|
|
|
ATRC 2005: Assessment, Restoration, & Preservation of Human Function
Mission and Vision
Research Themes
Relationship to NRH’s Clinical Program
Capacity Building
Relevance to the Armed Forces
Project A2: Comparison of Physiological Responses to Three Standard Modes of Excercise Testing in Persons with SCI
Project B1: Robotic-Assessent of Walking Ability Following Neurological Injury
Project C2: Computerized Cognitive and Communicative Treatment for Survivors of Brain Injury
Project C3: Online Health Survey and Statistical Analysis System
Project C4: Development and Evaluation of the TeleCog System for Remote Monitoring of Cognitive and Neurobehavioral Dysfunction
Project D1: ANAM Sports Medicine Battery (ASMB) Working Group
Project D2: Determinants of Health Outcomes among Adults with Disabilities
Mission and Vision
The mission of the John P. Murtha Assistive Technology Research Center (ATRC) at NRH is to invent, develop, evaluate, and deploy technologies that enhance recovery, foster independent living, and aid the clinical practice of rehabilitation medicine. Key to this mission, the ATRC strives to (1) enhance our understanding of the neurophysiological and neuropsychological basis of disability, (2) develop new methods and technologies to assess human function and performance, (3) develop new clinical interventions for patients with neurologically based impairments, and (4) evaluate the effectiveness of new and existing rehabilitation-related interventions.
The Center builds on a 15-year foundation of ongoing work at NRH and its partner organizations especially in the areas of neurologic assessment, technology development, telehealth, outcomes research, and health services research. Particularly noteworthy is the work of NRH's Neuroscience Research Center (NRC) funded through the Department of Defense. The mission of the NRC is to promote and accomplish rehabilitation-related basic and applied neuroscience research.
NRH's vision for the Center is two-fold: First, it is a center that contributes to the scientific body of knowledge through the completion of research studies described in this proposal, the publication of research findings in the peer-reviewed scientific literature, and the development of technologies that can be used in subsequent research, clinical practice, and the everyday lives of individuals with disabilities. Second, it is a center that builds capacity for future research through the recruitment of scientific investigators, the sponsorship of pilot studies that can subsequently compete for additional grant funding, and the consolidation of this space into a geographically defined assistive technology research center.
Continued growth and development of the Murtha ATRC also includes expanding research and academic collaborations with an array of local and regional partners. To this end, specific discussions have been undertaken resulting in partnerships and collaborations with the National Institutes of Health, the Uniformed Services University of the Health Sciences (USUHS), the Walter Reed Army Medical Center (WRAMC), the National Veterans Affairs Research and Development Program, and the Washington Veterans Affairs Hospital. NRH also benefits from an established Department of Rehabilitation Medicine at Georgetown University and strong partnerships with Georgetown University Hospital.
These relationships and collaborations enable the Center to leverage its resources to reach additional clinical populations, tap into the intellectual capital of partner organizations, and facilitate linkages between basic and more applied clinical neuroscience research. These collaborations frequently include teaching programs for a variety of health professionals and a substantial enrichment of the overall academic environment. In addition, the ATRC collaborates with partner organizations in co-sponsoring annual conferences on the future of medical rehabilitation, especially neuro-rehabilitation and technology-driven research. The annual conferences focus on emerging issues in neuroscience, medical rehabilitation science, research capacity building and the integration of basic and applied research.
Research Themes
The John P. Murtha ATRC is organized around four broad research themes:
- Enhancement our understanding of the neurophysiological and neuropsychological basis of disability - projects characterizing the effects of multisystem neurotrauma secondary to blast concussion, and measuring energy expenditure of individuals with paraplegia undergoing three different modes of exercise treatments to determine optimal outcome.
- Development of new methods and technologies to assess human function and performance – a quantitative technique for evaluating and tracking function in individuals with gait disorders following neurological injury.
- Development of new clinical interventions for patients with neurologically based impairment - projects developing suitable dynamic ankle-foot-orthosis using selective laser sintering rapid prototyping technology, computerized cognitive and communicative treatment for brain injury survivors, web-based health survey systems and remote monitoring of cognitive and neurobehavioral dysfunction.
- Evaluation of the effectiveness of new and existing rehabilitation-related interventions - projects to complete the clinical development of the Automated Neuropsychological Assessment Metrics (ANAM) Sports Medicine Battery and to understand the prevalence, type of disability, health care access, and health care utilization, and the relationship of these factors to health outcomes among adults with disabilities who have and have not served in the armed forces.
The above themes are addressed, mainly but not exclusively, via full-scale, hypothesis-driven research projects. These larger projects are in areas where NRH has a well-established track record and core of expertise. The remaining projects are smaller-scale, exploratory pilot-type studies that have promise for new funding from outside sources. Combined, our research plan includes a mix of exciting current projects and a deep and rich pipeline of future projects. Moreover, selection of projects for the NRH-ATRC has been based on careful and thoughtful review of their potential to later become self-supporting via competitive research funding mechanisms or commercial development.
For the ATRC to function as a productive and successful center, it needs to be more than a collection of thematically related projects. The center plan therefore includes projects which generate deliverables directly, as well as establish the framework for future research that may be funded from other sources. These links can have several forms. For example, a body of data from one project may determine the hypothesis to be tested in another. Similarly, two projects may intentionally take alternative approaches with the intent of comparing results at the end. A device or experimental test bed or survey instrument created in the course of one project may be handed off to another.
Well-functioning research centers also foster synergies that cut across individual projects and thus create opportunities that go well beyond the knowledge accumulated from each individual project. To capture this intellectual capital, the center is committed to sponsoring activities (e.g., conferences, synthesis papers, review articles) that transcend the boundaries of our individual projects.
Relationship to NRH’s Clinical Program
A signature of most, perhaps all, of the ATRC's work is its relevance to the service delivery needs of our patients. While it is certainly true that fundamental disabilities research—including experiments in animal models, computational modeling, and in vitro studies—can and will ultimately bear fruit in patient care, the ATRC focuses on studies that have the potential to influence the lives of patients sooner and more directly. Many of its projects involve NRH patients with neurological disabilities as study subjects and as evaluators of new technologies. This is a focus rather than a limitation. NRH CEO, Ed Eckenhoff has routinely stated, “I want to be able to walk into the PT gym, the patients' rooms, the specialty clinics and ultimately into our customers homes and see the techniques and technologies which were developed in our labs.”
A related principle for the center is the involvement of clinicians who have research skills and interests. This is essential for several reasons. NRH prides itself on a culture of innovation in clinical care. To support and solidify this inventiveness, clinicians must have the opportunity to influence the direction of neuroscience research based on their own observations of critical needs and unanswered questions. For this hospital to pursue a position of leadership in the world of clinical rehabilitation, its clinicians must be encouraged to be constructively critical of conventional care and seek evaluation and optimization of their own modes of practice. Operationally, this desirable inclusiveness of the ATRC research program requires concrete steps by clinical service managers to make it feasible financially and organizationally for staff members to devote a portion of their time to funded research. This has already been accomplished to a degree in connection with other center grant research at NRH and is extended and solidified under the ATRC.
| |
Capacity Building
Enhancing clinical staff participation in Center-related research is one example of the ways the Center supports the capacity building needed to help the Center move to the next stage of development at the end of the funding period. The capacity-building plan consists of three main elements: (1) staff recruitment and development, (2) interinstitutional and intrainstitutional collaborations, and (3) national conferences.
Staff recruitment and development
NRH is fortunate to have a core of nationally recognized researchers who provide the intellectual and research leadership needed to assure the Center's forward momentum. The Center's growth and development depend on its ability to attract promising investigators, including second-tier investigators who take on leadership roles as the Center matures. Some of these investigators come from the ranks of NRH clinical staff who have demonstrated a strong aptitude for research and wish to become more actively involved in research either as an adjunct to their clinical responsibilities or as a career change.
Expansion and consolidation of physical space and equipment
An important element in NRH's capacity-building plan is the completion of a geographically defined physical research space at NRH devoted to rehabilitation-related research. A new (summer 2004), 2500 square foot addition provides contiguous space that establishes a working environment in which investigators and support staff enjoy the benefits close proximity to one another affords: convenient sharing of ideas, resources, and research direction.
Inter-institutional collaborations
In addition to the ongoing professional relationships NRH maintains with several Washington-area institutions previously mentioned, NRH's research programs also have out-of-area collaborators in Boston, Houston, Salt Lake City, Minneapolis-St. Paul, Florida, Montana, Oregon, and the Pacific Rim, just to name a few. One hallmark of NRH-related research is its long track record of participation with investigators in other institutions. Broad collaboration adds intellectual firepower and augments the pool of possible study subjects.
| |
Relevance to the Armed Forces
Individually and collectively, ATRC projects benefit the men and women of the armed forces, their dependents, military retirees, and individuals served by the Department of Veterans Affairs (VA). Some of these projects benefit the armed forces because they address issues that arise from battlefield conditions. Others benefit the armed forces because they address human performance issues that arise from more chronic health concerns. Because NRH is mainly a post-acute care provider, most of the activity here addresses downstream health and disability issues whether they arise from acute or chronic health conditions.
Below is an overview of the military relevance associated with each research area:
Enhancement of our understanding of the neurophysiological and neuropsychological basis of disability
1) Comparison of physiological responses to three standard modes of exercise testing in persons with spinal cord injury. Military personnel are experiencing spinal cord injuries, as evidenced by a recent TV news story, and data from this project will help to determine the most effective methodology for measuring peak aerobic capacity. Obtaining this data will be helpful in maximizing the rehabilitation treatment and helping these individuals return to their optimal level of function.
Development of new methods and technologies to assess human function and performance
1) Robotic-Assessment of Walking Ability Following Neurological Injury. This project has widespread implications to soldiers who may suffer neurological injuries resulting in gait disorders such as spinal cord injury, stroke, or traumatic brain injury. The proposed technique will allow us to deliver more efficient therapy to these individuals by identifying the optimal training conditions under which they should be trained as well as allow us to track their functional recovery over the course of an intervention. This may ultimately lead to higher gains in walking ability and subsequently allow them to independently perform activities of daily living.
Develop new clinical interventions for patients with neurologically based impairments
1) Custom Dynamic Ankle-Foot Orthoses for Enhanced Function. The goal of this project is to develop a customized, strong, lightweight AFO that can be fabricated in a short time and at a reasonable cost. This would make it is ideally suited to provide military personnel and civilians, who have gait abnormalities due to injuries or illnesses, with a state-of-the art orthosis. In addition, it could be used in healthy military personnel who require performance enhancement and injury prevention when performing extremely demanding and hazardous types of activities.
2) Development and Evaluation of the TeleCog System for Remote Monitoring of Cognitive and Neurobehavioral Dysfunction. The TeleCog system developed will have applications for both civilian and military populations, including the ability to remotely monitor cognitive and neurobehavioral response to medical interventions (e.g., pharmacotherapy) or stressful environments (i.e., proximity to explosives or prolonged exposure to combat situations).
3) Computerized cognitive and communicative treatment for survivors of brain injury. The project will develop a software system that will be used to provide computerized treatment interventions for persons with cognitive impairments resulting from traumatic brain injury or stroke. The software will be able to serve both civilian and military populations as it has application in a range of rehabilitation disciplines such as speech-language pathology, neuropsychology, and occupational therapy.
4) Online Health Survey and Statistical Analysis System. This project is critical to managing and analyzing experimental data involving a wide array of studies. The proposed data management and analysis system will provide accurate record keeping, and provide clinicians the ability to monitor progress and outcomes of interventions and overall health status of military personnel.
Evaluation of the effectiveness of new and existing rehabilitation-related interventions
1) ANAM Sports Medicine Battery (ASMB) Working Group. A large majority of the data to be "harvested" and integrated into clinically usable form has been derived from military personnel, primarily West Point cadets and soldiers at Fort Bragg. Cerebral concussion is a common military injury and improved understanding of concussion monitoring and surveillance is of direct and immediate relevance to military medicine. This project will complete clinical development of the ANAM Sports Medicine Battery (ASMB) by creating a formal working group (ASMBWG) of current ASMB researchers, representing elite universities and institutions, who agree to share data, coordinate planning of future multi-site studies, and provide oversight for ASMB's deployment as a public health instrument for widespread clinical use.
2) Determinants of Health Outcomes among Adults with Disabilities. This study offers comparative information on factors affecting health outcomes for adults with physical disabilities who have and have not served in the military. The information will benefit the Army by identifying barriers to health care service delivery for former military personnel with physical disabilities. It will provide useful information on the occurrence of nationally targeted chronic conditions among adults with physical disabilities who have served in the military and may be using the VA health care system. By highlighting factors that may contribute to both positive and negative health outcomes for former military personnel who have physical disabilities, the study can help the Army direct its health care dollars to specific areas of greatest need. The data may also pinpoint opportunities for changes/enhancements to the Army's health care services delivery system that could foster greater health benefits for former Army personnel with physical disabilities.
The military and armed forces relevance of our activities depends on more than the intrinsic relevance of each project or group of projects. It also depends on our ability to foster professional relationships with armed forces personnel and with various military and veterans' health systems. Both previous and current ANAM work, for example, relies heavily on collaboration with armed forces personnel and related research organizations. Likewise, NRH is currently working with USUHS and WRAMC in a multi-center clinical drug trial investigating the effects of Modafinil in individuals with Post-polio syndrome. Similarly, NRH enjoys extensive contacts with colleagues in the Department of Veterans Affairs—in the national office, the Washington VA Hospital, and other VA hospitals in different parts of the nation. We believe that these networks are important in helping to disseminate the findings of our research to those who serve the men, women, and veterans of our armed forces.
Finally, we wish to underscore the important role that can be played by our project officers and sponsors in the U.S. Army Medical Research and Materiel Command (USAMRMC). We believe that, as the nerve center for much of the military's sponsored health-related research, USAMRMC can provide linkages to other investigators and potential users within the armed forces and VA systems.
|
|
|
|
|
|
|
|