The Department of Physical Medicine & Rehabilitation RISE (Research Innovation Services Enterprise) is pleased to provide Pilot Award funding to Faculty members through its Research Pilot Award competition. The objective of the Pilot Award competition is to enhance the value and effectiveness of pilot research conducted within the Department to accomplish three objectives:
PMR Pilot Proposal_Summer 2020
All recipients of PM&R Pilot Awards are required to complete studies according to the award requirements outlined by the Department of Physical Medicine and Rehabilitation in the Call for Proposals. If reporting and operating requirements have been met and the Principal Investigator (PI) is in good standing with the University of Colorado, PIs may request a one-time no-cost extension (NCE) to the project end date. Time extensions may be requested for periods of up to one year.
Download the extension/modification form
Proposal abstracts should be submitted by email to Lauren.B.Collins@cuanschutz.edu .
Questions regarding the application may be directed to Lisa.2.Brenner@cuanschutz.edu .
Principal Investigator: Andrew Smith, PT, PhD
Title: Machine learning to quantify muscle changes, lean body mass, and function in obese adults
Abstract: Just under half of Americans suffer from obesity, a condition related to heart disease, stroke, type 2
diabetes and types of cancer that can lead to preventable, premature death. Obesity is diagnosed using an
individual’s body-mass index, which is a metric that fails to account for high muscle composition versus high
fat composition. A more informative anthropometric measure is Lean Body Mass (LBM), which characterizes
the amount of fat-free tissue. Relationships between measures of body composition (i.e. LBM) to physical
function are mediated by measures of intramuscular adipose tissue (IMAT). Elevated IMAT in obese
individuals escalates the onset and progression of sarcopenia; and thus has prompted muscle quality to be
used as a diagnostic criteria for sarcopenia.
Although LBM is quantified using duel energy x-ray absorptiometry which exposes the patient to
ionizing radiation, existing magnetic resonance imaging (MRI) is now able to accurately estimate LBM.
Specifically, using only one mid-thigh MRI axial slice, thigh muscle cross-sectional area has been found to
predict LBM and accurately quantify IMAT.
However, the manual measurement of MRI scans can be subjective and time-consuming, limiting the
clinical applicability to estimate LBM and quantify IMAT. The ability to automate procedures to estimate LBM
from existing medical imaging would provide a convenient option for clinicians to provide data-driven
individualized care. Recently, convolutional neural networks (CNNs) have been reported as a viable
machine-learning-based approach to rapidly and accurately measure MRI of skeletal muscle. An available
CNN to provide swift quantification of LBM and IMAT and predict the functional status of obese individuals
would facilitate the desired data-driven individualized care of this patient population. Accordingly, the main
objective of the proposed research is to train and test a machine-learning model to automatically measure
mid-thigh muscle cross sectional area to both provide rapid estimation of LBM and IMAT, and predict the
functional status of obese adults. To accomplish this, we will leverage a pre-existing clinical MRI dataset from
the Department of Endocrinology.
Principal Investigator: Michael Bade, PT, PhD
Title: Multimodal Edema Management Program Post TKA
Abstract: Currently in the United States, more than 700,000 total knee arthroplasty (TKA) surgeries are performed annually with projections of 3.5 million performed annually by 2030.1,2 Postoperative knee swelling after TKA is profound and associated with decreased muscle activation, strength, range of motion, and functional performance as well as increased pain and post-surgical complications such as deep venous thrombosis (DVT).3-7 However, to date, traditional physical therapy interventions such as cryotherapy have demonstrated minimal effectiveness in reducing swelling and its associated sequelae.8 We have developed a novel multimodal edema management (MEM) program utilizing therapeutic exercise, compression garments, and self-administered lymphatic massage to decrease postoperative swelling. This pilot cohort study will determine the variability and responsiveness of bioimpedance spectroscopy (primary outcome) in response to the MEM program in 15 participants after TKA. Secondarily, we will determine the feasibility and patient perceptions of the MEM program after TKA by assessing: 1) adherence, 2) satisfaction, and 3) safety (secondary outcomes). Finally, we will explore the potential mechanistic relationship between postoperative swelling levels and quadriceps muscle activation deficits, strength and functional performance (secondary outcomes). The MEM program will be delivered in the home setting in addition to standard of care rehabilitation over three weeks. Outcomes will be assessed preoperatively and postoperatively at day 4, day 7, week 2, and week 3. Data from this study and historical swelling data of individuals after TKA (N=40) will be utilized to guide subsequent trial planning. This study is directly related to the departmental vision of improving the health of populations seeking care from PM&R professionals as well as providing the opportunity to collect data to leverage for future funding. Finally, our study team consist of a diverse range of health care professionals from physical therapy, occupational therapy, chiropractic, physiatry, and orthopedics. The investigative team possess a range of research experience which create opportunities to mentor more junior investigators and clinicians.
Principal Investigator: Mark M. Manago, DPT, PhD
Title: Instrumented motion analysis of hip and trunk movement compensations for people with multiple sclerosis
Abstract: Difficulty walking is one of the most commonly reported problems for people with multiple sclerosis (MS) and is associated with compensatory movement patterns. Movement pattern compensations can be the result of muscle weakness and lead to painful and/or inefficient gait that affects daily walking. Movement pattern compensations for people with MS have been well-documented at the ankle and knee through instrumented motion analysis, however less is known about the hip and trunk. This is a crucial gap in knowledge, as our recent work has demonstrated that hip abduction and trunk muscle strength are key predictors of gait performance, yet few strengthening studies have targeted these muscles to improve gait. By developing a better understanding of hip and trunk movement pattern compensations during gait and understanding how these compensations relate to hip and trunk muscle weakness, we can design strength training interventions for the hip and trunk that are both targeted to the appropriate muscles and that can specifically address movement pattern compensations. In addition to improving intervention at the hip and trunk, identifying patients who might benefit from proximal strengthening is also an important priority, yet clinical assessments of proximal muscle function, such as the Trendelenburg test, have not been studied in people with MS.
Therefore, the overall aim of this proposal is to improve understanding of hip and trunk movement pattern compensations in people with MS using instrumented motion analysis to 1) identify frontal plane compensations in the hip and trunk during gait and 2) validate the Trendelenburg test. A cross-sectional design consisting of one visit will be used. We hypothesize that instrumented motion analysis will 1) identify impairments in peak hip and trunk frontal plane moments and angles during gait, and 2) correlate with Trendelenburg angles as measured with goniometry during single-limb stance.
The results from this study would 1) be the final step in our development of a novel strengthening approach that incorporated hip and trunk muscles, and 2) improve clinical assessment of proximal muscle function in people with MS. This novel approach would have the potential to set a new standard for strength training and assessment in people with MS by addressing compensatory patterns, improving gait performance, and ultimately, increasing participation and quality of life.
Principal Investigator: Maryam Tahmasbi Sohi, MD
Title: Short term Effects of Intraarticular Triamcinolone Acetonide Injection on Serum Testosterone, LH and FSH Levels in Cohort of Male Veterans with Osteoarthritic Glenohumeral Joint:
A Prospective Pilot Study
Abstract: Musculoskeletal disorders are among the most frequently occurring chronic conditions affecting the US population. They have a substantial impact on quality of life, use of health care resources, and the nation's economy. Physiatry, among other specialties in medicine, is commonly involved in conservative management of musculoskeletal pain through therapy, activity modification, oral pain medications, and corticosteroid injections. Utilization of ultrasound guidance has improved the accuracy and efficacy for some of these injections, but there is relatively little data on their systemic effects with long-term and frequent use. Currently there have been no prior studies on the effects of localized corticosteroid injections on gonadal-pituitary axis. The overall objective of this pilot study is to determine the changes in gonadal-pituitary axis testosterone level after an ultrasound-guided injection of standard dosing of triamcinolone acetonide into the glenohumeral joint. To do this a before-after study, we will use a mixed effects model with a random intercept. Knowledge gained supports future, more rigorous trials that are focused on how modifications in frequency and dosing will influence adverse effects and efficacy of corticosteroid injections.
Principal Investigator: Amy Bodkin, PT, PhD, Aaron Powell, MD
Title: Validation of Gait Analysis in Children with Spina Bifida Using Plantar Pressures
Abstract: Children with spina bifida have numerous gait deviations and are heavily reliant on therapies, bracing, equipment, and surgical intervention to achieve and maintain ambulation. Objective measurement of gait is extremely helpful for clinical decision-making, but current kinematic gait studying techniques are cost prohibitive and generally uncovered by payers. Because of this, clinical decision-making is usually based on subjective bedside clinical examination and observation of gait.
Plantar pressure (PP) measurements (which visualize pressure fields between the surface of a foot and a supporting surface) can provide information on foot position, pressure distribution, and temporal-spatial parameters (gait speed, cadence, etc.) during gait. PPs are more efficient and less expensive than conventional 3-dimensional optical motion capture (OMC). These simple measures from PP gait analysis can be used to track progression of mobility impairments and assess risk for future health conditions in individuals with movement disabilities. Objective parameters obtained through PPs have been validated in typical gait patterns, but not for individuals with atypical plantar pressures and gait (the population that could benefit most from this technology).
The aim of this proposed pilot study is to establish validity and reliability of automated PP analysis to determine foot position and resultant pressure distribution during gait in children with spina bifida. Achieving the aims of this study would directly impact health outcomes of children with spina bifida by optimizing our ability to objectively evaluate multiple domains of their abnormal gait in an accurate, efficient, and economical way. It would also allow us to apply for future funding to create standardized gait measurement techniques for children with spina bifida that will decrease costs and improve the accuracy of clinical evaluation and decision-making.
Principal Investigator: Meredith Mealer, RN,
Title: The feasibility and acceptability of a written exposure therapy (WET) intervention in critical care rehabilitation nurses.
Abstract: Psychological distress is common in healthcare professionals, particularly in high stress areas such as the intensive care or progressive care units. This pilot study will assess the feasibility and acceptability of a 5-week written exposure
therapy (WET) resiliency focused intervention for critical care rehabilitation nurses. Developed over 30 years ago, expressive writing or written exposure therapies were founded on the Principal that the suppression of traumatic events inhibits the
ability to cope with traumatic experiences. Critical care nurses will be asked to write for 30 minutes about the most significant traumatic event they have experienced while working at the bedside as well as an experience that is still causes them
distress. Each week will continue to build off the prior weeks writing session with the ultimate goal of reframing the nurse's trauma narrative and future perspective when working in similar distressing environments. This pilot study will
help refine the intervention for feasibility and acceptability, so that a larger study can be conducted to determine the efficacy of the intervention at increasing resilience and decreasing symptoms of psychological distress in critical care rehabilitation
nurses.
Principal Investigator: Scott Laker, MD
Title: Factors Influencing Parental Return-to-Play Decisions in Post Adolescent Sport-Related Concussions:
A Mixed-Methods Exploratory Study
Abstract: This is a mixed-methods exploratory study of factors influencing parental concerns regarding their children’s return to play (RTP) following a sports related-concussion
(SRC). The study participants will be the parents of adolescents (age 13-18 years) that present to the Children’s’ Hospital Colorado Concussion Program with a SRC. We will recruit 100 participants (parents of adolescents with SRC) to complete
a quantitative survey. Twenty of these individuals will also be asked to participate in a qualitative, telephonic interview. As part of regular clinical care, all patients and parents complete a standardized intake questionnaire that includes injury
mechanism and characteristics, a symptom severity scale, data about past medical and surgical history, and additional historical information. Permissions will be obtained to use this data. As part of the proposed study protocol, one parent will complete
a quantitative pen and paper survey to ascertain factors associated with their child’s current injury that they expect will influence their decision to allow their child to RTP. This survey will also be used to gather information regarding demographics
including socioeconomic status, and baseline concussion knowledge. The same parent will be invited to complete a qualitative, telephonic interview, delivered by our post-doctoral team member, to increase understanding regarding factors associated
with the parent’s decision making about their child’s RTP. These quantitative and qualitative data will be analyzed to highlight parental concerns in RTP decisions, and to determine if there are any observations that warrant further study.
Principal Investigator: Cory Christiansen, PT, PhD
Title: Movement Strategies and
Physical Activity after Dysvascular Amputation
Abstract: Project Abstract: Over 1 million Americans currently live with lower-limb amputation and the number is expected to more than double by 2050. More than 80% of
all lower-limb amputations result from vascular complications due to diseases such as severe diabetes mellitus and/or severe peripheral artery disease, known as dysvascular amputation. Patients with dysvascular amputation have difficulty achieving
and sustaining independent ambulation with a prosthesis and have low levels of physical activity. Such poor ambulation and physical activity outcomes are likely linked to the compensatory movement patterns that patients adopt following dysvascular
amputation. Therefore, the overall aim of this investigation is to improve our understanding of the compensatory movement patterns adopted by patients with unilateral transtibial amputation to achieve independent ambulation and assess how the movement
compensations relate to overall physical activity and disability. To identify compensatory movement strategies after dysvascular amputation, a group of participants with diabetes and unilateral transtibial amputation (EXP group) will be compared to
a group of participants with diabetes and no major lower limb amputation (CTL group) using measurements of whole-body and body-segment angular momentum. Whole-body and body-segment angular momentum will be measured using 3-dimensional instrumented
motion analysis while participants perform level-ground walking (primary functional task), as well as 90 degree turns and stepping up/down onto stair steps. We expect that the EXP group will have 1) higher variability in movement patterns, 2) higher
peak to-peak ranges in whole-body angular momentum and larger segmental momentum contributions to whole-body angular momentum, and 3) higher segmental contributions to whole-body angular momentum from the torso/pelvis and contralateral limb compared
to the CTL group. Identifying specific compensatory movement pattern characteristics following unilateral transtibial amputation (dysvascular) will provide a basis for developing targeted rehabilitation assessment tools and intervention strategies.
In addition, we will examine the correlations that compensatory movement strategies have with gait speed, overall physical activity, and participant-reported disability.