Research & Training Initiatives

List of Research Projects

R1: Cardiovascular Disease Risk Stratification Across Injury Levels after Spinal Cord Injury: Assessment of Need for Intervention and Its Predictors

R2: Effect of an Acute, Intensive Exercise Intervention on the Prevention of Bone Mineral Density Loss in Individuals with Spinal Cord Injury

R3: Effect of Robotic Body-Weight Supported Treadmill Training on Bone Mineral Density and Selected Secondary Conditions in Individuals with Spinal Cord Injury

R4: Comparison of Exercise Training Formats in Individuals with Spinal Cord Injury

R5: Exercise and Secondary Conditions: A National Survey of Individuals with Spinal Cord Injury

List of Training Projects

T1: Monitoring and Prevention of Secondary Medical Complications Using a Peer Mentoring Approach

T2: Improving Clinical Practice Through Consumer-Driven Education: Development of the Consumer Professional Partner Program

T3: Preventing Secondary Conditions to Achieve Healthy Living with SCI: Research Findings & Innovative Training Concepts

T4: Building a Virtual Resource Network on Exercise and Prevention

R1: Cardiovascular Disease Risk Stratification Across Injury Levels after Spinal Cord Injury: Assessment of Need for Intervention and its Predictors

Spinal cord injury (SCI) generally makes the aging process occur at a faster rate. One of the results of this is an increase in cardiovascular disease (CVD). Medical research has found increased levels of unhealthy fats in the blood, problems with decreased blood flow to the heart, and a sedentary lifestyle in persons with SCI. A total of 240 individuals with SCI will be a part of this study.

One purpose of this project will be to measure traditional risk factors for CVD and calculate each person's risk score for CVD using a standard process. These risk scores will compare risk in persons with SCI to ablebodied individuals and help determine the need for taking steps to lower the risk in the SCI individuals. In order to measure the risk, the study will determine your age, level of SCI, ASIA classification, family history of CVD, body mass index, triglycerides (bad fats), high density lipoproteins (good fats), fasting blood glucose, blood pressure, peak oxygen intake, total calories eaten over 4 days, and use of tobacco.

A second purpose of the study will be to attempt to develop an equation that accurately predicts the peak aerobic capacity (ability to do endurance exercise) of persons with SCI. The ability of your body to use oxygen for exercise will be measured during an arm ergometer exercise test. We will analyze the importance of your age, resting heart rate, peak exercise heart rate, how hard you rate the exercise, your exercise time, and the highest level of exercise completed in this equation.

R2: Effect of an Acute, Intensive Exercise Intervention on the Prevention of Bone Mineral Density Loss in Individuals with Spinal Cord Injury

Osteoporosis is a significant secondary condition that occurs soon after acute spinal cord injury (SCI) and is directly related to the increased fracture risk seen in individuals with SCI. Further, the increased bone loss that eventually leads to osteoporosis, and which is characterized by heightened serum and urine calcium, may contribute to other secondary conditions, such as kidney stones and hypercalcemia.

In this project we have developed an intensive lower limb exercise program using functional electrical stimulation (FES) in adults with acute motor complete SCI. Twenty-six participants who are within 6 weeks of acquiring their spinal cord injury will be randomly assigned to either a control group or an intervention group. The control group will undergo usual inpatient rehabilitation for their SCI. The intervention group will undergo usual impatient SCI rehabilitation, as well as have 1-hour of functional electrical stimulation (FES) to both legs 5 days a week for 6 weeks. Bone density and muscle thickness will be monitored, and blood and urinary markers of bone loss will be measured at study entry, 3 and 6 months post-SCI, and then changes over time will be compared between both groups.

We propose that this program will slow the rate of bone loss through FES, thereby diminishing the development of osteoporosis.

R3: Effect of Robotic Bodyweight Supported Treadmill Training on Bone Mineral Density and Selected Secondary Conditions in Individuals with Spinal Cord Injury

Osteoporosis (low levels of minerals in the bone), cardiovascular disease, diabetes, and depression are secondary conditions that occur at a faster rate in persons with spinal cord injury (SCI) and are associated with a reduced amount of regular exercise. In the ablebodied population, exercise training is known to increase bone mineral levels, decrease certain risk factors for cardiovascular disease, improve the body's use of insulin, and decrease depression.

Thirty patients with chronic SCI will participate in this study and be assigned to either a usual care or an exercise training group where the mode of training will be upright robotic bodyweight supported treadmill walking (RBWSTW). This involves walking on a treadmill with a part of your weight supported by a harness from the ceiling and having your leg movement controlled by a computer.

The persons in the usual care group will receive the standard outpatient rehabilitation services from their doctors. Subjects in the study will be assigned to either group by chance. The individuals in the exercisetraining group will receive RBWSTW exercise three times per week for 6 months. Selected measurements will be done at the start of the study and after 3 and 6 months of training. The same measurements will also be done with persons in the usual care group. Dual xray absorptiometry (DXA) will be used to assess bone mineral density, standard blood tests will measure blood fats, glucose (blood sugar) and insulin levels, questionnaires will assess depression, pain, and quality of life, and a standardized level of submaximal RBWSTW will be used to measure fitness.

The study will compare these measurements to determine if the exercisetraining program has any effect on these measurements.

R4 Comparison of Exercise Training Formats in Individuals with Spinal Cord Injury

While few would argue as to the farreaching benefits of exercise, due to numerous barriers, it is difficult for individuals with spinal cord injury (SCI) to consistently participate in a routine exercise program. Sadly, individuals with SCI may have the greatest potential to benefit from exercise and physical activity since they are less fit, age at an accelerated rate compared with the nonSCI population, and are more susceptible to numerous, often preventable, secondary conditions.

This research project consists of a novel exercise program for individuals with SCI. The basic format of each program will be defined by both researchers and consumers with SCI, while still allowing flexibility for the individual needs of the participants with SCI. A consumerdefined exercise program developed and designed with the input of people with SCI can provide valuable information to help facilitate participation in, and longterm adherence to, routine physical activity.

The setting for these exercise programs will either be in the individual's own home or at the National Rehabilitation Hospital (NRH)'s exercise facilities in Washington, DC. Peer mentors will also work with some of the individuals in combination with their participation in the exercise program.

Through consistent participation in this exercise program, we anticipate that unplanned rehospitalizations, "sick" physician visits, and selected secondary conditions, including pressure sores, respiratory complications, depression, and pain, can be diminished or minimized.

R5. Exercise and Secondary Conditions: A National Survey of Individuals with Spinal Cord Injury

People with spinal cord injury are at high risk for developing secondary conditions such as urinary tract infections (UTI), pressure sores, cardiovascular disease (CVD), and osteoporosis. It has been suggested that participation in exercise or physical activity can reduce the risk of secondary conditions such as these among people with spinal cord injury (SCI).

This project uses a 2year national survey of people with spinal cord injury, combined with indepth interviews, to generate new knowledge about SCI and physical activity. This knowledge will allow health care professionals to target their exercise training recommendations and followup to those with SCI who are least likely to exercise, and to those who are most likely to benefit from exercise.

This research will determine the extent to which exercise can reduce the risk of a wide variety of specific secondary conditions, and enhance the community integration of people with SCI.

T1: Monitoring and Prevention of Secondary Medical Complications Using a Peer Mentoring Approach

It can be hard for newlyinjured individuals with SCI to avoid costly medical complications after discharge from a rehabilitation hospital. One of the major challenges for rehabilitation professionals is to make sure that people with SCI can take care of themselves and take steps to prevent medical complications after they leave the hospital and begin adjusting to their new life with a disability.

This study employs people with SCI as socalled "peer mentors" whose job will be to combine their personal experience with SCI with a skill set that focuses on prevention of secondary conditions. This combination will prepare them to help newly injured individuals with SCI improve their self care and prevention behaviors after discharge.

We will work with up to 10 peer mentors at the National Rehabilitation Hospital (NRH), and expect to assist 150 newlyinjured adults with SCI over 3 years to help prevent medical complications, such as pressure sores and urinary tract infections (UTI). Additional individuals with SCI will work as SCI Life Consultants, and together with peer mentors and research and training staff, will develop this peer mentor program.

T2 Improving Clinical Practice through Consumerdriven Education: Development of the Consumer Professional Partner Program

To address the lack of disabilityspecific knowledge and awareness among future health care professionals, this training project will employ consumers with spinal cord injury (SCI) as the educators of physical therapy and medical school students in the greater Washington, DC metropolitan area. People with SCI will teach and inform medical and physical therapy students about their firsthand experiences and rehabilitation needs, the importance of physical activity and exercise to prevent health problems such as heart disease and bone loss , and about general disability topics around SCI..

People with SCI will be immediately and intimately involved in the design, development, and delivery of the educational content and curriculum. This program, entitled the Consumer Professional Partner Program (CPPP), builds on a consumeraseducator program, called the Patient Partner Program, that has been tested in the education of physicians about arthritis. During the development phase, educators and students will both be invited to provide feedback about this program in the form of brief interviews. The program will also be offered over the Internet as a selfeducation module.

T3: Preventing Secondary Conditions to Achieve Healthy Living with SCI: Research Findings and Innovative Training Concepts

A twoday, fully accessible, national conference will be held in the fourth quarter of Year 3, entitled 'Preventing secondary conditions to achieve healthy living with SCI Research findings and innovative training concepts.' At this conference, experiences and preliminary findings from all of the Research and Training Projects will be presented to an audience consisting of clinicians, other health care professionals, researchers, policymakers, advocates, and consumers. Individuals with SCI will present and copresent along side clinical experts and researchers.

T4: Building a Virtual Resource Network on Exercise and Prevention

This training project will establish a comprehensive Virtual Resource Network on Exercise and Prevention through which knowledge gained from RRTC activities can be conveyed to consumers with spinal cord injury (SCI), health professionals, educators, and others. The Internetbased VRNEP will be fully accessible and regularly updated with information and resources regarding SCI, secondary conditions, physical activity, and prevention. People with spinal cord injuries will be significantly involved in identifying content areas as well as delivery methods.

This on-line network will allow for consumer input and feedback through online discussion forums, realtime Web casts, and webbased user questionnaires. By using this internet approach, the broadest possible access to the RRTC research and training information will be provided, and user feedback will be maximized.