Physical Therapy Research
Rancho and the Physical Therapy Department has had a longstanding commitment to research with relevance to rehabilitation. A number of active research initiatives illustrate Rancho’s commitment to conducting research relevant to the field of rehabilitation, disseminating research findings, and bringing them into rehabilitation practice. Research emphases, funding records, and dissemination activities are reported below. For related Publications and Presentations click here.
AREAS OF RESEARCH AND DISSEMINATION ACTIVITIES
OPTIMAL Theory and Applications; Interface of Psychological and Movement Science (Rebecca Lewthwaite, PhD)
Accelerating stroke rehabilitation through optimized motor performance and learning
Rancho Physical Therapy staff recently participated in a large Phase III multi-center clinical trial in upper extremity stroke rehabilitation (Co-Investigator Rebecca Lewthwaite, PhD; Site Coordinator, Oscar G. Gallardo, PT, DPT, NCS; Co-Site Coordinator, Covey J. Lazouras, PT, DPT, NCS). Individuals with stroke who received the Accelerated Skill Acquisition Program (ASAP) reported many beneficial outcomes relative to usual care counterparts. Principles behind this intervention have been formalized in the OPTIMAL theory of motor learning across movement situations from clinical to elite performers (Wulf & Lewthwaite, 2016). OPTIMAL theory emphasizes enhancing expectations/confidence, supporting performers’ autonomy, and instructing with an external focus of attention to optimize motor performance and learning. “Optimized” interventions have been adapted for inpatient, outpatient, and telehealth physical therapy for individuals with diverse neurological and orthopedic disorders. Clinicians in physical therapy, occupational therapy, and speech therapy have been oriented and/or trained over the past year or months to deploy optimized therapy for patients with varying conditions. OPTIMAL theory has also recently been incorporated into research interventions for pain management in spinal cord injury.
COVID-19 Recovery Project (Walt Weiss, PT, NCS, Coordinator)
In line with our historic role as a national leader for the comprehensive care of individuals battling polio in the last century, in April of 2020 clinicians at Rancho saw the immediate need to gather information and develop expertise for the comprehensive care of individuals recovering from COVID-19 as novel coronavirus infections began to extend across the world, causing the devastating COVID-19 pandemic. Rancho researchers and clinicians from departments across the organization including the Physical Therapy department began collaborating to initiate an outcome tracking project, with the goal of collecting an array of critical values and outcome measures to track patient demographics, level of disability, treatment course, and recovery. The goal of the COVID-19 Recovery Project is to gather these critical values to better understand the impact of the disease, the progression of the disease, and ultimately to improve the comprehensive care of individuals with COVID-19, to allow our patients to return to participating in important life activities.
Preserving Mobility and Function in Manual Wheelchair Users (Jan Furumasu, PT, Consultant)
Preserving shoulder function in individuals with spinal cord injury (SCI) continues to be a significant musculoskeletal
health goal. Evidence-based recommendations for preserving shoulder function promote adjustment in wheelchair (WC)
seating as a promising means to mitigate mechanical loading of the shoulder. It was hypothesized that personalized adjustments to WC seating can affect mechanical loading of the shoulder during manual WC propulsion and improve health-related quality of life. As expected, personalized WC reconfiguration significantly affected upper extremity and trunk coordination, reaction force generation, and shoulder net joint moment impulse during push (max reduction 47%). Self-reported survey results also indicated indices specific to shoulder pain, WC use in the community and health-related quality of life improved for all participants in one or more categories.
Robocamp (Julie Kasayama, PT, DPT, NCS, PT Director)
Physical therapists at Rancho Los Amigos contributed to the design and implementation of a unique, multi-year research program titled “Robocamp” where adolescent children with difficulty walking after cerebral hemispherectomy received high intensity training in an enriched camp-like setting. The intervention was delivered as a two-week rehabilitation camp with therapy evaluations, orthosis assessments, social activities, and 8 days of intensive therapy, each comprising of 3 hours/day of technology assisted training, 15 minutes/day of range and mobilization, and three hours/day of recreational therapy. Hokoma Lokomat, ArmeoSpring, and ArmeoPower, AlterG AntiGravity Treadmill, and Restorative-Therapies FES Leg System were used. This short duration, intensive regimen utilizing robotic mobility technology therapy in a fun, exciting, and socially engaging atmosphere improved walking endurance, fast walking velocity, upper extremity function, and physical activity confidence in subjects outside the acute recovery period after hemispherectomy. Robocamp completed its 6th summer camp in 2019 with very positive results, and fantastic reviews from all participants. The intervention protocol is currently being explored with other patient populations.
Healthy, Active Los Angeles (HALos) Community Wellness Program (Oscar Gallardo, PT, DPT, NCS, Director)
Health Services in partnership with The YMCA of Metropolitan Los Angeles (LA YMCA) and with a grant from the UniHealth Foundation, created the Health Services/YMCA Healthy, Active Los Angeles (HALos) Community Wellness Program in 2016. The HALos Program was designed to implement wellness services at YMCAs in low-income areas in order to maximize self-directed community-based health activities for LAHealth Services patients with chronic illnesses. Access to programs and services that enhance physical activity, self-management skills and secondary prevention occur through the coordinated services developed by a licensed physical therapist. Program enrollment began in July 2016 and over three years, this program provided access for 632 Health Services patients with chronic disease to engage in physical activity and coordinated wellness opportunities onsite at YMCA facilities in South and East Los Angeles, which serve some of our most socio-economically challenged urban Los Angeles communities.
Once enrolled in the program, participants were scheduled for a program orientation during which time they engaged in goal-setting with program staff and received a YMCA membership (for a maximum of 9 months) which provided access to all LA YMCA facilities. While enrolled in the program, participants were followed on an ongoing basis (weekly) by YMCA program staff and peer mentors to review/update program goals, identify need for referral to additional community resources, and ensure adherence to their wellness plan. The program offered bi-weekly wellness education sessions on variety of topics including: active living, stress reduction, setting wellness goals, using smartphone apps. In addition, one-on-one consultation sessions were available for those interested participants who seek an even more individualized opportunity. Additionally, other community partnerships were developed with the California State University- Los Angeles and the Pompea Smith Good Cooking/Buena Cocina Program to provide participants with nutrition education classes and individual coaching.
RanchoGait App (Kelley Kubota, PT, MS, NCS, Coordinator)
The Rancho Observational Gait Analysis (OGA) system is an internationally recognized clinical method to analyze gait. The RanchoGait App is an interactive program to enhance learning and application of OGA and the Rancho ROADMAP. It represents a collaboration amongst the Physical Therapy Department, Pathokinesiology Laboratory, and Rehab Engineering Department. The app can be used as an educational aid for novice clinicians and/or students to learn the fundamentals of gait and decision-making for orthoses in persons with neurologic involvement. The apps have several modules to 1) help clinicians learn essential elements of gait, 2) utilize a decision-making algorithm for lower extremity orthotic prescription, and 3) learn how to make different settings on an orthosis. The RanchoGait app is a unique technological advancement to enhance learning and review of gait analysis and to guide orthosis selection and modification. The gait sections of the app facilitate identification of the most significant gait deviations in persons with neurological disorders. The R.O.A.D.M.A.P. portion assists with orthotic prescription, and the MOPS Brace part assists with orthotic adjustment. This app can help educators supplement or review concepts taught in the classroom setting. It can help a student or novice clinician target interventions to improve the walking ability of patients with neurologic dysfunction. The app’s ease of use, portability, and utility are unique.
The Impact of Gender on Wellness Center Participation and Outcomes in Persons with Disabilities (Sonja Kiseljak-Dusenbury PT, DPT, MBA)
Research on the health and wellness of women with disability is limited. The few studies of the physical activity patterns of women with disabilities suggest that they are not engaging in physically active lifestyles. Understanding the role of gender in wellness behavior is critical to meeting the specific needs of women. The purpose of this research report is to explore differences between women and men in meeting physical and emotional expectations through attending activities in a hospital-based wellness center. For women, attending gym and fitness classes alone was not sufficient to meet physical and emotional expectations in women. Participation in recreational classes, however, was strongly related to improving subjective physical and emotional status in women.
High Intensity Functional Exercise Group Class for Acute Rehabilitation (Julia Mockeridge, PT, DPT)
The value of regular and vigorous physical activity for individuals with stroke and other neurological conditions is not disputed. But when and how to motivate a change from sedentary and impaired states to an exercising future remains a critical unanswered question. The High Intensity Functional Exercise (HIFE) program is designed for inpatients in acute rehabilitation programs and serves to introduce or reinforce for them the experience and importance of participation in physical activity to benefit cardiovascular health, muscular strength, endurance and power early in the care continuum.
Introduction is accomplished by group participation in a therapeutic exercise class with emphasis on intense functional movements in sequence that challenge cardiovascular and strength training concurrently. Education on current recommended daily activity AHA/ASA guidelines is provided. The outcomes of HIFE include early introduction to aerobic and resistance training and increased confidence in ability to participate in higher intensity activities. The HIFE program challenges current standards of practice for the inpatient rehabilitation setting and has replaced traditional therapeutic exercise classes in our setting.
PATHOKINESIOLOGY LABORATORY, RANCHO LOS AMIGOS NATIONAL REHABILITATION CENTER (Sara J. Mulroy, PhD, PT, Director)
The Pathokinesiology Laboratory has been engaged for many years in the analysis and interventions for neuropathological gait in individuals with stroke and lower limb loss, and wheelchair propulsion and pain management in individuals with spinal cord injury, among many other initiatives. Rancho Los Amigos National Rehabilitation Center (Southern California Spinal Cord Injury) has been part of the multi-center Spinal Cord Injury Model System funded by NIDILLR for many years. Below are research projects from the current funding cycle, 2016-2022. More details on present and past research projects can be found here.
ACTIVE FUNDING SUPPORT
“Development and community evaluation of a real-time system for monitoring, feedback, and training to prevent pressure injuries in individuals with spinal cord injury”
NIDILRR DRRP #DPHF20000168
09/01/2020 – 08/31/2024
The purpose of this project is to develop and evaluate the effectiveness of a novel prototype smart system aimed at providing real-time pressure sensing and pressure relief activity feedback under real-world conditions.
Jeffery W. Rankin, PhD Principal Investigator, Sara J. Mulroy, PhD, PT Co-Investigator
“MiGo-Wheels: A holistic feedback system to help wheelchair users maintain a healthy lifestyle”
NIH/NCMRR (PI: Justin Rowe, PhD, Flint Rehab)
04/1/2020 – 10/31/2020
The purpose of this project to develop a prototype of MiGo-Wheels, a holistic wellness monitor capable of providing goal-directed feedback and reminders to help wheelchair users develop and maintain healthy habits. The device will consist of an activity watch, a chair mounted sensor, and a belt clip. These devices will communicate with a social app on the users’ smartphones that will connect them with their peers and help them manage their activity, their pressure relief habits, their propulsion habits, and their use of wheelchair skills.
Sara J. Mulroy, PhD, PT Co-Investigator
“Development and Pilot Testing of a Community-based, Non-pharmacologic Pain Management Program for Persons with SCI”
Craig H. Neilsen Foundation
4/01/20 – 3/31/22
The purpose of this project is to develop and evaluate a 9-week community-based pain management program that consists of 3 primary elements: relaxation training, development of active pain coping strategies, and physical exercise. We will incorporate two types of relaxation training: meditation and heart rate variability biofeedback with deep breathing.
Sara J. Mulroy, PhD, PT Principal Investigator, Rebecca Lewthwaite, PhD Co-Investigator
“Spinal Cord Injury Pain Evolution (SCIPE) Study”
Department of Defense (PI: Thomas Bryce, MD, Mt. Sinai)
05/1/19 – 04/30/2022
The purpose of this project is to provide a comprehensive description of the development of pain sub-types and pain treatments used by persons with SCI in the US over the first year post injury and to identify predictive neurosensory characteristics and psychosocial factors for the later development of persistent neuropathic pain.
Sara J. Mulroy, PhD, PTx Co Investigator, Collaborating Site PI
“Evaluation of the MOTUS Smart Boot System as a Diabetic Foot Ulcer Offloading Intervention (Pilot).”
Rancho Research Institute
10/2019 – 9/2020
This project aims to determine the effectiveness of using biofeedback to improve patient adherence to using offloading footwear in individuals with diabetic foot ulcers through the use of a novel offloading device (MOTUS Smart).
Jeffery W. Rankin, PhD Principal Investigator
“Toward a Mechanistic Understanding of Optimization Principles Underlying Hemiparetic Gait.”
NIH/NCMRR 1 R01 HD091184-01A1 (PI: James Finley, PhD, University of Southern California)
05/16/2018 – 05/15/2022
This project seeks to identify how motor impairments in stroke survivors contribute to mobility deficits through the use of behavioral observations and computational models. This research will answer two fundamental questions: 1) Do improvements in symmetry lead to functional benefits such as a more efficient walking pattern or improvements in balance? 2) If stroke survivors retain the capacity to walk more symmetrically why do they choose to do otherwise?
Sara J. Mulroy, PhD, PT Co-Investigator
“Comparative Effectiveness of Off-the-Shelf (OTS) vs. Custom-made Ankle-Foot Orthosis in Individuals with Stroke.”
Admin for Community Living (ACL) – U.S. Dept. of Health Human Services/NIDILRR
Field Initiated Res – IFRE17000050
09/30/2018 – 09/29/2021
This project seeks to identify the individual patient characteristics that determine whether an individual’s walking function after a stroke is best enhanced with a prefabricated off the shelf ankle brace made of either plastic or carbon fiber or a custom-made articulating orthosis. We will assess daily stepping, patient preferences, and gait biomechanics and muscle activity in the three brace types using a cross-over design.
Sara J. Mulroy, PhD, PT Principal Investigator
“Southern California Spinal Cord Injury Model System at Rancho Los Amigos National Rehabilitation Center.”
Center Site Specific Research —“ A Randomized Comparative Effectiveness Trial to Evaluate Two Programs for Administration for Community Living (ACL) –
U.S. Dept. of Health Human Services/NIDILRR
09/30/16 – 9/30/21
The purpose of this project is to evaluate the effectiveness of two programs for promoting physical activity after spinal cord injury: a whole of day activity accumulation program and a planned arm crank ergometry exercise.
Sara J. Mulroy, PhD, PT Model System Co-Director of Research, PI of Site Specific Research study
“Interactive Tele-health and Auto-Biofeedback Sensor System for Individuals who Use Wheelchair”
Agency: NIH/NIA
9R44AG059275 – 03A1 Phase II SBIR grant (PI: Hung Nguyen, Biosensics, Inc.)
05/01/17 – 01/30/21
The purpose of this project is to develop and evaluate the effectiveness of a remote monitoring and feedback system of pressure relief activity for persons who use a manual wheelchair for mobility.
Sara J. Mulroy, PhD, PT Co-Principal Investigator
“Development of a Biopsychosocial Prospective Surveillance Model of Shoulder Pain in SCI “
DoD SCIRP: W81XWH-16-SCIRP-IIRA(PI: Margaret Finley, PT, PhD, Drexel University)
8/1/17-7/31/2020
Project Goals/Aims: Investigate the progression of impairments for the first year following injury beginning with inpatient rehabilitation in the acute phase. Specifically to determine musculoskeletal and psychosocial factors associated with shoulder pain in individuals with acute SCI, establish the changes in musculoskeletal and psychosocial factors in individuals with SCI between the acute phase of rehabilitation, at 6 months and one year post–SCI. and to determine the relationship between shoulder pain, musculoskeletal factors, psychosocial factors, and quality of life, during the first year following SCI.
Sara J. Mulroy, PhD, PT Consultant
COMPLETED LAST 5 YEARS:
“Southern California Spinal Cord Injury Model System at Rancho Los Amigos National Rehabilitation Center.”
Center Site Specific Research —”A Randomized Clinical Trial to Evaluate Two Prevention Programs for U.S. Dept. of Education/NIDRR H133N110018″
Administration for Community Living (ACL) – U.S. Dept. of Health Human Services/NIDILRR
11/01/11 – 9/30/17
The purpose of this project is to evaluate the effectiveness of two prevention programs for preserving shoulder function after spinal cord injury, a home-based shoulder exercise program combined with instructions to modify movement technique for upper extremity activities or an enhanced-interaction version with more direct contact, for exercise instruction and education.
Sara J. Mulroy, PhD, PT Model System Co-Director of Research, PI of Site Specific Research study
“Psychosocial contributors to pain management and physical activity after SCI”
Craig H. Neilsen Foundation
4/01/15 – 3/31/17
The purpose of this project is to utilize ecological momentary assessment (intermittent queries via phone app regarding current states/activities) to identify factors that facilitate physical activity and positive pain management strategies for persons with SCI to inform wellness and pain management programs for diverse populations.
Sara J. Mulroy, PhD, PT Principal Investigator, Rebecca Lewthwaite, PhD Co-Investigator
“Scapular Biomechanics and Shoulder Pain in Wheelchair Users with SCI”
Craig Nielsen Foundation:
07/01/2013 – 06/30/2016
Major Goals: The overall objective of this project is to identify the biomechanics of the scapula and shoulder pain development caused by the loads experienced by individuals who use a manual wheelchair and have SCI.
Sara J. Mulroy, PhD, PT Co- Investigator
“Interactive Tele-health and Auto-Biofeedback Sensor System for Individuals who Use Wheelchair”
Agency: NIH 1R43HD076524-01 Phase I SHIFT grant
04/01/13 – 03/31/16
The purpose of this project is to develop and evaluate the effectiveness of two remote monitoring and feedback systems for persons who use a manual wheelchair for mobility: PRESS, Pressure Relief Exercise Support System and WAMS: Wheelchair Activity Monitoring System,
Sara J. Mulroy, PhD, PT Co-Principal Investigator
“Modular Orthosis Prescription System (MOPS)”
U.S. Dept. of Education/NIDRR H133G100268
10/01/10 – 09/31/14
The purpose of this project is to develop a modular system to assist and guide in the prescription of lower extremity orthosis for individuals with neuromuscular disorders.
Sara J. Mulroy, PhD, PT Co-Principal Investigator, Philip S. Requejo, PhD Co-Principal Investigator
