Research

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

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 is to measure traditional risk factors for CVD and calculate each person's risk score for CVD using a standard process. These risk scores 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 determines 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 is 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 is measured during an arm ergometer exercise test. We 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.

If you live in the Washington, DC area and are interested in participating, please click here.

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 are randomly assigned to either a control group or an intervention group. The control group undergoes usual inpatient rehabilitation for their SCI. The intervention group undergoes 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 is monitored, and blood and urinary markers of bone loss are measured at study entry, 3 and 6 months post-SCI, and then changes over time are 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 are participating in this study and are assigned to either a usual care or an exercise training group where the mode of training is 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 receive the standard outpatient rehabilitation services from their doctors. Subjects in the study are assigned to either group by chance. The individuals in the exercisetraining group receive RBWSTW exercise three times per week for 6 months. Selected measurements are done at the start of the study and after 3 and 6 months of training. The same measurements are also done with persons in the usual care group. Dual xray absorptiometry (DXA) is used to assess bone mineral density, standard blood tests measure blood fats, glucose (blood sugar) and insulin levels, questionnaires assess depression, pain, and quality of life, and a standardized level of submaximal RBWSTW is used to measure fitness.

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

If you live in the Washington, DC area and are interested in participating, please click here.

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 is 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 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 2 year 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 hopes to 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.

The VTHM webcast that discusses this survey development can be found here: Relevancy, Accuracy, & SCI Research: A Request for Consumer Input in an SCI-Related Survey