The VA Palo Alto Rehab R&D Center of Excellence on Mobility continues to advance the mission of the Veterans Healthcare Administration by conducting basic science and clinical studies of the mechanisms responsible for neurological and orthopaedic impairments. This work forms the basis for developing new clinical treatments to reduce the disability of veterans and improve the effectiveness and efficiency of healthcare delivery by VA clinicians. Rehabilitation of physical impairments is most effectively accomplished by a multidisciplinary team. Likewise, development of innovative, clinically accepted, and commercially viable treatment methods requires ongoing cooperation and effective communications between Center investigators, clinical collaborators, industry, and the disabled community. This is accomplished through a variety of conduits. Clinical Collaboration: Investigations at the Center directly involve a number of local VA and Stanford clinicians, as well as leading clinical scientists at other institutions. Participation of these individuals in the research activities provides a mechanism through which clinical needs guide the development of new initiatives. It also facilitates acceptance of the products of Center research into clinical and surgical practice. During the past year, physicians at the Palo Alto VA and Stanford served as co-PI’s or investigators on most Center. The interdisciplinary nature of our work is represented by the 16 MD’s from 10 specialties (anesthesia, emergency medicine, hand surgery, neurology, orthopaedics, physical medicine and rehabilitation, pulmonology, radiology, spinal cord medicine, and urology) who actively participated in studies at the Center. In addition, 4 registered nurses, 4 physical therapists, 3 occupational therapists, and a pulmonary technologist participated in our projects. To further enhance communications with the local clinical and disabled communities, Center investigators participated in Grand Rounds, resident training programs, community-based organizations, and gave clinical in-service presentations. These personal contacts not only provided opportunities for information dissemination, but for feedback from numerous clinicians and disabled persons. Center researchers continued to maintain national and international interactions. Center investigators communicated with scientists at national and international meetings where they presented their research results. Collaborations were established or continued with clinical investigators at 4 other VA facilities (Cleveland, Houston, Kansas City, West Los Angeles). Clinical Trials: The methods used by Center investigators include theoretical, computational, animal studies, and human trials. Knowledge gained from basic science studies is applied to the development of new medical techniques and surgical procedures. Most of the clinical trials at the Center were ongoing during the past year. Two concluded and several new ones commenced. Clinical trials of robot-assisted upper limb therapy for hemiplegia in stroke subjects continued. Results from the previous study were presented at international meetings in Evry, France and Seoul, Korea. A multi-site clinical trial was designed and the MIME (TM) therapy robot was replicated for use at VA medical centers in Houston and Los Angeles. A Merit Review proposal to conduct a multisite clinical trial received approval. Funding for a Phase II SBIR proposal to commercially develop robot-assisted therapy was obtained by Applied Resources Corporation and the Center entered into a sub-contract for continued technology transfer efforts with that company. A new Merit Review project was approved to develop semi-automated methods that implement constraint-induced stroke rehabilitation without imposing the heavy workloads on therapy staff of current techniques. The initial prototype was delivered to the Birmingham VA for evaluation. Another clinical trial is testing whether strength training for the upper limb promotes greater recovery of function by stroke survivors. This work complements studies at the Center that have revealed new insights into changes in motor unit behavior following stroke. A clinical trial was completed that compared gait training involving stepping over real foam objects (over ground) to stepping over computer-generated objects (treadmill). Preliminary results demonstrated improvements for subjects in both training groups in walking speed, cadence, stride length, and ability to step over stationary objects. Treadmill intervention data show significantly increased walking speed and stride length measures for both normal and fast walking. Follow-on studies and commercialization of the method are being pursued. Scientists at the Kansas City VA and the Palo Alto Rehab R&D Center continued their clinical study testing the effectiveness of a post-stroke therapeutic exercise program designed to improve balance, strength, and cardiovascular endurance. They will also determine whether improved performance after treatment results from improved coordination. Local expertise with activity pattern characteristics as measured by EMG analyses and muscle force characteristics as calculated by computer simulation is being applied. Center investigators, along with local clinical collaborators and scientists at the Cleveland Rehabilitation R&D Center of Excellence on FES, have continued basic science and clinical studies to optimize the functional outcome of tetraplegic patients with impaired grasp who undergo tendon transfer surgery. Previous results are being utilized by hand surgeons locally and internationally. Continuing studies are expanding the scope of this research. |
