Physical Medicine & Rehabilitation Scholarly Activity
The Department of Physical Medicine & Rehabilitation supports scholarship in a variety of venues. The majority of the Department’s scholarship is clinically or educationally based and relates to function, disability, neurophysiology, technology, quality, and health and wellness. Faculty is encouraged to engage in clinically based research and other scholarly activity. Resident physicians are required to complete at least one approved project during their 3-year training program that results in an accepted platform/poster presentation with a PM&R national professional society, publication, educational module, quality improvement activity, or other scholarly product. Departmental support is provided for these activities (e.g., modest start-up funds, networking for national and local experts, travel/room for presentations at regional and national meetings).
Long-standing themes of inquiry are in the areas of health and wellness for people with disability, traumatic brain injury and concussion, and neurophysiology and electrodiagnosis, with the more recent addition of spinal cord injury medicine focused on electrical stimulation. Quality improvement projects, case reports and series, and other descriptive electronic health record reviews are commonly the base of resident and student projects.
Active Research and Scholarship Projects
Disability Research and Dissemination Center (DRDC)This cooperative agreement with National Center for Birth Defects and Developmental Disabilities (NCBDDD) is a multi-institutional resource for the disability science and research community and beyond, now in the 2nd 5-year funding cycle. The primary purpose of DRDC is to expand NCBDDD’s capacity to support research, knowledge and research translation, and dissemination of evidence-based practices related to birth defects and developmental and other disabilities (www.disabilityresearchcenter.com). SUNY Upstate Medical University is the site for the Research Translation Core (Margaret Turk, PM&R) and Evaluation Core (Telisa Stewart, Public Health & Preventive Medicine), with University of South Carolina (USC) housing the Administrative and Research Cores and American Association for Health and Disability (AAHD) housing the Dissemination Core.
Disability & Health Research Team Projects
The Disability & Health Research Team (DHRT) engages in a variety of research opportunities, such as systematic searches (scoping and/or review), large database analysis, and qualitative and evaluation methods. Additionally, the DHRT has focused on enhancing the integration of disability into medical education, with development of the Disability Integration Toolkit [link].
Disability Integration Toolkit
The Disability Integration Toolkit (DIT) provides resources and disability content for medical educators that can be integrated into the medical curriculum. These include clinical cases, small group activities, journal club recommendations, continuing education and other resources. The DIT undergoes a peer review and rigorous evaluation process. For more information about the DIT visit the DIT webpage
Medical Student Summer Clinical Externship (MSSCE)
Through collaboration with the Association of Academic Physiatrists (AAP), the Department of PMR at SUNY Upstate Medical hosts between four and eight rising second year medical students each summer. Through the support of PMR faculty and staff, students receive valuable shadowing and educational experiences designed to expose them to the field of PMR, and educate them regarding health experiences of patients with disability. Educational curriculum includes journal clubs, statistical presentations, and education on providing quality care to patients with disability. With support from the DHRT and PMR staff, each student also conducts a retrospective chart review and presents findings of their individual research project at the AAP annual meeting.
Electrical Stimulation for Bladder Management Program
This is a multi-center project with clinical testing based at the Syracuse VA and with basic science support in Cleveland. It has the ambitious goal of using electrical stimulation with multiple neural targets to solve the clinical problem of neurogenic bladder and eliminate need for urinary catheterization. It is the primary research focus of Dr. Brose. There are multiple directions of the work – genital nerve stimulation is the most developed of these and is aimed at reducing bladder hyper-reflexia, curing incontinence in persons with SCI and other neurologic conditions resulting in hyper-reflexive neurogenic bladder. Pudendal nerve stimulation is aimed at reducing urine outflow resistance, easing urinary voiding; and urethral stimulation is designed to initiate bladder voiding. The stimulation is also being investigated for bowel management.
Survey of Adults with Spina Bifida
This project is an outgrowth from the DRDC and earlier work with SBA. SBA contracted with Upstate to develop, implement, analyze, and publish information about the health of adults with spina bifida. A growing proportion of the Spina Bifida population has changed from a pediatric focus, to an adult focus and concentration on chronic needs – yet there has been no systematic collection of information about the health needs of these adults. The survey was launched at the 2016 Spina Bifida Association National Conference, with 852 valid responses related to health, function, and health care of adults with spina bifida for analysis.
Death Certificate Coding and Cause of Death for People with Intellectual and Developmental Disabilities
Scott D. Landes PhD, Professor in the Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs at Syracuse University (SU), has embarked on an analysis of death certificate data from the National Vital Statistics System 2012-2016 US Multiple Cause-of-Death Mortality files, to determine likely causes of death in this population. There is collaboration with PMR. Through a sequential coding revision process, erroneous coding of the developmental disability as proximate cause of death obscures preventable diseases or injuries, initiating the sequence of events leading to death. This research supports improved quality of care for people with disability and the need to integrate disability into for medical education.
National Spina Bifida Patient Registry (NSBPR)
Sponsored and funded by CDC since 2008, NSBPR houses data from now 24 spina bifida clinics nationally, including child and adult registrants. The overarching goal of NSBPR is to provide a framework to develop a systematic approach in determining present health status and needs and use of health care resources to improve the quality of care received at spina bifida clinics nationwide. All member clinics can develop plans for data analysis and follow CDC NCBDDD policies to evaluate existing medical services for spina bifida patients.
Balance, Physiological Reactivity and Neuropsychological Function Following Traumatic Brain Injury in Adolescent and Young Adult Populations
Richard Servatius PhD, VA Senior Researcher, is collaborating with PMR. This is a multi-method assessment to track functional deficits in the acute stages following mild to moderate traumatic brain injury in subjects ages 13-25. A neurocognitive battery will be performed and balance, fine motor control and acoustic startle response will be measured will be performed over a 3-month period.
Study of Postural Stability in Subjects with Myelopathy Using a Portable Virtual Reality Balance Protocol
Postural stability may be an early indicator of functionally significant myelopathy. This project based at both the Syracuse VA and at Upstate Medical Center uses virtual reality to test the balance of patients with and without myelopathy.
3-D Printing and Development of Low-Cost Orthotic, Prosthetic, and Other Devices
Rehabilitation focuses on enhancing function and quality of life for people with new and longstanding disability. Medical devices and equipment can be important elements of this process, although lack of insurance coverage and high costs often limit prescription and therefore use. This project develops state-of-the-art 3D printed, fused deposition modeling, prostheses, orthoses and adaptive equipment for single use, with open source sharing of designs or repeat printings where appropriate. Patients’ involvement in their care is increased by participation in the device's development; their goals for the device determines the modifications made as well as selecting cosmetic modifications and color of the material.
Stroke and Sleep Disorders
George Fulk PT, PhD, Professor and Chairman Department of Physical Therapy Education at the Upstate College of Health Professions and Karen Klingman PhD, Associate Professor Upstate College of Nursing, are collaborating with PMR to evaluate people post stroke, their sleep habits, and activity levels. The study aims to determine the impact of sleep disorders on recovery after stroke through a cross-sectional design. Subjects 6 months or more post stroke onset are evaluated through motor and balance measures, standardized questionnaires, single nocturnal oximetry, activity monitors, and activity diary. Activity and sleep will be compared.
Auditory Impact of Adolescent Concussion in Acute and Recovery Stages
This study is examining behavioral and electrophysiological indices of auditory functioning in youth recovering from concussion as well as uninjured controls. Cognitive and balance functioning is also assessed.
Objective and Subjective Effects of a School Day on Adolescents Recovering from Concussion
This study seeks to capture the effects of school attendance and academic effort on high school youth recovering from concussion. Concussion symptoms as well as objective measures of cognition and balance are recorded at the beginning and end of a school day for two weeks after injury. Uninjured control subjects are also evaluated over a similar period.
Relation Among Psychosocial Variables and Concussive Symptoms in Youth and Adolescents
Measures of mood, somatization, post-concussion symptoms, quality of life and academic stress are administered to adolescents recovering from concussion as well as their parents. Re-assessment is conducted after recovery or at 3 months from initial assessment, whichever comes first. The goal of this study is to analyze the relationship between these variables and recovery from concussion, and also to examine similarities and differences in parent versus child self-report.
Neurophysiology and Electrodiagnosis
Clinically-based studies evaluate underlying neurophysiology and/or develop techniques to better quantify normal and/or disease conditions. There is often a collaborative approach among Upstate researchers and Chinese colleagues. Recent studies have explored C7 root transfers, serial studies of sacrificed and accepting side affecting UMN and LMN manifestations; Electrodiagnostic techniques related to radiculopathy or neuropathy diagnoses, effect of environmental changes on nerve conductions; Recruitment patterns in disease conditions, UMN vs. LMN; Vibratory effects on neurophysiology.
Case Reports, Case Series, and Quality Improvement Projects
PMR faculty, residents and interested students develop in-depth reviews of unusual cases or circumstance and/or chart review with data analysis on various clinically relevant PMR topics. Abstracts are submitted to and usually accepted by a variety of PMR-related professional societies. In particular, Medical Student Summer Clinical Externship participants (with assistance from faculty and residents) complete summer projects for abstract submission to the Association of Academic Physiatrists, sponsored by Upstate PMR, for presentation at the annual meeting.