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Richard F. Macko, MD

Academic Title:

Professor

Primary Appointment:

Neurology

Secondary Appointment(s):

Physical Therapy, Medicine

Additional Title:

Director of the VA Rehabilitation Research and Development Center of Excellence in Exercise and Robotics; Associate Director of Research for the GRECC

Location:

Baltimore VA Medical Center,

Phone (Primary):

(410) 605-7063

Fax:

(410) 605-7913

Education and Training

1975-1979        Hiram College, Hiram OH; B.A. in Biology, Psychobiology, and General Science

 

1979-1983        Research Assistant: Case Western Reserve University Neurosurgery Dept.; Focus - Therapeutics models in acute ischemic stroke.

 

1983-1987        Ohio State University, Columbus, OH; Medical School; Basic Science - Independent Study

 

 

POST GRADUATE EDUCATION AND TRAINING

 

1987-1988        Riverside Methodist Hospital, Columbus, OH

Internship in Internal Medicine

 

1988-1991        UCLA Neurology, Los Angeles, CA; Neurology Residency

 

1991-1993        Stroke Fellowship; University of Southern California School of Medicine, Los Angeles, CA. Mentor Mark Fisher, MD.

 

1992-1993        Clinical stroke specialist during fellowship at Los Angeles VA; Outpatient Stroke Clinic under supervision of mentor, Mark Fisher, MD.

Biosketch

 

D.        Additional Information: Research Support and/or Scholastic Performance

Current Research Support

Maryland Innovation Initiative: (PI- Richard Macko)                                                                                1/31/2017 - 10/31/17

Development of a Portable Ankle Robot to Reverse Foot Drop after Stroke; develop alpha prototype, field test in outpatient physical therapy; move toward FDA approval, and advance technology transfer business plan toward product production.

 

VA Merit Review (Lead PI-Macko)                                                                                                                11/1/2015 – 10/31/2019

Ankle Robotics Treadmill Training to Improve foot Drop in Chronic Hemiparetic Stroke. Veterans Affairs Rehabilitation Research and Development Award (RR&D)

Role: Lead PI, CO-PI Anindo Roy, PhD. $1,100 over 4 years.

 

Abell Foundation Top Innovation (PIs - Macko, Roy, Forrester)                                                        2015-2017

Award for 2015; Development and testing of a Portable Lightweight Ankle Robotics Module to Improve Walking after Stroke. Co-PI’s Anindo Roy, Ph.D., Larry Forrester, Ph.D. and Richard Macko, M.D.; 50,000 Award

 

Interactive Video Exercise Tele-rehabilitation (IVET) 10/1/15 – Ongoing GRECC Demonstration Project

Develop and field test IVET as a web-based progressive exercise rehabilitation tool tailoring exercise to the functional and cardiometabolic health needs of individuals with cerebrovascular disease and other chronic neurological conditions. Determine the safety, treatment fidelity, initial efficacy of IVET in VA rural health setting to reinforcing proper and safe form using secured record and transmit or store and transmit functions to remote therapists for documentation and oversight.

Role: Lead PI, along with Dr. Hafer-Macko CO-PI

 

Baltimore VA Geriatrics Research Education and Clinical Center (GRECC)

PI: Leslie I. Katzel, M.D., Ph.D.

Associate Director for Research – Richard Macko                                                                         10/1/2016 – 9/31/2021         

GRECC establishes innovative research, clinical, and educational programs for Veterans with cardiometabolic risk factors and chronic disability conditions associated with advancing age, including stroke, Parkinson’s Disease and cognitive impairment in aging. The GRECC investigates structured exercise and nutrition interventions, alone and together, to improve fitness, physical function, cardiovascular, and brain health in chronic disease and disability associated with aging, and leverage bioengineering technologies including robotics to advance these approaches along with education and safety to improve health, quality of life, and functional independence for older veterans.

 

Recently Completed Research Support

 

RO1 HD068712-01 (MPI Macko/Forrester)                                                                                        11/1/2011- 01/31/2017

Early Exercise to Improve Muscle and Cardiometabolic Health after Stroke

Goal is to investigate hemiparetic sarcopenia and insulin resistance as a modifiable cardiometabolic risk factor for stroke by comparing early aggressive structured exercise vs. best medical care in Kingston Jamaica, at the University of West Indies.

Role: PI

 

2005-2015

PI: R. Macko Founding Director, VA Maryland Exercise and Robotics Center of Excellence.

Mission- develop and test models of task-oriented exercise and robotics to improve fitness, function, muscle structure and function, and cardiovascular health for individuals with stroke and other neurological and neuromuscular conditions.

 

 2014-2016        

VA Office Rural Health Clinical Demonstration Project: Interactive Video Exercise Tele-rehabilitation for Remote Care of Stroke and Cerebrovascular Disease Risk Factors in Rural Dwelling Veterans; Funding 311,000/ year. Continuation of successful project from 2015 with application funding for expansion in 2015-2016 fiscal year to web based tele-health version.

 

2015-2016        

VA Office Rural Health Clinical Demonstration Project: eMOVE Combines Interactive Video Exercise Tele-rehabilitation coupled with VA MOVE and TELE-MOVE for combined Exercise, Nutrition and Chronic Disease Management of Obesity and Associated Diseases including Diabetes/Neuropathy, Sleep Apnea, Osteoarthritis in Rural Dwelling Veterans. Funding renewal $308,000 per year.

Research/Clinical Keywords

Stroke, Robotics, Neurology, Telerehabilitation

Highlighted Publications

1. Macko RF, DeSouza CA, Tretter L, Silver KH, Smith GV. Anderson PA, Tomoyasu N, Gorman P, Dengel DR. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients: A preliminary report. Stroke 1997;28:326-330. PMID 9040684

2. Macko RF, Ivey, F, Forrester L, Hanley D, Sorkin JD, Katzel LI, Silver KI, Goldberg AP. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in chronic stroke patients: A randomized controlled trial. Stroke 2005; 36:2206-2211. PMID 16151035

3. Ivey FM, Ryan AS, Hafer-Macko CE, Goldberg AP, Macko, RF. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors. Stroke 2007; 38:2752-2758. PMID 17702957

4. Luft AR, Macko RF, Forrester LW, Federico V, Ivey FI, Sorkin JD, Whitall J, McCombe Waller S., Katzel L, Goldberg AP, Hanley DF. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke, 2008. 39(12): p. 3341-50. PMID 18757284

5. Quaney BM, Boyd LA, McDowd JM, Zahner LH, He J, Matthew SM, Macko, RF. Aerobic exercise improves cognition and motor function post-stroke. Neurorehabilitation and Neural Repair. Neurorehabil Neural Repair 2009;23(9)879-885. PMID 19541916

 

Expanded models of motor learning integrated exercise to other neurological conditions. Worked with engineers in multidisciplinary clinician-scientist teams to advance robotics and other bio-engineering approaches to better understand and therapeutically manipulate multi-segmental control of neuro-motor function to innovate care for neurological mobility conditions in aging.

6. Shulman LM, Katzel LI MD, Ivey FM, Sorkin JD, Knachelle Favors K, Anderson KE, Smith BS, Reich SG, Weiner WW, Macko RF. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol. 2013 Feb;70(2):183-90. PMID: 23128427

7. Gorman PH, Scott W, York H, Theyagaraj M, Price-Miller N, McQuaid J, Eyvazzadeh M, Ivey FM, Macko RF. Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial. J Spinal Cord Med. 2016;39(1):32-44. PMID: 25520035

8. 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. doi: 10.1186/s12984-016-0158-1. PMID: 27255156

9. Forrester LW, Roy A, Krywonis A, Kehs G, Krebs HI, Macko RF. Modular Ankle Robotics Training in Early Subacute Stroke: A Randomized Controlled Pilot Study. Neurorehabil Neural Repair. 2014 Feb 10. [Epub ahead of print]

10. Barton J, Rogers M, Sorkin J, Macko R. An Engineering Model of Human Balance Control-Part I: Biomechanical Model. J Biomech Eng. 2016 Jan;138(1). doi: 10.1115/1.4031486. PMID: 26328608

11. Larry W. Forrester, Anindo Roy, Charlene Hafer-Macko, Hermano I. Krebs, and

12. Richard F. Macko.Task-specific ankle robotics gait training after stroke: a randomized pilot study. Journal of NeuroEngineering and Rehabilitation.2016.13:51DOI: 10.1186/s12984-016-0158-1

Research Interests

(1) Develop and test disability and disease specific exercise training models that combine motor learning with exercise rehabilitation to improve functional mobility, fitness, cardiovascular-metabolic health, and brain health including cognitive function for individuals with stroke and other chronic mobility disability conditions associated with advancing age.

 

(2) Develop and apply robotics technologies, with a focus on modular adaptive control human robotics cooperative learning (e.g. Anklebot) to improve lower extremity motor control of walking and balance for individuals that have suffered a stroke, and other lower extremity physical disability conditions. Advance bioengineering models of multi-segmental motor control to measure and improve balance, gait function, and basic activities of daily living promoting functional independence for individuals with neurologic and other mobility disability conditions associated with aging. Apply such engineering models to robotics for advanced systems control to improve biomechanics of gait and balance in neurological and mobility disability conditions.

 

(3) Investigate exercise-mediated adaptations in brain plasticity, skeletal muscle, insulin sensitivity and glucose metabolism, cardio- and cerebrovascular systems including molecular, genetic, and epigenetic mechanisms that underlie the benefits of structured exercise and robotics therapies, in order to inform the design of the next generation of interventions. 

 

(4) Translate novel models of exercise and robotics therapies into practice at the community and home level using tele-rehabilitation and portable technologies to improve long-term fitness, physical function, heart and brain health for individuals aging with cerebrovascular disease or heightened stroke risk factors. Advance global health research toward the science driven models for integrative care and chronic disease management of cerebrovascular disease in aging that has now emerged as the leading cause for chronic disability worl-wide.