Rehabilitation Research & Development Service (RR&D)

The VA’s Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury is committed to improving all aspects of life for persons with spinal cord injury, and not just the most obvious one—that is, the inability to walk. Individuals with SCI face daily issues that involve bladder control to prevent accidents and infection, bowel care, blood pressure regulation, clearing lung secretions, breathing adequately, temperature regulation, osteoporosis, abnormal sugar and cholesterol metabolism, increased risk of vascular disease and several other health issues. Our Center’s investigators are actively working to better understand these health problems and to develop novel and effective solutions. The investigators in our Center have published more than 200 original articles in the field of SCI Medicine.

Areas of Research:

Cardiovascular/Autonomic Research
Investigator: Jill M. Wecht, EdD
After suffering a SCI, maintaining blood pressure is often a challenge. We are studying how SCI disrupts normal blood pressure regulation. The benefit of medications to keep blood pressure in the normal range while sitting is being evaluated. We believe that keeping blood pressure normal while seated upright should help maintain brain blood flow and improve thinking in persons with SCI.

Endocrine Research
Investigator: William A. Bauman, MD
After SCI, adverse changes occur in soft tissue body composition, which are associated with disorders of carbohydrate (e.g., sugar) and cholesterol metabolism. These disorders in metabolism predispose to microvascular dysfunction and cardiovascular disease. Strategies are being considered to reduce insulin resistance and improve insulin release after SCI. The higher prevalence of insulin-resistant states in the SCI population may adversely influence neural modulation of the tone of smaller vessels, which may have deleterious effects on carbohydrate metabolism and the development and/or healing of pressure ulcers. Cardiovascular disease is recognized as a major cause of illness and death in those with SCI. If those with increased cardiovascular risk can be more accurately identified, which is being accomplished by noninvasive means, then appropriate treatment may be instituted to lower the chance of having a heart attack. Our investigators are working to prevent bone loss of the paralyzed legs shortly after SCI or to reverse the bone loss in those with long-standing SCI with medications and/or by mechanical means (e.g., treatments to prevent osteoporosis). If our efforts are successful in improving bone mass and strength, then fractures that occur to the legs after minor trauma can be reduced or prevented.

Gastrointestinal Research
Investigator: Mark A. Korsten, MD
Having a SCI frequently results in difficulty with bowel evacuation. Our investigators are testing a dual medication combination whose novel delivery is being tested through the skin (e.g., transdermally via iontophoresis) to improve routine bowel care. How exoskeletal-mediated ambulation alters colonic motility is also being assessed using high resolution manometry methodology.

Pulmonary Research
Investigators: Gregory J. Schilero, MD & Miroslav Radulovic, MD
High thoracic and cervical level spinal injuries are associated with respiratory muscle weakness and impaired ability to cough effectively and/or to exhale forcefully. To reduce the tendency to retain secretions and to have a higher susceptibility to pulmonary infections, pharmacologic and mechanical interventions are being investigated to increase respiratory muscle strength and the ability to forcefully cough. In addition, persons with cervical SCI have a much higher prevalence of sleep disordered breathing than that observed in the general population, which may predispose to adverse cardiovascular sequelae. Ongoing studies are better defining the diagnostic criteria, as well as the cardiovascular and neurohormonal responses, to sleep apnea in persons with SCI. In addition, the inability to cough effectively when associated with esophageal dysmotility and acid reflux (gastroesophageal reflux disease or GERD), may result in chronic airway inflammation. Various medications and/or mechanical devices are being tested to strengthen cough, counteract airway inflammation and, ultimately, decrease respiratory symptoms and improve breathing. Disturbances of breathing during sleep are also being studied.

Physical Activity and Quality of Life Research
Investigator: Ann M. Spungen, EdD
Lack of mobility and accessibility makes exercising quite difficult for persons with SCI. Our investigators are studying exoskeletal-assisted walking as a form of exercise and mobility. The impact regular walking in these devices has on health and quality of life in persons with paralysis from SCI is also being investigated.

Thermal Regulation Research
Investigator: John P. Handrakis, DPT, EdD
In persons with tetraplegia, to maintain a constant body temperature is a challenge, even when exposed to small changes in temperature. Our investigators are studying the responses of the body and their effect on thinking to mild changes in environmental temperature under carefully controlled conditions in a thermal testing room. Drug and non-drug interventions, to assist the body to keep temperature in the normal range, are being tested.

Neurorehabilitation Research
Investigator: Noam Y. Harel, MD, PhD
Individuals with SCI usually have residual nerve connections, even if they do not have conscious control over these neural pathways. We are utilizing sophisticated approaches to identify these spared nerve pathways. To strengthen spared nerve pathways, different combinations of physical exercises, magnetic stimulation, and electrical stimulation are being employed in an effort to improve function.

Molecular Research
Investigator: Christopher P. Cardozo, MD
Following an SCI, muscles become atrophic (e.g., smaller) and bones osteoporotic (e.g., thinner and weaker). Changes in the nervous system predispose to spasticity. State-of-the-art methods are being used to understand how these deleterious changes occur and conduct research that investigates novel potential treatments to mitigate them.