The VA Palo Alto R&D Center of Excellence on Bone and Joint Rehabilitation advances the mission of the Veterans Healthcare Administration by conducting basic science and clinical studies of the mechanisms responsible for 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. A multidisciplinary team most effectively accomplishes bone and joint rehabilitation. 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 incorporation of Center research into clinical and surgical practice. Over the past 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 11 MDs from 7 specialties who actively participated in studies at the Center. In addition, 4 Registered Nurses, 5 Physical Therapists, and 2 Occupational Therapists 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 also for feedback from numerous clinicians and disabled persons. Our medical director, Dr. Nicholas J. Giori, has been highly effective at involving Stanford Orthopaedic Surgery residents in Center research. The recent Orthopaedic Research Day was hosted at the Center and involved an honored keynote speaker (Dr. Thomas Einhorn, Chair of Orthopaedic Surgery at Boston University) and research talks by all of the residents. Roughly half the resident research projects presented were conducted at the Bone and Joint Center. It provided excellent exposure for the Center's research and the extent to which we are impacting clinical care through training of future physicians. 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 several other VA facilities (Cleveland, Houston, Kansas City, Richmond, Gainesville, Miami, and West Los Angeles). Clinical Trials: The methods used by Center investigators include theoretical, computational, cell culture, 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. The collaborative work between Drs. Thomas P. Andriacchi (PhD) and Nicholas J. Giori (MD, PhD) continues to develop and progress in the area of gait biomechanics and OA progression. In this project various specially designed shoes (supplied at no cost by Nike) are provided to veterans suffering from osteoarthritis of the knee and evaluated in terms with both function questionnaires and objective measures of disease progression (e.g., cartilage thickness from MRI). Data collected in the Center's Human Motion Lab suggest that these shoes should alter motion and loading patterns of the knee so as to mitigate disease progression. 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 sciences. 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. Another focus area for the Center is semi-automated methods that implement constraint-induced stroke rehabilitation without imposing the heavy workloads on therapy staff of current techniques. We are working on this problem in both the upper and lower extremities. In additional to neural recovery, patients are evaluated in terms of the impact of these high-intensity training regimens on skeletal tissues. 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. Hand surgeons are utilizing previous results locally and internationally in a recently funded multi-center trail. Future Goals and Objectives: The Center will continue to build upon our record of success in competing for VA and non-VA sources of funding. This should result in increased leveraging of core funding and increased research and development productivity. Clinical impact will provide a measure of treatment and device success. We will continue to pursue meaningful clinical collaborations and interactions. High quality, citable publications will remain an important measure of research achievement. We will continue to disseminate the outcomes from our research to scientists, clinicians, and disabled individuals. |
