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Current Projects

Intermittent Theta Burst Stimulation to Promote Motor Re-education After Upper Limb Reconstruction

Funding: National Center of Neuromodulation for Rehabilitation Pilot Project Award

Project Summary: A repetitive, non-invasive brain stimulation technique referred to as theta burst stimulation can modulate corticomotor excitability and therefore has great rehabilitative potential for individuals with neurologic deficits, including individuals with spinal cord injury (SCI). In particular, intermittent theta burst stimulation (iTBS) can increase corticomotor excitability and may be a useful adjunct to physical rehabilitation to promote motor re-education after upper limb reconstruction in individuals with tetraplegia. Upper limb reconstruction involves surgical transfer of a non-paralyzed tendon or nerve with a redundant or less important function to perform a more critical function. Upper limb reconstruction is intended to help individuals achieve their goals related to activities of daily living and independence in the community. The long-term goal of our research is to determine whether iTBS combined with physical rehabilitation can improve motor re-education after reconstruction. As a first step, the purpose of our current work is to determine the effect of iTBS on corticomotor excitability of proximal muscles in nonimpaired individuals and two groups of individuals with tetraplegia: individuals with and without upper limb reconstruction.

This work is relevant to public health based on its potential to promote recovery of upper limb function after cervical SCI. Of the estimated 250,000 to 500,000 new cases of SCI each year worldwide, more than 50% occur at the cervical level and lead to tetraplegia; these patients rate improved upper limb function as the most desired outcome of rehabilitation, over other lost functions such as bowel, sexual function or walking ability. Thus, our research to optimize upper limb function for these individuals is of great importance.

Graduate students Neil Mittal and Blaize Majdic administer an intermittent theta burst stimulation protocol.

Development of Clinical Measures to Guide Neuromodulation Therapies

Funding: Virginia Commonwealth University Center for Clinical and Translational Research Endowment Fund (UL1TR000058 from the National Center for Advancing Translational Sciences)

Project Summary: Activation of upper limb muscles is important for independent living after cervical spinal cord injury (SCI) that results in tetraplegia. Individuals with tetraplegia rely on the upper limbs to perform daily self-care activities. Unfortunately, upper limb pain and injury resulting from muscle weakness are significant problems in tetraplegia that result in further debilitation and loss of independence. An emerging approach to address post-SCI muscle weakness is modulation of the nervous system via non-invasive electrical stimulation to re-supply nerve to paralyzed muscle fibers. To direct neuromodulation as an adjunct to physical rehabilitation, clinicians need more informative measures that can indicate changes in the nerve supply to muscle. The purpose of this project is to develop innovative methodology to reliably assess changes in nerve supply to muscle and indicate the location of the nervous system that is performing suboptimal. Neuromodulation techniques can then be targeted to precise locations of the nervous system.

Graduate student Paul Howell recording data to quantify cortical voluntary activation of the biceps.

Quantification of Shoulder Pathology and Manual Wheelchair Propulsion in Children and Adults with Spinal Cord Injury using Advanced Biomechanical Modeling and Diagnostic Imaging

Funding: Eunice Kennedy Shriver National Institute of Child Health & Human Development (Dr. Peterson is Co-Investigator) 1R01HD098698

Collaboration: This research is led by Dr. Brooke Slavens (University of Wisconsin- Milwaukee), in collaboration with VCU’s REALab, and researchers and clinicians at Northwestern University, Shriners Hospitals for Children – Chicago, Froedtert and the Medical College of Virginia, and the Clement J. Zablocki VA Medical Center.

Project Summary: The wheelchair is one of the most widely used assistive mobility devices impacting more than 3.6 million people in the U.S. over the age of 15, 90% of whom use manual wheelchairs. Spinal cord injury (SCI) is a leading cause for wheelchair use. Wheelchair use has detrimental consequences to the health of the user, including shoulder pain and pathology. These complications significantly affect manual wheelchair users throughout their lifespan by reducing quality of life. To improve the quality of life of wheelchair users, there is a need for the prevention of shoulder pain and pathology in manual wheelchair users. This project aims to elucidate the contributing mechanisms of shoulder dysfunction in patients with pediatric-onset SCI and adult-onset SCI through knowledge of joint dynamics, pain, and pathology transitionally across children and adults.