Research
The NUFSM Department of PM&R research portfolio is rich and diverse, reflecting the wide variety of interests and focus areas of our faculty and the breadth and magnitude of our Department’s resources. Our research makes an impact. Our faculty members are creating new knowledge and techniques through innovation and collaboration. Research also allows students to learn and grow through exploration, discovery, and insight. Most importantly, this research ultimately provides our patients with the benefit of receiving care that is derived from leading edge developments by well-known and highly experienced professionals. Our objectives in these research efforts are to enhance the quality of life of people with disabling conditions; to improve our understanding of the fundamental mechanisms by which disabling conditions and their recovery processes occur; and to create and evaluate new and more effective methods to assess and treat patients with disability. We not only develop and test potential solutions to important patient problems, but we also seek to understand the causes of disability and its recovery. Our Department is in the unique position to both provide and enhance care, and each of these activities informs and facilitates the other. Conducting research enables our Department’s clinical faculty members to provide better care. Providing patient care makes our research more relevant and insightful. This research is carried out by faculty members whose primary appointments are at the University and also by faculty members who are based at the Rehabilitation Institute of Chicago. Taken together, these research programs are indicative of the strong commitments that the Department and its faculty have made to the conduct of scholarly activity, to enhancing the nature and quality of care for our patients, and to improving our understanding of disability and its mechanisms. They also demonstrate the significant potential and real impact that this research has on the quality of life of people with disability. Recent Grant Awards:
Development of Sub-Ischial Prosthetic Sockets with Assisted-Vacuum Suspension for Highly Active Persons with Transfemoral Amputations
Department of Defense Peer Reviewed Orthopedic Research Program (PRORP) Technology Development Award: 9/15/10 – 9/14/13
P.I.: Stefania Fatone, PhD, PBO(Hons) Effect of Teriparatide, Vibration, and the Combination on Bone Mass and Bone Architecture in Chronic Spinal Cord Injury
Department of Defense U.S. Army Medical Research and Materiel Command Congressionally Directed Medical Research Programs; 2009 Spinal Cord Injury Research Program: 10/1/10 – 9/30/14
P.I.: Thomas J. Schnitzer, MD, PhD Areas of ResearchClinical
"Problem-Solving: A Stroke Caregiver Early Intervention”
Rosemarie B. King, PhD.
Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes (poor survivor function, decreased family functioning). Early intervention to prevent chronic distress is uncommon. This randomized, mixed-method, treatment-control trial, guided by a coping model, will test a caregiver problem-solving intervention (CPSI). The aims are to: 1) test the effect of CPSI on CG depressive symptoms, anxiety, preparedness, perceptions of life changes, family functioning, and survivor function during the first year of caregiving, 2) examine the mediation effects of appraisal of caregiving and problem-solving; and 3) describe the experience of being a CG and the experience of the intervention in CPSI CGs who are positive or negative responders on depressive symptoms. Stroke survivor-caregiver dyads (N = 280) will be randomly assigned to the CPSI or a waitlist control condition (WLC). The CPSI includes 2 sessions during acute rehabilitation and 8 telephone sessions through 3 months post-discharge with problem-solving tailored to the CG’s priorities and training in coping skills. To test its effectiveness, data will be collected on survivor and CG contextual factors, and mediating and outcome variables at baseline, post-intervention, and 6 months and 1 year post-discharge. The WLC CGs will be offered an intervention 6 months post-discharge. CPSI caregivers will be purposively sampled 1 year post-discharge based on changes in depressive symptoms, and interviewed about their experiences and responses to the intervention. Exploratory data will be collected on CG health behaviors, and survivor depressive symptoms, hospitalization, institutionalization, and mortality. Multivariate analysis of variance and regression techniques will be used to assess CPSI effects on CG outcomes and survivor function, and on mediators, respectively. Qualitative data will be analyzed using content analysis. Descriptive and univariate statistics will be used to assess the exploratory data. Funded by the NIH/National Institute of Nursing Research, this study is currently in its sixth year.
“Osteoarthritis Therapeutics: Pain and Structure"
“Chronic Pain and Corticol Structure and Function”
Thomas J. Schnitzer, MD
Research activities of our group focus on two major clinical areas: musculoskeletal pain and bone. In the area of musculoskeletal pain, the development and characterization of analgesic agents for the management of osteoarthritis has been a major focus for over the past decade. We have helped design and implement phase 2 studies of many of the major classes of drugs currently in use, including NSAIDs, cox-2 selective inhibitors, opioids, topical analgesic agents and novel approaches to pain including antibodies to NGF (nerve growth factor) and other agents active on the peripheral nervous system. In the area of chronic low back pain, our group has worked closely with Dr. A. Vania Apkarian in the Department of Physiology to describe and understand spontaneous chronic pain with a particular focus of the role of the cerebral cortex. By use of both anatomic and functional magnetic resonance imaging (fMRI), studies have demonstrated clear distinctions in brain structure and function in different pain states (acute and chronic as well as chronic low back pain vs chronic osteoarthritis pain). Current NIH-funded studies are evaluating the transition that occurs in some individuals who progress from acute to chronic pain in order to understand the changes that occur with the hope of eventually being able to modulate cortical activity to produce better clinical outcomes. “Bone Changes in Acute and Chronic Spinal Cord Injury”
Thomas J. Schnitzer, MD
Bone loss is known to be a major problem for individuals with disabilities, particularly those who are not able to ambulate or bear weight normally. The rapid and profound bone loss in patients with spinal cord injury has been well described, but yet no specific treatment has been evaluated to prevent this bone loss despite the fact that a range of potential anti-resorptive bone agents are currently available. Therefore, our group has initiated studies aimed at treating patients with acute spinal cord injury to attempt to maintain bone mass during their immediate post-injury period. In those individuals with SCI who have already lost significant bone mass, increased fracture risk leads to higher morbidity and health care costs. Standard anti-resorptive agents are not thought to be very effective at increasing significantly bone mass. Therefore, we have undertaken a second set of studies aimed at evaluating approaches to increase bone mass in these individuals, using physical and pharmacological interventions. Other Clinical Research Programs
Numerous other clinical research programs and projects are conducted primarily at the Rehabilitation Institute of Chicago under the leadership of PM&R faculty:
Stroke Rehabilitation Research & Training Center:
Elliot J. Roth, M.D., Principal Investigator
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education Neurologic Rehabilitation
One of 6 programs in the country within the National Center for Medical Rehabilitation Research, NIH; focus on neural engineering and robotic techniques Midwest Regional Spinal Cord Injury Care System:
David Chen, M.D., Principal Investigator
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education Midwest Regional Traumatic Brain Injury Care System:
Felise Zollman, M.D., Elliot J. Roth, M.D., Co-Principal Investigators
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education Machines Assisting Recovery from Stroke: A Rehabilitation Engineering Research Center:
William Zev Rymer, MD, PhD, Principal Investigator
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education
Outcomes Rehabilitation Research & Training Center:
Allen W. Heinemann, Ph.D., Principal Investigator
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education Sensory Motor Performance Program
William Zev Rymer, MD, PhD, Director For additional information on these and other research activities at the Rehabilitation Institute of Chicago, visit www.ric.org/research Training Grants
Pathophysiology and Rehabilitation of Neural Dysfunction:
William Zev Rymer, MD, PhD, Principal Investigator
The principal training objectives of this NIH-funded program remain the preparation of independent researchers, at both predoctoral and postdoctoral levels, for advanced careers in research areas relevant to the rehabilitation of neurologic disability. Our particular focus is on the “Pathophysiology and Rehabilitation of Neural Dysfunction”, with particular emphasis on the neural control of movement and its disturbance in common neurological disorders such as stroke and spinal cord injury. The information acquired by such studies should help the field to establish a rational basis for the application of rehabilitation interventions. In our 18th project year, six post-doctoral fellows were in training, together with three pre-doctoral candidates for a total of 36 and 24 months of support, respectively. The heart of our program centers on independent research projects led by predoctoral and postdoctoral trainees. In addition, we also support trainees with and intensive grant writing workshop. Students learned strategies for using electronic search tools to effectively identify appropriate funding opportunities; mastering fundamental principles of grant proposal writing; developing proposals that meet an agency’s mission; developing the hypothesis and specific aims sections of proposals; incorporating review criteria into your proposal writing; mastering electronic proposal submission; and increasing the opportunity of getting a proposal funded. To augment this training and to support trainee success in obtaining fellowship and future grant support, trainees also participating in peer review of one another’s fellowship applications complete with written critiques, closed door discussions, and thought challenges from participating faculty members. Nine predoctoral and Postdoctoral trainees pursue a total of 13 independent subprojects carved out of ongoing work within their host laboratories. 1. Finite Element Modeling of the Knee Joint to Simulate Surgical Procedures
Megan Barry’s predoctoral training project focuses on finite element modeling of the knee joint to simulate surgical interventions. It is our hope that this work will allow for better prediction of surgical outcomes to optimize results on a patient-specific scale. More scientifically guided surgical procedures should decrease the risk to the patient for the development of osteoarthritis and other joint related diseases in the future. Ms. Barry submitted and was awarded a predoctoral fellowship from the Arthritis Foundation for a Doctoral Dissertation Award entitled "Surgical & intrinsic factors contributing to patellofemoral pain post ACL-R, " attended the Segal North American Osteoarthritis Workshop (SNOW) in Chicago in October 2009, had her abstract accepted entitled "A Computational Framework to Guide Neuromuscular Rehabilitation Protocols Following ACL Reconstruction" for the 18th Annual Symposium on Computational Methods in Orthopedic Biomechanics and she will gave a podium presentation on March 5, 2010 at Tulane University in New Orleans. Following this presentation, she attended the annual meeting of the Orthopedic Research Society (March 6-9). 2. Regulation of co-contraction and proprioceptive feedback in an inverted pendulum model of standing posture
James Finley’s predoctoral training project seeks to understand how voluntary and involuntary commands to the lower limb are combined to provide stability during postural tasks. The general hypothesis for this work is that individuals compensate for increasingly challenging tasks by increasing joint stiffness through voluntary co-contraction and involuntarily increasing the sensitivity of stretch reflexes. Our results reveal that co-contraction magnitude and joint stiffness did indeed scale with increasingly destabilizing torques; however reflex amplitude was attenuated as stability was reduced. These findings suggest that the contribution of feedback mechanisms to postural stability depends on both the level of stability provided by the environment and how the environment influences the pattern of volitional activation. 3. Acceleration dependence and task-specific modulation of the soleus medium-latency stretch reflex
In contrast to the results from Mr. Finley’s primary project, “Regulation of co-contraction and proprioceptive feedback in an inverted pendulum model of standing posture, his studies in the upper limb demonstrate that stretch reflexes are enhanced during tasks that require increased stability. This discrepancy may be due to the fact that the upper limb studies typically examine longer latency reflex components which are more flexibly modulated to account for task demands. However, the conditions under which these responses exist in the lower limb remain unclear. Consistent long latency reflexes in the lower limb are most commonly observed with perturbations having smooth transitions and low acceleration, but are largely absent following rapid pulses or sharp ramp-and-hold perturbations. Hence, the purpose of this work is to determine if variations in the initial acceleration could be responsible for the inconsistency of reported long latency reflexes in the lower limb. Mr. Finley’s results demonstrate that the long latency reflexes in soleus are largest at moderate levels of acceleration, but become attenuated as acceleration was increased. Mr. Finley has given three conference presentations: Regulation of Feed-forward and Feedback Strategies at the Human Ankle during Balance Control. IEEE EMBC, Acceleration Dependence and Task-Specific Modulation of the Soleus Long-Latency Reflex. Society for Neuroscience, and Probing the Role of Feed-forward and Feedback Control during a Balance Task. Noise, Time Delay, and Balance Control. Banff Canada. He has also been awarded a National Institute of Biomedical Imaging and Bioengineering/National Institutes of Health Student Travel Fellowship 4. Learning to use a brain-controlled Functional Electrical Stimulation system
The goal of Emily Oby’s predoctoral training project is to develop a primate model of a novel Brain Machine Interface (BMI) that bypasses spinal cord injury using the brain’s natural signals to control electrical stimulation of paralyzed muscles. Using this approach, our laboratory has successfully stimulated muscles in the forearm via intramuscular EMG electrodes to enable a monkey to perform a simple wrist flexion/extension task. The next step is to show 2-D control by adding ulnar and radial deviation about the wrist as part of the task. Ms. Oby has given three conference presentations at the Society for Neuroscience Annual meeting: 1) Bypassing the injured spinal cord: A brain machine interface to provide voluntary control of paralyzed muscles, 2) Real-time control of a functional electrical stimulation system for wrist control and 3) Real-time control of a paralyzed limb: Restoration of grasp through cortically controlled FES. 5. Musculoskeletal Models and Simulations of Orthopedic Wrist Interventions
As part of her predoctoral training, Jennifer Nichols is developing musculoskeletal models and computer simulations to study two orthopedic surgical interventions at the wrist, proximal row carpectomy (PRC) and four corner fusion (4CF). Both of these surgeries are used to treat the same degenerative conditions of the wrist following complications from fracture or osteoarthritis. However, the surgical procedures and post-operative outcomes of PRC and 4CF are significantly different. Both result in impairment compared to the intact wrist, but PRC provides a greater wrist range of motion while 4CF provides greater grip strength. Through her research, Ms. Nichols will provide insight into the causes of these post-operative differences and examine the biomechanical advantages and disadvantages of each procedure. Her work will give surgeons the opportunity to make scientifically informed choices regarding whether PRC or 4CF is the best surgery for a given injury or disease. 6. Decerebrate Rigidity Illuminates Stroke Pathways in Humans
Derek Miller, is performing literature searches to shape and focus his dissertation work in the areas of stroke and spasticity. He is working on the premise that if inputs to the descending tracts are disrupted, there should be a milieu of measurable changes such as autonomic dysfunction and possibly abnormal startle reflexes. Mr. Miller is currently reviewing literature pertaining to decerebrate rigidity (DR), in attempts to outline the pathways present that are disrupted. Decerebrate rigidity is similar to spasticity in numerous ways and will hopefully illuminate the pathways that could be studied in the human. 7. Muscle Design for Postural Tasks
The control of movement is distributed throughout both the nervous system and the musculoskeletal system: the nervous system and musculoskeletal system constantly interact to produce effective movements. As a result, the complex properties of the musculoskeletal system strongly influence control, often times simplifying control. Predoctoral trainee, Anthony Jarc, completed his Master's thesis investigating how abstract representations of muscles could be designed in computation to maximize task performance. The methodology allowed Mr. Jarc to systematically examine the role of important aspects of muscle design, such as biarticular muscles. Mr. Jarc has also extended the work of Drs. Berniker and Tresch by using analytical techniques of system balancing and nonlinear model order reduction to find a low dimensional representation of the frog hind limb which succinctly captures how control inputs (muscle activations) are transformed into various system outputs (joint angles, endpoint position, etc.). Muscle synergies were then chosen to best control this low dimensional system by exploiting the passive dynamics of the musculoskeletal system. Mr. Jarc continues to work on this project for the remainder of his T32 support. He was recently awarded a pre-doctoral NRSA award to support this research. Mr. Jarc’s manuscripts include: 1) Berniker M, Jarc A, Bizzi E and Tresch M. Simplified and effective motor control based on muscle synergies to exploit musculoskeletal dynamics. class="jrnl"Proc Natl Acad Sci U S A class="src1". 2009 May 5;106(18):7601-6 and 2) Tresch MC, Jarc A. The case for and against muscle synergies. class="jrnl"Curr Opin Neurobiol class="src1". 2009 Dec;19(6):601-7. His conference presentations include: 1) Jarc A and Tresch M. The role of biarticular muscles through the optimization of musculoskeletal design. Society for the Neural Control of Movement. Waikoloa, HI, 2) Jarc A and Tresch M. Understanding the role of biarticular muscles through the optimization of musculoskeletal anatomy. Workshop on Multi-Scale Muscle Mechanics. Woods Hole, MA, and 3) Jarc A and Tresch M. Understanding the role of biarticular muscles through the optimization of musculoskeletal anatomy. Society for Neuroscience. He was awarded a National Research Service Award (NRSA) pre-doctoral award beginning this month entitled, “Restoration of Movement Using a Biologically-Inspired Control Strategy.” 8. Flexion-Withdrawal responses in arm of Spinal Cord injury patients 9. Effect of pre-pulse on movement initiation in control subjects 10. Movement in stroke patients.
Claire Honeycutt, a postdoctoral fellow in the laboratory of Eric Perreault was actively engaged in three separate projects. After completing various data collection and data analysis steps as well as initiating the development of pilot data, she was awarded a Northwestern University-Select teaching and research training (NU-START) program which is part of an NIH-funded Institutional Research and Academic Career Development Awards (IRACDA) (K12) program. Dr. Honeycutt’s manuscripts include: Honeycutt CF and Nichols TR. Disruption of cutaneous feedback does not alter the directional tuning of postural responses in the decerebrate cat. Exp Brain Res, under review, Honeycutt CF and Nichols TR. The decerebrate cat generates the essential features of the force constraint strategy. J Neurophys, 2010 Jan 20, and Honeycutt CF, Gottschall JS, Nichols TR. Electromyographic responses from the hind limb muscles of the decerebrate cat to horizontal support surface perturbations. J Neurophysiology. 2009Jun:101(6):2751-61. Dr. Honeycutt has one conference presentation: Riley ZA, Krepkovich ET, Honeycutt CF, Mayland EC, Murray WM, Perreault EJ. Cutaneous stimulation of the index finger of spinal-cord injured individuals can inhibit extensor muscles, but not excite flexor muscles in the upper limb. Society for Neuroscience. 11. Computational approaches to biological motor control
Dr. Max Berniker applied techniques from optimal control theory and Bayesian statistics to the study of normal and impaired motor systems. He worked on multiple computational and psychophysical studies. Extending his PhD work examining a simplified strategy for the control of high dimensional nonlinear motor systems. The results of that work were used to offer an explanation for the widely observed phenomena of muscle synergies. Working with Dr. Kording, a psychophysical study examining how human subjects acquire the statistics necessary to perform sensory-motor tasks was performed. Preliminary side-by-side comparisons of these results with computational models of the same task indicate that subjects perform in a near optimal fashion. More recent work has examined issues of interference and consolidation in motor adaptation. Psychophysical follow-up studies are planned to supplement these modeling studies of adaptation. The aim of this work is to gain a greater understanding of motor recovery and thus design more effective robot-assisted rehabilitation strategies. 12. Dr Berniker has 4 manuscripts and 4 conference presentations: 1) Berniker M and Kording K. Learning priors for Bayesian computation. J Neurophys Under Review, 2) Berniker M and Kording K. Iterative discrete-time local dynamic programming. IEEE Transactions on Systems, Man, and Cybernetics--Part B. Under review, 3) Berniker M, Jarc A, Bizzi E and Tresch M. Simplified and effective motor control based on muscle synergies to exploit musculoskeletal dynamics. class="jrnl"Proc Natl Acad Sci U S A class="src1". 2009 May 5;106(18):7601-6, 4) Berniker M and Kording K. Bayesian approaches to modeling action selection. Modeling Natural Action Selection, (CUP), 5) Berniker M and Kording K. A proposal for the study of adaptation and generalization for robot-assisted therapy. The American Congress of Rehabilitation Medicine-ASNR Joint Educational Conference. Denver CO, 6) Berniker M and Kording K. Interference and the Independence of Motor Adaptations. Society for the Neural Control of Movement, Waikoloa, HI, 7) Berniker M. People are very good at statistics - when they don't think they are actually doing statistics. Automatic Control Seminar ETH-Zurich, and 8) Berniker M. Chicago Chapter of the American Statistical Association 13. Computational approaches to biological motor control
Dr. Lynn Rogers’ research seeks to determine whether MRI guided rTMS targeted to the healthy hemisphere in patients with stroke has a beneficial effect on the results of concurrently performed task-oriented motor rehabilitation of the hand. In addition she will determine whether measures of motor tract integrity can be used in stroke patients to determine the prognosis of motor recovery and to monitor the effects of standard rehabilitation. Working with Dr. Richard Harvey, Medical Director for the Center for Stroke Rehabilitation at the Rehabilitation Institute of Chicago, Dr. James Stinear and the Nexstim Corporation, this project combines state-of-the-art brain stimulation technology with 6 weeks of intensive therapy. The results of this work will allow the assessment of magnetic resonance imaging (MRI_-guided rTMS as an adjuvant to therapy and serve to guide future research aimed at increasing the efficacy of motor rehabilitation following stroke. Advanced Rehabilitation Research Training Grant:
Allen W. Heinemann, PhD, Co-Principal Investigator
Jane L. Holl, MD, MPH, Co-Principal Investigator
The Institute for Healthcare Studies at the Feinberg School of Medicine, Northwestern University offers two-year post-doctoral research fellowships in health services research, funded by a National Research T32 Service Award (NRSA). This program is integrated with a National Institute of Disability and Rehabilitation Research (NIDRR) post-doctoral institutional training grant, and both a PhD and MD post-doctoral program in health services research sponsored by the Midwest Center for Health Services and Policy Research (MCHSPR), Hines VA Hospital (http://www.cmc3.research.va.gov). The purpose of the Northwestern University Health Services Research Post-Doctoral Fellowship is to help ensure that adequate numbers of highly trained individuals are available to carry out the Nation's health services research agenda in order to improve quality and safety of health care, enhance access and healthcare equity, and appraise the effectiveness of healthcare expenditures. The program is designed for professionals with a Medical Degree (MD) or Doctorate of Philosophy (PhD) who wish to gain expertise in health services research while pursuing research funding through grants and publishing their research findings. A large part of this experience is achieved through mentor relationships between fellows and distinguished faculty mentors. The fellowship currently requires completion of six core courses and two elective courses. Fellows may choose to expand the scope of formal coursework in order to complete either a Masters in Public Health (MPH), a Masters of Science in Clinical Investigation (MSCI), a Masters in Healthcare Quality and Safety at Northwestern University Graduate School, or a Masters in Epidemiology and Biostatistics (MEB). While Fellows are based at the Institute for Healthcare Studies, located on the Feinberg School of Medicine campus in downtown Chicago, they collaborate with core research faculty and staff throughout the Feinberg School of Medicine, Northwestern University including the Departments of Physical Medicine and Rehabilitation, Preventive Medicine, Internal Medicine, Pediatrics, and Psychiatry, Obstetrics and Gynecology, and Behavioral Medicine and with faculty and staff in many other Schools, Institutes, and Centers at Northwestern University. In addition, fellows collaborate with faculty and staff at the Center for Rehabilitation Outcomes Research (CROR, http://www.ric.org/research/centers/cror/index.aspx ) at the Rehabilitation Institute of Chicago (RIC), the Center for Outcomes, Research, and Education (CORE, http://www.enh.org/researchandacademics/research/centers/core/ ), the Center for Management of Complex Chronic Care (CMC3) http://www.cmc3.research.va.gov/ After completing the fellowship, fellows will have acquired the necessary skills and knowledge to be competitive for academic positions in healthcare institutions, or leadership positions in governmental and policy agencies and organizations. Rehabilitation Engineering Research Center and NU Prosthetics-Orthotics Research Program (NUPOC)
Rehabilitation Engineering Research Center for Prosthetics and Orthotics:
Steven Gard, Ph.D. and Stefania Fatone, Ph.D., Co-Principal Investigators
The vision of the Rehabilitation Engineering Research Center (RERC) for Prosthetics and Orthotics is to improve the quality of life for persons who use prostheses and orthoses through creative applications of science and engineering to prosthetics and orthotics (P&O). We want to uncover new knowledge and understanding in P&O and bring more quantification to the field, which we believe will enable us to develop new concepts and devices to improve the quality, cost-effectiveness, and delivery of P&O fittings. During the five years of this NIDRR grant cycle (2008-2013), NURERC will conduct seven research projects, five development projects, and multiple training and dissemination activities that will expand understanding of the biomechanics of human movement.
Funded by the National Institute on Disability and Rehabilitation Research,
Department of Education For more information about these programs, please visit:www.nupoc.northwestern.edu. |
