As part of the Veterans Healthcare Administration, the VA Palo Alto Rehab R&D Center of Excellence on Mobility exists to help improve the health of veterans and the delivery of healthcare by VA clinicians. Fulfilling the Center's mission of developing innovative clinical treatments and assistive devices for physically disabled veterans requires effective communications between Center investigators, clinical collaborators, industry, and the disabled community. This is accomplished through a variety of conduits. Local Collaboration: Investigators at the Center collaborated with a number of local VA clinicians and other investigators involved in rehabilitation-related research. Direct involvement of these individuals in the research activities insures rapid transfer of the products of Center research into clinical or surgical practice. It also provides a mechanism through which clinical needs influence the direction of new initiatives. During the period covered by this report, 22 physicians representing the specialties of hand surgery, neurology, orthopaedics, physical medicine and rehabilitation, rheumatology, urology, and others at the VAPAHCS and Stanford participated directly in Center studies. Also, 5 physical therapists, 2 occupational therapists, and two registered nurses with ongoing clinical care responsibilities played key roles in study design, conduct, and interpretation of results. Participation by Center staff occurs in grand rounds, residency training programs, community, and clinical in-service presentations. Personal contacts, through such presentations and participation in clinical and community events, not only provided opportunities for information dissemination but for subsequent feedback from clinicians and disabled persons. National and International Collaboration: Center investigators networked with clinicians at national and international scientific meetings where they presented their research results. This led to new collaborations with clinical investigators at other regional, national, and international medical centers (12 MD's, 9 PT's, 5 other clinicians). Clinical Trials: Six clinical trials were concluded, and another four are ongoing. The benefit of robot-assisted upper limb therapy in chronic stroke subjects was demonstrated. This work led to a recently funded Merit Review project to extend the method to a more acute stroke population and also to a successful SBIR Phase I project. A Phase II SBIR proposal has been submitted by the collaborating corporation. Multi-center clinical trials are being designed in conjunction with other VA facilities and academic centers. An experimental study produced results that are already having a clinical impact. Center investigators and their clinical collaborators validated a bio-mechanical model of muscles active in grasp and used it to optimize the functional outcome of tetraplegic patients who undergo tendon transfer surgery. Changing the moment arm of one tendon produced a significant improvement in pinch force. The method has been adopted by Stanford hand surgeons and by a surgery center in France. One of the project PI's is internationally recognized for his expertise in tendon transfers and has disseminated the results at 2 national courses and orthopaedic grand rounds at another university. Adoption at other sites is believed to have occurred, however no formal survey has been made. Another experimental study produced findings with immediate clinical implications. Backward walking was previously shown elsewhere to produce lower patellofemoral joint loads, compared to forward walking. Intuitively, backward pedaling might produce similar advantages over forward pedaling during rehabilitation of knee injuries. Experimental validation of a computer model of compressive and shear forces in the knee during pedaling revealed potentially harmful effects for certain clinical conditions but beneficial effects for others. This work is likely to promote injury-specific prescription of knee rehabilitation therapies. Patient Care: In response to the recommendations of site visit and center advisory committees, the time devoted to patient care by the Center medical director increased. In February 1999, Dr. Burgar became the director of the Comprehensive Rehabilitation Center and the Traumatic Brain Injury Unit at the Palo Alto VA Health Care System, devoting at least 24 hours per week to patient care. Five physical therapists and two occupational therapists also divided their time between clinical care and Center research activities. This direct clinical involvement provided a conduit for rapid exchanges of information between investigators, other clinicians, and patients. It also facilitated enrollment of subjects in clinical trials. |
