Dr Charlene Macko, CMO

Charlene Hafer-Macko, MD, Chief Medical Officer (CMO), is a biomedical engineer and neuromuscular neurologist with research encompassing muscle and metabolic mechanisms in neuro-rehabilitation, and robotics assisted rehabilitation with a focus on biomechanics of movement restoration. She received her master’s degree in Biomedical Engineering at Case Western Reserve University, and medical school training at Ohio State University. Following neurology residency at University of California Los Angeles (UCLA), she received fellowship training in clinical neuromuscular disorders and neurophysiology at UCLA, and research fellowship training in Peripheral Nerve Disease at Johns Hopkins University before joining University of Maryland, Departments of Neurology and Geriatrics Medicine.

Dr. Hafer-Macko’s early career research focused on inflammatory and immunological mechanisms in neuromuscular disease, including immune mediated neuropathies and myasthenia gravis. Recognizing that secondary changes in skeletal muscle induced similar inflammatory-metabolic pathologies after stroke, she developed a research program investigating muscular structural and metabolic abnormalities, and the specificity of exercise models to improve health and function. Utilizing biological and morphometric comparisons of hemiparetic and non-paretic muscle, her team demonstrated elevated inflammatory mediators, altered contractile proteins, and master transcriptional regulators of muscle metabolism and phenotype are impaired after stroke and modifiable by structured exercise. These advances understanding causal relationships between skeletal muscle structure, metabolism, and exercise underscore the importance of integrating exercise integrated with robotics as the foremost model to durably improve whole health and functionality for persons with stroke and other mobility disability conditions.     

Recognizing impaired biomechanics as a common factor limiting functional independence after stroke, as well as ability to participate in rehabilitative exercise, Dr.  Hafer-Macko’s research has expanded into shaping robotics integrated exercise to mutually improve gait biomechanics, muscle function, and cardiovascular-metabolic health. Her discoveries with the NextStep Robotics team that ankle robotics assisted gait training in person with chronic stroke produces emerging improvements the biomechanical safety and efficiency of gait suggests a priming of central neural plasticity and increased free-living ambulatory activity to stimulate ongoing improvements. These advances have led her to champion the implementation of robotics-assisted gait training at optimizing and exercise dose-intensities to mediate both central neural plasticity to shape gait biomechanics and peripheral adaptations to improve neuromuscular function and metabolism. Hence, Dr. Hafer-Macko’s whole health model strategically integrating exercise physiology and neuromuscular science with robotics has become an emerging direction in Nextstep Robotics. 

As CMO of NextStep Robotics, and Director of Education and Outreach, Dr. Hafer-Macko leads robotics integrated exercise endeavors as a cornerstone for whole health after stroke. In addition, she and her husband, Richard Macko, MD (CSO, NextStep Robotics) donate their time as Research Faculty at University of West Indies, SODECO (Solutions for Developing Countries) in Jamaica, and Fleni Neurological and Rehabilitation Institutes in Argentina to collaborate on the translation of evidence based exercise and robotics models into practice to reduce the global burden of stroke and other neurological disability conditions.