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Charlene E. Hafer-Macko, MD

Academic Title:

Associate Professor

Primary Appointment:

Neurology

Secondary Appointment(s):

Physical Therapy, Medicine

Additional Title:

Associate Professor of Neurology Neuromuscular Neurorehabilitation Divisions

Location:

110 S. Paca Street, 3rd Floor

Phone (Primary):

(410) 328-4323

Fax:

(410) 328-8981

Education and Training

1984-88          Medical Degree, Basic Science Curriculum - Independent Study Program

                       Ohio State University - College of Medicine,

 1988-89         Medical Internship

                       Olive View County Medical Center - Department of Medicine; Los Angeles

                       UCLA/Sepulveda Veterans Administration Hospital, Sepulveda, CA

 1989-92         Neurology Residency

                       University of California at Los Angeles, Department of Neurology,

 1992-93         Clinical Neuromuscular and Electromyography Fellowship

                       University of California at Los Angeles,

 1993-95         Peripheral Nerve and Neuromuscular Disease Fellowship,

                       Johns Hopkins University, Department of Neurology, Baltimore, MD

Biosketch

Major Research Interests:

  1. Inflammatory and metabolic adaptations in skeletal muscle after hemi-paretic stroke: Research investigates whether inflammation and oxidative injury are pathologic mechanisms responsible for sarcopenia, phenotypic alterations, and high prevalence of  diabetes and insulin resistance across the subacute into chronic phase of recovery from hemiparetic stroke.

    Mechanistic research investigates exercise-mediated adaptations in skeletal muscle using proteomic strategies, phosphorylation state, and enzymatic assays to identify protein alterations, novel proteins, levels oxidative injury, activation of specific signaling pathways differentially in the paretic and non-paretic thigh muscles after stroke. Genomic and DNA methylation strategies demonstrates that the skeletal muscle gene pathways altered following stroke are distinct from exercise mediated recovery mechanisms.

    Rehabilitation research explores the exercise timing, dose and specificity (aerobic, resistive training, task-relevance, and motor learning) that mediate adaptations in skeletal muscle and systemic metabolism to improve functional performance, cardio-vascular disease risk profile, and brain health (cognitive motor and executive function). 
  2. Exercise to improve function, cardiopulmonary health, and quality of life in adults with myasthenia gravis (MG). Research explores the factors that contribute to fatigue in myasthenia gravis and seeks to improve the chronic disease management strategies for myasthenia gravis patients. A comprehensive disease-specific  multi-modal (pulmonary, aerobic, and resistive / dynamic balance) exercise program has been designed to address the disability and health consequences of myasthenia gravis and medication side effect profile. Exercise and education program are designed to improve fitness, strength, endurance, functional performance, body composition, and cardio-metabolic health. New tele-health platform broadens the dissemination of this program.
  3. Health Education & Active Lifestyle Tele-rehabilitation at Home (HEALTH) began as an Veterans Administration, funded Office of Rural Health clinical demonstration program that implements a home-based exercise and wellness program to broaden outreach to our Veterans, thus filling a rehabilitation resource gap and optimizing chronic disease management of stroke for older Veterans living on Maryland’s rural Eastern Shore. We adapted our center-based group deficit-severity adjusted, task-oriented exercise rehabilitation model that synergizes locomotor task aerobic training with multi-segmental motor control and functional resistive training to improve gait and balance to be delivered safely by tele-health in the home.

    We have test piloted our innovative, scalable technology delivered on a low cost electronic tablet in two disability populations, stroke and myasthenia gravis. Our Interactive Video Exercise Tele-rehabilitation (IVET) has performance- and compliance-based progression exercise prescriptions tailored to each subject’s deficit severity to maximize safety, compliance, and physical function. IVET enables clinicians and therapists to individualize prescription: selection of progression level for each exercise (challenge); 2) assignment of movement repetitions and avatar pace/metronome cadence (dosage); 3) specification of sequence in which the exercises are performed (to minimize fatigue, maximize motivation for subjects); and 4) clamped avatar speed (% default, user can dial up- or down speed for their optimal comfort).

    The video capture of subjects at home allows a virtual therapist to monitor home exercise compliance and safety. Furthermore, this platform also provides patient-centered chronic disease and cardiovascular risk factor management coaching and weekly patient education modules and tutorials to engage subjects in healthy lifestyle modification training activities that will establish long-term health behaviors. There are no tele-rehabilitation programs or technologies that afford such a level of flexibility for tailored prescription or patient-therapist interaction.

Research/Clinical Keywords

myasthenia gravis, Neuromuscular disorders

Highlighted Publications

Serra MC, Hafer-Macko CE, Ryan AS. Reduced Resting Metabolic Rate in Adults with Hemiparetic Chronic Stroke. J Neurol Neurophysiol. 2015 Dec 22;6(6). PMID: 26973796

Ortmeyer HK, Ryan AS, Hafer-Macko C, Oursler KK. Skeletal muscle cellular metabolism in older HIV-infected men. Physiol Rep. 2016 May;4(9). PMID: 27166139
 
Forrester LW, Roy A, Hafer-Macko C, Krebs HI, Macko RF. Task-specific ankle robotics gait training after stroke: a randomized pilot study. J Neuroeng Rehabil. 2016 Jun 2;13(1):51. PMID: 27255156

Additional Publication Citations

Naumes J, Hafer-Macko C, Foidel S. Exercise and Myasthenia Gravis: A Review of the Literature to Promote Safety, Engagement, and Functioning. Int J Neurorehabilitation Eng 2016, 3: 218. Direct URL: http://dx.doi.org/10.4172/2376-0281.1000218

Ryan AS, Li G, Hafer-Macko C, Ivey FM. Resistive Training and Molecular Regulators of Vascular-Metabolic Risk in Chronic Stroke. J Stroke Cerebrovasc Dis. 2016 Dec 9. pii: S1052-3057(16)30451-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.003. PMID: 27955950 [Epub ahead of print]

Ivey FM, Prior SJ, Hafer-Macko CE, Katzel LI, Macko RF, Ryan AS. Strength Training for Skeletal Muscle Endurance after Stroke. J Stroke Cerebrovasc Dis. 2016 Nov 16. pii: S1052-3057(16)30420-7. PMID: 27865696 [Epub ahead of print]

Macko RF, Forrester T, Francis P, Nelson G, Hafer-Macko C, Roy A. Interactive Video Exercise Tele-Rehabilitation (IVET) for Stroke Care in Jamaica. IEEE-NIH Special Topics Conference on Health Care Innovations and Point-of-Care Technologies, 2016. [Epub ahead of print]

Hafer-Macko C, Naumes J, Macko R, Roy A. IEEE Proceedings, “Technology Platform for Tele-Rehabilitation Implementation in Mysathenia Gravis at the Point-Of-Care,” IEEE-NIH Special Topics Conference on Health Care Innovations and Point-of-Care Technologies, 2016. [Epub ahead of print]

Barton JE, Graci V, Hafer-Macko C, Sorkin JD, F Macko R. Dynamic Balanced Reach: A Temporal and Spectral Analysis Across Increasing Performance Demands. J Biomech Eng. 2016 Dec 1;138(12). PMID: 27551977

Ryan AS, Ivey FM, Serra MC, Hartstein J, Hafer-Macko CE. Sarcopenia and Physical Function in Middle-Aged and Older Stroke Survivors. Arch Phys Med Rehabil. 2016 Aug 13. PMID: 27530769

Serra MC, Balraj E, DiSanzo BL, Ivey FM, Hafer-Macko CE, Treuth MS, Ryan AS. Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke. Top Stroke Rehabil. 2017 Jan;24(1):18-23. PMID: 27322733

Forrester LW, Roy A, Hafer-Macko C, Krebs HI, Macko RF. Task-specific ankle robotics gait training after stroke: a randomized pilot study. J Neuroeng Rehabil. 2016 Jun 2;13(1):51. PMID: 27255156

Ortmeyer HK, Ryan AS, Hafer-Macko C, Oursler KK. Skeletal muscle cellular metabolism in older HIV-infected men. Physiol Rep. 2016 May;4(9). PMID: 27166139

Serra MC, Hafer-Macko CE, Ryan AS. Reduced Resting Metabolic Rate in Adults with Hemiparetic Chronic Stroke. J Neurol Neurophysiol. 2015 Dec 22;6(6). PMID: 26973796

Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis. 2015 Nov;24(11):2539-46. PMID: 26303787