UPMC Physician Resources

Archives for Rehabilitation

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) Annual Assembly 2017 — Oct. 12-15, Denver

The UPMC Department of Physical Medicine and Physical Rehabilitation will be well-represented at the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Annual Assembly 2017 in Denver, Co. Faculty research will be featured in both oral and poster presentations throughout the conference, including:

Michael Munin, MD

(Preconference Course) Optimizing Outcomes for Patients with Spasticity: Improving Assessment and Maximizing Intervention Options
Colorado Convention Center, Meeting Room 708-712
Wed. Oct. 11 – 8am-5pm

Ultrasound Guidance for Lower Limb Chemodenervation Procedures
Colorado Convention Center, Mile High Ballroom 4EFThurs. Oct. 12 – 8am-11am

US as an Extension of EMG/NCV
Colorado Convention Center, Meeting Room 702-706
Fri. Oct 13 – 10am-11:15am

Learning Center: Chemodenervation – Chemodenervation of the Upper Limb
Colorado Convention Center, Exhibit Hall D
Sat. Oct. 14 – 10:30am-12pm

Ultrasound Guidance for Head and Neck Chemodenercation Procedure
Colorado Convention Center, Mile High Ballroom 4EF
Sat. Oct. 14 – 2pm-5pm

Jose Ramirez-Del Toro, MD

Regenerative Medicine: Stem Cell Treatment in Osteoarthritis Office-Based Application
Colorado Convention Center, Mile High Ballroom 4AB
Wed. Oct. 11 – 2pm-5pm

Regenerative Medicine: Stem Cell Treatment in Osteoarthritis Office-Based Application
Colorado Convention Center, Mile High Ballroom 4EF
Fri. Oct. 13 – 8am-11am

Natasa Miljkovic, MD, PhD

Positioning Physiatry in the Care Continuum, Part 1
Colorado Convention Center, Meeting Room 702-706
Thurs. Oct. 12 – 2pm-3:30pm

Personalized Medicine in Cognitive Rehabilitation: How to Approach Challenging Cases of Delirium, Dementia and Agitation
Colorado Convention Center, Mile High Ballroom 2B
Fri. Oct. 13 – 10am-11:15am

Michael Boninger, MD

Natasa Miljkovic, MD, PhD

Positioning Physiatry in the Care Continuum, Part 2
Colorado Convention Center, Meeting Room 702-706
Thurs. Oct. 12 – 3:45pm-5:15pm

Kentaro Onishi, DO

The Great Debate. What the Evidence Shows in Musculoskeletal and Sports Medicine
Colorado Convention Center, Meeting Room 601-603
Thurs. Oct. 12 -9:30am-11am

Advanced Musculoskeletal Ultrasonography – Emerging Technologies Beyond Grayscale Ultrasound
Colorado Convention Center, Meeting Room 601-603
Fri. Oct. 13 – 2pm-3:15pm

Gwendolyn Sowa, MD, PhD

The Cellular and Systemic Effects of Exercise on the Aging Spine and Musculoskeletal System
Colorado Convention Center, Meeting Room 605
Fri. Oct. 13 – 4pm-5:30pm

Marissa Pfoff, MD
Leading in Research: Pain and Spine Medicine Podium Session
Colorado Convention Center, Meeting Room 705
Fri. Oct. 13 – 8am-9:15am

2017 AAPM&R Resident Posters

Resident(s) Collaborator Title
Geoff Henderson Amanda Harrington, MD New Onset Upper Extremity Weakness in a Woman with Pre-Existing Paraplegia: A Case Report
Geoff Henderson Andrew D. Althouse, PhD, Kelly Allsup, BS, and Daniel E. Forman, MD Is Cardiac Rehabilitation Useful for Cardiovascular Disease Patients Who are Frail?
Mark Linsenmeyer Gary Galang, MD Disorders of Consciousness due to Anoxic Brain Injury: a Case Series of 8 Patients
Mark Linsenmeyer Julie Lanphere, DO Management of Severe Autonomic Instability in a Patient with Multiple System Atrophy and a Concurrent Blood Pressure Cap: a Case Report
Marissa Pavlinich William Anderst, PhD, Tom Gale, MS, Kris Gongaware, Michael Schneider, PhD DC Intervertebral Kinematics in the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation
Brittni Micham Julie Lanphere, DO Anton-Babinski Syndrome Diagnosed During Inpatient Rehabilitation: A Case Report
Brittni Micham Amanda Harrington, MD Heterotopic Ossification Treated with Etridronate for Eight Years: A Case Report
Alyssa Neph John Horton, MD Spinal Dural Arteriovenous Fistula- a Diagnostic Dilemma
Allison Schroeder Kentaro Onishi, DO Utility of Dynamic Sonographic Examination and Intervention in the Management of Proximal Tibiofibular Joint Osteoarthritis in the Context of Partial Fibulectomy: A Case Report
Steph Schaaf Dr. Sowa/Dr. Cortazzo Association of Clinical Characteristics and Response to Lumbar Epidural Steroid Injections in Subjects with Axial Low Back Pain
Steph Schaaf Dr. Stepanczuk Vertebral Artery Dissection and Stroke in a Female Marathon Runner

Partnership for Public Service Honors VA Pittsburgh/Pitt Researcher with ‘Oscar’ of Government Service 2017 Service to America Medal honors Dr. Rory Cooper as “America’s best in government”

The Partnership for Public Service will honor Rory Cooper, PhD, research scientist at VA Pittsburgh Healthcare System and professor at the University of Pittsburgh, with a Samuel J. Heyman Service to America Medal (Sammie) on Sept. 27 for his work as director of the Human Engineering Research Laboratory (HERL).

Cooper will receive the Sammie in the Science and Environment category for developing adaptive wheelchairs at HERL, a collaboration between Pitt, VA Pittsburgh Healthcare System and UPMC. Cooper is HERL’s founding director and its VA senior research career scientist.

An Army veteran, Cooper was cited in his nomination for designing innovative wheelchairs and other assistive technologies that have markedly improved the mobility and quality of life for hundreds of thousands of veterans and other people with disabilities. He led projects that include development of a wheelchair with robotic arms and hands that can grasp objects, personal vehicles that enable people to access terrain their wheelchairs can’t traverse and manual wheelchairs with more comfortable and adjustable seats.

Cooper and six other winners were chosen from 26 finalists and more than 440 nominees by a selection committee that includes leaders from government, business, the foundation and nonprofit community, academia, entertainment and the media. The entire awards ceremony will be streamed live from Washington, DC, and viewable on the Partnership for Public Service’s Facebook page beginning at 6:30 p.m. EDT.

“The federal government is a unique instrument for our country. The 2017 Service to America Medal recipients represent the best in government, the unsung heroes who quietly work behind the scenes to serve their country and the public good,” said Max Stier, Partnership for Public Service president and CEO. “It is important, especially in these uncertain times, to celebrate and recognize the Sammies honorees and their colleagues throughout the government who are making a positive difference in people’s lives.”

Cooper is the FISA Foundation/Paralyzed Veterans of America chair of the Department of Rehabilitation Science and Technology in Pitt’s School of Health and Rehabilitation Sciences. He also serves as the school’s associate dean for inclusion and a distinguished professor, as well as a professor of bioengineering, physical medicine and rehabilitation, and orthopaedic surgery.

To learn more about the Sammies, visit servicetoamericamedals.org.

McGowan Institute for Regenerative Medicine Faculty Member Publication Named a NIEHS Top Paper of 2016

The National Institutes of Health, National Institute of Environmental Health Sciences (NIEHS), recently honored its 2016 Papers of the Year—the top 25 of 2700 publications.

In that elite group, McGowan Institute for Regenerative Medicine faculty member Fabrisia Ambrosio, PhD, MPT, Director of Rehabilitation for UPMC International and an Associate Professor in the Department of Physical Medicine & Rehabilitation at the University of Pittsburgh, and her team were recognized for their paper entitled “Arsenic promotes NF-kB-mediated fibroblast dysfunction and matrix remodeling to impair muscle stem cell function,” published in the journal Stem Cells.

McGowan Institute faculty member Donna Stolz, PhD, Associate Director of the Center for Biologic Imaging, University of Pittsburgh School of Medicine, and an Associate Professor in the Departments of Cell Biology and Pathology at the University of Pittsburgh, is a co-author on the study.

The paper’s abstract reads:

Arsenic is a global health hazard that impacts over 140 million individuals worldwide. Epidemiological studies reveal prominent muscle dysfunction and mobility declines following arsenic exposure; yet, mechanisms underlying such declines are unknown. The objective of this study was to test the novel hypothesis that arsenic drives a maladaptive fibroblast phenotype to promote pathogenic myomatrix remodeling and compromise the muscle stem (satellite) cell (MuSC) niche. Mice were exposed to environmentally relevant levels of arsenic in drinking water before receiving a local muscle injury. Arsenic-exposed muscles displayed pathogenic matrix remodeling, defective myofiber regeneration and impaired functional recovery, relative to controls. When naïve human MuSCs were seeded onto three-dimensional decellularized muscle constructs derived from arsenic-exposed muscles, cells displayed an increased fibrogenic conversion and decreased myogenicity, compared with cells seeded onto control constructs. Consistent with myomatrix alterations, fibroblasts isolated from arsenic-exposed muscle displayed sustained expression of matrix remodeling genes, the majority of which were mediated by NF-κB. Inhibition of NF-κB during arsenic exposure preserved normal myofiber structure and functional recovery after injury, suggesting that NF-κB signaling serves as an important mechanism of action for the deleterious effects of arsenic on tissue healing. Taken together, the results from this study implicate myomatrix biophysical and/or biochemical characteristics as culprits in arsenic-induced MuSC dysfunction and impaired muscle regeneration. It is anticipated that these findings may aid in the development of strategies to prevent or revert the effects of arsenic on tissue healing and, more broadly, provide insight into the influence of the native myomatrix on stem cell behavior.

2017 AAP Annual Meeting — Feb. 7-11, Las Vegas, NV

The UPMC Department of Physical Medicine and Rehabilitation will be well represented at the 2017 AAP Annual Meeting in Las Vegas Feb. 7-11.  Several experts from the department will lead discussions and present posters during this five day conference, including a seminar by Gwendolyn Sowa, MD, PhD, Professor and Chair, Department of Physical Medicine and Rehabilitation. Dr. Sowa’s seminar will take place Thursday, Feb. 9, from 12:30 to 5:30 p.m. on the topic of Women  in Academic Physiatry: Pearls in Career Development

Awards

Shanti Pinto, MD, brain injury medicine fellow, will receive the Association of Academic Physiatrists‘ Best Paper Award for “Cost-Efficacy Analysis of Routine Venous Doppler Ultrasound for Diagnosis of Deep Venous Thrombosis at Admission to Inpatient Rehabilitation.” The award recognizes and seeks to encourage young researchers, while strengthening all investigation in the field of PM&R.

Joshua Rothenberg, DO, sports medicine fellow, will be awarded the McLean Outstanding Fellow Award from the Association of Academic Physiatrists. The award recognizes an AAP member fellow for outstanding academic performance in academic leadership, teaching and education, and research. Dr. Rothenberg will receive the award during the AAP Annual Meeting in February 2017.

To view a full list of UPMC presentations and presenters, click here and here.

 

American Academy of Pediatrics Webinar Series on Zika Virus featuring Amy Houtrow, MD, PhD — Jan. 10, 2017

Recognizing Microcephaly and Other Presentations of Zika Virus Syndrome
Tuesday, Jan. 10, 2 p.m. ET
Registration is required.

Dial-In Information
Phone: 844-216-1726
Conference ID: 18985179
Registration Link: https://cc.readytalk.com/r/viw68r9pls12&eom

Description
Over the past year, congenital Zika virus syndrome has captured the attention of the world because of the devastating effects it can have on infants’ development. In recognition that pediatricians (primary care providers, clinicians, and subspecialists) will require support and guidance, the American Academy of Pediatrics Webinar Series on Zika Virus Syndrome was created. During the first webinar in this series, expert speakers will provide an overview of the neurodevelopmental manifestations of congenital Zika virus syndrome. Experts will also describe how to monitor symptomatic and asymptomatic infants, including how to collaborate with specialists to ensure a continuum of care.

Speakers
Amy Houtrow, MD, PhD, MPH, FAAP
Dr Houtrow is pediatric rehabilitation medicine physician and health services researcher.  She is an Associate Professor and Vice Chair in the Department of Physical Medicine and Rehabilitation for Pediatric Rehabilitation Medicine at the University of Pittsburgh School of Medicine. She directs the Pediatric Rehabilitation Medicine Fellowship and is the Chief of Pediatric Rehabilitation Medicine Services and the Medical Director of the Rehabilitation Institute at the Children’s Hospital of Pittsburgh. Dr Houtrow’s main clinical focus is caring for children with disabling conditions to help to improve functioning and quality of life to the greatest degree possible. Her research focuses on improving how children with disabilities and their families access health care to optimize health care delivery.

Edwin Trevathan, MD, MPH, FAAP
Dr. Trevathan is a child neurologist, an epidemiologist, and a public health leader, who is internationally known for his expertise in childhood epilepsy, disorders of the developing brain, developmental disabilities, and birth defects. Trevathan is a Professor of Pediatrics and Neurology at Vanderbilt University School of Medicine, and a pediatric neurologist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. Dr Trevathan has held a number of senior leadership positions in academia and in government. He has served as Executive Vice President and Provost at Baylor University; Dean of the College for Public Health and Social Justice at Saint Louis University; Director of the Division of Pediatric and Developmental Neurology at Washington University in St. Louis, MO; and Director of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention.

Additional Information
Please email DisasterReady@aap.org with any questions prior to the webinar.

 

 

In a First, Pitt-UPMC Team Help Paralyzed Man Feel Again Through a Mind-Controlled Robotic Arm

PITTSBURGH, Oct. 13, 2016 – Imagine being in an accident that leaves you unable to feel any sensation in your arms and fingers. Now imagine regaining that sensation, a decade later, through a mind-controlled robotic arm that is directly connected to your brain.
That is what 28-year-old Nathan Copeland experienced after he came out of brain surgery and was connected to the Brain Computer Interface (BCI), developed by researchers at the University of Pittsburgh and UPMC. In a study published online today in Science Translational Medicine, a team of experts led by Robert Gaunt, Ph.D., assistant professor of physical medicine and rehabilitation at Pitt, demonstrated for the first time ever in humans a technology that allows Mr. Copeland to experience the sensation of touch through a robotic arm that he controls with his brain.
“The most important result in this study is that microstimulation of sensory cortex can elicit natural sensation instead of tingling,” said study co-author Andrew B. Schwartz, Ph.D., distinguished professor of neurobiology and chair in systems neuroscience, Pitt School of Medicine, and a member of the University of Pittsburgh Brain Institute. “This stimulation is safe, and the evoked sensations are stable over months.  There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.”
This is not the Pitt-UPMC team’s first attempt at a BCI. Four years ago, study co-author Jennifer Collinger, Ph.D., assistant professor, Pitt’s Department of Physical Medicine and Rehabilitation, and research scientist for the VA Pittsburgh Healthcare System, and the team demonstrated a BCI that helped Jan Scheuermann, who has quadriplegia caused by a degenerative disease. The video of Scheuermann feeding herself chocolate using the mind-controlled robotic arm was seen around the world. Before that, Tim Hemmes, paralyzed in a motorcycle accident, reached out to touch hands with his girlfriend.
But the way our arms naturally move and interact with the environment around us is due to more than just thinking and moving the right muscles. We are able to differentiate between a piece of cake and a soda can through touch, picking up the cake more gently than the can. The constant feedback we receive from the sense of touch is of paramount importance as it tells the brain where to move and by how much.
For Dr. Gaunt and the rest of the research team, that was the next step for the BCI. As they were looking for the right candidate, they developed and refined their system such that inputs from the robotic arm are transmitted through a microelectrode array implanted in the brain where the neurons that control hand movement and touch are located. The microelectrode array and its control system, which were developed by Blackrock Microsystems, along with the robotic arm, which was built by Johns Hopkins University’s Applied Physics Lab, formed all the pieces of the puzzle.
In the winter of 2004, Mr. Copeland, who lives in western Pennsylvania, was driving at night in rainy weather when he was in a car accident that snapped his neck and injured his spinal cord, leaving him with quadriplegia from the upper chest down, unable to feel or move his lower arms and legs, and needing assistance with all his daily activities. He was 18 and in his freshman year of college pursuing a degree in nanofabrication, following a high school spent in advanced science courses.
He tried to continue his studies, but health problems forced him to put his degree on hold. He kept busy by going to concerts and volunteering for the Pittsburgh Japanese Culture Society, a nonprofit that holds conventions around the Japanese cartoon art of anime, something Mr. Copeland became interested in after his accident.
Right after the accident he had enrolled himself on Pitt’s registry of patients willing to participate in clinical trials. Nearly a decade later, the Pitt research team asked if he was interested in participating in the experimental study.
After he passed the screening tests, Nathan was wheeled into the operating room last spring. Study co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, M.D., Ph.D., assistant professor, Department of Neurological Surgery, Pitt School of Medicine, implanted four tiny microelectrode arrays each about half the size of a shirt button in Nathan’s brain. Prior to the surgery, imaging techniques were used to identify the exact regions in Mr. Copeland’s brain corresponding to feelings in each of his fingers and his palm.
“I can feel just about every finger—it’s a really weird sensation,” Mr. Copeland said about a month after surgery. “Sometimes it feels electrical and sometimes its pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”
At this time, Mr. Copeland can feel pressure and distinguish its intensity to some extent, though he cannot identify whether a substance is hot or cold, explains Dr. Tyler-Kabara.
Michael Boninger, M.D., professor of physical medicine and rehabilitation at Pitt, and senior medical director of post-acute care for the Health Services Division of UPMC, recounted how the Pitt team has achieved milestone after milestone, from a basic understanding of how the brain processes sensory and motor signals to applying it in patients
“Slowly but surely, we have been moving this research forward. Four years ago we demonstrated control of movement. Now Dr. Gaunt and his team took what we learned in our tests with Tim and Jan—for whom we have deep gratitude—and showed us how to make the robotic arm allow its user to feel through Nathan’s dedicated work,” said Dr. Boninger, also a co-author on the research paper.
Dr. Gaunt explained that everything about the work is meant to make use of the brain’s natural, existing abilities to give people back what was lost but not forgotten.
“The ultimate goal is to create a system which moves and feels just like a natural arm would,” says Dr. Gaunt. “We have a long way to go to get there, but this is a great start.”
The lead author on the research publication is Sharlene N. Flesher, of Pitt. Additional authors on this research are Stephen T. Foldes, Ph.D., Jeffrey M. Weiss and John E. Downey, all of Pitt; and Sliman J. Bensmaia, Ph.D., of the University of Chicago.
Primary support for the study was provided by the Defense Advanced Research Projects Agency’s (DARPA) Revolutionizing Prosthetics program through contract N66001-10-C-4056. Additional support was provided by the Office of Research and Development, Rehabilitation Research and Development Service, U.S. Department of Veterans Affairs, grant numbers B6789C, B7143R, and RX720 and the National Science Foundation Graduate Research Fellowship grant DGE-1247842.

Gwendolyn Sowa, MD, PhD, Named Chair of Pitt’s Department of Physical Medicine & Rehabilitation

The University of Pittsburgh School of Medicine has chosen one of its own renowned faculty members to be the next chair of the Department of Physical Medicine and Rehabilitation (PM&R). Gwendolyn Sowa, MD, PhD, who will assume her new role July 1, also holds joint appointments in the School of Medicine’s Department of Orthopaedic Surgery and the Swanson School of Engineering’s Department of Bioengineering. She also serves as associate dean for medical student research and medical director of UPMC Total Care-Musculoskeletal Health.

“Dr. Sowa’s many accomplishments demonstrate her ability to cross specialties and to collaborate effectively in the clinical, research and educational arenas,” noted Arthur S. Levine, MD, Pitt’s senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of Medicine. “She is the definition of a committed teacher and mentor.”

The department of PM&R ranks among the nation’s top programs in research funding from the National Institutes of Health and includes a team of multidisciplinary faculty members who train and educate the next generation of rehabilitation physicians and researchers, specializing in the fields of traumatic brain injury, spinal cord injury, stroke, diseases and disorders of the musculoskeletal and peripheral nervous system, and many other conditions that affect function and mobility.

“We are fortunate to have had Dr. Sowa as an internal candidate,” said Steven D. Shapiro, MD, executive vice president, chief medical and scientific officer, and president, Health Services Division, UPMC. “Her extraordinary dedication to every aspect of her work will continue to strengthen the innovative mission of this program.”

Dr. Sowa’s research centers on molecular, laboratory-based translational and clinical research, investigating the effect of motion on inflammatory pathways and the beneficial effects of exercise. She is co-director of the Ferguson Laboratory for Orthopaedic and Spine Research, a 3,000-square-foot laboratory fully equipped to perform molecular assays, including gene expression analysis, protein analysis, cell and organ culture, histology, and cellular and spinal biomechanical testing. She also has an active research program investigating the role of serum biomarkers in guiding individualized treatment in intervertebral disc degeneration and back pain. She has received national recognition for her research.

Dr. Sowa completed her MD and PhD in biochemistry at the University of Wisconsin-Madison, followed by residency training at Northwestern University, Rehabilitation Institute of Chicago.

Association of Academic Physiatrists Honors Pitt/UPMC Physician

Michael Boninger, M.D., director of the UPMC Rehabilitation Institute and professor and chair of the Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, received the 2016 Association of Academic Physiatrists (AAP) Distinguished Academician Award at the association’s annual meeting Friday in Sacramento, Calif. Each year, the AAP honors one academic physiatrist who has achieved distinction and peer recognition regionally or nationally for outstanding performance in teaching, research or administration.

“I feel very lucky to work in a field where I have the opportunity to help people. The University of Pittsburgh and UPMC have provided me the opportunity, support and collaborators to excel in this pursuit,” Dr. Boninger said.

The author of four U.S. patents, Dr. Boninger is recognized for his extensive research on spinal cord injury, assistive technology and overuse injuries, particularly those associated with manual wheelchair propulsion.

Dr. Boninger earned his medical degree at Ohio State University. He completed residencies at St. Joseph Mercy Hospital in Ann Arbor and the University of Michigan Medical Center, where he became the chief resident, physical medicine and rehabilitation. He came to the University of Pittsburgh when he won a postdoctoral fellowship in engineering and rehabilitation technology in 1994.

The AAP Distinguished Academician Award was established in 1995. Dr. Boninger is the first faculty member from Pitt’s Department of Physical Medicine and Rehabilitation to win this national award.

Many Eligible Low-Income Kids with Mental Disabilities Not Getting SSI Benefits, Says IOM Report

PrintMany low-income children with mental disorders who are eligible for federal benefits may not be receiving them, according to a new report from the National Academies of Sciences, Engineering and Medicinethat was co-authored by a researcher from the University of Pittsburgh.

The findings of “Mental Disorders and Disabilities Among Low-Income Children” also noted that the number of children who do receive assistance has been rising in accordance with overall mental health trends and rising poverty rates.

“Federal assistance programs for children with mental disabilities are being underutilized when they could help cover the costs to improve the health and wellbeing of the child and family,” said Amy Houtrow, MD, PhD, MPH, associate professor of physical medicine and rehabilitation and pediatrics, Pitt School of Medicine, who served on the committee that authored the report. “It appears that more kids could benefit from available funding, and the medical community could help eligible families become aware of the benefits and how to apply.”

For the report, the committee examined the U.S. Social Security Administration’s Supplemental Security Income (SSI) program, which provides benefits to low-income people with disabilities.

The percentage of poor children who received federal disability benefits for at least one of 10 major mental disorders increased only slightly from 1.88 percent in 2004 to 2.09 percent in 2013, the report said. While 20 to 50 percent of potentially SSI-eligible kids with autism spectrum disorders received benefits; depending on state of residence, just 4 percent of potentially SSI-eligible kids with oppositional defiant disorder or conduct disorder; and 3 percent of those with mood disorders, received benefits.

“We also found that while the percentage of American children living in impoverished households has increased, particularly during the economic recession from 2008 to 2010,” said Dr. Houtrow, who also is chief, Division of Pediatric Rehabilitation Medicine, at Children’s Hospital of Pittsburgh of UPMC. “Further, the proportion of children who have disabilities has increased every decade since the 1960s. This means that more children should qualify for federal benefits,” she added.

Computer Simulation Predicts Development, Progress of Pressure Sores

PITTSBURGH, June 25, 2015 – Researchers at the University of Pittsburgh School of Medicine have devised a computational model that could enhance understanding, diagnosis and treatment of pressure ulcers related to spinal cord injury. In a report published online in PLOS Computational Biology, the team also described results of virtual clinical trials that showed that for effective treatment of the lesions, anti-inflammatory measures had to be applied well before the earliest clinical signs of ulcer formation.

Pressure ulcers affect more than 2.5 million Americans annually and patients who have spinal cord injuries that impair movement are more vulnerable to developing them, said senior investigator Yoram Vodovotz, Ph.D., professor of surgery and director of the Center for Inflammation and Regenerative Modeling at the Pitt School of Medicine.

“These lesions are thought to develop because immobility disrupts adequate oxygenation of tissues where the patient is lying down, followed by sudden resumption of blood flow when the patient is turned in bed to change positions,” Dr. Vodovotz said. “This is accompanied by an inflammatory response that sometimes leads to further tissue damage and breakdown of the skin.”

“Pressure ulcers are an unfortunately common complication after spinal cord injury and cause discomfort and functional limitations,” said co-author Gwendolyn A. Sowa, M.D., Ph.D., associate professor of physical medicine and rehabilitation, Pitt School of Medicine. “Improving the individual diagnosis and treatment of pressure ulcers has the potential to reduce the cost of care and improve quality of life for persons living with spinal cord injury.”

To address the complexity of the biologic pathways that create and respond to pressure sore development, the researchers designed a computational, or “in silico,” model of the process based on serial photographs of developing ulcers from spinal cord-injured patients enrolled in studies at Pitt’s Rehabilitation Engineering Research Center on Spinal Cord Injury. Photos were taken when the ulcer was initially diagnosed, three times per week in the acute stage and once a week as it resolved.

Then they validated the model, finding that if they started with a single small round area over a virtual bony protuberance and altered factors such as inflammatory mediators and tissue oxygenation, they could recreate a variety of irregularly shaped ulcers that mimic what is seen in reality.

They also conducted two virtual trials of potential interventions, finding that anti-inflammatory interventions could not prevent ulcers unless applied very early in their development.

In the future, perhaps a nurse or caregiver could simply send in a photo of a patient’s reddened skin to a doctor using the model to find out whether it was likely to develop into a pressure sore for quick and aggressive treatment to keep it from getting far worse, Dr. Vodovotz speculated.

“Computational models like this one might one day be able to predict the clinical course of a disease or injury, as well as make it possible to do less expensive testing of experimental drugs and interventions to see whether they are worth pursuing with human trials,” he said. “They hold great potential as a diagnostic and research tool.”

The team included co-senior author Gary An, M.D., of the University of Chicago; Cordelia Ziraldo, Ph.D., Alexey Solovyev, Ph.D., Ana Allegretti, Ph.D., Shilpa Krishnan, M.S., David Brienza, Ph.D., Qi Mi, Ph.D., all of Pitt; and M. Kristi Henzel, M.D., Ph.D., of the Louis Stokes Cleveland Veterans Affairs Medical Center.

The project was funded by the U.S. Department of Education; National Institutes of Health National Institute on Disability and Rehabilitation Research grant H133E070024; and an IBM Shared University Research Award.

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