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Rehabilitation Medicine Department
Project numbers
Diagnostic Capabilities of Ultrasound on the Oropharynx and Larynx
A Rigid Body Database on Normal Gait
Effects of Pre-op vs. Post-op Chemotherapy on Upper Extremity Function
Ultrasound and Videofluoroscopic Imaging in Oral-pharyngeal Dysphagia in Neurologically Impaired Subjects
Development of Normative Ultrasound Databases of Tongue Surface Configuration
Oxygen Uptake Kinetics During Recovery from Maximal and Submaximal Exercise
Linking Occupational Therapy Process and Patient Performance: The Personal Computer in Occupational Interventions
Rehabilitation Medicine Department Screening Protocol
INTRAMURAL RESEARCH PROJECT Z01 CL-60011-19 RM
October 1, 1997 to September 30, 1998
Title of Project: Diagnostic Capabilities of Ultrasound on the Oropharynx and Larynx
Principal Investigator: B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: L.H. Gerber, M.D., RM
Collaborating Units: NICHD (G.C. Fishman, Ph.D.)
NINDS
NCI
Med Diet (Plymouth, MN; D. Tymchuck)
NIDCD (C. Van Waes, M.D.)
Staff-Years: 0.66
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: The purpose of this project is to evaluate the ability of noninvasive ultrasound imaging to contribute to the diagnosis of impaired swallow and speech and to evaluate the oropharyngeal structures (tongue, palate, oral muscles, hyoid, larynx) in normal and abnormal populations.
In cooperation with DCD and NCI, we continue to use ultrasound imaging to track head and neck tumor growth and tissue change during experimental treatments with paclitaxel being conducted concurrently with radiation therapy and other experimental treatments in patients with advanced tumors. We completed analysis of ultrasound swallowing studies and functional swallowing outcomes of the 23 patients seen initially. We were able to track the natural evolution of swallowing function and have charted the course of recovery of oral motor function and mortality in this group of subjects. We have successfully built and tested an ultrasound transducer stabilizing device to alleviate the errors intrinsic to data collection using the handheld system we have used in the past. We can now study patient change resulting from treatment with enhanced reliability.
We have initiated a rigorously designed pilot study of the effects of viscosity on swallowing using ultrasound imaging. We anticipate this information will be valuable for the many individuals with dysphagia who are prescribed special diets. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01CL-60017-08 RM
October 1, 1997 to September 30, 1998
Title of Project: A Rigid Body Database on Normal Gait
Principle Investigator: S.J. Stanhope, Ph.D. (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: K.L. Siegel, M.A., P.T., RM
T.M. Kepple, M.A., RM
L.H. Gerber, M.D., RM
Collaborating Units: None
Staff-Years: 1.0
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: The Biomechanics Laboratory continues to develop and test techniques designed to explore the complex relationship between impairments of the neuromusculoskeletal system, functional limitations, and disability. One study of 18 normal subjects investigated the effect of dramatically different walking speeds on the mechanics of walking. Through the use of mechanical power analysis, it was demonstrated that two modes of walking may exist rather than a continuum of a single walking strategy. Another study evaluated a new technique for determining the role each major muscle group of the lower extremity plays in providing support to and propulsion of the body during walking. The results indicate forward progression was produced primarily by the ankle plantar flexors with a significant assist from the knee extensors. The results of these studies suggest that a complete and numerically consistent mechanical characterization of human movement is feasible. The application of these analytic techniques to the evaluation of human motion will have implications for rehabilitation and surgical treatment in patient populations. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60037-07 RM
October 1, 1997 to September 30, 1998
Title of Project: Effects of Pre-op vs. Post-op Chemotherapy on Upper Extremity Function
Principal Investigator: S. Adams, P.T. (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: None
Collaborating Units: NCI, SB (D. Danforth, M.D.)
Staff-Years: 1.5
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: Patients entered on the National Cancer Institute's protocol entitled "Effects of Pre-operative Chemotherapy on Axillary Lymph Node Metastasis in Stage II Breast Cancer: A Prospective Randomized Trial" are being studied to evaluate the effects of pre-operative vs. post-operative chemotherapy on upper extremity strength, range of motion and edema. All patients are seen for an initial physical therapy evaluation prior to any definitive surgical or chemotherapeutic treatment. Routine follow-ups are performed to assess changes in initial evaluation parameters. All patients receive standardized physical therapy intervention as needed through their course of treatment.
This study was terminated December 1997 due to slow accrual rate of patients. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60042-11 RM
October 1, 1997 to September 30, 1998
Title of Project: Ultrasound and Videofluoroscopic Imaging in Oral-pharyngeal Dysphagia in Neurologically Impaired Subjects
Principal Investigator: B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: B. Solomon, M.S., RM
C. Frattali, Ph.D., RM
Collaborating Units: NINDS (M. Dalakas, M.D.; M. Hallett, M.D.;
I. Litvan, M.D.; L. Ver Hagen, M.D.)
NICHD, IRTA (G.C. Fishman, Ph.D.)
Staff-Years: 0.80
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: This past year we have focused our ultrasound (US) and videofluoro-scopic (VF) studies of swallowing on a new group of patients with progressive supranuclear palsy (PSP) and have begun to follow some of the original patients with cystinosis whom we studied in 1989-1991. We are currently examining the affects of denepezil on oral motor and swallowing function in patients with PSP. Patients do not receive treatment but are reevaluated using US and VF before, during, and after drug administration. We have seen 14 patients and are halfway through the study.
We are also using the computerized swallowing programs we developed last year to conduct a frame-by-frame analysis of timing and displacement of the hyoid bone. We have completed a study using simultaneous EMG and VF to aid our understanding of the ability of the deglutitive motor system to accommodate the changing demands of differing swallowing patterns. The concept of a delay in the pharyngeal swallow has been considered as a primary diagnostic sign of dysphagia on the VF examination. We are studying this finding, and it appears that the pattern may be part of the normal swallow. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60043-11 RM
October 1, 1997 to September 30, 1998
Title of Project: Development of Normative Ultrasound Databases of Tongue Surface Configuration
Principal Investigator: B.C. Sonies, Ph.D. (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: W. Gandler, M.E., CIT
Collaborating Units: CIT, NIH (K. Kempner, M.E.; Mark Vivino, M.E.)
Catholic Univ. Biomedical Engineering and
Electrical Engineering (Washington, DC;
C. Lathan, Ph.D.; N. Namazi, Ph.D.)
M. Tracey, M.B.E.
Staff-Years: 0.6
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: Considerable advances have been made in a new application of duplex Doppler imaging to analyze the motion of the hyoid bone during swallowing. Using this newly developed technique, we provide both real-time two-dimensional (2D) B-mode scans, and a spectrum of Doppler-Shift frequencies of a moving object (the hyoid bone). Because the Doppler-Shift spectrum delineates the velocity distribution of the hyoid bone and its muscular attachments, a trajectory of hyoid motion can be calculated. Additionally, we found that velocity spectra displayed the patterns of motion characteristic of hyoid movement. Velocity information permits calculation of durational measures of an entire oropharyngeal swallow. Validation of the ultrasound duplex Doppler technique was completed on two normal swallowers. Minimal variation was found within normal subjects, thus giving highly reliable data for use in future studies of abnormal subjects.
Our efforts in utilizing noninvasive real-time ultrasound imaging to reconstruct the tongue have been highly successful. Considerable progress has been made in developing techniques to automate the three-dimensional (3D) ultrasound imaging and reconstruction procedure. Modifications were made during the ultrasound video image digitizing and contour tracing processes. Advanced contour tracing procedures are being utilized well. We used a position sensor to locate the ultrasound transducer during image acquisition to enable the 3D registration of the 2D images. Tongue surface configurations have been reconstructed at rest, during bolus containment in the oral phase of swallowing.
This procedure will be applied to reconstruction of tumor sites in future investigations in our laboratory. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60050-02 RM
October 1, 1997 to September 30, 1998
Title of Project: Oxygen Uptake Kinetics During Recovery from Maximal and Submaximal Exercise
Principal Investigator: B. Drinkard, M.S., P.T. (Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: S. Stanhope, Ph.D., RM
J. Shah, M.D., RM
Collaborating Units: Kansas State Univ. (T. Barstow, Ph.D.)
Staff-Years: 0.1
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: We have collected data for one of five normal healthy volunteer
subjects in this pilot study. There were no complications with exercise testing.
After analyzing oxygen uptake (VO2) during recovery from exercise, we found that the time constant for VO2 (our dependent variable) varied significantly with recovery time. We believe that this would influence study outcomes and are therefore consulting with the Division of Computing Resources to identify more objective methods for analysis.
Continuance of this protocol is necessary to finish pilot data collection to help determine the effect of exercise intensity on dynamic changes in VO2 during recovery from exercise. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60051-02 RM
October 1, 1997 to September 30, 1998
Title of Project: Linking Occupational Therapy Process and Patient Performance: The Personal Computer in Occupational Interventions
Principal Investigator: S. Robertson, M.S., OTR/L, FAOTA (Senior Investigator)
RM, CC, NIH, Bethesda, MD 20892
Other Personnel: A.P. Colborn, Ed.D., OTR/L, FAOTA, Research Consultant, RM
Collaborating Units: NIMH
National Rehabilitation Hospital (Washington, DC; S. Smith)
Staff-Years: 0.2
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
(a1) Minors
(a2) Interviews
Summary of Work: The Occupational Therapy Section has implemented this study to better understand the complex phenomenon of occupational therapy process as it occurs in routine treatment sessions. Analysis of 20 subjects has been completed. Twenty patients (ten male, ten female) of mixed ethnicity were treated by four expert and two novice therapists (six female). Patients represented a wide variety of diagnoses [(mental illness (n=7, 35 percent), neurological (n=5, 25 percent), cancer (n=4, 20 percent), musculoskeletal (n=2, 10 percent), and spinal cord injury (n=2, 10 percent)]. Patient goals centered on work/productive roles (n=12, 60 percent) and activities of daily living (n=8, 40 percent). Patients were administered a focused interview following routine treatment sessions using the personal computer. Transcribed interviews were analyzed using principles of content analysis, including frequency counts and Spearman Correlation. Four process elements were found: occupational form, occupational performance, goals of treatment, and reflection. The most prevalent element cited was reflection (patient=48 percent; therapist=37 to 40 percent). Further study of occupational therapy process is recommended. (Return to project list)
INTRAMURAL RESEARCH PROJECT Z01 CL-60052-01 RM
October 1, 1997 to September 30, 1998
Title of Project: Rehabilitation Medicine Department Screening Protocol
Principal Investigator: L.H. Gerber, M.D. (Senior Investigator) RM, CC, NIH, Bethesda, MD 20892
Other Personnel: None
Collaborating Units: None
Staff-Years: 0.3
Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither
x (a1) Minors
(a2) Interviews
Summary of Work: The primary function of the Rehabilitation Medicine Department is to diagnose and treat patients who have a dysfunction in locomotion, activities of daily living, occupational or avocational roles, communication, deglutition, or chronic pain. The major goal of the department is to help patients achieve maximal function so that they may resume optimal performance in their daily living activities. The Screening Protocol provides clinicians in the Rehabilitation Medicine Department a vehicle for developing and piloting new tests, techniques, technology, or equipment for evaluation and treatment of patients and/or subjects.
- The Rehabilitation Medicine Screening Protocol was used to pilot the following ten projects:
- Ultrasound determination of quadriceps displacement during muscle contraction in patients with polymyositis and normal subjects.
- Pilot study to examine interrater reliability of the Kendall 10-Point Manual Muscle Testing Scale for the evaluation of muscle strength in children with dermatomyositis.
- Pilot study to examine interrater reliability of the Kendall 10-Point Manual Muscle Testing Scale for the evaluation of muscle strength in adults with polymyositis.
- Abnormal gait assessment.
- Pilot study to examine interrater reliability of the Brief Assessment of Motor Function (BAMF). Z01 CL-60052-01 RM (2)
- Pilot Study to examine content validity of the Myositis Performance Profile.
- Pilot study to assess muscle strength and performance in patients with hypoparathyroidism with synthetic human parathyroid hormone.
- Pilot study to examine the feasibility of using the Myrom dynamometer for the evaluation of muscle weakness in adults with myositis.
- Pilot study to examine concurrent validity for fine motor skills using the BAMF for children.
- Evaluation of pain intensity scales. (Return to project list)