Home > Research > Projects
Currently Funded Research Projects
Spinal Cord Injury
$1 Million NIH Grant Targets Shoulder Pain In Patients with Spinal Injuries
Sara Mulroy, director of the Pathokinesiology Laboratory at Rancho Los Amigos
National Rehabilitation Center, has been awarded a five-year, $1.04 million grant from
the National Institutes of Health's National Center for Medical Rehabilitation Research
to study the risk factors for shoulder pain in patients with spinal cord injury. Mulroy
said the most common diagnoses for people with spinal cord injury who have shoulder pain
are inflammation and tears in the the rotator cuff tendons of the shoulder. This
pathology has been attributed to increased weight bearing on the arms during wheelchair
propulsion, transfers in and out of the wheelchair and raising body weight on the arms to
relieve pressure on the skin. Pilot studies by Mulroy and colleagues at Rancho Los
Amigos suggest that the movement pattern an individual uses to propel a wheelchair
can impact the risk of developing shoulder pain.
In the NIH-funded study, Mulroy and her colleagues will follow 320 subjects with
paraplegia from spinal cord injury for a period of three years to determine the factors
associated with shoulder pain. At the end of three years they compare the patterns of
wheelchair propulsion, muscle strength and wheelchair activity levels in subjects who
develop shoulder pain with those who remain pain-free.
The overall goal of the study is to develop recommendations to reduce the strain and
joint deterioration that may occur with long-term weight bearing on the arms to prevent
further loss of functional independence after spinal cord injury.
Interventions for SCI Shoulder Function in Wheelchairs
(National Institutes of Health #RO1 HD37098)
Following a Spinal Cord Injury, many individuals must rely on pushing a manual
wheelchair for mobility. Better wheelchair designs and improved community accessibility
have significantly increased work and recreational opportunities. Unfortunately, after many
years of increased arm use, some persons develop disabling shoulder pain. In an attempt to
reduce the demands placed on the shoulder during manual wheelchair propulsion, this
project evaluates two therapeutic interventions: adjusting seating posture and exercise.
Engineering Solutions for a Shoulder Preserving Wheelchair
(National Institute of Disability and Rehabilitation Research #H133E020732)
The Engineering Solutions for a Shoulder Preserving Wheelchair project is being
conducted in the Pathokinesiology Laboratory as part of a Rehabilitation Engineering
Research Center (RERC); Keep Moving: Technologies to Enhance Mobility and Function
for Individuals with Spinal Cord Injury (SCI). This project is designed to evaluate the
effectiveness of alternative propulsion systems for reducing the demands associated with
manual wheelchair use. This includes a lever design, power-assisted push-rim design,
and compliant push-rim design. A combined approach using laboratory-based
experimentation and computer modeling techniques will be used to develop specific
clinical criteria for prescription of currently available manual wheelchair propulsion
devices. Upper extremity mechanical and muscular demands, and metabolic energy cost will
be quantified from individuals with varying strength levels during wheelchair
propulsion. Dynamic simulation, numerical optimization, and analysis techniques
will be utilized to identify factors that may further reduce
stress on the shoulder of individuals with SCI.
Strengthening and Optimal Movement for Painful Shoulders in Chronic Spinal Cord
Injury “STOMPS”
(Foundation for Physical Therapy and National Institute of
Disability and Rehabilitation Research #H133B031002-04)
The STOMPS project is being conducted as part of a clinical research network in
collaboration with the Department of Biokinesiology and Physical Therapy at the
University of Southern California. This clinical investigation is designed to evaluate
the efficacy of an exercise program on shoulder pain in persons with paraplegia
following spinal cord injury. Participants are randomly assigned to receive either a
12-week home exercise program or education about shoulder care. Pre- and post-intervention
evaluations, performed at the Pathokinesiology Laboratory, will evaluate shoulder
function, pain, and activity level.
Diabetes/Amputee
Quantified Custom Inserts - An Amputation Prevention Program for Diabetes Mellitus
(National Institute of Disability and Rehabilitation Research H133G020002)
Structural irregularities in the forefoot are a common cause of injurious pressure
concentrations during walking. Persons with normal sensation recognize these areas of
high pressure as painful and quickly seek relief. Persons with diabetes, who lack
sensation in their feet, frequently develop foot ulcers, which often lead to infection
and amputation. Preservation of the patient’s limb depends on reducing the foot’s
injurious pressure experienced while walking. Today’s techniques of shoe and insert
production are inconsistent and varied because no objective criteria for an effective
shoe system has been developed. This project is designed to identify the footwear
factors that will reduce plantar pressures in the diabetic foot to a safe walking level.
Stroke
Strength Training Effectiveness Programs for Stroke
(Foundation for Physical
Therapy)
The Strength Training Effectiveness Programs for Stroke (STEPS) project is being
conducted as part of a clinical research network in collaboration with the Department
of Biokinesiology and Physical Therapy at the University of Southern California.
This multi-center clinical investigation is designed to evaluate the effectiveness of
various therapeutic treatment interventions in persons with stroke. Six-week treatment
interventions include combinations of body-weight supported treadmill training,
stationary bicycle ergometry, and lower extremity resistance exercises. In addition to
clinical testing and isometric strength assessments, a subset of 20 subjects in the
project will have quantitative gait evaluations at the Pathokinesiology Laboratory.
Pre- and post-intervention gait evaluations will include stride analysis, motion and
forceplate analysis, as well as dynamic electromyography.
A Multi-Center, Double-Blind, Placebo-Controlled, Parallel Group Safety Study of
Pulmonary Function in Patients with Reduced Lung Function Treated with BOTOX®
(Botulinum Toxin Type A) Purified Neurotoxin Complex for Focal Upper Limb Spasticity
Due to Upper Motor Neuron Syndrome
Principle investigator: Ziyad Ayyoub, M.D.
(Back to Top)
Page last updated January 1, 2011
Please forward any comments or problems with this Web Site to
webmaster@rancho.org
