Michael C. Munin, MD, Receives 2024 AANEM Distinguished Researcher Award

Michael C. Munin, MD, professor in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine, has been honored with the 2024 Distinguished Researcher Award by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Dr. Munin serves as the vice chair for Strategic Planning and Program Development in the Department, and he is co-director of the EMG Labs at UPMC Presbyterian, Shadyside, and Mercy hospitals.

The annual award from AANEM recognizes researchers “who have made continuous significant contributions to clinical neurophysiological, neuromuscular, or musculoskeletal research.” The 2024 award will be presented to Dr. Munin during the 2024 AANEM Annual Meeting in October.

During his career, Dr. Munin has made extensive contributions to clinical research and advanced the field of neuromuscular and electrodiagnostic medicine.

He has been recognized previously by the AANEM for his work validating the Modified Heckmatt scale in grading ultrasound images of patients with spasticity, having received the organization’s Scientific Impact Award in 2022.

“The AANEM’s Distinguished Researcher Award is a great honor to receive,” says Dr. Munin. “I always had an interest in research because there is much in medicine we don’t fully understand. Performing research that answers pertinent clinical questions was very important to me and was instilled by an early mentor and past AANEM member, Gerald J. Herbison.”

More About Dr. Munin

Dr. Munin joined UPMC and the University of Pittsburgh in 1992 after completing his medical training and residency at Thomas Jefferson University. He has been in Pittsburgh ever since.

When he arrived in 1992, the Department of Physical Medicine and Rehabilitation did not exist in its current form as a standalone department but was contained as a division within the Department of Orthopaedic Surgery.

“When I came to Pittsburgh, I think I was only the third PM&R attending in the division,” says Dr. Munin. “One of our goals was to build a nationally recognized PM&R department, and we were very successful in that work.”

Indeed, the PM&R department at the University of Pittsburgh officially became a department in 2000 and has since become one of the largest and most productive clinically and academically in the United States, with a stellar reputation for clinical, basic science, and translational research across the entire PM&R spectrum.

"The growth and success of our department over the last 30-plus years – being a part of that transformation has been tremendously satisfying," says Dr. Munin. “But we’re going to keep on going. We have so much more to accomplish.”

Becoming a PM&R Physician

Dr. Munin’s path to becoming a PM&R physician began somewhat unexpectedly during medical school when he was assigned to a rehabilitation hospital's spinal cord injury service.

“That experience led to a deep interest in the clinical complexities of dealing with catastrophic injuries and the multidisciplinary approach required in rehabilitation medicine,” says Dr. Munin.

His work with musculoskeletal and neuromuscular medicine grew during residency training, particularly with electrodiagnostic medicine, eventually leading to a career focused on diagnosing and treating neuromuscular diseases. Throughout his career, Dr. Munin has published more than 75 peer-reviewed original articles and 16 book chapters, reflecting his commitment to improving patient care through research.

Early Research and Fellowship Training

One of the early experiences that helped to shape Dr. Munin's clinical and research career was being selected for the Research Enrichment Program for Physiatrists, which is funded by the National Institute on Disability Rehabilitation Research (NIDRR).

“I was selected for this fellowship shortly after beginning my work in Pittsburgh,” says Dr. Munin. “The program helped me to obtain essential research methodology and statistical analysis skills and ultimately led to receiving my first research grant, which centered around determining optimal rehabilitation strategies following hip and knee arthroplasty through a randomized clinical trial.”

This work was published in JAMA (see additional reading links below) and highlighted the importance of early intensive rehabilitation protocols for improved outcomes in patients. This paper also won Best Scientific Research Paper in the Established Physiatrist Category, Physical Medicine & Rehabilitation Education and Research Fund, in 1998.

“I think our study was one of the first to really explore and understand the clinical benefits of early rehabilitation and mobility after joint replacement surgery,” says Dr. Munin. “The orthopaedic department at the time had several surgeons, including Drs. Rubash and Crossett, who allowed for this work to flourish as one of the foundational studies on improving outcomes through early, intensive rehab.”

Dr. Munin’s early work also included collaborations with, among others, former University of Pittsburgh researcher Eric Lenze, MD, now the chair of Psychiatry at Washington University in St. Louis. In this work. Dr. Munin and colleagues were interested in optimizing rehabilitation therapy for hip fractures in older, more frail populations, looking at whether patients had better outcomes from rehab in skilled nursing facilities or from inpatient rehabilitation units.

“We found that our hip fracture patients who were living in the community at the time of fracture could tolerate more intensive rehabilitation while in the inpatient unit and had better clinical outcomes and also experienced less depression,” says Dr. Munin.

Clinical Research for Neuromuscular Disorders – Laryngeal EMG; Botulinum toxin, Spasticity and Ultrasound Guidance

Dr. Munin’s most notable academic contributions include his work on laryngeal electromyography (EMG). He and his research collaborators have authored numerous studies that have significantly advanced the diagnosis, prognosis, and treatment of voice disorders following focal laryngeal neuropathies. They developed innovative electrodiagnostic techniques to measure electrical synkinesis and were the first to use turns analysis to quantify reduced motor unit recruitment in voice disorders.

“What this research has developed are techniques to improve the predictive value of laryngeal EMG for patients,” says Dr. Munin. “This helps to guide treatment decisions and consequently long-term patient outcomes.”

Dr. Munin has also played significant roles in industry-funded clinical trials, particularly in the treatment of muscle spasticity. He has been involved in Phase I, II, and III studies, including a pivotal multicenter trial evaluating efficacy of incobotulinumtoxinA for upper limb spasticity that was published in Muscle and Nerve in 2016.

Dr. Munin was an early advocate for using neuromuscular ultrasound for botulinum toxin injections, demonstrating its precision in targeting key muscles and reducing complications. His research on the subject has shown that ultrasound-guided injections are more accurate and can reduce adverse effects, such as dysphagia, in patients with cervical dystonia.

New Areas of Research

In addition to his ongoing studies of laryngeal EMG and the use of botulinum toxin for treating spasticity disorders, Dr. Munin is currently working on projects designed to assess muscle changes via ultrasound in patients with spasticity, understanding how changes in muscle sonographic appearance influence where botulinum toxin injections are performed in order to achieve more robust efficacy and outcomes.

Work with National Organizations

Dr. Munin says that his long-term involvement with AANEM has been highly influential in his professional growth as a clinician and researcher. His prior roles with the organization include board member and chair of the Workshop Committee, and he was recently appointed to the AANEM Awards Committee.

Dr. Munin is also a member of the American Board of Electrodiagnostic Medicine and currently serves on the organization's EM examination committee.

“These are ways that I can give back to the field and help its growth, but I’ve also personally benefitted because of learning opportunities they present,” says Dr. Munin.

Additional Reading

The following is a selected list of research publications authored by Dr. Munin covering the spectrum of his research interests, including those studies mentioned in the article.

• Munin MC, Rudy TE, Glynn N, Crossett LS and Rubash HE. Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA 1998; 279: 847-852.
• Munin MC, Rosen CA, Zullo T. Utility of laryngeal electromyography in determining recovery after vocal fold paralysis. Arch Phys Med Rehabil 2003; 84:1150-3.
• Munin MC, Seligman K, Dew MA, Quear T, Skidmore ER, Gruen G, Reynolds CF, Lenze EJ: Effect of rehabilitation site on functional recovery after hip fracture. Arch Phys Med Rehabil 2005; 86:367-72.
• Lenze EJ, Munin MC, Dew MA, Marin RS, Butters MA, Skidmore ER, Whyte EM, Begley AE, Reynolds CF: Apathy after hip fracture: a potential target for intervention to improve functional outcomes. J Neuropsychiatry Clin Neurosci 2009; 21:271-8
• Statham MM, Rosen CA, Nandedkar SD, Munin MC. Quantitative laryngeal electromyography: Turns and amplitude analysis. Laryngoscope 2010; 120:2036-41.
• Henzel MK, Munin MC, Niyonkuru C, Skidmore ER, Weber DJ, Zafonte RD. Comparison of surface and ultrasound localization to identify forearm flexor muscles for botulinum toxin injections. PMR2010; 2:642-646.
• Smith LJ, Rosen CA, Niyonkuru C, Munin MC. Quantitative electromyography improves prediction in vocal fold paralysis. Laryngoscope 2012; 122: 854-9.
• Rosen CA, Smith LJ, Young V, Krishna P, Muldoon M, Munin MC. Prospective investigation of nimodipine for acute vocal fold paralysis. Muscle Nerve 2014; 50: 114-118.
• Matsumoto ME, Khan M, Jayabalan P, Ziebarth J, Munin MC. Heterotopic ossification in civilians with lower limb amputations. Arch Phys Med Rehabil 2014; 95:1710-3.
• Ingle J, Rosen CA, Smith LJ, Young V, Munin MC. Prospective evaluation of the clinical utility of laryngeal electromyography. Laryngoscope 2014; 124: 2745-9.
• Wininger YD, Buckalew NA, Kaufmann RA, Munin MC: Ultrasound combined with electrodiagnosis improves lesion localization and outcome in posterior interosseous neuropathy. Muscle Nerve 2015; 52: 1117-1121.
• Elovic EP, Munin MC, Kaňovský P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxinA for upper limb post-stroke spasticity. Muscle Nerve 2016; 53:415-21.
• ME Matsumoto, J Berry, H Yung, M Matsumoto, MC Munin. Comparing electrical stimulation with and without ultrasound guidance for phenol neurolysis to the musculocutaneous nerve. PMR 2018; 10: 357-364.
• Moreta MC, Fleet A, Reebye R, McKernan G, Berger M, Farag J, Munin MC. Reliability and validity of the Modified Heckmatt scale in evaluating muscle changes with ultrasound in spasticity. Archives of Rehabilitation Research and Clinical Translation 2020 https://doi.org/10.1016/j.arrct.2020.100071.