EXHIBITS

OBJECTIVES: Restore arm and leg mobility to physically disabled veterans and others by developing innovative clinical treatments and technological devices.

RESEARCH PLAN: The focus is on disabilities caused by neurologic and orthopaedic impairments, especially those from stroke, spinal cord injury, arthritis, and osteoporosis. The approach is to integrate medical, engineering, and scientific disciplines and provide cohesion among basic, applied and clinical research. The cornerstone to our approach is the cross-fertilization of ideas and methods and the formation of interdisciplinary teams working on peer-reviewed projects.

METHODS: The basis for the projects is the scientific foundation the Center has established to understand the role of physical activity in skeletal health and impairment, the engineering methodology developed for understanding muscle coordination and its role in disabling motor impairments, and the experience acquired in designing, developing, evaluating, and technology transfer of devices and clinical methodologies.

FINDINGS: Studies in animals and humans show that our theories for the mechanical regulation of skeletal tissues (bone, cartilage, fibrous tissues) are viable and applicable to a variety of orthopaedic issues, including osteoporosis countermeasures, fracture healing, and the evaluation and design of total joint replacements. Experimental studies and computer simulations of upper and lower limb movement tasks have elucidated principles of muscle coordination in healthy individuals and mechanisms by which impaired coordination gives rise to functional limitations in individuals with spinal cord injury and post-stroke hemiplegia. See website: http://guide.stanford.edu

CLINICAL RELEVANCE: Independence and quality of life will be improved in persons with post-stroke hemiplegia, spinal cord injury, and degenerative joint disease.

(Supported by Rehab R&D Service, Dept. of Veterans Affairs (VA) )

OBJECTIVES: The Seattle VA Rehab R&D Center has been recently established to study amputation prevention, lower limb prosthetics, and the outcome of amputee patients. The initial objectives are to 1) improve the possibility of preservation of the lower limb; 2) make more effective decision regarding amputation versus salvage; 3) study the effect of amputation level and its relationship to wound healing and post amputation function; 4) evaluate the mechanical function of prosthetics to allow the optimal design for the individual amputee; 5) improve the process of fitting and design of prostheses; and 6) develop functional outcome tools to measure outcomes of amputees.

RESEARCH PLAN: Support and initiate research collaboration between clinical and basic scientists from the Seattle VA; Univ of Washington Depts of Orthopedics, Rehabilitation Medicine, and Bioengineering; and Prosthetics Research Study.

METHODS: 1) Create an effective program for prevention of limb loss by developing a better basic understanding of the deformities that lead to ulceration, the role of prophylactic correction of deformity, and the role of protective footwear. 2) Improve prosthetic design by measuring the effect of impact absorbing prosthetic shanks in below knee prostheses and investigations into the development of a powered prostheses. 3) Develop more effective outcome tools to assess the benefits of salvage vs. amputation. 4) Disseminate information regarding prevention, prosthetic prescription and design to primary care physicians, surgeons, rehab specialists, prosthetists, engineers, and amputees by way of peer reviewed publications, presentations, educational CD ROMs and interactive websites.

FINDINGS: Forthcoming from the following projects in progress: Effect of Custom Orthotics on Hindfoot Kinematics of the Foot and Forefoot Pressure Distribution; 3D Geometry and Plantar Pressure in Adult Foot Deformity; Equinus Contracture Measurement in Diabetic Foot Ulcer Patients; Development of Powered Prosthetic Lower Limb; Silicone Suspension Liner/Socket with Distal Locking Pin vs. Conventional Socket with Pelite Liner and Elastomeric Sleeve Suspension; Outcomes Assessment of Amputation vs. Vascular Bypass Surgery in Diabetes.

CLINICAL RELEVANCE: The focus of the Center is broad based and patient directed. It is structured to address major questions in care and treatment of the amputee: amputation prevention, surgical decision making, selection of the appropriate prosthesis, design of prosthetic devices, assessment of the functional outcome and quality of life issues.

(Supported by the Veterans Administration Rehabilitation R&D Center Grant #AO806-C)

Initiated in 1997, the National Center for Rehabilitative Auditory Research has been established to foster multidisciplinary research that can help hearingimpaired veterans. The Center sponsors investigators whose research is clinically oriented so as to improve currently available rehabilitation techniques. Six additional sites, located in Oregon, California, New Mexico, Tennessee, and New York, join with the Portland Rehabilitative Auditory Research Center team to address a wide range of topics including: Development of innovative hearing aid technology so as to improve communication; efforts to decrease hearing damage due to anticancer medications currently in widespread use in the U.S.; investigation of possible mechanisms for hearing damage, using animalbased research to understand the processes underlying human hearing loss; development of sophisticated new diagnostic methods for detecting and evaluating hearing impairment in humans, both in the standard audiometric range as well as the ultraaudiometric (high frequency) range; and development of methods for evaluating and treating tinnitus. The Center also sponsors a number of educational and outreach efforts to disseminate information to other health care professionals as well as to veterans and their families. In addition to its many professional publications, the Center offers mentoring axid specialized instruction at undergraduate, graduate, and postgraduate levels. A summary of its achievements and ongoing efforts can be viewed at its newlycreated World Wide Web site (address to be provided).

OBJECTIVE: The mission of the Rehabilitation Research and Development (R&D) Center in Functional Electrical Stimulation (FES) is to improve the quality of life of veterans with disabilities through the use of FES and enable the transfer of this technology into clinical deployment.

METHODS: FES uses controlled electrical current to activate muscles that are paralyzed as a result of spinal cord injury (SCI) or other central nervous system disorder. The aim is to bypass the damaged portion of the nervous system with pacemaker-like implants that restore useful function. FES has implications for many aspects of spinal cord injury including activities of daily living; mobility; cardiovascular health; integrity of skin, muscles, bones, and joints; respiratory function; and bladder/bowel control. People with other central nervous system disorders, such as stroke and head injury, may also benefit from FES advances.

RESEARCH PLAN: Short-term research plans include initiating clinical trials of FES for functional restoration of standing/transfer and limited mobility in individuals with stroke or incomplete SCI and bladder and bowel control for individuals with SCI. Technology transfer activities will focus on gait restoration in unilaterally involved individuals and an advanced system to provide restoration of upper arm and hand function in individuals with SCI.

CLINICAL RELEVANCE: The results of these undertakings will be to assist individuals with paralysis in achieving greater independence and to advance knowledge in the basis and use of functional electrical stimulation. (Primary support is provided by the Department of Veterans Affairs Rehabilitation Research and Development Service, the National Institutes of Health, the Food and Drug Administration, the Whitaker Foundation, the National Science Foundation, the Spinal Cord Research Foundation of the Paralyzed Veterans of America (PVA), and the Buckeye Chapter PVA.)

OBJECTIVES: The objectives of the Center are to improve the function, independence, and quality of life of Veterans aging With disabilities and those acquiring disabilities as they age.

RESEARCH PLAN: The objectives will be accomplished by research directed toward understanding the mechanisms underlying impairments and disabilities and applying this understanding to the design, testing, and evaluation of creative rehabilitative interventions. The Center's research focuses on three areas: 1) vision; 2) environment and behavior; and 3) exercise and physical performance; and the interactions among them.

METHODS: The Developmental Research Program which utilizes core support for 710 projects per year, fosters interdisciplinary collaboration among Center investigators and investigators from its three major university affiliates (Emory, Georgia Tech, and Georgia State University), involves graduate students and junior investigators, and generates preliminary data for major research proposals. Two advisory groups provide national expertise and consumer input on Center activities. Three local research support groups help to ensure the clinical applicability of Center research and enhance interdisciplinary and inter-institutional collaboration.

FINDINGS: Center research has resulted in an understanding of the mechanisms of impairments and disabilities among aging Veterans; development and evaluation of rehabilitative interventions and technologies targeted at reversing, preventing, or stabilizing impairments and disabilities that impact the function, independence, and quality of life of aging Veterans and their caregivers; and the utilization, cost effectiveness, and satisfaction associated with these interventions in VA and other systems.

CLINICAL RELEVANCE: In recognition of the multi-factorial nature of impairment and disability of aging Veterans, Center research and development address the interface of the aging Veteran and his/her capabilities on the one hand, and the psychosocial and physical environment of care on the other hand.

(The Atlanta VA Rehab R&D Center is funded by the Department of Veterans Affairs Rehabilitation Research and Development Service.)

OBJECTIVES: Do people with physical disabilities age prematurely? In addressing this and related questions, the Center seeks to define and describe physiological, psychological and functional changes in people with physical disabilities as they age and to design treatment interventions to prevent these changes.

RESEARCH PLAN: The Center is developing a database designed to follow physiological, psychological and functional changes in people with physical disabilities. The Center will develop interventions such as exercise and nutrition to prevent deleterious changes and improve function. design, implement and evaluate programs for the prevention of complications resulting from inactivity. Research encompasses physical, mental, social and spiritual dimensions in a holistic framework intended to create a model program for the care of aging veterans with disabilities.

METHODS: Initial Center projects examine the effects of exercise after spinal cord injury, the effects of nutrition on veterans in the Extended Care Unit, improvements in crutch design, the benefits of education and training for family members caring for veterans after stroke, and sexual function after stroke.

FINDINGS: Although the Center is new, efforts by Center investigators will be presented related to progress in the areas mentioned above, with particular emphasis on research in general health issues after spinal cord injury (bladder, skin, spasticity), on exercise and fatigue, on details of database implementation and other aging-related issues.

CLINICAL RELEVANCE: Research has shown that the previously assumed "natural decline associated with aging" is not necessarily inevitable; increased activity and other health promoting behaviors may prevent and indeed even reverse these effects.

(supported by VA Rehabilitation Research and Development Service)

Go to top.

Last revised Wed 05/05/1999