2019 Featured Stories
Several members of the MetroHealth Rehabilitation Institute team had an opportunity Friday to showcase their work and our facilities to State Rep. Jeff Crossman, who represents Parma, Brooklyn Heights, Cuyahoga Heights, and part of southwest Cleveland.
John Chae, MD, Vice President of Research and Sponsored Programs and Chair of the Department of Physical Medicine and Rehabilitation (PM&R); P. Hunter Peckham, PhD, Co-Director of the MetroHealth Rehabilitation Institute and a staff scientist in Orthopedics and PM&R; Jayme Knutson, PhD, Director of Research for PM&R; and Kim Anderson, PhD, a staff scientist in PM&R, hosted the tour.
Rep. Crossman had an opportunity to learn about the research and work being done at the Rehabilitation Institute, especially in the areas of spinal cord injury, stroke therapies and technology to relieve chronic pain. The Institute focuses on restoring function, social participation and quality of life to persons with signiﬁcant disabilities. The team’s approach is to deliver outstanding rehabilitation care, train the next generation of rehabilitation clinicians and scientists, and discover new knowledge that becomes part of our standard of care. Rep. Crossman also toured The Zubizarreta House, our fully accessible facility where out-of-town patients can stay when receiving these treatments at MetroHealth. The 7,000-square-foot, one-story house can house several patients and is located near the MetroHealth Old Brooklyn Medical Center.
Dennis Bourbeau, PhD, Staff Scientist in the department of Physical Medicine and Rehabilitation (PM&R), received a 3-yr, $735,000 grant from the Craig H. Neilsen Foundation entitled “Ambulatory closed-loop stimulation to inhibit neurogenic bladder overactivity”.
Following spinal cord injury (SCI), most individuals develop neurogenic bladder characterized by overactivity, which can severely impair a person’s health and quality of life and is associated with high costs. Electrical stimulation of the genital nerves has been shown to inhibit overactive bladder to improve bladder capacity and urinary continence in men and women with SCI. The objective of this project is to evaluate the potential feasibility and effectiveness of automated closed-loop genital nerve stimulation to stop unwanted bladder contractions using a custom algorithm and a wireless, catheter-free bladder pressure sensor developed with collaborators.
Dr. Bourbeau is Assistant Professor of PM&R at Case Western Reserve University.
P. Hunter Peckham, PhD, Co-Director of the MetroHealth Rehabilitation Institute and staff scientist in the Departments of Orthopedics and Physical Medicine and Rehabilitation (PM&R), was elected Fellow of the International Academy of Medical and Biological Engineering (IAMBE). IAMBE is a non-profit society of distinguished scholars engaged in medical and biological engineering research to further the field of biomedical engineering or bioengineering. The Academy is composed of Fellows who have made significant contributions to and played leadership roles in the field of medical and biological engineering. This honor recognizes Dr. Peckham’s contributions to and leadership in the field of medical and biological engineering at the international level.
Dr. Peckham is Member of the National Academy of Engineering, Fellow of the National Academy of Inventors and Fellow of the American Institute for Medical and Biological Engineering. Dr. Peckham is Distinguished University Professor, Donnell Professor of Biomedical Engineering and Professor of Orthopedics and Physical Medicine and Rehabilitation at Case Western Reserve University.
John Chae, MD, VP for Research and Sponsored Programs and Chair of the Department of Physical Medicine and Rehabilitation (PM&R), is co-editor of DeLisa’s Physical Medicine and Rehabilitation: Principles and Practice. The 1,760-page volume presents the most comprehensive review of the state of the art, evidence-based clinical recommendations for physiatric management of disorders affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons.
Written by the most recognized names in PM&R research and education, the sixth edition of DeLisa’s pioneering textbook presents both the scientific fundamentals as well as the latest clinical treatments and rehabilitative techniques for a broad array of conditions, disabilities and diseases. Other PM&R faculty at the MetroHealth System contributing to the volume include Jayme Knutson, PhD, Director of Research and Associate Professor of PM&R and Richard Wilson, MD, Director of Division of Neurological Rehabilitation and Associate Professor of PM&R. Dr. Chae is Professor and Chair of PM&R and Professor of Biomedical Engineering.
MetroHealth served as a major contributor to a multi-center, randomized, controlled trial that demonstrated home-based telerehabilitation was as effective as in-clinic therapy for upper limb recovery after stroke. The paper entitled “Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke” was published in the June, 2019 issue of JAMA Neurology.
One hundred twenty-four participants who experienced a stroke 4 to 36-weeks prior and had mild to moderate upper limb deficits were enrolled at 11 sites across the United States between 9/18/15 and 12/28/17. Both groups received supervised and unsupervised treatment sessions that focused on repetitive task practice and functional training over a 6-week period.
Unsupervised sessions for both groups were carried out at home. For the supervised sessions, the TR group received their treatments at home using an internet-enabled computer and 12 gaming input devices with remote therapist supervision via video conferencing. The IC group received their supervised sessions in clinic under the “in-person” supervision of a therapist.
At 30 days after the end of treatment, both groups had experienced similar improvements in their upper limb hemiparesis and function based on objective measures, indicating that TR is not inferior to IC therapy. However, participant motivational factors and self-reported perception of motor and functional recovery were slightly higher in the IC group.
As the US healthcare system transitions to population health, telemedicine in general, and telerehabilitation in physical medicine and rehabilitation (PM&R) in particular, will be major considerations in the ongoing dialogue and formulation of value-based medicine.
Steven Cramer, MD, Professor of Neurology at the University of California, Irvine, served as the principal investigator (PI) of this NIH sponsored clinical trial. Jayme Knutson, PhD, Director of Research for the department of PM&R and Associate Professor of PM&R at Case Western Reserve University (CWRU), served as the site PI at MetroHealth. Among 11 sites, MetroHealth contributed the 3rd highest number of participants to the clinical trial. Other contributors to the trial at MetroHealth include Margaret M. Maloney, RN; Gregory Naples, MS; Amy S. Friedl, MS, OTR/L; Kristine M. Hansen, MPT; Mary Y. Harley, OT/L; Terri Z. Hisel, OTR/L; and John Chae, MD. In addition, MetroHealth was supported by the Cleveland NINDS Stroke Trial Collaborative (NIH U10 grant awarded to CWRU; PI: Anthony Furlan, MD).
Dr. Kim Anderson, a staff scientist in the Department of Physical Medicine and Rehabilitation (PM&R), was awarded a 3-year, $803,000 grant by the Department of Defense (DoD). Funds will be used to lead a qualitative research study to understand how veterans and civilians with spinal cord injury (SCI) experience recovery in their first year after injury as they attempt to reintegrate into the community.
Data will be collected by interviewing veterans and civilians living with SCI and their caregivers. Understanding the experience of veterans and civilians as they undergo recovery and navigate resources will offer clinicians and researchers opportunities to improve access and develop more relevant treatments to improve function and reintegration.
This study is a collaboration between researchers at the MetroHealth System, (Kim Anderson, PhD; Anne Bryden, MA, OTR/L); sociologists at Case Western Reserve University (Sue Hinze, PhD; Brian Gran, PhD) and clinicians at the Veterans Affairs Northeast Ohio Health System (Mary Ann Richmond, MD; Angela Kuemmel, PhD). Dr. Anderson joined the PM&R department in March of 2018 from the University of Miami where she was Professor of Neurological Surgery. Her appointment to Professor of PM&R is pending CWRU review.
John Chae, MD, Vice President for Research and Sponsored Programs and Chair of Physical Medicine and Rehabilitation, was appointed to serve on the National Academy of Medicine (NAM) Membership Subcommitee on Health and Technology. The NAM, formerly the Institute of Medicine, is one of three academies that make up the National Academies of Sciences, Engineering, and Medicine. Its mission is to improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally. Seventy-five regular and 10 international members are elected annually by the membership “for distinguished contributions to medicine and health."
For 2019, five slots will be allocated to the subject emphasis area of Health and Technology. The subcommittee will identify candidates with expertise in areas that include basic science and its translation to technologies that enhance health and patient care; engineering research and its translation to the development of instrumentation to support diagnosis, monitoring and other health-related activities; the curation of health data to allow inference; and the development and implementation of analytical methods leading to tools that can facilitate health-related assessments and decision-making to a wide range of users.
The National Academy of Sciences, the first of the three academies, was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. The National Academies of Engineering and Medicine were established in 1964 and 1970, respectively. Dr. Chae is a member of the NAM and Professor and Chair of Physical Medicine and Rehabilitation and Professor of Biomedical Engineering at Case Western Reserve University.
Kevin Kilgore, PhD, staff scientist in the departments of Orthopedics and Physical Medicine and Rehabilitation (PM&R), was awarded a $600,000, 3-year grant from the Craig H. Neilsen Foundation to develop an implanted blood pressure (BP) sensor for persons with spinal cord injury (SCI). The sensor will monitor BP during episodes of autonomic dysreflexia (AD), a lifelong and potentially life-threatening condition for individuals with SCI associated with a rapid rise in BP. The application proposes to estimate BP using implanted optical and electrical sensors and includes pre-clinical and clinical feasibility studies. The study will inform future design of a fully implanted version of the BP warning system. Although the first clinical target is AD for persons with SCI, Dr. Kilgore and his team plan to expand the use of this sensor to many other health monitoring applications in the future.
Dr. Kilgore is Professor of Orthopedics, PM&R and Biomedical Engineering, Case Western Reserve University (CWRU). His co-investigators include Pedram Moheseni, PhD, Professor of Electrical Engineering and Computer Science, CWRU; Laleh Najafizadeh, PhD, Associate Professor of Electrical and Computer Engineering, Rutgers University; Greg Nemunaitis, MD, Director of Spinal Cord Medicine, MHS, and Professor of PM&R, CWRU; and Tina Vrabec, PhD, staff scientist, MHS, and Assistant Professor of PM&R,* CWRU.
*Pending CWRU appointment review.
The department of Physical Medicine and Rehabilitation (PM&R) at the MetroHealth System (MHS) and Case Western Reserve University (CWRU) is ranked number 2 in the nation in National Institutes of Health (NIH) funding among PM&R departments in U.S. Medical Schools. The Blue Ridge Institute for Medical Research rankings are based on data released by the NIH for all active awards during the 2018 fiscal year, which began October 1, 2017 and ended September 30, 2018.
The department of PM&R at CWRU is based at the MHS and is housed within the MetroHealth Rehabilitation Institute, whose mission is to restore function, societal participation and quality of life for persons with significant neurological and musculoskeletal impairments and functional limitations. The Institute is committed to a transdisciplinary approach that delivers outstanding rehabilitation care, trains the next generation of rehabilitation clinicians and scientists, and discovers new knowledge that translates to clinical practice.
The MetroHealth Rehabilitation Institute is world renowned for the development and clinical implementation of sophisticated electrical stimulation systems that reanimate paralyzed muscles; restore limb, trunk, respiratory, bowel and bladder function; and facilitate neurological recovery following stroke, brain injury and spinal cord injury (SCI). Major new initiatives include interventions for the treatment of chronic pain and cardiac and pulmonary dysfunction in the non-neurologically impaired population. The research program within the Institute is staffed by biomedical engineers, electrical engineers, neuroscientists, neurosurgeons, occupational therapists, orthopedic surgeons, physiatrists, and physical therapists.
The MetroHealth Rehabilitation Institute presently has over $52 million in extramural research funding with two thirds awarded by the NIH. Independent Investigators in the Institute, defined as a Principal Investigator (PI) or Co-PI of a NIH R01 or equivalent award, include:
* Kimberly Anderson, PhD, Professor of PM&R*: Perspectives of people living with SCI and electrical stimulation for motor recovery in SCI (DoD)
* Niloy Bhadra, MD, PhD, Associate Professor of PM&R*: Electrical nerve block (NIH)
* Dennis Bourbeau, PhD, Assistant Professor of PM&R: Electrical stimulation for bladder function in SCI (NIH, VA)
* John Chae, MD, Professor of PM&R & Biomedical Engineering (BME): Peripheral nerve stimulation (PNS) for musculoskeletal pain (NIH)
* Anthony DiMarco, MD, Professor of PM&R & Physiology/Biophysics: Respiratory neuroprosthesis for SCI (NIH)
* Kevin Kilgore, PhD, Professor of Orthopedics, PM&R and BME: Upper limb neuroprosthesis for SCI and electrical nerve block (NIH, VA, FDA)
* Krzysztof Kowalski, PhD, Associate Professor of PM&R*: Respiratory neuroprosthesis in SCI (VA)
* Jayme Knutson, PhD, Associate Professor of PM&R: Electrical stimulation for hemiparesis (NIH, VA)
* Gregory Nemunaitis, MD, Professor of PM&R: SCI Model System (NIDILRR)
* P. Hunter Peckham, PhD, Professor of BME & Orthopedics: Upper limb neuroprosthesis for SCI (NIH)
* Mary Jo Roach, PhD, Associate Professor of PM&R*: SCI Model System (NIDILRR)
* Richard Wilson, MD, Associate Professor of PM&R: PNS for musculoskeletal pain (NIH)
* Pending CWRU review
Kim Anderson, PhD, a staff scientist in the department of Physical Medicine and Rehabilitation (PM&R), was awarded a $630,000 grant by the Department of Defense (DoD) to lead a clinical trial targeting restoration of reaching and grasping function in individuals with spinal cord injury.
A randomized controlled trial will compare electrical neuromodulation delivered by MyndMove® therapy to intensive upper-limb conventional therapy. The study will enroll individuals with moderate to severe upper limb motor impairment following an incomplete, sub-acute, traumatic spinal cord injury. The trial is sponsored by MyndTec Inc. and funded by the DoD. Dr. Anderson, in collaboration with Dr. James Wilson, will co-lead the trial at the MetroHealth Rehabilitation Institute and Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), respectively. Other participating centers include Houston, Toronto and Vancouver.
Dr. Anderson joined PM&R in March of 2018 from the University of Miami where she was Professor of Neurological Surgery. Her appointment to Professor of PM&R is pending a Case Western Reserve University (CWRU) review. Dr. James Wilson is a staff physiatrist in the Spinal Cord Injury Medicine service at the LSCVAMC, a staff scientist in the department of PM&R at MetroHealth, and Clinical Instructor of PM&R at CWRU. His appointment to Assistant Professor of PM&R is also pending a CWRU review.
The cover of the January 2019 issue of the American Journal of Physical Medicine and Rehabilitation features an article entitled "Complete restoration of respiratory muscle function in three subjects with spinal cord injury."
The respiratory neuroprosthesis, developed by MetroHealth scientists Anthony DiMarco, MD and Krzysztof Kowalski, PhD, in collaboration with Robert Geertman, MD, PhD and Kutaiba Tabbaa, MD, provides inspiratory function by electrically pacing the diaphragm and coughing function through electrical stimulation of the spinal cord.
The diaphragm pacing was successful in maintaining three patients off of mechanical ventilation. The coughing system demonstrated peak expiratory airflow and pressures comparable to normal cough. Subjects reported much greater ease in raising secretion with the coughing function, which is critical in reducing the risk of respiratory infections and other pulmonary complications in the spinal cord injured population.
Dr. DiMarco is Professor of Physical Medicine and Rehabilitation; Dr. Kowalski is Clinical Associate Professor of Medicine; Dr. Geertman is Assistant Professor of Neurological Surgery; and Dr. Tabbaa is Clinical Assistant Professor of Anesthesiology, Case Western Reserve University (CWRU) School of Medicine. Dr. DiMarco is the Principal Investigator of the U01 Award from the NIH – National Institute for Neurological Diseases and Stroke that funded the study. The study was also supported by the CWRU Clinical and Translational Sciences Collaborative funded by the NIH – National Center for Advancing Translational Sciences.
Richard Wilson, MD, Director of the Division of Neurological Rehabilitation in the Department of Physical Medicine and Rehabilitation (PM&R) and John Chae, MD, Chair of PM&R and Vice President for Research and Sponsored Programs, presented at a National Academy of Medicine Workshop entitled “The Role of Nonpharmacological Approaches to Pain Management.”
The workshop, held on December 4-5 in Washington, DC, was based on recommendations regarding nonpharmacological approaches to pain in the 2011 Institute of Medicine report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research” and the 2017 National Academies of Sciences, Engineering and Medicine’s report, “Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.”
The objective of the workshop was to review the current state of evidence on the effectiveness of nonpharmacological treatments and the use of diverse health models for pain management. Dr. Wilson shared information on implantable devices and nonpharmacological approaches to pain management.
Dr. Chae served on the workshop’s planning committee. Drs. Wilson and Chae are NIH funded investigators with extensive experience in the development and clinical assessment of implantable technologies for the treatment of pain. Dr. Wilson is Associate Professor of PM&R and Dr. Chae is Professor and Chair of PM&R and Professor of Biomedical Engineering at the Case Western Reserve University School of Medicine.