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Currently Funded Research Projects
Spinal Cord Injury
Southern California Spinal Cord Injury Model System
The Southern California Spinal Cord Injury Model Systems (SCIMS) Program at Rancho
Los Amigos National Rehabilitation Center (Rancho) is designed to optimally leverage the
enhanced clinical and research capacities at Rancho that have evolved from the fusion of
a long legacy of clinical excellence and dedication to patient-focused research. The overarching
objective of the Southern California SCIMS is to generate new knowledge that will directly
contribute to improving health and function and community participation for persons with
spinal cord injury (SCI).
Rancho continues to serve a large SCI population with over 250 new admissions each year
and a long tradition of serving individuals who are often from underserved populations including
individuals from racial and ethnic minorities (80% of our SCI population) and those from
economically-disadvantaged backgrounds (over 50% of our SCI population). Information from
his group of patients makes a unique contribution to the SCIMS regarding the specific rehabilitation
trends and needs of these under-served groups.
Rancho operates under the Los Angeles County (LAC) Department of Health Services and is
recognized by the County as the primary rehabilitation provider for severe trauma and disease.
We have significantly expanded our long-term medical and rehabilitation programs including
the establishment of an Outpatient Day Rehabilitation program for intensive, coordinated
post-discharge rehabilitation; the Enhanced Patient Centered Medical Home for Persons with
Spinal Cord Disorders to serve the ongoing medical needs of the SCI population, and a Health
and Wellness Center designed to meet the fitness, recreational and educational needs of people
with disability as well as community members to foster participation and community integration.
Our site-specific research program is generating new knowledge that directly contributes to
improving health and function and community participation for persons with SCI by establishing
evidence-based guidelines for an efficacious program for prevention of shoulder pain. Our
participation in the multi-site collaborative research projects is generating cutting edge
technology for monitoring physical activities of persons with subacute and chronic SCI and
generating new knowledge for improving life satisfaction and reducing breathlessness in SCI.
The Southern California Spinal Cord Injury Model System is supported by grant #H133N110018 of the
National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of
Education. For your comments and questions, contact us at (562) 401-7541 or scims@larei.org
$1 Million NIH Grant Targets Shoulder Pain In Patients with Spinal Injuries
Sara Mulroy, director of the Pathokinesiology Laboratory at Rancho Los Amigos
National Rehabilitation Center, has been awarded a five-year, $1.04 million grant from
the National Institutes of Health's National Center for Medical Rehabilitation Research
to study the risk factors for shoulder pain in patients with spinal cord injury. Mulroy
said the most common diagnoses for people with spinal cord injury who have shoulder pain
are inflammation and tears in the the rotator cuff tendons of the shoulder. This
pathology has been attributed to increased weight bearing on the arms during wheelchair
propulsion, transfers in and out of the wheelchair and raising body weight on the arms to
relieve pressure on the skin. Pilot studies by Mulroy and colleagues at Rancho Los
Amigos suggest that the movement pattern an individual uses to propel a wheelchair
can impact the risk of developing shoulder pain.
In the NIH-funded study, Mulroy and her colleagues will follow 320 subjects with
paraplegia from spinal cord injury for a period of three years to determine the factors
associated with shoulder pain. At the end of three years they compare the patterns of
wheelchair propulsion, muscle strength and wheelchair activity levels in subjects who
develop shoulder pain with those who remain pain-free.
The overall goal of the study is to develop recommendations to reduce the strain and
joint deterioration that may occur with long-term weight bearing on the arms to prevent
further loss of functional independence after spinal cord injury.
Interventions for SCI Shoulder Function in Wheelchairs
(National Institutes of Health #RO1 HD37098)
Following a Spinal Cord Injury, many individuals must rely on pushing a manual
wheelchair for mobility. Better wheelchair designs and improved community accessibility
have significantly increased work and recreational opportunities. Unfortunately, after many
years of increased arm use, some persons develop disabling shoulder pain. In an attempt to
reduce the demands placed on the shoulder during manual wheelchair propulsion, this
project evaluates two therapeutic interventions: adjusting seating posture and exercise.
Engineering Solutions for a Shoulder Preserving Wheelchair
(National Institute of Disability and Rehabilitation Research #H133E020732)
The Engineering Solutions for a Shoulder Preserving Wheelchair project is being
conducted in the Pathokinesiology Laboratory as part of a Rehabilitation Engineering
Research Center (RERC); Keep Moving: Technologies to Enhance Mobility and Function
for Individuals with Spinal Cord Injury (SCI). This project is designed to evaluate the
effectiveness of alternative propulsion systems for reducing the demands associated with
manual wheelchair use. This includes a lever design, power-assisted push-rim design,
and compliant push-rim design. A combined approach using laboratory-based
experimentation and computer modeling techniques will be used to develop specific
clinical criteria for prescription of currently available manual wheelchair propulsion
devices. Upper extremity mechanical and muscular demands, and metabolic energy cost will
be quantified from individuals with varying strength levels during wheelchair
propulsion. Dynamic simulation, numerical optimization, and analysis techniques
will be utilized to identify factors that may further reduce
stress on the shoulder of individuals with SCI.
Strengthening and Optimal Movement for Painful Shoulders in Chronic Spinal Cord Injury “STOMPS”
(Foundation for Physical Therapy and National Institute of Disability and Rehabilitation Research
#H133B031002-04)
The STOMPS project is being conducted as part of a clinical research network in
collaboration with the Department of Biokinesiology and Physical Therapy at the
University of Southern California. This clinical investigation is designed to evaluate
the efficacy of an exercise program on shoulder pain in persons with paraplegia
following spinal cord injury. Participants are randomly assigned to receive either a
12-week home exercise program or education about shoulder care. Pre- and post-intervention
evaluations, performed at the Pathokinesiology Laboratory, will evaluate shoulder
function, pain, and activity level.
Diabetes/Amputee
Quantified Custom Inserts - An Amputation Prevention Program for Diabetes Mellitus
(National Institute of Disability and Rehabilitation Research H133G020002)
Structural irregularities in the forefoot are a common cause of injurious pressure
concentrations during walking. Persons with normal sensation recognize these areas of
high pressure as painful and quickly seek relief. Persons with diabetes, who lack
sensation in their feet, frequently develop foot ulcers, which often lead to infection
and amputation. Preservation of the patient’s limb depends on reducing the foot’s
injurious pressure experienced while walking. Today’s techniques of shoe and insert
production are inconsistent and varied because no objective criteria for an effective
shoe system has been developed. This project is designed to identify the footwear
factors that will reduce plantar pressures in the diabetic foot to a safe walking level.
Stroke
Strength Training Effectiveness Programs for Stroke
(Foundation for Physical
Therapy)
The Strength Training Effectiveness Programs for Stroke (STEPS) project is being
conducted as part of a clinical research network in collaboration with the Department
of Biokinesiology and Physical Therapy at the University of Southern California.
This multi-center clinical investigation is designed to evaluate the effectiveness of
various therapeutic treatment interventions in persons with stroke. Six-week treatment
interventions include combinations of body-weight supported treadmill training,
stationary bicycle ergometry, and lower extremity resistance exercises. In addition to
clinical testing and isometric strength assessments, a subset of 20 subjects in the
project will have quantitative gait evaluations at the Pathokinesiology Laboratory.
Pre- and post-intervention gait evaluations will include stride analysis, motion and
forceplate analysis, as well as dynamic electromyography.
A Multi-Center, Double-Blind, Placebo-Controlled, Parallel Group Safety Study of
Pulmonary Function in Patients with Reduced Lung Function Treated with BOTOX®
(Botulinum Toxin Type A) Purified Neurotoxin Complex for Focal Upper Limb Spasticity
Due to Upper Motor Neuron Syndrome
Principle investigator: Ziyad Ayyoub, M.D.
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