terms of how that affects rehabilitation has been very important.
So I've really valued my experience in both worlds.
I think that has really helped me in my career.
I know you started in physical therapy, undergrad physical therapy, immediately got a job in
that space.
Have you always been sort of interested in the body and movement?
I've always been interested in the body and movement.
I grew up in rural Vermont.
So there's nothing to do in the 1970s in rural Vermont than go outside and play, and ski,
and skate, and other kinds of activities.
So we were very active as kids.
I think there were five of us, so my mom just wanted us out of the house.
And then I went to school and I became a physical therapist and I thought, oh, I didn't really
know what it was.
And then when I got out of school, I swore I was never going back to school like everyone
else.
And then two years later, I went back and I got a post-professional master's degree
because I didn't really know that much about what a PhD was or why I would get one.
And then about six months into my master's degree, I was like, I really like this academic
thing and then decided to go on and get the PhD.
So I did that at Washington University.
And then I was fortunate enough to come here to the University of Rochester and work with
Mark Schieber to do a post-doctoral fellowship.
And when did you think, oh, neuroscience and neuroscience research, that's something that
I need to learn more about?
I think that developed through my clinical experiences where I enjoyed interacting with
people who had different neurological conditions.
And so one of the things that spurred me to start this research career was as a young
physical therapist, I would evaluate and treat a patient.
And patient A would get better and patient B wouldn't.
And I would have no idea why.
And was it something I did?
Was it something in their initial presentation?
And so I was just curious about how the brain worked and how it repaired itself after injury.
OK.
And you talked about your coming here for a post-doc, coming to University of Rochester,
working with Dr. Schieber.
And the whole reason you're with us today is Dr. Schieber.
Can you talk a little bit about that specific post-doctoral experience and sort of what
lessons you still take with you today and the impact it's had on your work now?
Sure.
Doc is an incredibly kind and patient man.
He's a stickler for precision.
And so he always wanted to make sure that we use the right words.
And he wanted us to be very clear in our communication.
And I think that training in that environment has made me a better science communicator,
perhaps not in this podcast, but in my writing, which has then allowed me to be successful
in this career that I've chosen.
So one is his kind of precision, his patience with us, his humility.
So he's always just been really interested in the data.
He's not necessarily interested in showing you that he's the best or that his hypothesis
has to be correct.
He's interested in exploring what's in the data that's coming in and really trying to
understand it.
And that's been incredibly valuable.
The one thing I haven't been able to do.
When you sit with Mark, he rubs his mustache like this.
I don't know if you've seen that.
And so my husband has been trying to cure me for 20 years of sometimes I'll sit there
as I'm thinking hard, I'm like rubbing my upper lip.
So you pick that up from your mentors too.
That's interesting.
We can pick up like ticks and stuff from our mentors.
I didn't know that.
You mentioned patience a little there.
And I'm in preparation for talking to you today.
I listened to some previous interviews you were on and you've talked about Mark passing
on that patience and the importance of having patience.
And that really is, I know especially in research, you're thinking in terms of years down the
road, not necessarily the next day.
And you're getting a lot of potentially wrong answers in your research.
So I'm sure patience is key.
Is that something you're passing on to your trainees today?
I try, yeah.
Patience and then I would add persistence to that.
So when I was a postdoc, there were a series of things that happened in the lab that made
it hard to collect data.
Like an electrode broke and they couldn't get another electrode.
Or somebody was leaving, he had to train somebody else.
And so as a grad student and a postdoc, you're always worried about the timing.
You're like, I gotta get done this.
I gotta get done that because I need these different markers for my career.
But he was like, okay, we can handle this.
And sure enough, we handled it.
I love that.
Along those same lines, you mentioned you have a passion for helping your trainees and
others move forward in their careers.
Where do you get that dedication to mentorship from?
I think that comes from the mentors that I've had as well.
I think that the most rewarding part of this job is not a paper in a particular journal
or a particular promotion, but actually seeing a young scientist figure out that they can
do it and that they can be successful.
So I like that part.
What do you think is the key to a successful mentee mentor relationship?
I would say the most important thing is communication.
And then second to communication would be adaptability or flexibility.
And so I say that because when I became a PI, I borrowed the traits from my mentors
that I liked and used those traits.
And my first PhD student was a lot personally like me, and it worked beautifully.
And I thought, what a great mentor I am.
And then subsequent PhD students came along, and I wasn't as good because I was just assuming
that what worked for me worked for everyone else.
And that's not the case.
And so different trainees need different things.
And they need different things both in terms of how you communicate with them as well as
different training experiences.
And so learning to communicate with them to figure out what they want and what their goals
are and then helping to work with them to adapt the training experience so that we can
achieve those goals.
And then again, checking in with them to see, are we achieving these goals?
Are these still your goals?
And John, I think would agree.
I've heard him say, when you talk to folks that mentor and they've had a successful relationship,
they have to remember, that's what you've done.
You've successfully mentored one person.
When you go on to the next one, it could be a very different mentee mentor relationship.
And one last thing here, I think, and you probably touched on a little bit of this,
but any kind of final parting thoughts for any trainees that are going through either
graduate school or postdoc and looking to either get into this field or they're coming
up on thesis defense and thinking about, I'm getting ready to go into the professional
world.
What am I doing?
Do you have any advice for them?
You can do it.
I think a lot of trainees have imposter syndrome.
And I had this.
This is actually a great story.
So when you go through your training, your drafts of your manuscripts get read by your
mentor multiple times and get marked up and you have to send it back and make it better
and things like that.
So the very first paper that I ever put out of the lab as a PI, I was very nervous that
Mark wasn't reading it or another previous mentor hadn't been reading it.
And I was like, I just got to send it in.
It turned out it was a good paper.
But you feel like you shouldn't be allowed to do this and you feel like you're not quite
ready, but you really are.
Yeah.
And on our podcast that I mentioned we host with alumni, The Next Step, a lot of them
talk about building that confidence in your competence and knowing that you deserve a
seat at the table.
So I think that's great.
And hopefully our trainees take that to heart.
You mentioned imposter syndrome.
Here you are now at the helm of the same PhD program that you went through at WashU as
director now.
So that's kind of full circle.
Can you elaborate on coming back to that a little bit?
Sure.
So just for the listeners, I'm a graduate of the PhD program in movement science at
WashU and now I'm the director of the PhD program in movement science.
So it's really fun to see all these young individuals coming in and when we have applicants
coming in for interviews or either informational or the formal interview process, I always
tell them that they could be me, that I had been through the program and now graduated
from it.
I'm also the PI of the T32 that I was a trainee on.
So that's also a fun situation to be in.
Yes.
Yeah.
That's great.
Thank you so much Dr. Lang for joining us today.
I really appreciate it.
You're welcome.
Thank you for having me.