Presentation on theme: "University of Maryland Older Americans Independence Center"— Presentation transcript:
1University of Maryland Older Americans Independence Center OAIC OverviewJuly 19,2013PIs: Andrew Goldberg, MDJay Magaziner, PhD, MS Hyg
2University of Maryland Claude D University of Maryland Claude D. Pepper Older Americans Independence CenterMission:Cardiovascular and neuromotor deconditioning are fundamental to the functional impairments and disabilities observed in older people with chronic disease. The goals of the UM-OAIC are to determine the mechanisms and efficacy of motor learning-based exercise rehabilitation programs designed to restore and maintain function and the prevent the functional declines that put older adults with chronic disease at risk for disability.
3PartnershipsDivision of Gerontology & Geriatric MedicineVA Geriatric Research,Education, & Clinical Center (GRECC)Kernan Orthopedics and Rehabilitation HospitalVA Geriatrics ServiceDivision of Endocrinology, Diabetes & NutritionVA Rehabilitation & Development Center of Excellence in Exercise &Robotics for NeurologicalDisorders (MERCE)Department of NeurologyGeriatrics & Gerontology,Education & Research ProgramMultiple Sclerosis Center of ExcellenceUniversity ofMaryland,BaltimoreBaltimore VA Medical CenterMental Health Service MIRECCCenter for Research on AgingLoch Raven CommunityLiving CenterNutrition Obesity Research CenterUniversity of Maryland Claude D. Pepper Older American Independence CenterDepartment of Physical Therapy and Rehabilitation ScienceRegional Medical Education Center (RMEC)Department of Epidemiology & Public HealthChesapeake Health Education Program (CHEP)
4Principal Investigator: Andrew P. Goldberg, MD UNIVERSITY OF MARYLAND CLAUDE D. PEPPER OLDER AMERICANS INDEPENDENCE CENTERPrincipal Investigator: Andrew P. Goldberg, MDExternal Advisory BoardLeadership/Administration CoreA. Goldberg, MD, Leader / J. Magaziner, PhD, MS Hyg, Co-LeaderData Safety Monitoring Boards· Full Committee · SubcommitteeAdministration and Program ManagementK. Longo, MS A. Sullens, MAPublications CommitteeResearch CoresRC-1: Biostatistics, Informatics and Translational ResearchCore Leaders:J. Sorkin, MD, PhDJ. Magaziner, PhD, MSHygRC-2: Applied Physiology and Tissue MechanismsCore Leaders:A. Ryan, PhDL. Katzel, MD, PhDResearch Career Development CoreCore Leaders:A. Goldberg, MDJ. Magaziner, PhD, MSHygPilot/Exploratory Studies CoreCore Leaders:M. Rodgers, PhD, PTA. Goldberg, MDRC-3: Mobility Function and Neuromotor PlasticityCore Leaders:R. Macko, MDM. Rogers, PhD, PT
5Conceptual Model of the UM-OAIC Preventive and Restorative Research in Chronic Diseases of Aging Interdisciplinary Conceptual ModelFunctional RecoveryAgingClinical PhenotypesExercise & Neuromotor LearningRehabilitationFunctional Outcomes and Translation into the CommunityChronic DiseaseImproved Quality of LifePathophysiology & Mechanisms of Functional ImpairmentsAcute Event“Free-Living”IndependenceResearch Working Groups (RC-1)Preventive & Restorative Lifestyle HabitsCommunity Trials“Real World” OutcomesMedical PracticeClinical Evaluation (RC-2)Mechanisms (RC-2,3)Interventions (RC-2,3)
6RC1: Biostatistics, Informatics & Translational Research Specific Aims:To provide biostatistical and informatics support to investigators,Foster the design of motor learning-based exercise rehabilitation interventionsFacilitate the translation of interventions from the laboratory to the clinic and the communityOrganize Research Working Groups (RWGs) that will assist OAIC investigators in the design and conduct of research studies
7RO1: Community Ambulation Following Hip Fracture RC-1 ResearchRO1: Community Ambulation Following Hip Fracture(3 clinical sites)Primary Aim: To determine if a “specific” 16-week multi-modal intervention based on aerobic conditioning, specificity of training, and muscle overload initiated 2-3 months post fracture is more successful in producing community ambulators than a “non-specific” multi-modal control intervention of transcutaneous electrical nerve stimulation, flexibility activities, and active range of motion exercises.
8R37: Effects of Multi-Modal Exercise Intervention Post Hip Fracture This is an ancillary study to the Phase III RO1 randomized clinical trial, with specific aims to evaluate mechanisms underlying community ambulation: body composition, bone turnover, hormone regulation, aerobic capacity, balance, gait, inflammation, affect, and cognition.
9RC 2: Applied Physiology and Tissue Mechanisms Specific Aims:Facilitate the conduct of musculoskeletal and tissue mechanistic exercise rehabilitation and preventive medical research in aging and disability across the UM-OAIC projectsPerform medical assessments and cardiovascular screening of research volunteers to ensure patient safety and eligibility for research protocols.Develop and test of novel exercise-based interventions in older volunteers in UM-OAIC research.Conduct clinical applied training in translational research and the assessment of cardiovascular and physiological outcomes of exercise rehabilitation in aging and laboratory training of standardized core methodologies to facilitate translational research.Provide study support, mentor and train UM-OAIC researchers in the performance of applied exercise physiology and tissue mechanisms research relevant to exercise–based rehabilitation in older people with chronic disabling diseases
10Stroke. 2013: In PressSubjectsMen and women (n=10)50-76 yearsLower Body RT3x/week12 weeks1RM Strength22% ↑ Leg press45% ↑ Leg extensionInsulin SensitivityNo change in MM/I ↑31%
11Muscle Hypertrophy after RT Stroke. 2011: 42(2):RT Reduces Muscle Myostatin mRNAMuscle Hypertrophy after RT16%40%14%49%27%
12RC 3: Mobility and Neuromotor Plasticity Specific AimsProvide expertise and investigator resources to assess the multi-system neuromotor, biomechanical, motor learning and behavioral factors affecting mobility performance. Design and conduct of novel motor learning based exercise interventions:Determine the quantitative measures of whole-body multi-segmental neuromotor controlUnderstanding the mechanisms of exercise-mediated neuroplasticity of balance, locomotion, and upper limb activities in older people with chronic diseases.Mentor junior faculty and train UM-OAIC investigators in the mechanistic study of neuromotor control, exercise- mediated neuroplasticity and motor learning.
13RO1: Intervention to Enhance Lateral Balance Function & Prevent Falls in Aging Specific AimsTo determine the effects of (a) step training, (b) hip abductor- adductor (AB-AD) muscle strengthening, and (c) a combined step training & muscle strengthening program compared to (d) a standard flexibility & relaxation program (control) on the stepping response characteristics to an external balance perturbation.To determine the effect of step training, with and without the strengthening intervention, compared to the control group on maximum hip AB-AD joint torque and power.Secondary aim is to determine the prospective fall frequency of the different intervention groups during monthly follow-up for 1-year post-training.
14Robotics Training after Stroke Mission and Long-term Objectives:Develop and deploy state-of-the-art modular lower extremity robotic technology to improve walking and balance function and promote durable benefits toward mobility independence in older individuals with stroke and other neurologic diseases.
15Deficit-adjusted Robotics Training after Stroke Deficit-adjusted robotic assistanceTerminal stance: push-off for propulsionSwing: drop foot and safe landingLevel of robotic assistanceBiomechanical models specific to deficitCapacity to predict optimal robotic supportCan a deficit-adjusted approach reduce drop foot and/or increase push off propulsion in chronic hemiparetic stroke?
16Robotics Training Eliminates Foot Drop in Chronic Stroke FREE WALKING TRIALS6 weeksRETN: 8 degPRE: 2.5 degcommunityambulatorPatient reported discarding use of her assistive ankle brace at home-community at 6-week follow-up and beyond
17Improvement in Standing Balance: Better Dynamic Inter-limb Weight Transfer -> Reduced Fall Risk DORSAL VIEW OF POSTURAL SWAYPREPOSTRaw time series95% confidence ellipseAnterior-Posterior Center of Pressure (m)Δ Variability of Sway = -50%Medial-Lateral Center of Pressure (m)Medial-Lateral Center of Pressure (m)
18Selected On-going Trials PITrialPopulationJ. Magaziner, PhD, MS Hyg/ R. Craik, PhD, PTCommunity Ambulation Following Hip Fracture (RC 1, 2, 3) Hip FractureM. Stuart, PhD/ R. Macko, MDAdaptive Physical Activity for Chronic Stroke (RC 1) Chronic Stroke SurvivorsA. Ryan, PhD/ C. Hafer- Macko, MDAging, Inflammation and Exercise in Chronic Stroke (RC 1, 2, 3,)M. Rogers, PhD, PT, FAPTAIntervention to Enhance Lateral Balance Function and Prevent Falls in Aging (RC 2,3)Older Adults with and without a Recent FallL. Forrester, PhDAnkle Robotic Training after Stroke: Effects on Gait and Balance (RC 2, 3)S. Prior, PhDAerobic Exercise (AEX) to Improve Regulation of Endothelial Progenitor Cells (EPCs) and Vascular Function in Older Adults with T2DM (RC 1, 2)Type 2 Diabetes MellitusR. Macko, MD; T. Forrester, MDEarly Exercise to Improve Muscle and Cardiometabolic Health After Stroke (RC 3) Acute Stroke SurvivorsS. Seliger, MD, MS; D. Weiner, MD, MS, co-PIRandomized Trial of Exercise Training on Cognitive and Physical Function in CKD (RC 1, 2, 3) Chronic Kidney Disease
19Recently Funded Trials InvestigatorGrant TitleS. PriorPaul B. Beeson Patient-Oriented Research CDA in Aging (K23): Effects of Aerobic Exercise on EPCs and Vascular Dysfunction in Aging and T2DMK. Oursler/ A. Ryan VA Merit: Effect of Exercise Training on Inflammation and Function in HIV infected VeteransM. SerraCDA: Treadmill Rehabilitation, Energy Utilization, and Oxidative Stress in StrokeJ. RussellVA RR&D Merit: Improving Autonomic Function and Balance in Diabetic Neuropathy
20UM-OAIC Research Career Development Core Goals:Provide an enriched, mentor-based research training and educational environment to:Promote the career development of junior faculty toward independence as investigators in aging-related research related to the UM-OAIC themes.Train future leaders in academic gerontology and geriatric medicine.Support the training of trainees and junior faculty pursuing research careers in aging by emphasizing multidisciplinary training to learn novel approaches to improving function and independence in older people.
21Current RCDC Jr. Scholars Douglas Savin, PhD, PT (mentors - Drs. Rogers, Wittenberg and Whitall) 3rd year RCDC Jr. Scholar “Comparison of Reactive Step Training and Voluntary Task-Oriented Training to Induce Neuromotor Changes for Improving Balance and Preventing Falls” Pilot Funding 07/2012Avellino Verceles MD (mentors - Drs. Goldberg, Terrin, and Hasday) 3rd year RCDC Jr. Scholar “Development of a Multimodality Strengthening and Mobility Program for Ventilator Dependent Older Patients” Pilot Funding 07/2012Michael Dimyan, M.D. (mentors - Drs. Wittenberg, Macko) 2nd year RCDC Jr. Scholar “Investigating Brain Network Interactions in Stroke and Aging Using Concurrent Transcranial Magnetic Stimulation and Functional Magnetic Resonance Imaging (TMS-fMRI). Goal is to investigate key brain motor network determinants of movement using concurrent TMS-fMRI”
22RCDC Jr. Scholars in the Pipeline Junior faculty at UMB and JHU interested in RCDC Scholar positions:Laura Buchanan, MD(Trauma Surgery UM – Acute rehabilitation post abdominal surgery)Sandra Quezada, MD, MS (Gastroenterologist UM- inflammatory bowel disease)Gautam Ramani, MD (Cardiologist UM-rehabilitation in heart failure patients)Monica Serra, PhD, RD (Exercise physiologist UM- exercise-rehabilitation, metabolism and nutrition in obesity, breast cancer and stroke survivors)
23Pilot/Exploratory Studies Core (PESC) Goal of the PESC:To provide start-up support for high quality pilot and exploratory research to acquire information needed to select or design future crucial studies of the mechanisms underlying disability, recovery and prevention in older persons and the functional and clinical responses to rehabilitation.
242012 PilotsRobert Creath, PhD (mentor – Dr. Rogers) “Using Self-triggered, Sensory-enhanced Gaze Shift to Improve Axial Turning Deficits in Persons with Parkinson’s disease.”Avelino Verceles, MD & Chris Wells, PhD, PT, CCS, ATC (mentor – Dr. Goldberg) “Development of a Rehabilitation Strengthening and Mobility Program for Ventilator Dependent Older Patients.”Douglas Savin, PhD, PT (mentor – Dr. Rogers) “Comparison of Reactive Step Training & Voluntary Task- Oriented Training to Induce Neuromotor Changes for Improving Balance & Preventing Falls.”Kelly Westlake, PhD, PT (mentor – Dr. Rogers) “Probing the Neural Basis & Influence of Cognitive Changes on Impaired Balance in Older Adults.”
252013 PilotsL. Buchanan, MD (mentor – Dr. Magaziner) “Using Rehabilitation and Exercise to Improve Outcome of Older Amercians in the Setting of Emergency Surgical Disease.”S. Kesmodel, MD & M. Serra PhD (mentor – Dr. Goldberg) “Effects of a Structured Exercise Program on Functional and Metabolic Declines in Postmenopausal Breast Cancer Patients Taking Aromatase Inhibitors.”D. Loane, PhD (mentor – Dr. Faden) “The Effect of Voluntary Exercise on Microglial Activation Phenotypes and Repair Processes in the Aged Injured Brain.”N. Steinle, MDH. & Resnick, PhD , MPH (mentor – Dr. Goldberg) “YMCA-Veterans Wellness Program: Pilot Study of a Novel Approach to Weight Loss and Disability Prevention in Older, Overweight Veterans.”
26Selected Community-Based Programs/Dissemination Exercise rehabilitation programs for stroke survivors are now based at the Baltimore VA, three senior centers in Howard County, the Loch Raven VA and Kernan Hospital. A collaboration is developing with the Baltimore City Department of Aging senior centers.(Richard Macko, MD)Myerberg Senior Center is the site of a growing, multi-faceted collaboration with the Center for Research on Aging and a falls prevention research project. (Mark W. Rogers, Ph.D., P.T.) Weinberg Place is the site of an exercise research and nutrition study, a collaboration between Weinberg Senior Living and School of Nursing investigators. (Barbara Resnick, Ph.D., Kathleen Michael, Ph.D., RN).The Program in Aging, Trauma, and Emergency Care (PATEC) is collaborating with clinical researchers in the OAIC to develop programs for early rehabilitation of older trauma patients and investigate neural mechanisms underlying brain injury to improve outcomes in older trauma patients. (Jay Magaziner, PhD, MS Hyg)