Paul Rhee suffered a stroke that resulted in weakness and spasticity in his right arm and leg. His son, Dr. Peter Rhee, spent the next decade perfecting his research that led to the intricate hand nerve surgery that restored his father’s mobility and function.

When Paul Rhee had a stroke in 2015, it changed everything. He lost movement in his arm, endured painful spasms, and withdrew from daily life because of the unwanted attention his bent arm caused. Simple joys — social gatherings, attending church, spending time with family, holding a fishing rod — slipped away. 

For his son, Peter Rhee, D.O., M.S., a hand and microvascular surgeon at Mayo Clinic, the experience was both deeply personal and professionally motivating. “Fishing was something my dad and I always dreamed of sharing across generations. After his stroke, even that was gone,” Dr. Rhee recalls. “It took away part of who he was.”

Fishing was more than just a pastime. For Dr. Rhee, it was symbolic of family and continuity. 

That loss became a powerful motivator. Dr. Rhee was determined not just to help his father, but to develop a treatment that could restore hope for patients everywhere who live with spasticity following brain or spinal cord injury.

The Mayo difference

What Dr. Rhee achieved could only happen at Mayo Clinic.

Spasticity occurs when the brain or spinal cord can’t properly control signals to the muscles, causing them to contract uncontrollably and often creating deforming postures. Traditional treatments for spasticity focus on surgically altering the muscles, but Dr. Rhee identified the nerves as the root problem. 

Developing a new surgical procedure was no small task. It required years of research and the support of a broad, multidisciplinary team at Mayo Clinic. Physical medicine physicians, anesthesiologists, rehabilitation specialists, therapists, and scientists in the Motion Analysis Lab all played crucial roles in bringing Dr. Rhee’s vision to life.

“I don’t think it would have been possible, even if I had the will as the surgeon, without the supporting cast, the resources, the support — everyone buying into the fact that no matter how complicated it is, we can do it together,” Dr. Rhee explains.

Mayo’s Motion Analysis Lab is nationally accredited and one of fewer than 20 labs of its kind in the U.S., it is also one of only two that evaluates both children and adults. Here, patients aren’t studied through static images like X-rays or MRIs. Instead, they are evaluated while moving, allowing experts to see exactly when and how their muscles misfire or fail.

Patients often arrive without a clear diagnosis, only knowing that something isn’t working the way it should. Staff in the lab spend three to four hours with each patient, using advanced motion capture and electromyography (EMG) sensors to measure how the brain communicates with the muscles. Some sensors are placed on the skin for larger muscles, while fine wire electrodes, as thin as a human hair, are used for deeper or smaller muscles. These tools provide precise, real-time data about how the muscles respond to nerve signals.

“By using dynamic EMG, we can see how the muscles are firing compared to how the arm moves,” says Dr. Rhee. “That helps us plan the surgery with a level of accuracy that isn’t possible in most academic medical centers in the world. With every patient visit, I had more ideas about how to treat patients like my father,” he says.  

This level of integration between science and surgery is rare. “The only way you can get this kind of information is through the collaboration of a physician and a scientist,” says Kenton Kaufman, Ph.D., Director, Motion Analysis Lab. “We can see how the upper extremity muscles are functioning while the person is moving. And these types of studies are not done anywhere else but at Mayo Clinic.”

The Motion Analysis Lab doesn’t just inform surgery; the team collects data during surgeries themselves. The lab is able to study human muscle physiology in-vivo, something not done anywhere else in the world. This research has already led to publications in top-ranked medical journals and continues to advance the understanding of spasticity and its treatment.

“Dr. Rhee’s procedures not only restore function, but also quality of life,” adds Dr. Kaufman. “Patients sense the hope that they’ll have a better outcome, because of the time we take to gather the data needed to achieve the best possible surgical results.”

From a single patient to nationwide impact

Dr. Rhee, the sole physician qualified to conduct Paul Rhee's surgery, obtained institutional authorization following a thorough review by the Mayo Clinic Ethics Committee. In December 2022, and again in March 2023, Dr. Rhee performed his new surgical procedure on his father. 

The results were profound. Paul regained movement in his arm, was able to relax muscles that had been locked in place for years, and found the confidence to reengage with his community. Most importantly, he could once again hold a fishing rod — a milestone that symbolized freedom and independence.

“After the surgery, he no longer feared people staring at his arm and was able to reconnect with his community,” Dr. Rhee reflects.

The same procedure is now changing lives for patients across the country. Dr. Rhee and his team perform two to three of these complex upper extremity reconstructions each week, often lasting up to 14 hours and involving the entire limb from shoulder to fingertip. Mayo Clinic is one of fewer than 10 centers nationwide where this type of surgery is available, and the team performs more spasticity-related reconstructions than any other center in the U.S.

Dr. Rhee also trains fellows in hand and reconstructive surgery, ensuring that the next generation of surgeons can carry this innovation forward. Over the past six years, nearly 30 physicians have learned the procedure under his guidance. “Following the Mayo brothers’ tradition of sharing expertise, we are expanding access to this surgery worldwide,” he notes.

His colleague, Kitty Wu, M.D., who trained under Dr. Rhee and joined Mayo’s staff in 2023, is expanding the technique further to treat lower extremity spasticity. “Our procedures are restoring hope for patients who thought they had forever lost the function of their limb,” Dr. Wu says. “In some cases, the procedure even prevents permanent disability.”

“Dr. Wu trained at Mayo and expanded on our unique techniques. Together, we offer comprehensive upper and lower extremity reconstructive surgery to adult and pediatric patients,” Dr. Rhee adds.  

For Dr. Rhee, the lessons extend beyond the operating room. “I ask patients what they want to do most that they can’t do now. For many in the Midwest, it’s fishing — something close to my heart as well. When I can say, ‘I believe we can get you back to fishing, holding a grandchild or simply moving without pain’ it builds trust and hope. And that’s what Mayo is about.”

Category of one

What happened for Paul Rhee is much more than a single success story. It represents the best of Mayo Clinic: a seamless integration of practice, research and education; teams of experts working together; and a patient-first mission that drives innovation.

Thanks to this pioneering work, Paul can once again fish with his son and grandchildren, an experience the family thought was lost forever. Thanks to the pioneering spirit of our staff, stories like Paul’s remind us why Mayo Clinic remains a place where innovation, teamwork and patient-first care change lives every day.

Watch: Dr. Rhee and his father before and after the surgery

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In this Mayo Clinic Minute, Dr. Kenton Kaufman, the W. Hall Wendel Jr. Musculoskeletal Research Professor who is behind the study, explains the findings and why it's never too late to improve your balance.

Watch: The Mayo Clinic Minute

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Aging can be a balancing act, and according to Mayo Clinic research, your ability to balance on one leg can be a meaningful measure of aging.

"This was a study looking at markers of aging in older adults," explains Dr. Kaufman, senior author of the study and director of the Motion Analysis Laboratory at Mayo Clinic. 

Forty healthy, independent, community-dwelling people over age 50 underwent various tasks known to be markers of aging, including balance.

"We were comparing different markers of aging and trying to see which one was the most predictive of declines with aging," says Dr. Kaufman.

Standing on one leg

He says, if someone can stand with all their weight on one leg for 30 seconds, they're doing very well.

"Balance is complicated. It involves many different systems. It involves your vision, your vestibular system, your somatosensory system and your neuromuscular system. All those have to work in coordinated fashion to keep you on one leg," says Dr. Kaufman.

All of those systems deteriorate with age and increase the risk of falls. The good news is it's never too late to improve your balance, it just takes practice.

"The important message is to try it at home. It's very simple, easy to do. It's quick. If you are unable to stand on your leg for five seconds, at least five seconds, then you're at risk of falling," says Dr. Kaufman.

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ROCHESTER, Minn. — How long a person can stand — on one leg — is a more telltale measure of aging than changes in strength or gait, according to new Mayo Clinic research. The study appears today in the journal PLOS ONE.

Good balance, muscle strength and an efficient gait contribute to people's independence and well-being as they age. How these factors change, and at what rate, can help clinicians develop programs to ensure healthy aging. Individually, people can train their balance without special equipment and work on maintaining it over time.

In this study, 40 healthy, independent people over 50 underwent walking, balance, grip strength and knee strength tests. Half of the participants were under 65; the other half were 65 and older.

In the balance tests, participants stood on force plates in different situations: on both feet with eyes open, on both feet with eyes closed, on the non-dominant leg with eyes open, and on the dominant leg with eyes open. In the one-legged tests, participants could hold the leg they weren't standing on where they wanted. The tests were 30 seconds each.

Standing on one leg — specifically the nondominant leg — showed the highest rate of decline with age.

"Balance is an important measure because, in addition to muscle strength, it requires input from vision, the vestibular system and the somatosensory systems," says Kenton Kaufman, Ph.D., senior author of the study and director of the Motion Analysis Laboratory at Mayo Clinic. "Changes in balance are noteworthy. If you have poor balance, you're at risk of falling, whether or not you're moving. Falls are a severe health risk with serious consequences."

Unintentional falls are the leading cause of injuries among adults who are 65 and older. Most falls among older adults result from a loss of balance.

In the other tests:

• Researchers used a custom-made device to measure participants' grip. For the knee strength test, participants were in a seated position and instructed to extend their knee as forcefully as possible. Both the grip and knee strength tests were on the dominant side. Grip and knee strength showed significant declines by decade but not as much as balance. Grip strength decreased at a faster rate than knee strength, making it better at predicting aging than other strength measures.
• For the gait test, participants walked back and forth on an 8-meter, level walkway at their own pace and speed. Gait parameters didn't change with age. This was not a surprising result since participants were walking at their normal pace, not their maximum pace, Dr. Kaufman says.
• There were no age-related declines in the strength tests that were specific to sex. This indicates that participants' grip and knee strength declined at a similar rate. Researchers did not identify sex differences in the gait and balance tests, which suggests that male and female subjects were equally affected by age.

Dr. Kaufman says people can take steps to train their balance. For example, by standing on one leg, you can train yourself to coordinate your muscle and vestibular responses to maintain correct balance. If you can stand on one leg for 30 seconds, you are doing well, he says.

"If you don't use it, you lose it. If you use it, you maintain it," Dr. Kaufman says. "It's easy to do. It doesn't require special equipment, and you can do it every day."

Funding for this study includes the Robert and Arlene Kogod Professorship in Geriatric Medicine and W. Hall Wendel Jr. Musculoskeletal Professorship.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Rhoda Madson, Mayo Clinic Communications, newsbureau@mayo.edu

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ROCHESTER, Minn. — Mayo Clinic has received authorization from the Federal Risk and Authorization Management Program to begin operating the Limb Loss and Preservation Registry, a national collaborative warehouse for data on people who have lost limbs and may or may not have access to prosthetics. The registry will be the first of its kind in the U.S.

The goal of the Limb Loss and Preservation Registry is to generate knowledge about which advances make a difference in the care of people with limb loss and limb difference. Mayo is in sole charge of registry development and operations, reporting to the National Institutes of Health and the Department of Defense.

Mayo won the competitive federal contract and has been developing a network of health care team members, researchers, regulators, industry representatives and patient groups to communicate their goals and collect information that has not previously been assembled. The project will alleviate significant data gaps about limb loss in the U.S.

"Until now, there has been little evidence on effective clinical practices and technologies in this field," says Kenton Kaufman, Ph.D., a Mayo Clinic researcher and head of the project. "This data repository is being hailed as the first national registry of its kind, geographically and demographically providing data that will improve prevention, treatment and rehabilitation efforts for this population."

The Federal Risk and Authorization Management Program is a program that promotes the adoption of secure cloud services across the federal government by providing a standardized approach to security and risk assessment for cloud technologies and federal agencies. The Limb Loss and Preservation Registry is vitally necessary for the future of patient care, technology advances, and a range of other sustainable efforts in the prosthetic field, says Dr. Kaufman. The data gap is considerable. In some cases, available statistics are over two decades old, and longitudinal data has never been collected.

The registry will help manufacturers with data and feedback on how to improve the next generation of prosthetic devices. It will show insurers possible alternatives to amputation and how devices can improve patient lives. Data will help hospitals and therapists understand long-term use of prosthetics and reasons why problems may occur after patients leave rehabilitation centers. Overall, the registry will help clinicians make the best-informed considerations about prosthetics and treatments.

The Thought Leadership & Innovation Foundation will help Mayo Clinic create the database. The foundation is a nonprofit organization that works at the nexus of science, technology and public health. It will build the centralized data warehouse and analyze data that will lead to improved care and patient outcomes.

"The Limb Loss and Preservation Registry addresses a substantial public health knowledge gap by giving stakeholders the ability to analyze data by age, gender, type of limb loss or preservation surgery and prosthetic device," says Reed Hartley, executive director of the Thought Leadership & Innovation Foundation. "This will refine rehabilitation approaches and guide improvement of devices for people with limb loss."

To learn more about the registry, visit its website.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Bob Nellis, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Mayo Clinic launches first national collaborative Limb Loss and Preservation Registry appeared first on Mayo Clinic News Network.

Listen: Mayo Clinic Radio 6/15/19

On the Mayo Clinic Radio podcast, Dr. Leonard Berry, a health care delivery expert and author of "Management Lessons From Mayo Clinic", shares his thoughts on the role of kindness in cancer care. Also on the podcast, Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon, and Dr. Kenton Kaufman, director of the Motion Analysis Laboratory at Mayo Clinic, discuss their research on preventing wrist injuries in tennis players. And Vic Nole Jr., executive director of the Life Sciences Incubator at Mayo Clinic's Florida campus, explains how the incubator helps advance new ideas and products from the research lab through product development and into the clinic.  

The post #MayoClinicRadio podcast: 6/15/19 appeared first on Mayo Clinic News Network.

On this Mayo Clinic Radio program, Dr. Berry will share his thoughts on the role of kindness in cancer care. Also on the program, Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon, and Dr. Kenton Kaufman, director of the Motion Analysis Laboratory at Mayo Clinic, will discuss their research on preventing wrist injuries in tennis players. And Vic Nole Jr., executive director of the Life Sciences Incubator at Mayo Clinic's Florida campus, will explain how the incubator helps advance new ideas and products from the research lab through product development and into the clinic.  

Here's your Mayo Clinic Radio podcast.

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Cancer is a disease that affects nearly everyone. An estimated 1.7 million new cases of cancer were diagnosed in the U.S. in 2018 and more than 600,000 people died from the disease, according to the National Cancer Institute. A cancer diagnosis brings with it emotions for the patient, as well as the family and caregivers. Feelings of depression, anxiety and fear are common, presenting a challenge for the care team. "Cancer is a life-changing experience, it may not be life ending, but it's always life-changing. And it impacts the family, not just the patient," says Dr. Leonard Berry, a health care delivery expert and author of "Management Lessons From Mayo Clinic."

On the next Mayo Clinic Radio program, Dr. Berry will share his thoughts on the role of kindness in cancer care. Also on the program, Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon, and Dr. Kenton Kaufman, director of the Motion Analysis Laboratory at Mayo Clinic, will discuss their research on preventing wrist injuries in tennis players. And Vic Nole Jr., executive director of the Life Sciences Incubator at Mayo Clinic's Florida campus, will explain how the incubator helps advance new ideas and products from the research lab through product development and into the clinic.  

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post The role of kindness in cancer care appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Berry will share his thoughts on the role of kindness in cancer care. Also on the program, Dr. Sanj Kakar, a Mayo Clinic orthopedic surgeon, and Dr. Kenton Kaufman, director of the Motion Analysis Laboratory at Mayo Clinic, will discuss their research on preventing wrist injuries in tennis players. And Vic Nole Jr., executive director of the Life Sciences Incubator at Mayo Clinic's Florida campus, will explain how the incubator helps advance new ideas and products from the research lab through product development and into the clinic.  

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Kindness in health care / preventing wrist injuries / Life Sciences Incubator appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — In a new study published in Prosthetics and Orthotics International, Mayo Clinic researchers describe the direct medical costs of falls in adults with a transfemoral amputation. In this type of amputation, the leg is amputated above the knee. This work “provides a comparison for policymakers when evaluating the value of more expensive … technologies,” say the authors.

Every week in the U.S., more than 3,500 people have a transfemoral amputation. However, of the 185,000 new amputee patients each year, only 25-30 percent receive a prosthetic leg and knee.

Of those who receive a prosthetic leg and knee, the policies that govern insurance payments grant basic mechanical knees for most. Despite growing data that newer technology reduces falls and improves physical capabilities, only high-functioning patients (based on mobility and activity levels) are deemed eligible for a knee with microprocessor technology.

A team of Mayo Clinic researchers would like to change that.

“We want to help provide the best quality of life and prosthesis for each individual,” says Benjamin Mundell, Ph.D., the study’s lead author. Dr. Mundell, a trained health economist who is currently a medical student at Mayo Clinic School of Medicine, says, “It is important to look beyond the initial cost differences of a microprocessor knee compared to a mechanical knee and understand what downstream costs might be avoided with a better prosthesis.”

“Microprocessor knees are designed to help improve balance and reduce falls,” he says. “The fear of falling for those with mechanical knees likely reduces their overall physical activity and if they do fall and require hospitalization, the cost of care is almost as expensive as a microprocessor knee.”

Data and costs

Using the Rochester Epidemiology Project, a health records linkage collaboration in Minnesota and Wisconsin, the team examined the records of 77 individuals receiving a transfemoral amputation between 2000 and 2014. They found that 46 of these patients had received a prosthetic knee. Of these, 22 individuals experienced 31 falls that resulted in an emergency department visit or hospitalization. If they fell more than once during an 18-month period, both incidents were excluded from the cost analysis to prevent misalignment of costs.

What the researchers found, using standardized Medicare cost data from the Rochester Epidemiology Project’s new Cost Data Warehouse, was that the average additional cost in the 6 months following a fall can be substantial. The additional fall cost for individuals requiring an emergency department visit was $18,000. For patients who had to be hospitalized, this extra expense was more than $25,000.

“Understanding the costs is part of basic health economics,” says Kenton Kaufman, Ph.D., the study’s senior author, who is a biomedical engineer and orthopedics researcher at Mayo Clinic. “This study quantifies the cost of falls that require medical attention – providing evidence that it may not be economical to withhold microprocessor knees from patients with moderate ambulatory capabilities.”

He believes the costs to patients are much higher than the study shows.

“We know our cost estimate underestimates the true cost of a fall, because we didn’t include indirect costs, such as lost wages, caregiving expenses and transportation costs,” says Dr. Kaufman.

Better knees, please

Medicare Functional Classification Levels, also known as K levels, are used to determine which prosthetic device is medically necessary for a patient.

“Shouldn’t the goal be to provide the best quality of life?” asks Dr. Mundell.

“Value is the new metric in health care as we try to contain costs,” he says. “Part of understanding the value of advanced medical devices is measuring what future costs they can help patients avoid. Measuring the quality of life a device provides for each individual is difficult. We focused on the costs of falls ─ events that microprocessor knees are designed to help avoid. A policymaker or payer can then look at the cost of a device and compare it to the cost of an adverse event that the device can prevent when deciding whether or not the device offers additional value.”

Medicare Functional Classification Level 2, in which the patient is described as having “the ability or potential for ambulation with the ability to traverse low-level environmental barriers, such as curbs, stairs or uneven surfaces,” nets a mechanical knee.

To be considered Level 3 or 4 (on a scale 0-4), and thus eligible for the microprocessor knee, a patient needs extensive physician documentation that he or she is likely to engage in activities that would use the leg more than the normal day-to-day walking, stairs, etc., that are part of an average American adult’s lifestyle.

“For many, the default may be a mechanical knee, because it is easier to prove basic necessity than to ensure the rigorous documentation requirements for one with advanced – and more costly – technology,” says Dr. Kaufman.

“One of the reasons we work on improving technology in prosthetic knees is to help individuals become more agile, more balanced and less likely to fall,” says Dr. Kaufman. “But if people aren’t able to access this technology, they may become more vulnerable and less active than their condition would normally indicate.”

“We hope that our research increases understanding of the cost-benefit equation from the patient’s perspective,” Dr. Kaufman says. “Greater mobility gives people more freedom to live healthier lives.”

This study was supported by the American Orthotic and Prosthetic Association; the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; and the Rochester Epidemiology Project, which receives administrative and financial support from the center.

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About the Rochester Epidemiology Project
The Rochester Epidemiology Project is a collaboration of clinics, hospitals, and other medical and dental care facilities in southern Minnesota and western Wisconsin. Founded by Mayo Clinic and Olmsted Medical Center in 1966 in Olmsted County, Minnesota, the collaboration stretches across 27 counties. Olmsted County Public Health Services is its first public health member. This collaboration and sharing of medical information makes this area of Minnesota and Wisconsin one of the few places where true population-based research can be accomplished. For more information about the Rochester Epidemiology Project, visit the Rochester Epidemiology Project website.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

MEDIA CONTACT
Elizabeth Zimmermann Young, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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