RehabMed titles and studies



	INTRAMURAL RESEARCH PROJECT Z01 CL-60011-18 RM October 1, 1996 to September 31, 1997 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 C. Van Waes, M.D., NIDCD K. Matthews, Ph.D., IRTA, NICHD M. Gignilliat, B.S.E., RM Collaborating Units: NICHD; NINDS (F. Ondrey, M.D., Ph.D.; G. Thomas, M.D.); NCI; Washington University School of Medicine, St. Louis, MO (M. De Baun, M.D., Ph.D.); Promethius Systems, Portsmouth, NH (Richard Poore) Staff-Years: 0.66 Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither (a1) Minors (a2) Interviews Summary of Work: This project evaluates 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. Our focus for the year was to develop, in cooperation with DCD and NCI, a method to reliably track head and neck tumor growth or tissue change during experimental treatments being conducted with paclitaxel concurrent with radiation therapy on patients with advanced tumors. We were able to visualize changes in tumor growth on ultrasound and to make reliable area measurements of area of tissue changes. We are still working on a method to deal with tissue characterization (i.e., symmetry, edge detection). Ultrasound helps to determine whether abnormalities are present in swallowing function and during laryngeal closure. We are continuing to work on a system to catalogue the tumors and to develop markers for changes in tissue. To better understand muscular coordination during swallowing, we have developed a method to simultaneously perform ultrasound studies with submental surface electro- myography of the floor muscles of the mouth. We have found that there is a correlation of .99 p.>.001 between the peak amplitude on the EEG and maximum hyoid elevation on ultrasound. We have been able to determine patterns of swallowing abnormality that differ from those of normal subjects using these simultaneous methods. (Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60017-07 RM October 1, 1996 to September 30, 1997 Title of Project: A Rigid Body Data Base on Normal Gait Principal 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 Unit: ARB, NIAMS (J. Holden, Ph.D.) 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 neuromusculo- skeletal system, functional limitations, and disability. One study of 18 normal subjects investigated the effect of dramatically different walking speeds on the mechanics of walking. It was demonstrated that, through the use of mechanical power analysis, 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 played by each major muscle group of the lower extremity in providing support to and propulsion of the body during walking. The results indicate that 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 has implications for rehabilitation and surgical treatment in patient populations. (Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60037-06 RM October 1, 1996 to September 30, 1997 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: D. Danforth, M.D., SB, NCI Collaborating Unit: SB, NCI Staff-Years: 1.5 Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither (a1) Minors (a2) Interviews Summary of Work: Patients entered in 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 followups are performed to assess changes in initial evaluation parameters. All patients receive standardized physical therapy intervention as needed throughout their course of treatment.(Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60042-10 RM October 1, 1996 to September 31, 1997 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: M. Dalakas, M.D., NINDS M. Hallett, M.D., DIR, NINDS B. Solomon, M.S., RM M. Gignilliat, B.S.E., RM Collaborating Units: NINDS (I. Litvan, M.D., L. Van DerHagen, M.D.); University of Wisconsin, GREC (G. Dengel, M.S.) Staff-Years: 0.80 Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither (a1) Minors (a2) Interviews Summary of Work: During the past year we have focused our ultrasound and videofluoroscopic studies on patients with progressive supranuclear palsy, post-pallidotomy Parkinson's disease, and corticobasal degeneration. Followup studies were performed on patients with inclusion body myositis and poly- myositis in preparation for long-term descriptions of these conditions. Considerable effort has been spent to develop a computer program that digitizes and analyzes the videofluoroscopic images. This model allows us to examine the timing of specific swallowing events and the range of motion of specific structures in sequential and discrete swallows. Post-Pallidotomy Study Twelve patients who underwent bilateral pallidotomy and were evaluated at NIH received comprehensive oral motor and swallowing evaluations 1 month before and 2 months following the procedure. Intrasubject comparisons were made to determine whether swallowing severity and function swallowing changed after surgery. Findings revealed great variability across the evaluation parameters, with more patients who worsened on the pharyngeal and esophageal phases and no difference on the oral findings. In spite of changes in the instrumental swallowing studies, 10 out of 12 subjects did not evidence any category change in the severity and functional outcome rating scales. This study suggests that pallidotomy does not conclusively benefit subjects with respect to either oral motor or swallowing ability.(Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60043-10 RM October 1, 1996 to September 30, 1997 Title of Project: Development of Normative Ultrasound Data Bases of Tongue Surface Configuration Principal Investigator: B.C. Sonies, Ph.D. (Senior Investigator) RM, CC, NIH, Bethesda, MD 20892 Other Personnel: M. Gignilliat, B.S.E., RM K. Matthews, Catholic University, IRTA Fellow Collaborating Units: NICHD; DCRT (K. Kempner); Catholic University, Biomedical Engineering and Electrical Engineering (C. Lathan, Ph.D.; N. Namazi, Ph.D.) 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 applying 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 (2-D) 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. The ultrasound duplex Doppler technique was validated on 2 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 using 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 (3-D) ultrasound imaging and reconstruction procedure. Modifications were made during the ultrasound video image digitalizing and contour tracing processes. Advanced contour tracing procedures are being utilized as well. We used a position sensor to locate the ultrasound transducer during image acquisition to enable the 3-D registration of the 2-D images. Tongue surface configurations have been reconstructed at rest, during bolus containment in the oral phase of swallowing, and during articulation of sustained vowels. This procedure will be applied to reconstruction of tumor sites in our future investigations. (Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60049-03 RM October 1, 1996 to November 30, 1996 Title of Project: Characterization of Fatigue and Its Relationship to Performance Principal Investigator: L.H. Gerber, M.D. (Senior Investigator) RM, CC, NIH, Bethesda, MD 20892 Other Personnel: S.E. Straus, M.D., LCI, NIAID G. Furst, M.P.H., OTR/L, RM B. Drinkard, M.S., P.T., RM J.K. Dale, R.N., DIR, NIAID Collaborating Units: NIAID; NIAMS Staff-Years: .001 Human Subjects: x (a) Human subjects (b) Human tissues (c) Neither (a1) Minors (a2) Interviews Summary of Work: A pilot study correlating patients' perception of physiological and psychological aspects of fatigue with exercise performance was done to quantify fatigue and its effect on function. Twenty-seven patients with a >6-month history of fatigue and rheumatoid arthritis (RA), polymyositis (PM), or chronic fatigue syndrome (CFS) were evaluated (9 per group). Each completed the following questionnaires: Multidimensional Assessment of Fatigue (MAF); the Human Activity Profile, which provides a score for maximum activity (MAS), adjusted activity (AAS), and a dyspnea scale; the Sickness Impact Profile (SIP), which assesses physical and psychosocial issues; the Profile of Mood States (POMS); and NIH Activity Record (ACTRE). Oxygen consumption and anaerobic threshold were measured during bicycle ergometry to each patient's tolerance. Spearman rank correlation coefficient (rho) was used to rank exercise tolerance (ET) (ET = VO² measured/VO² predicted), anaerobic threshold (AT) data, and self-reported measures of fatigue and activity. R values > 0.5 are reported when p < 0.02. Patients who reached substantial level of effort and who had low ET also had a low AT (r = 0.788). The MAS was correlated with the measured VO² (r = 0.56), ET (r = 0.62), the AAS (r = 0.70) and dyspnea (r = 0.57). The AAS was also correlated with the SIP physical mobility scale (r = 0.77). The latter was correlated with dyspnea (r = 0.52) and MAF (r = 0.59). Fatigue reported from the POMS, ACTRE, and MAF did not correlate with either measured VO² or ET. AT correlated with activity-associated fatigue measured on the ACTRE (r = 0.57). This study showed that physiological measures of fitness did not correlate with self- reported measures of fatigue in the aggregated group. Only in patients with CFS did a self-report of fatigue (MAF) correlate with ET (p = 0.05). Seven CFS, 5 RA and 2 PM patients performed below the median of ET, which was 58%. Patients with CFS had the lowest exercise performance of the 3 diagnostic groups. This protocol was terminated in November 1996 at completion of patient recruitment. (Back to the project list.)



	INTRAMURAL RESEARCH PROJECT Z01 CL-60050-01 RM October 1, 1996 to September 30, 1997 Title of Project: Oxygen Uptake Kinetics During Recovery From Maximal and Submaximal Exercise Principal Investigator: B. Drinkard, M.S., P.T. (Investigator) RH, CC, NIH, Bethesda, MD 20892 Other Personnel: S. Stanhope, Ph.D., RM J. Shah, M.D., RM Collaborating Unit: None 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 1 of 5 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.(Back to the project list.)

INTRAMURAL RESEARCH PROJECT Z01 CL-60051-01 RM

October 1, 1996 to September 30, 1997

Title of Project: Linking Occupational Therapy Process and Patient Performance:
The Personal Computer Activity 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, 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 continues to collect and
analyze data to better understand the complex phenomenon of occupational interventions with clients of various diagnoses and demographic profiles. From focused interviews with
14 patient-therapist teams, data have been collected on the process of occupational therapy
as patients use the personal computer in treatment . Both patients and therapists have been interviewed and the 135 interviews have been transcribed. Data analysis began with the development of coding systems to capture themes in the process of therapy. Coding of
the text-based data, using grounded theory and content analysis, has been integrated into quantitative formats compatible with computer statistical analysis packages. Data collection continues in collaboration with the National Rehabilitation Hospital. To date, one
peer-reviewed publication, five presentations, one poster, one abstract, and two articles
have been generated from this study.(Back to the project list.)

Questions about the Clinical Center? OCCC@nih.gov

Or call: (301) 496-2563

National Institutes of Health, Warren Grant Magnuson Clinical Center, Bethesda, Maryland 20892. Last Modified 3/98

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