by Eric Topol, MD
BRad BErk And I were classmates at the University of Rochester School of Medicine and Dentistry. It didn’t take long for me—maybe minutes—to know he was one of the smartest people I’d ever met. Our careers as cardiologists have crossed many times over the ensuing forty-five years we’ve known each other. We’ve both had major career changes, some due to opportunities and others due to necessity. But Brad’s career has been nothing short of meteoric. Starting as chief of the cardiovascular division at Rochester in 1998, he became the chair of medicine in 2001 and assumed the role of CEO of the University of Rochester Medical Center in 2006.
But when Brad’s life suddenly changed—after suffering a serious bicycle accident that left him a quadriplegic—that didn’t hold him back.
He made a remarkable recovery and returned one year later to his role as CEO. After many accomplishments, he stepped down in 2015 to found the University of Rochester Neurorestoration Institute. Brad anticipated a dramatic change in neurorehabilitation, beyond the obvious personal meaning. He realized that devices would replace drugs for treatment of many neurological diseases and that these new technologies would promote neuroplasticity and recovery, changing millions of lives.
After his accident, Brad realized there was a paucity of information on the practical aspects of recovery from spinal cord injury, stroke, and traumatic brain injury. That’s why this book he’s written is so important. He refers to these three diseases as acute neurological injuries (ANI), due to their sudden onset and profound impact on daily life. Specifically, he’s recognized the many features common in all ANIs, especially the psychological trauma. Finally, he foresaw the future advances in neurorehabilitation and the need for people to be prepared by keeping themselves as healthy as possible.
I empathize deeply with Brad, especially when it comes to the difficulties of finding proper resources to make decisions about your medical problems. In my most recent book, Deep Medicine, I tell the story of my own rehabilitation after a total knee replacement. I was born with a rare disease called osteochondritis dissecans. But the surgeon who replaced my knee didn’t take my condition into account and prescribed the usual rehabilitation: aggressive movement of the knee to maintain full range of motion. Unfortunately, in my case, this caused reoccurrence of the cartilage and bone damage, leading to scar tissue. Thankfully, I was able to find someone with expertise in developing a rehab program that would work for me. As Brad emphasizes throughout this book, you and your family should be as educated as possible, so you can assemble a team that addresses your problems comprehensively and competently. This book will help you do just that.
A key feature of this book is the identification of similar problems among people who suffer an ANI. In particular, many people experience depression, frequently accompanied by anxiety. The modern-day poster children for ANI are individuals who experience a traumatic brain injury (TBI), such as our soldiers in Afghanistan and Iraq injured by explosive devices, and football players whose brains show evidence of a disease called chronic traumatic encephalopathy (CTE) and who often die by suicide as a result. Brad points out how important it is to treat these twin hurdles of depression and anxiety, so we don’t lose valuable time for rehabilitation immediately after injury.
He also discusses two novel concepts regarding neurorehabilitation: continuous rehabilitation and the use of integrative medicine. The benefit of continuous rehabilitation is evidenced by Brad himself, who chronicles his slow-but-steady improvement in regaining many aspects of his prior life, including sports such as cycling and skiing, and daily physical therapy and exercise. Particularly interesting for me was his discussion of integrative medicine; he recommends incorporating several aspects of traditional Chinese medicine as complements to Western medicine.
While I found the whole book fascinating, the last chapter in part four was the most enjoyable, since my own three books all dealt with how novel technology influences medicine. This is an exciting time for neurorehabilitation, and Brad combines the best elements of the past with a carefully justified focus on future therapies.
While he and I were at the University of Rochester, we were taught the biopsychosocial model of medicine, which emphasizes the critical role of the environment and your mental health in determining illness. When Brad was CEO of URMC, he initiated a patient-and-family-centered care program that focused on compassion and attentiveness. Compassion is the natural feeling that people in health care bring to their patient interaction by showing that they care about them. Attentiveness is how we show compassion. Brad’s book provides healthy amounts of both for patients, families, and providers. The promises of future devices that will enable people to walk—and eventually, to use their brains to control their paralyzed limbs—cannot be considered in isolation. The best practice of medicine remains an art, and Brad has painted an encouraging picture of present and future recovery.
It is an honor to write this foreword. Brad’s book is essential for everyone who has experienced a spinal cord injury, stroke, or traumatic brain injury.
Eric Topol, MD
January 29, 2021
ERic TOpol, MD, is the founder and director of the Scripps Translational Science Institute, a professor of molecular medicine, and executive vice president of Scripps Research. One of the top ten most cited researchers in medicine, Topol was elected to the National Academy of Medicine and has led many of the trials that have shaped contemporary treatment for heart disease. He lives in La Jolla, California.