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Rehabilitation research center extends far reach

by Dawn Brazell
Public Relations

Aaron E. Embry, DPT, makes his final calculations, adjusts an investigative stimulation device he's using to treat Alaskan Lisa Von Bargen, and then helps get her walker set.

"OK. Make magic," he said, following closely behind as he assesses her response to a targeted intervention to reduce foot drop. "Let's go down this way."

Von Bargen nods as she heads down the hallway on the second floor of MUSC's Center for Rehabilitation Research in Neurological Conditions. That's why she traveled all the way from Alaska to participate in research studies currently being conducted. It was past time for some magic in her life.

Drs. Aaron E. Embry and Mark Bowden (center) adjust a stimulation device to assess Alaskan Lisa Von Bargen's response to a targeted intervention to reduce foot drop.

Five years ago, a car accident injured her spinal cord. She had to have one vertebrae removed and two others fused. With a diagnosis of incomplete tetraplegia, the former long distance runner found at first that she was unable to move from the neck down.

"They gave me less than a 5 percent chance that I would ever be able to walk again, so it was a huge change. To quote James Bond, 'I do not play the odds.' I was very assertive with my rehab. I was lucky that the accident happened at work, so I had insurance coverage, and I've had friends and family who have worked with me until I could do it on my own."

When she was in Seattle recently consulting with her physical therapist, she was handed a magazine article that described the research and vision of MUSC's center to develop a toolbox of best measurements and interventions to allow therapists to provide the best patient treatments. Her therapist told her that the approach MUSC was developing was what she needed.

Sold at Hello
Von Bargen, the community and economic development director for Valdez, ended up talking to researcher Mark Bowden, Ph.D. Bowden explained how the center customizes research into experimental interventions aimed at retraining the body to maximize a person's rehabilitative capacity.

"I was sold in an instant. He had me at 'hello' at that point. It's all I could have imagined and more because it's state-of-the-art technology and people working on the cutting edge of research."

Researchers at the center, which celebrated its grand opening last May, focus on behavioral measurement techniques, detailed engineering analyses and novel explorations into nervous system function and plasticity to help individuals with neurological injury and disorders. They don't believe in one therapy fits all.

An advantage of the center is its high-tech equipment that includes an instrumented split-belt treadmill that can measure 3-D ground reaction forces, a motion-capture system that allows movement data to be collected at a speed of up to 242 frames a second, a perturbation system for investigating balance during walking and a $150,000, Zero G computer-controlled, bodyweight support system that assists someone walking on a treadmill or on the ground.

Bowden, who's an assistant professor in the Department of Health Sciences and Research and the Division of Physical Therapy, said the 'permissive' environment created by the bodyweight support system allows researchers to challenge Von Bargen in a new way. They can remove her walker and challenge her balance to get her to activate trunk muscles she needs to strengthen. This environment also allows researchers to challenge an individual's speed and endurance more than a traditional rehabilitation laboratory. Detailed biomechanical analyses allow the therapists to understand her specific deficits, which is critical for choosing the most effective interventions, he said.

Customized Therapy
Her schedule kept her from being able to participate in an intensive experimental intervention, so they decided to do several days of cross-sectional research experiments, assessing her immediate responses to a variety of theory-based interventions. At the end of the week the researchers discussed what they had found and synthesized those findings into a description of her underlying deficits and her responses to various theoretical interventions, he said.

While the researchers will use this information to suggest what they believe to be the most promising experimental interventions, Von Bargen will coordinate the research findings with her clinical team in Alaska with the end goal of developing a program that she could independently follow at home. She hopes to return for two weeks in September to enroll in a mobility training program.

Von Bargen said she could tell a difference in her walking just in her brief visit here. It's given her hope that she can continue to make mobility gains in the future. "They told me, 'you now have a partner in life as you go through this,' and that was incredible."

To her, life is about moving and being able to function independently.

"I still have what I call 'blow my head off' kind of days where I get so frustrated not being able to do a task or be independent. It's a struggle. Every day is a struggle. Having a spinal cord injury is like killing someone without taking their life away. You go from being an active person and a normal regular life to being absolutely trapped, and I'm more fortunate than most."

She encourages other people with spinal cord injuries to realize it is the hardest work they'll face in life, and that they will have to push themselves. She's glad to see a shift in rehabilitation to customize treatment programs and hopes insurance will be able to offer more coverage for that type of treatment to others in the future. There are people with her type of injury who haven't had access to the therapy she's gotten and have not shown the same improvement, she said.

Bowden agrees."We don't do a good job in our current medical model for spinal cord injury rehabilitation in determining what that capacity can be," he said. "In doing so, we can help patients reach their potential rather than settling for some externally defined capacity that may or may not be true."



Friday, March 2, 2012

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