The VA Palo Alto R&D Center advances the mission of the Veterans Healthcare Administration by conducting basic science and clinical studies of the mechanisms responsible for neurologic and orthopaedic impairments. This work forms the basis for developing new clipical treatments to reduce the disability of veterans and improve the effectiveness and efficiency of healthcare delivery by VA clinicians. Rehabilitation 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. Over the jast year, physicians at the Palo Alto VA and Stanford served as co-PI's or investigators on many Center projects. The interdisciplinary nature of our work is represented by the 17 MD's from 7 specialties who actively participated in studies at the Center. In addition, 4 registered nurses, 5 physical therapists, and 2 occupational 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 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. Initial work has begun on a new orthopaedic clinical trial in the Orthopaedic Rehab area in a collaboration between Dr.'s Andriacchi and Giori. In this project various specially designed shoes (supplied at no cost by Nike) will be provided to veterans suffering from osteoarthritis of the knee and evaluated in terms of disease progression. Data collected in the human motion lab suggest that these shoes should alter motion and loading patterns of the knee so as to remove the cause of disease. Additionally, Dr. Andriacchi has begun a funded study to identify, develop, and deploy gait assessment technology in a multi-center context. Input from the other VA Rehab R&D Centers is being solicited to identify interest and needs among the centers. Further, this project aims to develop a markerless gait analysis system which will have important applications in both orthopaedic and neurologic gait science. Finally, a clinical science project has begun which will collect gait information for veterans undergoing total knee arthroplasty for knee osteoarthritis. These data will be correlated biochemical markers of osteoarthritis as well as cartilage thickness measurements made from the surgical specimens and long-term success measures. Clinical studies on stroke and SCI patients continue at the Center as well. Clinical trials of robot-assisted upper limb therapy for hemiplegia in stroke subjects continued. A multi-site clinical trial is underway and the MIME therapy robot was replicated for use at VA medical centers in Houston and Los Angeles. A Merit Review-funded project to conduct a multi-site clinical trial had begun. 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 begun 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. 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. |
