UAB Insight Rehabilitation Volume 3 - Page 2

N OT E WO RT H Y P R E S E N TAT I O N S F E AT U R E D CLINICAL TRIAL Pregnancy. Labor, Delivery, and Postpartum Outcomes of Women with and without Spinal Cord Injury (SCI): an Observational Study. The study will follow women with SCI through pregnancy and postpartum to determine if they experience unique complications during pregnancy and delivery that able bodied women do not experience. This will be accomplished by pairing age- and parity-matched pregnant, ablebodied women through pregnancy and delivery. The study will also determine if unique psychosocial concerns arise for women with SCI. Results will provide the first, prospective, longitudinal data on this important group of individuals to help with education of professionals as to their unique care needs. PI: Amie B. McClain, MD. Contact: Jan Troncale, 205.934.3330. UAB PM&R Finding Promise in Constraint-Induced Therapy for Limb Paralysis Due to Stroke, Multiple Sclerosis Rehabilitation specialists at UAB are investigating constraintinduced (CI) movement therapy as an initiative for stroke rehabilitation and multiple sclerosis. The technique has found success in several other neurological disorders, including children with cerebral palsy. CI therapy founder Edward Taub, PhD, of the Department of Psychology, joined UAB in 1986 following his seminal animal studies that found an intensive training program could remodel the brain and counteract partial paralysis from neurological injury. Taub began human studies, including one of the earliest randomized, controlled clinical trials in neurological rehabilitation. The approach has since been reproduced successfully in numerous trials. It is now considered a mainstream program, and patients travel from around the world to UAB for th e program. Patients in CI therapy wear a restraint on the unaffected arm to Dr. Mark and physical therapy assistant Katherine Pinion work with a head injury patient in clinic. A systematic program of behavior-reinforcement techniques keep it from assisting the arm that has paralysis, says Victor Mark, takes treatment benefits from the clinic to the real world. The MD, associate professor in the Department of Physical Medicine patients sign a contract with the therapist, agreeing to perform and Rehabilitation. Restraining the “good” arm encourages the after-hours homework exercises, keep a home-practice diary, brain to “rewire” itself. Mark, Taub, and project leader Gitendra report daily in a structured interview about how the limb was used Uswatte, PhD, are funded by the NIH to study whether the the previous day, and meet with the therapist for 30 minutes before treatment can be given entirely in the home setting with a therapist each training session. monitoring the patient’s training practice via Internet. “Current findings are very encouraging, and if this is successful, the treatment can reach out to patients far from major centers, with substantial reduction in treatment costs,” says Mark. CI therapy requires the patient to undergo intensive, outpatient Mark is also medical director for the UAB outpatient adult CI therapy clinic that provides therapy for restricted limb use following stroke, traumatic brain injury, or neurosurgery for tumors. He also has National MS Society funding to study CI therapy for restricted arm use in adults with MS. “Results so far have been work for 3 hours at a time for 2 or 3 consecutive weeks, moving the outstanding, and soon we hope to see whether the treatment can patient to progressively more challenging tasks. also benefit restricted walking in this population,” he says. continued from cover rehabilitation and research we can provide as a member of the model system program,” says Novack. After completing projects on return-to-driving over partnership with components of the UAB Health weight control compared to other states. Our pilot data “We are proud of the high level of treatment, unfortunately are particularly challenged by issues of organizations such as the Alabama Department of are obese a year after the injury.” DeSilva Codirects Neuroscience Graduate Program Researcher Tara DeSilva, PhD, who recently joined the faculty of PM&R and the UAB Civitan International Research Center, has been appointed codirector of the UAB Neuroscience Graduate Program. DeSilva recently finished her postdoctoral training at Harvard Medical School and Children’s Hospital, Boston. She earned her PhD degree in biological chemistry from the University of Pennsylvania. The program seeks to train students to become innovative neuroscientists through a theme-based curriculum that teaches neuroscience ideas that become stepping stones to more indepth research. The program is offered through many labs, not limiting students to a department but to a discipline. MS Research: ‘Reinsulating’ Neuronal Pathways The demyelination of pathways between neurons in the brain is known to lead to the motor dysfunctions that are a MEASURES OF SUCCESS Rehabilitation Services and the Alabama Head Injury The new, in-house project proposes a lifestyle intervention, tailoring an established, evidence-based Foundation. The TBI Model System of Care Program was the past few years, the UAB TBIMS is pivoting to a program that has proven successful with other groups, established by Congress in 1988 and is funded by the new research focus on lifestyle change following TBI, he adds. Researchers Laura Dreer, PhD, and Laura National Institute on Disability and Rehabilitation specifically emphasizing weight control/loss, he says. Vogtle, PhD, are PI and co-PI, respectively. Research. “Obesity is a national issue, and Alabama’s citizens Floyd Named PM&R Research Director Candace Floyd, PhD, recently was named PM&R director of research. Floyd, an associate professor who joined UAB in 2006, holds positions from Virginia Commonwealth University and completed postdoctoral training at the University of California-Davis before joining the Davis faculty. She holds positions at several UAB interdisciplinary centers and is secretary-treasurer of the National Neurotrauma Society. Her research projects are funded by the DOD, NIH, and National Football League, and last year she was named scientific director for the T. J. Atchison Spinal Cord Injury Research Program. Floyd recently was appointed to hold the Women’s Committee of Spain Rehabilitation Center Endowed Chair in Rehabilitation Neuroscience Research. System and between UAB and community indicate that a fourth of patients with TBI seen at UAB UAB MEDICINE NEWS Activities of the UAB TBIMS reflect an active UAB TBI Outcomes Since funding began in 1998, the UAB TBI Model System has enrolled 860 participants in the national TBI database, placing UAB in the top five in the country for enrollment. One-year-after injury statistics show promising results. Funding for the TBI Model System is provided by the National Institute on Disability and Rehabilitation Research. prominent feature of multiple sclerosis. Now research efforts in the Department of PM&R are attempting to improve the brain’s ability to myelinate, or “insulate,” the pathways to ensure proper communication between neurons. Tara DeSilva, PhD, is looking for why myelin injury is important for understanding why the brain is susceptible to the devastating syndrome. She focuses on the role of glutamate, a brain transmitter that plays an important signaling role during the myelin insulating process. Her research has shown that when glutamate production is disrupted, the insulation around the nerves decreases substantially. DeSilva’s laboratory also is interested in how glial progenitor cells, which are found near brain lesions in MS, can be activated to restart the myelination process. The research has shown that certain signaling pathways in glial progeni tor cells are necessary for remyelinating the brain, providing a possible therapy for brain repair. Neurobehavior Clinic The Neurobehavior Clinic is a program focusing on people with acquired brain disorders who exhibit significant behavioral and/or emotional problems. The clinic is a collaboration between the UAB Department of Physical Medicine and Rehabilitation and the Alabama Head Injury Foundation (AHIF) and takes place at the Linc Point facility operated by United Cerebral Palsy. Robert Brunner, MD, and Thomas Novack, PhD, provide information regarding medication management and behavioral interventions. Service coordinators with the AHIF, who also attend the clinic, then assist the consumers and family members in implementing the recommendations. The clinic, unique in Alabama, operates once a month. Eick J* and Richardson EJ. “Investigating Effective Components of Two Virtual Walking Paradigms: Subjective Report and Validation with Objective Measures of Sensorimotor Cortical Activation,” Association of Academic Physiatrists Annual Meeting, March 6-10, 2013, New Orleans. Hagan K* and Floyd CL. “Neurogenesis and cognitive impairment following mild traumatic brain injury,” Association of Academic Physiatrists Annual Meeting, March 6-10, 2013, New Orleans. *Awardee of Fellowship for Rehabilitation Research Experience for Medical Students 2012. FAC ULT Y BY SP ECI A LT Y Musculoskeletal Johnny Markus Carter, DO Laura B. Kezar, MD Anthony C. Pitts, MD Danielle K. Powell, MD Martin Setliff, MD Musculoskeletal & Occupational Medicine Michelle J. Turnley, MD Neuro-Psychology Amie Knight, PhD Thomas A. Novack, PhD Sarah Wright, PsyD Rehabilitation Psychology J. Scott Richards, PhD Elizabeth Richardson, PhD Research Yu-ying Chen, MD, PhD Tara DeSilva, PhD Michael J. DeVivo, DrPH Candace Floyd, PhD Spinal Cord Injury Amie B. McLain, MD Keneshia M. Kirksey, MD Stroke Victor W. Mark, MD Xiaohua Zhou, MD Traumatic Brain Injury Robert C. Brunner, MD 2 F OR REF ERR A L S: 1- 8 0 0 - 8 2 2- 6 47 8 MOR E INF OR M AT ION: uabmedicine.org /physician 3