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Teachers College, Columbia University
Physical ACtivity and Exercise outcomes in Huntington’s disease PACE-HD
PACE-HD is a multi-center trial being conducted in Europe and in the U.S. Dr. Quinn serves a co-PI alongside Dr. Monica Busse of Cardiff University. PACE-HD will utilize a systematic approach for routinely collecting prospective physical activity and fitness data and monitoring physical activity behavior in a cohort of 120 individuals with Huntington’s disease. A database structure will be utilized in this study to track physical activity and exercise behavior alongside standardized disease-specific outcome measures during two annual visits. Assessment will incorporate VO2max and the use of wearable technologies that capture and quantify dose (frequency, duration, intensity) of physical activity in a large HD cohort.
A additional component of the PACE-HD study is a within-cohort randomized control trial (RCT) of a 12 month exercise intervention in HD, comparing a supported and structured aerobic exercise training program to activity as usual. This intervention will also incorporate a physical activity coaching program (Engage-HD) with a view to encouraging longer term exercise uptake. The results from this study will inform a larger scale evaluation of mobility and physical activity participation in relation to disease progression and exercise behavior, and furthermore support the robust delivery of exercise trials delivered via a robust platform in the future.
PRE-ACTIVE HD: Feasibility and acceptability of implementing a clinic-based physical activity coaching intervention in people with premanifest and early stage HD
This study will implement a clinic-based physical activity coaching intervention in people with pre-manifest and early stage HD at Columbia University Huntington’s Disease Center of Excellence. This study is an extension of Engage-HD (ISRCTN65378754) developed and evaluated a physical activity behavioural change intervention. In a study conducted in the UK, this intervention was found to be feasible and accept to patients with mid stage HD, and those in the intervention group demonstrated higher levels of self-reported physical activity, self-efficacy for exercise, and cognition (SDMT) compared to a social contact control group. We have not yet applied this intervention in pre-manifest and early stage HD, where we believe it is most critical to engage in exercise. To date, no study has prospectively evaluated a physical activity intervention to facilitate exercise uptake in these earliest stages.
This study will explore the feasibility and acceptability of the Engage-HD intervention in individuals with pre-manifest and early stage HD, and using the data will make relevant adaptations to prepare for a US-based Phase II evaluation. We will recruit 14 individuals (7 pre-manifest and 7 early stage) with genetically confirmed Huntington’s disease. Individuals will undergo a one-hour coaching session, followed by 3 remote video conferences over a 4 monthe period to facilitate exercise uptake and physical activity. Participants will be given a disease-specific physical activity workbook and will be given a wearable physical activity monitor to monitor activity over the 4-month intervention. Participants will undergo assessments at baseline and post intervention, which will include the IPAQ, Lifespace Assessment, and UHDRS TMS, Functional assessment and cognition.
This study is funded by the Huntington Study Group, and will begin recruitment April 2017.
Parkinson’s Disease Initiative
The Teachers College Parkinson’s Disease Initiative is a joint collaboration with the NRR lab and the Laboratory for the Study of Upper Airway Dysfunction under the direction of Dr. Michelle Troche (Program in Communication Sciences and Disorders). This program works collaboratively with the Movement Disorders Center at Columbia University Medical Center to support several studies currently under development in our labs.
(1) Use of wearable technologies to support treatment strategies for gait and balance impairments. This study involves using wearable technologies in our laboratory and in the home setting to evaluate motor problems and to assess the effectiveness of both pharmacological and physical interventions.
(2) Motor control-guided dance to treat bradykinesia in Parkinson's disease. This study will evaluate a dance program specifically designed to address disease-specific impairments in people with PD. This study is a being conducted with collaborators David Leventhal (Dance for PD) and Dr. Pietro Mazzoni, Dr. Gammon Earhart and Dr. Ryan Duncan (Washington University, St. Louis.
(3) Evaluation of a novel dual task upper extremity assessment. The study will evaluate the validity and clinical applicability of a novel dual task assessment (C3T). This study is being conducted in collaboration with Cardiff University, Cardiff, UK and is being led by TC student Julie Fineman, EdM, PT
(4) Assessment of sit to stand training in people with early stage Parkinson’s disease. This study is currently under development, led by TC student Katrina Long, MS, OTR/L.
Huntington’s Disease Exercise studies – in collaboration with Cardiff University, Cardiff, UK
(1) Exert-HD - Exercise Rehabilitation Trial in Huntington's Disease
Dr. Lori Quinn, Dr. Monica Busse, Professor Helen Dawes, Professor Anne Rosser, Dr. Andrea Nemeth, Dr. Ralf Reilmann, Dr. Hugh Rickards, Dr. Raymund Roos, Ms. Julia Townson, Dr. Mark Kelson. Study Coordinator: Ms. Katy Debono. Funded by the Jacques and Gloria Gossweiller Foundation, Switzerland ExeRT-HD is a single blind, exploratory phase II randomised, multi-site trial of an exercise-based intervention for people with early-mid stage HD. A total of 32 participants have been recruited across five EHDN sites: Cardiff, Birmingham, Oxford, Leiden, and Muenster. Primary analyses from this study have been published, and secondary analyses are ongoing.
(2) Engage-HD – Supporting Activity Engagement in People with Huntington’s Disease: A Phase II Evaluation
Dr. Monica Busse; Dr. Lori Quinn, Professor Anne Rosser, Professor Helen Dawes, Professor Kerry Hood. Funded by the National Institute of Social Care and Health Research (NISCHR) in Wales. This recently completed randomized study aimed to evaluate two different supported home-based activity programs that have been specifically developed for people with HD, each of which has different attributes, either social or physical. Coaches worked with participants to develop either a social or physical activity program that is specific to their individual interests and abilities.
Assessment of interlimb coordination in children and adults with hemiplegia
The NRR lab is working in collaboration with Dr. Susan V. Duff (PI) from Chapman University, Irvine, CA, Dr. Eric Wade (co-investigator), University of Tennessee Knoxville, TN and Heather Ruthrauff, MS, OTR/L on this project, designed to identify unique features of interlimb coordination during unimanual, bimanual asymmetric or bimanual symmetric tasks in children and adults with hemiparesis. The long-term goal of this project is to design and test an objective measure of cooperative limb function for use in the home and community setting. This study is funded by the APTA Academy of Hand and Upper Extremity Physical Therapy Leslie Harris Lindsey Grant for Research in the Hand and Upper Quadrant award and the American Society for Neurorehabilitation Seed Funding for Collaborative Clinical Research Projects.
Idea to Goals
This project is being conducted in collaboration with Agnes McConlogue, Clinical Associate Professor at Stony Brook University, Stony Brook, NY. The purpose of this study is to address the following questions: If school-based physical therapists are given training on utilizing a unique, collaborative goal setting methodology, and support throughout the school year to create and monitor progress of set goals, will there be improvements in the abilities of therapists to: 1) create goals that meet the standards of best practice, and 2) influence intervention choices for improved outcomes and collaborate with school staff and families in order to improve options for carryover and subsequent improved goal-mastery?
The investigators provide training to participating therapists on the utilization of a goal setting methodology that focuses on creating goals that are collaborative, meaningful, relevant and measurable. The program spans over the school year and includes: one-day training on goal setting methodology; three phone calls to provide mentorship regarding goal setting/progression; pre/post survey on therapists’ perceptions regarding goal setting and practical use of goal setting methodology. The participants will provide examples of goals prior to the one-day training and again at the end of the school year, analyzed utilizing a grading rubric created by the investigators.
iWEAR: Integrating wearable technologies to quantify meaningful activity in Huntington Disease
Employing more sensitive monitoring approaches to quantitatively measure physical activity and functional ability is important for assessment in patients with neurological conditions. Developments in wearable remote monitoring sensors and systems have excellent potential to provide a broader understanding of physical activity behaviors. The NRR lab is collaborating with researchers at Columbia University Medical Center (Dr. Karen Marder and Dr. Ashwini Rao), Cardiff University, Cardiff UK (Professor Monica Busse, Professor Anne Rosser, Mr. Vince Poile), Tel Aviv University, Israel (Dr. Tanya Gurevich, Ms. Noit Inbar, Professor Jeffrey Hausdorff) and George Huntington Institute, Munster, Germany ( Dr. Ralf Reilmann and Dr. Lisa Muratori) to conduct a multi-site study funded by the Jacques and Gloria Gossweiler Foundation. In this cross-sectional study, we will evaluate the feasibility, acceptability and utility of wearable activity monitors in people with early-mid stage HD, with the ultimate goal of developing phenotype classifications based on performance of functional activities (in a controlled setting) and community-based physical activity (7 day home monitoring). We will utilize data from both the activity monitors and body sensors, in combination with clinical assessments, to study dominant clinical presentations and explore possible phenotypic classifications in HD. This will support the development of successful best practices for the design and planning of studies that utilize wearable activity monitoring devices in the future.
Reduction of Gait Asymmetry Using the Tethered Pelvic Assist Device (TPAD) in Individuals Chronically Post-Stroke
Asymmetrical gait is common in individuals after stroke due to the hemiparetic nature of the disease. Traditional care models, treadmill based training, and robotic training have all worked to reduce asymmetry in this population; however, despite efforts, individuals remain with motor deficits that limit community participation. The tethered pelvic assist device (TPAD) has been developed by Dr. Sunil Agrawal (Dept. of Mechanical Engineering, Columbia University). This is a novel robotic device that uses an arrangement of force tethers attached to a pelvic belt to manipulate load forces on the pelvis during treadmill-based gait training. In this non-randomized pilot study of feasibility, we will use the TPAD to maintain a prescribed force, guiding the pelvis to increase loading onto the paretic limb while the user freely controls the spatiotemporal aspects of limb movement during gait. On completion of the daily TPAD treadmill training, participants will also receive additional overground gait training that reinforces skills learned with the TPAD. The purpose of this study is to evaluate the overall feasibility in terms of safety, adherence and treatment tolerance as well as establish preliminary efficacy of implementing this five-day TPAD and overground training paradigm to reduce asymmetry in individuals with chronic stroke. This study is being conducted in the Department of Rehabilitation & Regenerative Medicine at Columbia University Medical Center in collaboration with Dr. Joel Stein, and is being led by TC student Lauri Bishop, PT, DPT.
Feasibility of Utilizing Microsoft HoloLens by People with Parkinson’s Disease
The NRL Lab is collaborating with Dr. Akin Beckley and Dr. Sam Rosenberg (Columbia University Medical Center) and Dr. Steven Feiner (Columbia University Engineering Department) to conduct a feasibility study on the use of the Microsoft HoloLens by people with Parkinson’s Disease. The Microsoft HoloLens (https://www.microsoft.com/hololens), is a commercially-available augmented reality headset that projects 3D virtual images onto what the person wearing it sees and hears in the real world. This makes it possible for the wearer to interact with 3D models of virtual objects within an unmodified environment such as a home or an office space. The goal of this studyis to address the feasibility of this device being used by people with Parkinson’s Disease in the hopes of developing rehabilitative interventions using the Microsoft HoloLens in the future.
Dancers Realize Excellence through Arts and Movement (DREAM): An inclusive dance program to promote participation in children with developmental disabilities
The DREAM project aims to evaluate the experiences of children with and without development disabilities who participate in a 5 day inclusion dance program in Harlem, NY. This study is a collaboration between the NRL Lab, Agnes McConlogue Ferro, Stony Brook University, and Dr. Laura Azzarito, Teachers College. National Dance Institute has partnered with Board certified pediatric physical therapist Agnes McConlogue Ferro to create a workshop that offers children of all abilities the chance to move, dance, and go beyond what they believe possible. Using NDI's unique pedagogy and the expertise of an NDI teaching artist team led by Master Teacher Kay Gayner, this 5-day program hones the abilities of learners with special needs through dance, live music, and performance. In this program, children with disabilities are paired with typically developing peers to maximize participation. Dancers work together under the guidance of Kay, Agnes, NDI teaching artists, and physical therapy students to master choreography and gain partnership and performance skills, working toward functional goals within a joyful, rigorous, and supportive group dynamic. The workshop culminates in an informal performance celebrating the children’s achievements. The study will explore qualitative methods of inquiry through the use of visual explorations of the children’s self-perception and view of participation in the DREAM program.