LAREI

SPINAL CORD INJURY

$1 MILLION NIH GRANT TARGETS SHOULDER PAIN IN PATIENTS WITH SPINAL CORD INJURIES
Sara Mulroy, Director of the Pathokinesiology Laboratory at Rancho Los Amigos National Rehabilitation Center, has been awarded a five-year, $1.04 million grant from the National Institutes of Health's National Center for Medical Rehabilitation Research to study the risk factors for shoulder pain in patients with spinal cord injury. Mulroy said the most common diagnoses for people with spinal cord injury who have shoulder pain are inflammation and tears in the the rotator cuff tendons of the shoulder. This pathology has been attributed to increased weight bearing on the arms during wheelchair propulsion, transfers in and out of the wheelchair and raising body weight on the arms to relieve pressure on the skin. Pilot studies by Mulroy and colleagues at Rancho suggest that the movement pattern an individual uses to propel a wheelchair can impact the risk of developing shoulder pain.

In the NIH-funded study, Mulroy and her colleagues will follow 320 subjects with paraplegia from spinal cord injury for a period of three years to determine the factors associated with shoulder pain. At the end of three years they will compare the patterns of wheelchair propulsion, muscle strength and wheelchair activity levels in subjects who develop shoulder pain with those who remain pain-free.

The overall goal of the study is to develop recommendations to reduce the strain and joint deterioration that may occur with long-term weight-bearing on the arms to prevent further loss of functional independence after spinal cord injury.

Interventions for SCI Shoulder Function in Wheelchairs (National Institutes of Health Grant #RO1 HD37098)
Following a Spinal Cord Injury (SCI), many individuals must rely on pushing a manual wheelchair for mobility. Better wheelchair design and improved community accessibility have significantly increased work and recreational opportunities for persons with SCI. Unfortunately, after many years of increased arm use, some persons develop disabling shoulder pain. In an attempt to reduce the demands placed on the shoulder during manual wheelchair propulsion, this project evaluates two therapeutic interventions: adjusting seating posture and exercise.

Engineering Solutions for a Shoulder Preserving Wheelchair (National Institute on Disability and Rehabilitation Research, U.S. Department of Education, Grant #H133E020732)
The Engineering Solutions for a Shoulder Preserving Wheelchair project is being conducted in the Pathokinesiology Laboratory as part of a Rehabilitation Engineering Research Center (RERC); Keep Moving: Technologies to Enhance Mobility and Function for Individuals with Spinal Cord Injury (SCI). This project is designed to evaluate the effectiveness of alternative propulsion systems for reducing the demands associated with manual wheelchair use. This includes a lever design, power-assisted push-rim design, and compliant push-rim design. A combined approach using laboratory-based experimentation and computer-modeling techniques will be used to develop specific clinical criteria for prescription of currently available manual wheelchair propulsion devices. Upper extremity mechanical and muscular demands, and metabolic energy cost will be quantified from individuals with varying strength levels during wheelchair propulsion. Dynamic simulation, numerical optimization, and analysis techniques will be utilized to identify factors that may further reduce stress on the shoulder of individuals with SCI.

Strengthening and Optimal Movement for Painful Shoulders in Chronic Spinal Cord Injury “STOMPS” (Foundation for Physical Therapy and National Institute on Disability and Rehabilitation Research, U.S. Department of Education, Grant #H133B031002-04)
The STOMPS project is being conducted as part of a clinical research network in collaboration with the Department of Biokinesiology and Physical Therapy at the University of Southern California. This clinical investigation is designed to evaluate the efficacy of an exercise program on shoulder pain in persons with paraplegia following spinal cord injury (SCI). Participants are randomly assigned to receive either a 12-week home exercise program or education about shoulder care. Pre- and post-intervention evaluations, performed at the Pathokinesiology Laboratory, will evaluate shoulder function, pain, and activity level in those with SCI.

DIABETES/AMPUTEE

Quantified Custom Inserts - An Amputation Prevention Program for Diabetes Mellitus (National Institute of Disability and Rehabilitation Research, U.S. Department of Education, Grant #H133G020002)
Structural irregularities in the forefoot are a common cause of injurious pressure concentrations during walking. Persons with normal sensation recognize these areas of high pressure as painful and quickly seek relief. Persons with diabetes, who lack sensation in their feet, frequently develop foot ulcers, which often lead to infection and amputation. Preservation of the patient’s limb depends on reducing the foot’s injurious pressure experienced while walking. Today’s techniques of shoe and insert production are inconsistent and varied because no objective criteria for an effective shoe system has been developed. This project is designed to identify the footwear factors that will reduce plantar pressures in the diabetic foot to a safe walking level.

STROKE

Strength Training Effectiveness Programs for Stroke (Foundation for Physical Therapy)
The Strength Training Effectiveness Programs for Stroke (STEPS) project is being conducted as part of a clinical research network in collaboration with the Department of Biokinesiology and Physical Therapy at the University of Southern California. This multi-center clinical investigation is designed to evaluate the effectiveness of various therapeutic treatment interventions in persons with stroke. Six-week treatment interventions include combinations of body-weight supported treadmill training, stationary bicycle ergometry, and lower extremity resistance exercises. In addition to clinical testing and isometric strength assessments, a subset of 20 subjects in the project will have quantitative gait evaluations at the Pathokinesiology Laboratory. Pre- and post-intervention gait evaluations will include stride analysis, motion and forceplate analysis, as well as dynamic electromyography.

A Multi-Center, Double-Blind, Placebo-Controlled, Parallel Group Safety Study of Pulmonary Function in Patients with Reduced Lung Function Treated with BOTOX® (Botulinum Toxin Type A) Purified Neurotoxin Complex for Focal Upper Limb Spasticity Due to Upper Motor Neuron Syndrome
Principal Investigator: Ziyad Ayyoub, M.D.Research Coordinator: Shawn Phipps, M.S., OTR/L