Ten Things I Have Learned From Dr. Steven L. Wolf

Show Leadership

Leadership in academics requires a special energy, as it is often undertaken atop one’s many assigned duties. Steve showed signs of leadership at an early stage (he was president of his class at Clark University) and since then has contributed immensely to our field in a leadership capacity.

At Emory University he is (or recently was) a professor in the Departments of Rehabilitation Medicine, Geriatrics, Cell Biology, and Adult & Elder Health, plus Director of Research in the Department of Rehabilitation Medicine and Director of the Program in Restorative Neurology, plus a member of the Admissions Committee. In parallel, he held adjunct appointments at the Georgia Institute of Technology and served on the editorial board for 20 different journals. Over the years, Steve held leadership positions at wide-ranging institutions, including the Muscular Dystrophy Association of America, American Physical Therapy Association, American Congress of Physical Medicine, and the U.S. Olympic Committee, to name but a few. Steve is also co-Chair of the Stroke Rehabilitation & Recovery Group in the NIH StrokeNet clinical trials network, where I have had the privilege of working with him directly for 12 years. His feedback to investigators who come to this group is detailed but encouraging, thorough yet friendly, and his knowledge about comma usage would have impressed Charles Dickens.

Be Interdisciplinary in Your Approach

So much of modern clinical practice occurs in a silo. In research, we sometimes have greater leeway to initiate creative connections. There can be no better setting for this than rehabilitation medicine, which by its nature is quite multidisciplinary. And here Steve Wolf’s research is exemplary. His work in mixed reality, ⁴ cyber-human interfaces, ⁵ and the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) trial ⁶ are but 3 examples. One editorial he co-authored emphasized the need for a common language. ⁷ In “Pros and woes of interdisciplinary collaboration with a national clinical trial,” ⁸ Steve, along with colleagues in physical therapy and nursing, discussed a range of issues encountered in the context of interdisciplinary collaboration, for example, sensitivity to what different clinical fields hold as important, the critical importance of maintaining strong communication lines, the need to establish procedural rules early on, and the rich educational and mentoring opportunities that arise in this context.

Stay Curious and Venturesome

Steve’s curious nature was apparent early in his career, when, following completion of his Physical Therapy training, he took the uncommon step to pursue a PhD; one must have the best tools to most fruitfully indulge one’s curiosity. Building on this training, Steve has demonstrated both depth and breadth during his career. Thus while his most cited paper is the EXCITE trial, ¹ Steve has also published clinical studies of EMG biofeedback, mirror therapy, a pneumatic muscle hand therapy device, an adaptive mixed reality system, dancing the tango, botulinum toxin type A, operant conditioning of spinal reflexes, ⁹ home-based reach-to-grasp training, robotics, corticocortical paired associative stimulation, telerehabilitation, vagus nerve stimulation, vibrotactile stimulation, deep brain stimulation, tDCS, and Tai Chi (the report on which was selected as the best paper of the 1990s by the Journal of the American Geriatrics Society).

Be Inventive

In a classic paper from 1989, ¹⁰ Steve and colleagues translated prior observations by Sarah Tower and Ed Taub on upper extremity disuse following a pyramidal tract lesion in primates, and in doing so demonstrated the existence of learned nonuse in humans as well as its capacity for improvement through a forced use paradigm, noting: “Clearly these chronic neurological patients had learned, through circumstance and formal rehabilitation, how to optimally use their noninvolved limb and, concurrently, how not to use the involved upper extremity.” The “2-week forced use interval” introduced in this study would eventually become constraint-induced movement therapy.

But how should a person measure the benefit of this formal rehabilitation? In the same manuscript, Wolf and colleagues introduced a scale that combined scores from multiple functional tasks, which ultimately became the Wolf Motor Function Test. One lesson here is that if you don’t see what you need, invent a solution (and then rigorously evaluate it).

Good Clinical Research Relies on Good use of the Scientific Method

A common theme across decades of Steve Wolf’s research is a meticulous approach to study design and execution. Hypotheses build from prior observations and a foundation of published research. Across Steve’s many trials over the decades, when evidence favors a particular intervention, the reader has some idea as to why, and conversely, when the data do not support the efficacy of an experimental intervention, the reader has insight as to why it did not work.

Stick With It

Tenacity is in Steve’s blood (he was born to parents who fled their home country for their very lives). Ask him about a study of his that did not go as expected, and he will tell you what he learned from it. He comes back to a problem strengthened—not discouraged—by what the last study showed. Ask him his thoughts on an issue, and after his first email arrives, a few hours later you might get a “just one more thought” comment that would make Detective Columbo jealous. His publications span 6 decades, and he continues to contribute impactfully to the scientific literature at an age when most investigators have long since retired.

Remain Critical of the Field and of your Own Work

Francis Crick once said that “A good scientist values criticism almost higher than friendship.” Over the course of a career, one’s critical skills evolve. Some become petty or scathing; others, sycophantic or overly political. Constructive critics tend to provide feedback that is polite, reasoned based on good science, directed toward actionable improvement, and focused on content more than ego. Here Steve is exemplary. Through his many administrative appointments, manuscript and grant reviewer roles, and in hallway chats at countless scientific meetings, Steve has dispensed a constructive form of criticism from which hundreds of this journal’s readers have benefited. And he is interested in critiques of his own work, some of which comes from his own pen, for example, in editorials such as “Revisiting constraint-induced movement therapy: are we too smitten with the mitten? Is all nonuse ‘learned’? and other quandaries” ¹¹ and “Looking in the rear view mirror when conversing with back seat drivers: the EXCITE trial revisited.” ¹²

Be Generous

A look back at Steve Wolf’s career teaches us about the immense importance of contributing to your team—locally, nationally, and internationally. As Cicero wrote: “Not for ourselves alone are we born.”

Steve’s approach to being a clinician scientist emphasizes the value of giving of yourself to your field. His trainees are numerous. He has served on many editorial boards, committees (intra- and extramural), and study sections. He has reviewed for many journals (some reportedly printed by Gutenberg himself). He has consulted for many groups, companies, and investigative teams. Steve Wolf has many forms of expertise in neurological rehabilitation and has been generous in sharing these, to the betterment of clinical care and clinical research. Two recent examples, on behalf of NINDS ¹³ and of the American Heart Association, ¹⁴ illustrate this point well.

Look for Ways to Make Clinical Research Impactful

Performing human subjects research that addresses basic science questions without directly improving patient outcomes is not shameful, but neither is it shameful to do work that does improve clinical care.

In 1983, Steve got a grant entitled “Effect of a ‘forced use’ paradigm on recovery of upper extremity function in stroke and closed head injured patients” from the National Institute on Disability and Rehabilitation Research (a precursor to the National Institute on Disability, Independent Living, and Rehabilitation Research). Since then, he and his teams worked to develop this intervention to the point where there is now excellent evidence for the efficacy of constraint-induced movement therapy. Through teamwork, meticulous attention to details, and refinement informed by successive studies, Steve created a new treatment option for some forms of hemiparesis (and one that inspired a constraint-induced approach to the treatment of many other forms of neurological impairment). Indeed, the Physiotherapy Evidence Database (PEDro) lists the EXCITE trial among the top 25 trials that are ground-breaking and changed the way people are treated for a variety of conditions seen by physiotherapists and other healthcare professionals (see https://pedro.org.au/english/learn/top-25-trials/). Steve has also published numerous other trials that have advanced a range of neurorehabilitation therapeutics.

Those who aim to engage in research that aims to improve neurorehabilitation treatment options can learn a lot from reviewing the arc of Steve Wolf’s career.

Be Nice

I have had the privilege of knowing Steve Wolf for 3 decades. During this time, I have been impressed with his passion, which is as infectious as it is deep, and what a nice person he is, a Wolf (though not a wolf) in sheep’s clothing. We should all be so lucky as to have as successful and impactful a career, while maintaining such a positive attitude, as Dr. Steven L. Wolf.