By Martha Nolan McKenzie, Illustrations by Andrew Baker
Civil engineers have nothing on Emory Doctor of Physical Therapy researchers. Investigators have been building bridges that span disciplines, institutions and countries in an effort to improve treatments and outcomes.
DPT researchers have established footings in a myriad of local institutions, including Georgia Institute of Technology, Shepherd Center, Children's Healthcare and the Atlanta VA Medical Center. Emory research bridges stretch as far as Canada and New Zealand.
The research being conducted by this host of collaborators spans the spectrum from basic science at the molecular level to animal models in the lab and from clinical applications at the bedside to outreach in the community.
"We are trying to break down the silos that tend to exist in research," says Randy Trumbower, PT, PhD, assistant professor. "We feel different perspectives and fresh insights can be very helpful, even critical. So we are working hard to build collaborations to connect our research to other disciplines outside physical therapy, to other institutions outside Emory and to other cities, states and countries. Our goal is to expand physical therapy research with the hope of improving the lives of people with a neurological injury."
|L to r: Steven Wolf, Sarah Blanton, and Randy Trumbower|
Here's a look at the many collaborations taking place:
SPINAL CORD REHABILITATION RESEARCH
Trumbower has built ties with many institutions. At Georgia Institute of Technology alone, he is working with investigators in four different areas – neuroscience, physiology, rehabilitation and engineering. And Georgia Tech's Parker H. Petit Institute for Bioengineering & Bioscience provides funding for research Trumbower is doing in his Emory lab on a therapy involving repetitive acute intermittent hypoxia (AIH).
At the Center for Robotics and Intelligent Machines, Trumbower is collaborating with other engineers to develop haptic interfaces (devices that provide tactile feedback and virtual reality) for spinal cord injury rehabilitation research. "Haptic robots allow you to simulate things you would experience in the real world but in the controlled environment of a lab," says Trumbower, who has program faculty appointments in the Department of Biomedical Engineering, Robotics PhD program and the School of Applied Physiology at Georgia Tech. "For example, a haptic robot can create an isolated resistance in one direction or it can produce vibration as if holding a power tool. This novel technology allows researchers an opportunity to get a sense of how the intact or injured nervous system is able to adapt to changes in our environment."
With collaborators in the School of Applied Physiology, Trumbower is looking at mechanisms of motor control in the spinal cord. In the Department of Biomedical Engineering, he is quantifying underlying neuromotor deficits that affect muscle coordination during walking after spinal cord injury.
Other collaborations include the University of Wisconsin, where he is working with the Department of Comparative Bioscience, Neuroscience, and Veterinary Sciences to look at the molecular, cellular and behavioral changes associated with AIH-induced neural plasticity in rats with spinal cord injury.
"My approach in research is to build bridges of collaboration that incorporate a broad range of expertise with a common mission to improve neurologic rehabilitation," says Trumbower.
COMBINING GENOMICS AND NEUROREHABILITATION
Steven L.Wolf, PT, PhD, FAPTA, FAHA, professor, has joined forces with researchers at the University of California Irvine in a first-of-its-kind study that melds genomics and neurorehabilitation. The collaboration grew out of Wolf's participation in the multi-site Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study, which tests an experimental arm therapy called Accelerated Skill Acquisition Program (ASAP). The therapy combines challenging, intensive and meaningful practice of tasks of the participant's choice compared to standard occupational therapy.
While Wolf is finishing up data collection in the ICARE study, he has begun collaboration on the genetic study. "There is evidence in animals models of stroke of a variation in genetic makeup, or a polymorphism, that involves brain-derived neurotrophic factor BDNF," says Wolf. "About 25 percent of humans have this polymorphism, and if they sustain a stroke, they have a harder time recovering. We swabbed the inside cheeks of about 75 percent of the participants in the ICARE study to check for the presence of the polymorphism and we'll compare that to their outcome in the study. This is particularly exciting because it represents one of the first genomic studies of neurorehabilitation."
CARING FOR THE CAREGIVERS
Sarah Blanton, PT, DPT, NCS, assistant professor, is teaming up with researchers at Emory's Nell Hodgson Woodruff School of Nursing, the Byrdine F. Lewis School of Nursing and Health Professions at Georgia State University and the Georgia Tech Interactive Media and Technology Center. Her goal – to discover ways to more fully integrate the caregiver in stroke rehabilitation.
"Over the last 13 years I have coordinated multiple stroke research studies at Emory, including two of the largest, multi-site NIH funded, randomized control trials in stroke rehabilitation to date," says Blanton. "Through interactions with stroke survivors struggling to regain their functional independence, I realized the integral role of the family caregiver, underscoring the impact of stroke on the family, not just the patient. However, few resources were available to support effective integration of the caregiver in physical therapy."
Her research has centered on a novel caregiver-focused intervention (CARE-CITE) designed to foster problem solving and skill building while facilitating caregiver involvement in the application of constraint-induced movement therapy (CIMT) for the stroke survivor's upper extremity.
"As a next step, I would like to expand upon this work to translate the intervention into a more accessible tele-health platform in the home environment," says Blanton.
MS REHABILITATION RESEARCH
Manning J. Sabatier, PhD, CSCS, assistant professor, is working with scientists at the Shepherd Center in Atlanta to evaluate a four-week functional electrical stimulation (FES) cycling program on multiple sclerosis (MS) patients. "We are studying MS patients with higher disability," says Sabatier.
"They are unable to activate their own muscles at a level that represents a potent exercise stimulus, so we use electrical stimulation to activate the muscles," says Sabatier. He hopes that the result is better muscle metabolic function, better neural function and improved quality of life. Such improvements would also decrease the likelihood that patients would succumb to chronic diseases associated with low physical activity, such as cardiovascular disease and diabetes.
|L to r: Ben Rogozinski, Trisha Kesar, and Manning Sabatier|
The current research group has found that people with MS can safely participate in FES cycling exercise. One of the outcomes Sabatier hopes for is reduced spasticity. Toward that end, he is measuring spinal reflexes to see if they correspond with improvements in spasticity. Eighty-five percent of people with MS have spasticity, which results in involuntary contractions of muscles. This critically impairs coordinated control of movement and quality of life. To evaluate spinal reflexes, Sabatier will measure muscle EMG responses (or electrical activity coming from the muscle) to carefully controlled electrical stimulation of the tibial nerve. Sabatier is hypothesizing that FES cycle training will reduce spasticity.
STUDYING GAIT AND CEREBRAL PALSY
Ben M. Rogozinski, DPT, assistant professor, is in the beginning stages of collaborating with Children's Healthcare of Atlanta (CHOA) to benefit people with cerebral palsy. Rogozinski, who has an extensive background in clinical work within motion analysis labs, has been negotiating with CHOA to use the Emory motion analysis lab. Evaluation of patients in the lab would aid in clinical and surgical decision-making with regards to neuro- and surgical-based interventions.
"So if a CHOA orthopedic surgeon, for example, was contemplating doing any kind of surgical intervention with one of the patients in the clinic, he or she would refer the patient to me to perform a gait study," says Rogozinski. "In a gait study, we learn all about the way the child walks, and once we can identify all of the patient's deviations, we can then postulate the causes of those deviations. That helps us have a better understanding of what surgical intervention would be the best fit for the child."
Along the way, Rogozinski will collect clinical data. "We have some specific research we want to do on the horizon," he says. "But by collecting lots of clinical data, you can also go back and mine that data for retrospective studies as well."
COLLABORATING WITH CHOA ON HEMOPHILIA RESEARCH
Trisha M. Kesar, PT, PhD, assistant professor, is gearing up to work with Rogozinski in another collaboration with CHOA, along with the Emory department of pediatrics. This project focuses on patients with hemophilia. "CHOA has a long-standing center that focuses on research on adults and children with hemophilia, but there has been insufficient focus in the hemophilia research literature on the biomechanics of walking," says Kesar. "The project we are working on will use gait analysis as a tool for evaluating changes in joint function in individuals with hemophilia and for developing new treatments."
People with hemophilia suffer bleeding into the joints, which causes pain and can lead to progressive degeneration of the joints. "One of the gaps in the literature is how this bleeding in the joints causes changes in gait patterns, and also how these changes in gait patterns can predispose someone to more joint bleeding," says Kesar. "We would like to take patients with mild and severe hemophilia into the motion analysis lab to see if the severity of the disease corresponds to the severity of disruption in gait patterns."
The bridges that Emory is building with institutions beyond the Emory walls, and even outside the physical therapy profession, will expand and strengthen physical therapy research. "If you want science to move forward, you need to build a lot of bridges," says Trumbower. "There is so much information out there, it's just not efficient to stay in your silo and try to work it all out by yourself. We are hoping this will be the common theme in our division."