2002 — 2003 |
Earhart, Gammon M |
F32Activity Code Description: To provide postdoctoral research training to individuals to broaden their scientific background and extend their potential for research in specified health-related areas. |
Locomotor Adaptation Following Podokinetic Stimulation @ Oregon Health and Science University
DESCRIPTION:(provided by applicant) The major objective of this research is to gain a better understanding of locomotor adaptations made in response to altered sensory inputs. The proposed studies focus on the role of sensory information relayed from the "feet up" in the adaptation of locomotor trajectory. Recent work has shown that, following podokinetic stimulation (i.e., stepping in-place on a rotating treadmill for 20-40 minutes), blindfolded subjects asked to step in-place or walk in a straight line on a stationary surface will unknowingly rotate relative to space. This adaptation, called podokinetic after-rotation (PKAR), has two distinct components: 1) a short-term effect with a time constant of 5-10 minutes and 2) a long-term effect with a time constant of 1-2 hours. A more complete understanding of PKAR may be useful for developing rehabilitation strategies for people with balance and gait disorders. The proposed experiments will use podokinetic stimulation as a means of assessing the effects of altered sensory inputs on the control of orientation during locomotion. Specific Aim I examines the kinematic and electromyographic features of PKAR. Specific Aim 2 addresses the generalizability of adaptations of forward walking to other behaviors and asks whether the left and right limbs can be independently adaptated. Specific Aim 3 explores the role of the cerebellum in the acquisition and maintenance of locomotor adaptations to podokinetic stimulation
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0.933 |
2005 — 2009 |
Earhart, Gammon M. |
K01Activity Code Description: For support of a scientist, committed to research, in need of both advanced research training and additional experience. |
Parkinsonian Gait Disorders: Mechanisms and Treatment
DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award will provide the applicant, a doctorally and postdoctorally educated physical therapist, with the training necessary to achieve the long-term objective of an independent career in rehabilitation research. The applicant's expertise in the study of neural control of locomotion will be combined with the sponsor's expertise in the evaluation, treatment, and study of individuals with Parkinson's disease. The training provided will allow the applicant to investigate mechanisms underlying gait difficulties in individuals with Parkinson's disease, with the ultimate goal of developing rehabilitative strategies to maximize functional mobility in these individuals. The proposed studies will focus on turning during walking, as many subjects with Parkinson's disease have difficulty with turning and little research has focused on this functionally critical movement. The proposed studies will address the following hypotheses: 1) problems with the selection and production of appropriate motor patterns contribute to impaired turning movements, 2) conventional pharmacological treatments partially improve turning motor patterns but do not completely address the problem, 3) subjects with Parkinson's disease retain the ability to modify locomotor output and produce appropriate turning patterns when provided with relevant external stimuli, and 4) rotating treadmill stimulation may be an effective rehabilitative tool for providing these external stimuli, thereby enhancing turning ability. All of these hypotheses will be investigated using whole-body, 3-D movement analyses in conjunction with electromyographic recordings. Subjects with Parkinson's disease will be compared to age- and gender-matched control subjects. Results of the proposed studies will provide important insights regarding the effects of Parkinson's disease on gait, evaluate the effectiveness of current therapies in addressing gait difficulties, and guide future rehabilitation strategies for improving functional mobility in people with Parkinson's disease.
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2009 — 2010 |
Earhart, Gammon M |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Oculomotor Control and Gait in Parkinson Disease
Abstract Many individuals with Parkinson disease (PD) experience a reduction in mobility with gait difficulties that include impaired turning that can trigger freezing. These turning difficulties are particularly critical since falls during turning carry an eightfold greater risk of hip fracture compared to falls during straight line walking. Furthermore, people with PD are over three times more likely to sustain a hip fracture than age-matched cohorts without PD, and the cost of care for hip fractures in individuals with PD is approximately $192 million per year. Given the personal and economic impacts associated with falls, it is critical that we develop interventions to reduce falling risk during turning among those with PD. Mechanisms underlying impaired turning in PD are not well understood. We think that: 1) individuals with PD who have difficulty turning will show impaired ability to rapidly switch movement directions of not just the limbs but also the eyes and 2) eye movement impairments may contribute to difficulties with turning. Through use of kinematic and videooculographic analyses, along with a rotating circular treadmill and optokinetic stimulation, we will determine: 1) whether individuals with PD who have turning difficulty show impairments in ability to rapidly switch movement direction of the eyes and lower limbs, and 2) whether deficits in eye movement control contribute to turning difficulties in PD. The long-term objective of the proposed research is to better understand the relationship between oculomotor and limb motor control deficits in individuals with PD and how these deficits relate to impaired turning. Using the knowledge gained, we aim to develop innovative gait rehabilitation approaches for individuals with PD with the ultimate goal of reducing falls and hip fractures in this population.
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1 |
2012 — 2016 |
Earhart, Gammon M. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Exercise and Parkinson's: Comparing Interventions and Exploring Neural Mechanisms
DESCRIPTION (provided by applicant): Parkinson disease (PD) is characterized by substantial disability and reduced quality of life, both of which can be attributed in large part t difficulties with walking. Evidence suggests that exercise may be an important adjunct to traditional treatments, particularly with respect to locomotor function. In particular, dance and treadmill training have been individually shown to improve walking performance and quality of life. At present it is not clear whether dance or treadmill training have similar effects or if oneis superior to the other. Moreover, our understanding of the mechanisms by which these exercise interventions convey benefits is extremely limited. This study aims to address these knowledge gaps by directly comparing dance, treadmill training and stretching (control group). The primary area of interest is the effects on gait, with secondary measures of disease severity, balance, and quality of life. We will determine not only the effects of the interventions on locomotor performance, but will also investigate the effects of the interventions on brain connectivity and brain function at rest and during imagined walking tasks. Participants will be randomly assigned to dance, treadmill training, or a stretching/flexibility control group. Participants will be assesed over a period of 6 months at 3 different time points. We hypothesize that both dance and treadmill training will lead to improvements in forward walking, but that dance will result in greater improvements in backward walking compared to treadmill training. Furthermore, we hypothesize that the tango and treadmill interventions will have different effects of brain functio and connectivity. We expect dance to enhance the activity and connectivity of the premotor and supplementary motor areas. We expect treadmill training to enhance activity and connectivity of the primary somatosensory cortex and the cerebellum. We do not expect changes in brain activity or connectivity in the control group. Relevance PD affects 1-1.5 million Americans, leading to substantial disability, reduced quality of life, and an annual expenditure of more than $34 billion in health care costs. Difficulties with walking are a major contributor to disability ad walking speed is a strong predictor of mortality. Exercise therapies hold promise for improving walking as well as quality of life. In particular, dance and treadmill training have been reported o improve walking, but head to head comparisons of these methods have not been made and the neurophysiologic effects of these interventions remain unknown. This study will directly compare the effects of dance, treadmill training and stretching (control group) and will utilize neuroimaging techniques to explore the neurophysiologic effects of these interventions on brain function and connectivity. The results obtained will help us to better understand whether and how exercise influences function in PD and which brain regions are involved. The knowledge gained has the potential to alter our approach to the treatment of gait difficulties in PD, as it my assist in the development of new or improved exercise interventions and/or identification of new surgical targets for deep brain stimulation.
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1 |
2013 — 2017 |
Earhart, Gammon M. |
T32Activity Code Description: To enable institutions to make National Research Service Awards to individuals selected by them for predoctoral and postdoctoral research training in specified shortage areas. |
Doctoral Training Program in Movement Science
? DESCRIPTION (provided by applicant): A primary goal of the National Center for Medical Rehabilitation Research is to bring the health-related problems of people with disabilities to the attention of America's best scientists in order to capitalize upon the myriad advances occurring in the biological, behavioral, and engineering sciences. To achieve this goal, it is imperative tha we train top-notch rehabilitation scientists. This grant will support training of outstanding rehabilitation scientists by providing highly interdisciplinary predoctoral and postdoctoral trainig (4 predoctoral and 1 postdoctoral slots per year) in Movement Science to students from diverse backgrounds. The training program, while administratively housed within the Program in Physical Therapy, is strongly interdisciplinary. At present, over half of our predoctoral trainees and all of our post-doctoral trainees are from non-PT backgrounds (e.g., biomedical engineering, exercise science, kinesiology, neuroscience, occupational therapy, dance, physics). The environment at Washington University Medical Center is ideally suited for this training because it combines a premiere medical school with a strong infrastructure for research and a hospital system that includes a world-class rehabilitation center. Our training program utilizes the expertise of outstanding investigators from throughout the University to provide interdisciplinary guidance in academic and research activities. The PhD curriculum is built on the concept of the movement system and encompasses three core areas: biocontrol, biomechanics, and bioenergetics. The program has active involvement from well-respected and established investigators in many related fields including Neuroscience, Biomedical Engineering, Mechanical Engineering, Orthopedic Surgery, Radiology, Medicine (Physiology), and Psychology. The engagement of established investigators with an interest in integrating basic science and clinical manifestations of disease and injury results in the production of top quality, interdisciplinary research in rehabilitation. This is evidenced in the success of our trainees, who average 6 peer-reviewed publications during their training. Average time to completion of degree is 4.6 years in the full time pre-doctoral program, which now has a 25-year history of success and a graduation rate of over 90%. All training grant funded graduates are employed in academic settings and productive in obtaining extramural funding, publishing research in the area of rehabilitation, and training other scientists and professionals in rehabilitation related fields.
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1 |
2018 — 2021 |
Earhart, Gammon M. Ellis, Theresa |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Walking and Mhealth to Increase Participation in Parkinson Disease (Whip-Pd) @ Boston University (Charles River Campus)
PROJECT SUMMARY Parkinson disease (PD) is one of the most disabling chronic health conditions affecting older adults globally. While advances in medical and surgical management of PD have increased lifespans, they have not effectively altered the progressive decline in physical function and quality of life associated with PD. Identifying effective ways to improve function, slow decline and prevent or reduce disability remains of utmost importance in PD. Of particular concern in PD is gait decline, which is considered a red flag signaling emerging disability. Our prior work showed that people with PD experienced a 12% decline in amount of walking over one year ? despite relative stability of motor impairments during that year. Treatment targeting walking, the most rapidly changing aspect of disability in PD, may have the greatest influence on slowing the impact of disease progression on physical function and reducing disability. Traditionally, rehabilitation has targeted impairments and functional limitations with the expectation that gains would translate into greater participation in real-world activities. However, the evidence suggests that this does not occur. In this proposal, we suggest a paradigm shift in which the primary target of the intervention is real- world walking behavior, as greater walking activity could preserve walking function and slow disability. The primary factors that limit engagement in walking in PD are psychological (e.g., low self-efficacy) rather than physical (e.g., motor impairments) in nature. As such we will evaluate a cognitive-behavioral approach, grounded in social-cognitive theory and targeted at enhancing walking activity. Our ?connected behavioral approach? links physical therapists to persons with PD using a mobile health (mHealth) platform to deliver strategies to increase self-efficacy and provide goal-oriented, dynamic walking routines and walking enhancing exercises over one year. We will compare this approach to a control intervention which provides equivalent components and dosing of walking and a walking enhancing exercise program delivered by physical therapists but without a cognitive-behavioral mHealth approach. We hypothesize that the mHealth group will demonstrate higher amounts of walking activity and greater walking capacity relative to the control group. With regard to mechanism underlying improvements in the mHealth group, we hypothesize that self-efficacy will mediate changes in amount of walking and that changes in amount of walking will mediate changes in walking capacity over one year. The insights to be gained regarding mechanisms underlying changes noted will be critical to inform rehabilitation interventions designed to encourage sustained, long-term physical activity. If effective, our ?connected behavioral approach? offers a unique, generalizable and scalable means to increase walking activity and improve walking capacity, thereby reducing disability in PD and perhaps in other chronic progressive conditions.
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0.931 |
2019 — 2020 |
Earhart, Gammon M. |
R61Activity Code Description: As part of a bi-phasic approach to funding exploratory and/or developmental research, the R61 provides support for the first phase of the award. This activity code is used in lieu of the R21 activity code when larger budgets and/or project periods are required to establish feasibility for the project. |
Sing For Your Saunter: Using Self-Generated Rhythmic Cues to Enhance Gait in Parkinson's
PROJECT SUMMARY/ABSTRACT Older adults, and particularly those with Parkinson disease (PD), may experience walking difficulties that negatively impact their daily function and quality of life. This project will examine the impact of music and singing on walking performance, with the goal of understanding what types of rhythmic cues are most helpful to people with Parkinson disease and older adults. Our pilot work suggests that imagined, mental singing while walking helps people walk faster with greater stability, whereas walking to music also helps people walk faster but with reduced stability. In Aim 1, we will compare walking while mentally singing to walking while listening to music, using personalized cues tailored to each person's walking performance. We will also test whether finger tapping, a rhythmic task similar to walking in many ways, responds similarly while mentally singing and listening to music. In Aim 2, we will investigate the brain mechanisms underlying the enhancements in movement performance seen with mental singing or music listening. We will use magnetic resonance imaging (MRI) to measure brain activity during finger tapping with and without various cues to understand which areas of the brain are more or less responsive to different types of cues. Using the information gained in the first two aims, we will then conduct an intervention study in Aim 3 to compare and contrast the effects of music-based vs. singing-based training for people with PD. We will determine which training method results in the greatest improvements in walking and tapping performance and measure changes in brain activity with training. We will also ask the participants how acceptable and usable the different training approaches are. This work is among the first to focus on singing as an intervention to improve walking in PD and is innovative in its use of this novel, untapped, highly accessible, adaptable, low-cost approach that has the potential to enhance walking, thereby improving everyday function and quality of life for people with PD.
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