Alzheimer's Disease & Research Center of California
The world-renowned Pathokinesiology Laboratory investigates human movement, especially the biomechanics, muscle function, and energy requirements of walking. The overriding goal of the lab's clinical and research efforts is improvement of patient care for individuals with movement disorders which include orthopedic disabilities, spinal cord injury, brain injury, cerebral palsy, stroke, and post-polio syndrome. The unit was founded in 1968 by pioneering orthopedic surgeon Jacquelin Perry, M.D. and is now under the direction of Sara Mulroy, PhD, PT with consultation from orthopedic surgeons, Vance Eberly, MD and Kevin Rolfe, MD. Dr. Mulroy and the staff of the Pathokinesiology Laboratory collaborate in many of their clinical research endeavors with Rancho's Rehabilitation Engineering Department, which is under the direction of Philip Requejo, PhD.
For decades, the Pathokinesiology Laboratory has been a leader in physical therapy and rehabilitation research related to gait and mobility in individuals with stroke, spinal cord injury, amputations, and other neurological and orthopedic disorders. Since 1996, the Pathokinesiology Laboratory has been supported by funding from the National Institute of Health (NIH), and the National Institute for Disability Rehabilitation and Research (NIDRR), among other foundations.
Rebecca Lewthwaite, PhD, Director of Rehabilitation Outcomes Management and Director of (PT) Research and Education, conducts clinical research in stroke and Parkinson's disease, as well as basic movement science research about the role of motivation in motor learning and neurorehabilitation. She is an investigator in the NIH-funded multi-site randomized controlled trial on stroke rehabilitation of the upper extremity, Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (I-CARE) Initiative (University of Southern California, Carolee J. Winstein, PI; NIH NCT00871715).
A number of Rancho physical therapists have participated in many roles in large clinical trials. Other clinical research has been conducted by many Rancho physical therapists over the years, including a line of research on wheeled mobility and pediatrics by Jan Furumasu, PT, and another on aging with a disability by Physical Therapy Chief, Lilli Thompson, PT, NCS.
The Pathokinesiology Laboratory accepts referrals from clinics, physicians, and other healthcare providers. For more information, contact:
Sara Mulroy, PhD, PT
Rancho is internationally recognized for its many contributions to rehabilitation medicine. As a research-oriented hospital, Rancho continues to shape the field through groundbreaking research and studies.
Mike Carlson, Cheryl LP Vigen, Salah Rubayi, Erna Imperatore Blanche, Jeanine Blanchard, Michal Atkins, Barbara Bates-Jensen, Susan L Garber, Elizabeth A Pyatak, Jesus Diaz, Lucia I Florindez, Joel W Hay, Trudy Mallinson, Jennifer B Unger, Stanley Paul Azen, Michael Scott, Alison Cogan & Florence Clark (2017): Lifestyle intervention for adults with spinal cord injury: Results of the USC–RLANRC Pressure Ulcer Prevention Study, The Journal of Spinal Cord Medicine, DOI: 10.1080/10790268.2017.1313931
Phipps, S. & Roberts, P. (2012). Predicting the effects of cerebral palsy severity on self-care, mobility, and social function. American Journal of Occupational Therapy, 66, 422 – 429. http://dx.doi.org/10.5014/ajot.2012.003921
Leland, N. E., Crum, K., Phipps, S., Roberts, P., & Gage, B. (2015). Health Policy Perspectives: Advancing the value and quality of occupational therapy in health service delivery. American Journal of Occupational Therapy, 69, 1 - 7. http://dx.doi.org/10.5014/ajot.2015.691001
Phipps, S. & Richardson, P. (2007). Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure. American Journal of Occupational Therapy, 61, 328 – 334. http://dx.doi.org/10.5014/ajot.61.3.328
Ávila, LTG, Chiviacowsky S, Wulf G, Lewthwaite R. Positive social-comparative feedback enhances motor learning in children. Psychology of Sport & Exercise. 2012;13:849-853.
Blydt-Hansen E. Tailor-made seating. Rehab Management. 2011; 24(5):16-18.
Burnfield JM, Eberly VJ, Gronley JK, Perry J, Yule WJ, Mulroy SJ. Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees. Prosthetics & Orthotics International. 2012;36:95-104.
Chen S, Lewthwaite R, Schweighofer N, Winstein CJ. Discriminant validity of a new measure of self-efficacy for reaching movements after stroke-induced hemiparesis. Journal of Hand Therapy. 2013;26:116-123.
Chiviacowsky S, Wulf G, Lewthwaite R. Self-controlled learning: The importance of protecting perceptions of competence. Frontiers in Psychology: Movement Science and Sport Psychology. 2012. doi: 10.3389/fpsyg.2012.00458.
Cozby JR, Reischl SF, Meyer L. Differential diagnosis of pain: ankle pain In TE Davenport, K Kulig, CA Sebelski , J Gordon, H Watts (Eds.), Diagnosis for physical therapists: a symptom based approach. Philadelphia PA: FA Davis, Inc.:, 2012.
Cozby JR, Reischl SF, Meyer L. Differential diagnosis of pain: foot pain. In TE Davenport, K Kulig, CA Sebelski , J Gordon, H Watts (Eds.), Diagnosis for physical therapists: a symptom based approach. Philadelphia PA: FA Davis, Inc.:, 2012.
Cozby JR. Differential diagnosis of pain: lower leg pain. In TE Davenport, K Kulig, CA Sebelski , J Gordon, H Watts (Eds.), Diagnosis for physical therapists: a symptom based approach. Philadelphia PA: FA Davis, Inc.:, 2012.
Davenport TE, Reischl SF, Sungkarat S, Cozby JR, Meyer L, Fisher BE. Alteration in corticospinal excitability, talocrural joint range of motion, and lower extremity function following manipulation in non-disabled individuals. Othopedic Physical Therapy Practice. 2013;25:97-102.
Eberly V, Ibanez M, Blydt-Hansen E, Requejo P, Mulroy S. Comparison of walking function in bilateral KAFOs to a robotic exoskeleton system for a person with a spinal cord injury – a case study. Poster presented at the APTA Combined Sections Meeting, Las Vegas, NV, February, 2014.
Eberly VJ, Mulroy SJ, Gronley JK, Perry J, Yule WJ, Burnfield JM. Impact of a stance phase microprocessor-controlled knee prosthesis on level walking in lower functioning individuals with a transfemoral amputation. Prosthetics & Orthotics International. 2013 Oct 17. [Epub ahead of print]
Eng J, Mulroy SJ. Stepping forward with gait rehabilitation. Physical Therapy. 2010;90:146-8.
Goldberg EJ, Requejo PS, Fowler EG. Joint moment contributions to swing knee extension acceleration during gait in children with spastic hemiplegic cerebral palsy. Journal of Biomechanics. 2010; 43:893-9.
Goldberg EJ. Requejo PS. Fowler EG. Joint moment contributions to swing knee extension acceleration during gait in individuals with spastic diplegic cerebral palsy. Gait & Posture. 2011;33:66-70.
Guerette P, Furumasu J, Tefft D. The positive effects of early powered mobility on children's psychosocial and play skills. Assistive Technology. 2013;25:39-48.
Hooyman A, Wulf G, Lewthwaite R. Impacts of autonomy-supportive versus controlling language on motor learning. Human Movement Science, 2014, in press.
Kemp BJ, Bateham AL, Mulroy SJ, Thompson L, Adkins RH, Kahan JS. Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: a randomized control trial. Journal of Spinal Cord Medicine. 2011;34:278-84.
Kubota K, Eberly V, Requejo P, Mulroy S. Development of an Interactive Smartphone / Tablet “App” to Teach /Review Rancho Normal Gait and the Problem Solving Approach. Platform presentation at the Combined Sections Meeting of the American Physical Therapy Association, Las Vegas, NV. February 2014.
Kubota K, Eberly V, Requejo P. Clinical Decision-Making Algorithm for Orthotic Prescription: Current Applications and Future Developments. Workshop for 2012 Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Annual Conference, Baltimore, MD. July 2012.
Kubota, K. The Rancho ROADMAP: A Tool for AFO and KAFO Prescription. Physical Therapy Products. September/October 2013.
Lange BS, Requejo P, Flynn SM, Rizzo AA, Valero-Cuevas F, Baker L, Winstein C. The potential of virtual reality and gaming to assist successful aging with disability. Physical Medicine and Rehabilitation Clinics of North America. 2010;21:339-56.
Lazouras CJ. Shin pain in a child. In TE Davenport, K Kulig, Sebelski CA, Gordon J, Watts H (Eds.), Diagnosis for physical therapists: a symptom-based approach (Chapter 49). Philadelphia, PA: FA Davis, 2012.
Lewthwaite R, Wulf G. Grand challenge for movement science and sport psychology: embracing the social-cognitive-affective-motor nature of motor behavior. Frontiers in Psychology: Movement Science and Sport Psychology, 2010.DOI: 10.3389/fpsyg.2010.00042.
Lewthwaite R, Wulf G. Social comparison feedback affects motor learning. Quarterly Journal of Experimental Psychology. 2010;63:738-749.
Lewthwaite R, Wulf G. Motor learning through a motivational lens. In N Hodges & AM Williams (Eds.), Skill acquisition (p. 173-191), 2nd Ed., Vancouver, Canada, Routledge, 2012.
Lohse KR, Wulf G, Lewthwaite R. Attentional focus affects movement efficiency. In N Hodges & AM Williams (Eds.), Skill acquisition (p. 40-58), 2nd Ed., Vancouver, Canada, Routledge, 2012.
Marchal-Crespo L, Furumasu J, Reinkensmeyer DJ. A robotic wheelchair trainer: design overview and a feasibility study. Journal of Neuroengineering & Rehabilitation. 2010;7:40.
McKay B, Lewthwaite R., Wulf G. Enhanced expectancies improve performance under pressure. Frontiers in Psychology: Movement Science and Sport Psychology, 2012. doi: 10.3389/fpsyg.2012.00008.
McNitt-Gray JL, Munaretto J, Zaferiou A, Requejo PS, Flashner H. Regulation of reaction forces during the golf swing. Sports Biomechanics. 2013;12:121-31.
Mulroy SJ, Klassen T, Gronley JK, Eberly VJ, Brown DA, Sullivan KJ. Gait parameters associated with responsiveness to treadmill training with body-weight support after stroke: an exploratory study. Physical Therapy. 2010;90:209-23.
Mulroy SJ, Eberly VJ, Gronley JK, Weiss W, Newsam CJ. Effect of AFO design on walking after stroke: impact of ankle plantar flexion contracture. Prosthetics & Orthotics International. 2010;34:277-92.
Mulroy SJ, Thompson L, Kemp B, Hatchett P, Newsam CJ, Gutierrez DD, Ge T, Lighthall Haubert L, Eberly VJ, Azen S, Winstein CJ, Gordon J, and Physical Therapy Clinical Research Network (PTClinResNet). Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in chronic spinal cord injury: a randomized, controlled trial. Physical Therapy Journal. 2011;91:305-324.
Mulroy SJ, Winstein CJ, Kulig K, Beneck GJ, Fowler EG, DeMuth SK, Sullivan KJ, Brown DA, Lane CJ. For the Physical Therapy Clinical Research Network. Secondary mediation and regression analyses of the PTClinResNet database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials. Physical Therapy. 2011;91:1766-79.
Munaretto JM, McNitt-Gray JL, Flashner H, Requejo PS. Reconfiguration of the upper extremity relative to the pushrim affects load distribution during wheelchair propulsion. Medical Engineering & Physics. 2013;35:1141-9.
Munaretto JM, McNitt-Gray JL, Flashner H, Requejo PS. Simulated effect of reaction force redirection on the upper extremity mechanical demand imposed during manual wheelchair propulsion. Clinical Biomechanics. 2012;27:255-62.
Nadalin M, Lazouras C, Fisher B. Manual muscle testing may not accurately predict muscle activation in function post stroke. Poster presentation at the annual conference of the California Physical Therapy Association Oakland, CA, October 2010.
Nadalin M, Lazouras C, Fisher B. Lower extremity muscle activation is increased during functional movements compared with isolated volitional contraction following stroke. Poster presentation at the annual conference of the Society for Neuroscience, San Diego, CA, December, 2010.
Pascua LAM, Wulf G, Lewthwaite R. Additive benefits of external focus and enhanced performance expectancy for motor learning. Journal of Sports Sciences, 2014, in press.
Raina S, McNitt-Gray J, Mulroy S, Requejo P. Effect of choice of recovery patterns on handrim kinetics in manual wheelchair users with paraplegia and tetraplegia. Journal of Spinal Cord Medicine. 2012; 35:148-55.
Raina S, McNitt-Gray JL, Mulroy S, Requejo PS. Effect of increased load on scapular kinematics during manual wheelchair propulsion in individuals with paraplegia and tetraplegia. Human Movement Science. 2012;31:397-407.
Rizzo A, Requejo P, Winstein CJ, Lange B, Ragusa G, Merians A, Patton J, Banerjee P, Aisen M. Virtual reality applications for addressing the needs of those aging with disability. Studies in Health Technology & Informatics. 2011;163:510-6.
Rosen L, Arva J, Furumasu J, Harris M, Lange ML, McCarthy E, Kermoian R, Pinkerton H, Plummer T, Roos J, Sabet A, Vander Schaaf P, Wonsetter T. RESNA position in application of powered wheelchairs for pediatric users. Assistive Technology. 2009;21:218-25.
Schweighofer N, Lee JY, Goh HT, Choi Y, Kim S, Stewart JC, Lewthwaite R, Winstein CJ. Mechanisms of the contextual interference effect in individuals poststroke. Journal of Neurophysiology. 2011;106: 2632–2641.
Stewart JC, Lewthwaite R, Winstein CJ. Self-efficacy for reach actions after stroke: a pilot study. Journal of Sport &Exercise Psychology. 2010;32;S131.
Stoate I, Wulf G, Lewthwaite R. Enhanced expectancies improve movement efficiency in runners. Journal of Sports Sciences. 2012;30:815-823.
Tefft D, Guerrette P, Furumasu J. The impact of early powered mobility on parental stress, negative emotions and family. Physical and Occupational Therapies in Pediatrics. 2011; 31: 4-15.
Winstein CJ, Lewthwaite R, Blanton SR, Wolf LB, Wishart LR. Infusing contemporary motor learning research into neurorehabilitation practice: a historical framework with the Accelerated Skill Acquisition Program exemplar. Journal of Neurologic Physical Therapy, in press.
Winstein CJ, Requejo PS, Zelinsky EM, Mulroy SJ, and Crimmins E: A transformative subfield in rehabilitation science at the nexus of new technologies, aging, and disability. Frontiers in Psychology: Movement Science and Sports Psychology, 2012, 3:340. doi: 10.3389/fpsyg.2012.00340.
Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Blanton S, Scott C, Reiss A, Cen SY, Holley R, Azen SP, for the ICARE Investigative Team. Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE): a randomized controlled trial protocol. BMC Neurology. 2013;13:5.
Wulf G, Chiviacowsky S, Lewthwaite R. Normative feedback effects on the learning of a timing task. Research Quarterly for Exercise and Sport. 2010; 81:425–431.
Wulf G, Chiviacowsky SC, Lewthwaite R, Campos T. Motor learning benefits of self-controlled practice in persons with Parkinson’s disease. Gait & Posture. 2012;35:601–605.
Wulf G, Chiviacowsky SC, Lewthwaite R. Altering mindset can enhance motor learning in older adults. Psychology & Aging. 2012;27;14–21.
Wulf G, Lewthwaite R, Hooyman A. Can ability conceptualizations alter the impact of social comparison in motor learning? Journal of Motor Learning and Development. 2013: 1:20-30.
Wulf G, Lewthwaite R, Winstein CJ. Motor learning and fundamental psychological needs: Implications for stroke rehabilitation. In J Mehrholz (Ed.), Rehabilitation nach Schlaganfall (Rehabilitation after stroke) (p. 27-41). Stuttgart: Thieme, 2011.
Wulf G, Lewthwaite R. Effortless motor learning? An external focus of attention enhances movement effectiveness and efficiency. In B Bruya (Ed.), Effortless attention: a new perspective in attention and action (p. 75-101). Cambridge, MA: MIT Press, 2010.
Wulf G, Lewthwaite R. Motor learning after stroke: optimizing practice conditions in clinical rehabilitation. In C Dettmers & KM Stephan (Eds.), Motorische Therapie nach Schlaganfall (Motor therapy after stroke) (p. 93-105). Bad Honnef: Hippocampus Verlag, 2011.
Wulf G, Lewthwaite R. Motor learning: practical aspects. In H Pashler (Ed.), Encyclopedia of the Mind (p. 529-532). Thousand Oaks: Sage Publications, 2013.
Wulf G, Lewthwaite R. Motorisches Lernen. In C Zalpour (Ed.), Lexikon Physiotherapie. Heidelberg, Germany: Springer Verlag, 2010.
Wulf G, Shea CH, Lewthwaite R. Motor skill learning and performance: A review of influential factors. Medical Education. 2010;44:75-84.
Yamada, KA, Lewthwaite R, Popovich JM, Jr, Beneck GJ, Kulig K. The Low Back Activity Confidence Scale(LoBACS): preliminary validity and reliability. Physical Therapy, 2011;91:1592-1603.
Zigler JE, Resnik C, Carroll L, Ramirez AN, Atkins M, Thompson L. Rehabilitation. In JE Zigler, FJ Eismont, SR Garfin, AR Vaccaro (Eds.), Spine Trauma (2nd Ed.). Rosemont, IL: American Academy of Orthopaedic Surgeons, 2011.
Aisen ML, Kerkovich D, Mast J, Mulroy S, Wren TA, Kay RM, Rethlefsen SA. Cerebral palsy: clinical care and neurological rehabilitation. Lancet Neurology. 2011;10:844-52.
Rancho Levels of Cognitive Functioning
Rehabilitation Engineering Program
Rancho Rehabilitation Engineering is nationally recognized for its applied research contributions to the development of assistive technologies for persons living with disability. Our missions are to create and evaluate new technologies for persons with disabilities and to recruit and train persons to become rehabilitation engineering professionals. The Rehabilitation Engineering center is part of Rancho Research Institute (RRI) and an important component of Rancho Los Amigos National Rehabilitation Center's rehabilitation program since the 1960s, when major contributions were made to the development of orthoses, skeletal fixation systems and powered wheelchairs, and functional electrical stimulation.
Rehabilitation Engineering Center (RERC) on Technologies for Children with Orthopedic Disabilities
(National Institute of Disability and Rehabilitation Research # H133E003001)
The goal of this RERC is to improve the lives of children with orthopedic disabilities through research and development on three of the most important life activities of children: manipulation, mobility, and play and recreation.
Rehabilitation Engineering Center (RERC) on Spinal Cord Injury
(National Institute of Disability and Rehabilitation Research #H133E020732.)
This RERC improves the lives of individuals with SCI by promoting their health, safety, independence, and active engagement in daily activities through R&D on a key issue for individuals with SCI, the need to maintain mobility for as long as possible in order to enhance independent function.
Rehabilitation Engineering Center (RERC) on Technologies for Successful Aging with Disability (collaboration between the University of Southern California and Rancho)
(National Institute of Disability and Rehabilitation Research # H133E080024)
This project enhances the lives of individuals aging with and into disability through: (1) development and delivery of cutting-edge technologies for identification, evaluation, and rehabilitation of motor processes that facilitate or impede functional performance, employment, and community participation for the intended beneficiaries; (2) employment of state-of-the-art data management, dissemination, and performance evaluation techniques to ensure that the knowledge and products emergent from the RERC are accessible for all intended beneficiaries; (3) assembly of a multidisciplinary team of experts in clinical rehabilitation, engineering, and gerontology, along with a select group of technology partners, and disability advocates to ensure that our short- and long-term outcome goals are successfully implemented; and (4) alignment of the clinical and technological strengths of several area programs into an integrated infrastructure to provide training opportunities for future rehabilitation researchers.
Long-term effect of tendon transfer on activities of daily living in individuals with spinal cord injury.
(R24 Pilot Funding. National Skeletal Muscle Research Center (NSMRC). University of California, San Diego, Department of Orthopedic Surgery and Bioengineering)
The purpose of this pilot study was to determine the long-term effects of tendon transfers on functional mobility in individuals with tetraplegia. The purpose of our ongoing research is to determine how tendon transfer surgery has improved function in activities of daily living. We hypothesized that tendon transfer surgery that aimed to restore lateral pinch grip function improved the effective force applied during activities of daily living and as a result contributed to a significant improvement in the overall quality of life post-surgery.
Southern California Spinal Cord Injury Model Systems
(National Institute of Disability and Rehabilitation Research #H133G100268)
(see Pathokinesiology Laboratory Description)
Modular Orthoses Prescription System (MOPS)
(National Institute of Disability and Rehabilitation Research #H133G100268)
(see Pathokinesiology Laboratory Description)
Scapular Biomechanics and Shoulder Pain in Wheelchair Users with SCI
(see Pathokinesiology Laboratory Description)
Evaluating the Integration of Low-Cost Emerging Technology and Personalized Model Simulation Results in the Wheelchair Prescription Process
(Department of Defense SC130030)
Preserving shoulder function in individuals with spinal cord injury (SCI) continues to be a significant musculoskeletal health goal. Because of the detrimental impact on functional mobility and the difficulty in treatment of shoulder pain once it occurs, effective strategies for preserving musculoskeletal health of the shoulder need to be identified and implemented within the first year after SCI. Our interdisciplinary research team proposes to build upon evidence-based clinical guidelines8 and personalize the wheelchair seating process by evaluating the integration of low-cost technology and innovative computational resources into the wheelchair prescription and fitting process.
Phil Requejo, Director
Research at Rancho
Spinal Cord Injury Project
Southern California Spinal Cord Injury Model System
Rancho Los Amigos National Rehabilitation Center (Rancho) is one of 14 institutions recognized for its expertise in the care of persons with spinal cord injury by the National Institute on Disability and Rehabilitation Research (NIDRR). Rancho has been awarded a five-year grant to establish a Spinal Cord Injury Model System (SCIMS). Rancho is the only such program in California and the only public hospital to receive this honor.
The overarching objective of the Southern California SCIMS is to generate new knowledge that will directly contribute to improving health and function and community participation for persons with spinal cord injury (SCI).
Rancho continues to serve a large SCI population with over 200 new admissions each year and a long tradition of serving individuals who are often from underserved populations including individuals from racial and ethnic minorities (80% of our SCI population) and those from economically-disadvantaged backgrounds (over 50% of our SCI population). Information from this group of patients makes a unique contribution to the SCIMS regarding the specific rehabilitation trends and needs of these under-served groups.
Rancho's site-specific research study is titled, "A Randomized Clinical Trial to Evaluate Two Prevention Programs for Maintenance of Shoulder Health and Function after Spinal Cord Injury". This study will determine the most effective program to prevent shoulder pain which is a common problem after spinal injury.
Rancho is participating in 3 multi-site research modules. We are the lead center on the module "Wearable Technology for Telecare Monitoring of Persons with Sub-acute and Chronic Spinal Cord Injury (SCI)". In this study we are developing and testing a new portable device (called PRESS) to monitor daily pressure-relief activity that will provide feedback to the individual and his/her clinician to establish healthy behaviors and prevent pressure ulcer development.
We are also participating in two modules led by other centers on the "Importance of Regular Exercise and Activity in Improving Life Satisfaction and Reducing Breathlessness", and "Pregnancy, Labor, Delivery, and Postpartum Outcomes of Women with and without Spinal Cord Injury."
The Southern California Spinal Cord Injury Model System is supported by grant #H133N110018 of the National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of Education. For your comments and questions, contact us at (562) 385-7541 or firstname.lastname@example.org.
For more information, click on Spinal Cord Injury Project, or contact:
Chair's: Mindy Aisen, MD and Yaga Szlachcic, MD