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Stroke rehabilitation, we spend a lot of time thinking about what the brain can do and how

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the brain controls movement, but then once people move into their everyday lives, we

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have to think about personal and environmental factors that might affect whether you actually

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move or don't move.

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Hi, I'm Jeff Kozlowski, host of the Next Step podcast at University of Rochester School

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of Medicine and Dentistry, sitting in today for Dr. John Fox.

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Welcome to another episode of Neuroscience Perspectives.

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I'm thrilled to be joined by Dr. Katherine Lange, the Barbara J. Norton Professor of

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Physical Therapy, Professor of Neurology and Occupational Therapy at Washington University

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in St. Louis.

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She is a motor systems neuroscientist and expert physical therapist dedicated to bettering

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the lives of people with stroke and neurological and neurodevelopmental conditions by developing

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effective and efficient rehabilitation.

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She studied the brain as a graduate student and postdoc and its role in motor control

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and upper extremity movement.

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She has a passion for helping people move forward in their career and has been recognized

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for her contributions as a fellow for both the American Society of Neurorehabilitation

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and the American Physical Therapy Association.

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Thank you, Dr. Lange, for taking the time to join us today.

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How are you?

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Thank you for having me.

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Absolutely.

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Welcome back to Rochester.

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So, first, let's start with your research.

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Can you just talk to us a little bit about what you're currently investigating?

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Sure.

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So, I've spent, you know, 25 years studying upper extremity, upper limb movement, looking

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at recovery after stroke and how we can optimize rehabilitation.

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And during this kind of journey, we stumbled on wearable sensors.

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And we started using wearable sensors because we wanted to know what people were doing when

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they weren't in the clinic, when they were outside of the laboratory or the clinic spaces.

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And it turns out that by putting these sensors on people, we're able to measure their movement

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out in the real world.

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And we ended up with a lot more questions than we have answers.

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And so, one of the things that we discovered after running a clinical trial where lots

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of people in the clinical trial got better, it turns out they got better on the tests

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that we gave them in the clinic, but they did not actually use their limb more at home

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as measured with the wearable sensors.

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And that opened up this kind of overwhelming set of questions.

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Like we'd always assumed that because you got better on our in-clinic tests, you would

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get better at home.

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And in fact, as a professor, a person who teaches physical and occupational therapy

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students, I've taught that for a long time.

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And so, this was a real eye-opener.

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And so, we then started a series of investigations asking whether it was just something that

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just happened in our research study.

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Was this unique to the upper limb?

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If we were doing a rehabilitation for the lower limb, like walking training, would we

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see this kind of discrepancy between what people can do in the clinic versus what they

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actually do out in the real world?

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And then, is this unique to stroke?

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So, is this something that just happens with people with stroke or does it happen to other

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neurorehabilitation populations?

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And so, we embarked on a study where we enrolled people that were receiving outpatient physical

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and occupational therapy.

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We tested their abilities in the clinic, and then we tested their abilities outside the

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clinic as they were moving through their episode of care.

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And what we showed was that only about 20 percent actually improved in both how they

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did in the clinic and how they did at home.

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About 80 percent improved in how they did in the clinic.

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And so, we have this discrepancy where we think that we're providing services to help

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people get better, but some of those improvements may not be translating into people's everyday

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lives.

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And so, that was a real eye-opener for us.

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And so, it's not necessarily something that people are not doing when they get home.

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It's just that they're more equipped to do it better in the clinic?

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Well, you can think about it as what you can do versus what you do do.

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So, I could have gotten up this morning, and I could have gone to the U of R track and

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run intervals, an interval workout.

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But I didn't do that.

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And you probably didn't do that either.

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And so, I think what we have to consider is that there, at least with stroke rehabilitation,

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we spend a lot of time thinking about what the brain can do and how the brain controls

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movement.

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But then, once people move into their everyday lives, we have to think about personal and

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environmental factors that might affect whether you actually move or don't move.

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And so, a good example of that would be I can help somebody rehabilitate their walking

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in my clinic that has an even floor, and it's a safe place to walk.

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But if they go home and they don't have a space to walk, either it's unsafe because

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it's a broken sidewalk, or there's too many cars, or there's no sidewalk, or unsafe for

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other reasons, then the services that I've delivered might not be translating out into

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their lives.

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So, these sensors, what else can they be used for?

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So, the beauty of the sensors is they can be used to answer all kinds of questions.

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So, for example, we have a collaboration with Child Psychiatry, and we are putting the sensors

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on infants, and we're looking to characterize motor behavior within the first year of life

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as a potential predictor to the development of autism spectrum disorder.

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When you think about autism, it's actually a collection of kind of endophenotypes that

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go on to be the clinical syndrome.

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And one of those that seems to be very important is actually motor capabilities.

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And so, we've got sensors on infant, six-month-old infant wrists, and it's actually a twin cohort

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design.

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So, we're examining the heritability, the monozygotic twin-twin correlation versus the

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dizygotic twin-twin correlation, and then the stability of those measures over time

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and their ultimate predictive ability for the development of autism or autistic traits.

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So, can you talk a little bit then about sort of the relationship and how physical therapy

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and neuroscience together have sort of helped you in career development or building your

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career?

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Sure.

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So, I think it's helped in a number of ways.

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Having trained first as a physical therapist, as I moved into the neuroscience world, I

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had the perspective of what people with different physical therapy injuries or brain damage

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look like and what the rehabilitation experience was.

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And I think that's a really important, has been a really important factor in helping

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me ask questions as well as communicating to my neuroscience peers about the human

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experience of the conditions that people are studying.

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Likewise, I think as I move in the physical therapy community, having a deep understanding

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of how the brain controls movement, at least what we know so far, and the limits and possibilities

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of that in terms of how that affects rehabilitation has been very important.

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So I've really valued my experience in both worlds.

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I think that has really helped me in my career.

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I know you started in physical therapy, undergrad physical therapy, immediately got a job in

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that space.

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Have you always been sort of interested in the body and movement?

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I've always been interested in the body and movement.

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I grew up in rural Vermont.

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So there's nothing to do in the 1970s in rural Vermont than go outside and play, and ski,

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and skate, and other kinds of activities.

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So we were very active as kids.

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I think there were five of us, so my mom just wanted us out of the house.

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And then I went to school and I became a physical therapist and I thought, oh, I didn't really

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know what it was.

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And then when I got out of school, I swore I was never going back to school like everyone

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else.

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And then two years later, I went back and I got a post-professional master's degree

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because I didn't really know that much about what a PhD was or why I would get one.

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And then about six months into my master's degree, I was like, I really like this academic

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thing and then decided to go on and get the PhD.

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So I did that at Washington University.

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And then I was fortunate enough to come here to the University of Rochester and work with

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Mark Schieber to do a post-doctoral fellowship.

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And when did you think, oh, neuroscience and neuroscience research, that's something that

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I need to learn more about?

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I think that developed through my clinical experiences where I enjoyed interacting with

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people who had different neurological conditions.

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And so one of the things that spurred me to start this research career was as a young

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physical therapist, I would evaluate and treat a patient.

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And patient A would get better and patient B wouldn't.

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And I would have no idea why.

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And was it something I did?

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Was it something in their initial presentation?

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And so I was just curious about how the brain worked and how it repaired itself after injury.

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OK.

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And you talked about your coming here for a post-doc, coming to University of Rochester,

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working with Dr. Schieber.

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And the whole reason you're with us today is Dr. Schieber.

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Can you talk a little bit about that specific post-doctoral experience and sort of what

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lessons you still take with you today and the impact it's had on your work now?

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Sure.

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Doc is an incredibly kind and patient man.

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He's a stickler for precision.

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And so he always wanted to make sure that we use the right words.

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And he wanted us to be very clear in our communication.

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And I think that training in that environment has made me a better science communicator,

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perhaps not in this podcast, but in my writing, which has then allowed me to be successful

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in this career that I've chosen.

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So one is his kind of precision, his patience with us, his humility.

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So he's always just been really interested in the data.

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He's not necessarily interested in showing you that he's the best or that his hypothesis

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has to be correct.

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He's interested in exploring what's in the data that's coming in and really trying to

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understand it.

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And that's been incredibly valuable.

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The one thing I haven't been able to do.

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When you sit with Mark, he rubs his mustache like this.

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I don't know if you've seen that.

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And so my husband has been trying to cure me for 20 years of sometimes I'll sit there

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as I'm thinking hard, I'm like rubbing my upper lip.

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So you pick that up from your mentors too.

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That's interesting.

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We can pick up like ticks and stuff from our mentors.

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I didn't know that.

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You mentioned patience a little there.

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And I'm in preparation for talking to you today.

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I listened to some previous interviews you were on and you've talked about Mark passing

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on that patience and the importance of having patience.

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And that really is, I know especially in research, you're thinking in terms of years down the

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road, not necessarily the next day.

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And you're getting a lot of potentially wrong answers in your research.

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So I'm sure patience is key.

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Is that something you're passing on to your trainees today?

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I try, yeah.

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Patience and then I would add persistence to that.

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So when I was a postdoc, there were a series of things that happened in the lab that made

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it hard to collect data.

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Like an electrode broke and they couldn't get another electrode.

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Or somebody was leaving, he had to train somebody else.

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And so as a grad student and a postdoc, you're always worried about the timing.

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You're like, I gotta get done this.

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I gotta get done that because I need these different markers for my career.

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But he was like, okay, we can handle this.

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And sure enough, we handled it.

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I love that.

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Along those same lines, you mentioned you have a passion for helping your trainees and

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others move forward in their careers.

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Where do you get that dedication to mentorship from?

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I think that comes from the mentors that I've had as well.

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I think that the most rewarding part of this job is not a paper in a particular journal

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or a particular promotion, but actually seeing a young scientist figure out that they can

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do it and that they can be successful.

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So I like that part.

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What do you think is the key to a successful mentee mentor relationship?

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I would say the most important thing is communication.

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And then second to communication would be adaptability or flexibility.

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And so I say that because when I became a PI, I borrowed the traits from my mentors

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that I liked and used those traits.

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And my first PhD student was a lot personally like me, and it worked beautifully.

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And I thought, what a great mentor I am.

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And then subsequent PhD students came along, and I wasn't as good because I was just assuming

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that what worked for me worked for everyone else.

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And that's not the case.

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And so different trainees need different things.

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And they need different things both in terms of how you communicate with them as well as

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different training experiences.

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And so learning to communicate with them to figure out what they want and what their goals

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are and then helping to work with them to adapt the training experience so that we can

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achieve those goals.

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And then again, checking in with them to see, are we achieving these goals?

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Are these still your goals?

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And John, I think would agree.

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I've heard him say, when you talk to folks that mentor and they've had a successful relationship,

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they have to remember, that's what you've done.

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You've successfully mentored one person.

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When you go on to the next one, it could be a very different mentee mentor relationship.

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And one last thing here, I think, and you probably touched on a little bit of this,

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but any kind of final parting thoughts for any trainees that are going through either

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graduate school or postdoc and looking to either get into this field or they're coming

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up on thesis defense and thinking about, I'm getting ready to go into the professional

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world.

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What am I doing?

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Do you have any advice for them?

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You can do it.

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I think a lot of trainees have imposter syndrome.

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And I had this.

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This is actually a great story.

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So when you go through your training, your drafts of your manuscripts get read by your

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mentor multiple times and get marked up and you have to send it back and make it better

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and things like that.

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So the very first paper that I ever put out of the lab as a PI, I was very nervous that

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Mark wasn't reading it or another previous mentor hadn't been reading it.

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And I was like, I just got to send it in.

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It turned out it was a good paper.

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But you feel like you shouldn't be allowed to do this and you feel like you're not quite

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ready, but you really are.

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Yeah.

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And on our podcast that I mentioned we host with alumni, The Next Step, a lot of them

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talk about building that confidence in your competence and knowing that you deserve a

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seat at the table.

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So I think that's great.

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And hopefully our trainees take that to heart.

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You mentioned imposter syndrome.

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Here you are now at the helm of the same PhD program that you went through at WashU as

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director now.

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So that's kind of full circle.

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Can you elaborate on coming back to that a little bit?

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Sure.

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So just for the listeners, I'm a graduate of the PhD program in movement science at

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WashU and now I'm the director of the PhD program in movement science.

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So it's really fun to see all these young individuals coming in and when we have applicants

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coming in for interviews or either informational or the formal interview process, I always

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tell them that they could be me, that I had been through the program and now graduated

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from it.

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I'm also the PI of the T32 that I was a trainee on.

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So that's also a fun situation to be in.

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Yes.

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Yeah.

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That's great.

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Thank you so much Dr. Lang for joining us today.

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I really appreciate it.

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You're welcome.

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Thank you for having me.

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Thank you for having me.