UAB Insight Rehabilitation Volume 4 - Page 3

P U B L I C AT I O N S O F N OTE Mark VW, Taub E, Uswatte G, Bashir K, Cutter GR, Bryson CC, Bishop-McKay S, Bowman MH. “Constraintinduced movement therapy for the lower extremities in multiple sclerosis: case series with 4-year follow-up.” Arch Phys Med Rehabil. 2013 Apr;94(4):753-60. Labbe DR, Vance DE, Wadley V, Novack TA. “Predictors of Driving Avoidance and Exposure Following Traumatic Brain Injury.” J Head Trauma Rehabil. 2013 Mar 7. Epub ahead of print. Barker MD, Whyte J, Pretz CR, Sherer M, Temkin N, Hammond FM, Saad Z, Novack TA. “Application and Clinical Utility of the Glasgow Coma Scale Over Time: A Study Employing the NIDRR Traumatic Brain Injury Model Systems Database.” J Head Trauma Rehabil. 2013 Mar 26. Epub ahead of print. Day NL, Floyd CL, D’Alessandro TL, Hubbard WJ, Chaudry IH. “17ß-estradiol confers protection following traumatic brain injury in the rat and involves activation of g protein-coupled estrogen receptor 1 (GPER).” J Neurotrauma. 2013 Sept 1;30(17):1531-41. UAB Medicine News UAB PM&R Joins Small Group of Centers Committed to Transverse Myelitis Research, Treatment Funding from a foundation set up by a patient with a 46-year history of transverse myelitis (TM) is propelling UAB into the small group of centers in this rare inflammatory demyelinating disease. TM affects myelin specifically in the spinal cord. Researcher Tara DeSilva, PhD, recently joined the PM&R faculty to conduct research on this and other neuroimmunological diseases that affect nerve fiber insulation. Multiple sclerosis (MS) is the prototype of this type of disease and is the most common disease that affects myelin in the brain and spinal cord. “Understanding how the mechanisms work that underlie the immune system’s destruction of myelin is relevant to both of these devastating diseases,” she says. Her laboratory has demonstrated that the essential brain neurotransmitter glutamate plays an important signaling role in the myelin insulating process. DeSilva has shown that damage occurs to the myelin sheath when proper glutamate concentrations in the brain are disrupted. A physical therapist helps Mike Jezdimir during a therapy session. that can be targeted for intervention,” DeSilva says. Jezdimir contracted TM in 1967 and has been followed by physiatrist Amie McLain, MD, chair of PM&R, for several years. Funding from the Mike L. Jezdimir Transverse Myelitis Foundation has given her research group the opportunity to study human samples from patients with MS and TM. The study His foundation supports UAB research on nontraumatic spinal cord injury. DeSilva’s lab also is interested in brain repair mechanisms. DeVivo Paper Is ‘Most Cited’ in Spinal Cord A review of trends in spinal cord injury (SCI) rehabilitation by Michael DeVivo, DrPH, has been named as 2012’s most cited paper from the journal Spinal Cord [epub January 2012], the premier international peer-reviewed journal devoted to SCI research. DeVivo, director emeritus of the National SCI Statistical Center housed at UAB, based the article on his invited 2011 presentation to the State of the Science in SCI Rehabilitation: Informing a New Research Agenda conference prior to the joint annual meeting of the International Spinal Cord Society and the American Spinal Injury Association. A professor in the Department of Physical Medicine and Rehabilitation, he served as manager of analytic services, co-director, and eventually as director of the National SCI Statistical Center from its founding in 1983 until his retirement in 2005. He also was senior scientist, UAB Injury Prevention Research Center, coordinator of the Urological Rehabilitation and Research Center, and manager of analytic services for the UAB SCI Care System and Medical Rehabilitation Research and Training Center. He earned his MPH, MBA, and DrPH degrees from UAB. Spina Bifida Transition Clinic Grows A clinic for former pediatric patients with spina bifida who are transitioning to adult care is growing in size. UAB Physical Medicine and Rehabilitation partners with the departments of Urology and Neurosurgery and with physicians at Children’s of Alabama for this specialized clinic. UAB and Children’s added a faculty member soon after inaugurating the clinic in 2012, and now a second monthly clinic has been scheduled to care for the current 105 patients. Physiatrist Amie McLain, MD, says the transition clinic helped make 2012 the first year that more patients exited the pediatric spina bifida clinic than entered it. “A s a spina bifida patient ages out of pediatric care, both patient and family members are highly anxious about leaving their childhood physicians,” says McLain. “We are able to provide accurate evaluation and direction into future care that helps ease this transition.” Search On for Neuropathic Pain Etiology Investigator Elizabeth Richardson, PhD, recently was awarded an NIH early career award to help better understand the complex biopsychosocial factors involved in the development of chronic post-SCI neuropathic pain (NP). She will explore the relationship of NP to emotional dysfunction such as in the body’s stress response system as well as to brain function. Using a combination of variables, her team will try to determine how psychological functioning preinjury and acutely following SCI affects the development of NP. She also will seek to identify relationships between neural markers of somatosensory cortical reorganization and SCIrelated NP outcomes just after and at up to 2 years of injury, and to examine cortical structural and functional resting state neural patterns that may correlate with SCI-related pain outcomes. “Identification of predictors will advance understanding of causal mechanisms and hopefully lead to new treatments and, potentially, prevention of neuropathic pain in this population,” she says. N OTEWORTHY P RESE N TAT I O N S Amie B. McLain, MD, “Overcoming Physical Limitations to Obtaining Care.” Moving Beyond Pediatric Incontinence: The Challenges of Transitional Care Conference, University of Toronto, Toronto, June 8, 2013. Michael J. DeVivo, DrPh, “Suicide in an aging spinal cord injury population.” Annual Meeting of the International Spinal Cord Society, Istanbul, October 28-30, 2013. Yuying Chen, MD, PhD, “Endocrine, nutritional and metabolic diseases after spinal cord injury: mortality risk and trends.” Annual Meeting of the International Spinal Cord Society, Istanbul, October 28-30, 2013. Candace L. Floyd, PhD, “Mn porphryins in spinal cord injury and will attempt to elucidate biomarkers for early detection and “Glial progenitor cells that can produce myelin show up in areas intervention. TM has an acute onset, so therapeutic interventions where myelin has been destroyed,” she says. “We are showing that are required immediately. The disease is often misdiagnosed as MS, certain signaling pathways in glial progenitor cells are necessary complicating patient management. “Understanding the molecular to restart the myelination process, providing a possible target for differences in these diseases will be critical for early detection and therapy for brain repair.” She is also on the faculty of the UAB Phthalocyanines, Istanbul, treatment as well as to provide new insights in disease processes Center for Glial Biology in Medicine. June 22-27, 2014. continued from cover spinal cord related pain — lessons from preclinical models.” International Conference on Porphyrins and Amie B. McLain, MD, “The Use of tech VR goggles and sophisticated software, which study position their wheelchair in front of the monitor proved costly and not easy for pilot study participants to align with the video. The 3D video of an actor walking makes patients feel as though they are walking, too. Neurologic Examination to Predict Awareness and Control of Lower Urinary Tract Function post SCI.” have found a partial reversal of the functional brain to use. “We asked for ideas from a patient panel of changes associated with the pain, providing a possible volunteers, and wound up with a low-cost, portable bore and the method of mapping the somatosensory Injury Association, Chicago, May 6-8, physiological basis for why the pain is occurring,” system based on a 3D monitor, 3D glasses, and a cortex, only persons with paraplegia are being 2013. Richardson says. Blu-ray player that most people can easily operate at recruited for the 2-week home-based trial. Persons home.” with high-level injuries (tetraplegia) are eligible to She says the virtual reality aspect of the trial emerged from a study in Australia in which four of five The system makes use of a video that shows a subjects showed good pain relief and, as subjects spent walking actor in the first-person view from the upper more time with the system, of extended duration. chest to the ground. “Seeing it,” she says, “you That trial employed mirrors to help with the illusionary effect. Richardson’s team started with high- 2 F o r R e f e rra l s : 8 0 0 . 8 2 2 . 6 4 7 8 Because of the limiting physical nature of an MRI Annual Meeting of the American Spinal participate in a 1-day trial, which involves viewing one session of the 3D stimulus in the laboratory setting. The 2-week trial includes daily pain diaries and imagine you’re looking down at your own legs and surveys by study staff, who will follow subjects for 6 walking.” The participants in the treatment arm of the months with extensive telephone surveys. M o r e I n f o rma t i o n : u a b m e d i c i n e . o r g / p h y s i c i a n 3