Shepherd Center Marks 30 Years of Research Innovation

Behind the unparalleled clinical care patients with spinal cord injury (SCI) receive at Shepherd Center is a robust research engine that has been gaining steam for three decades to study and advance SCI rehabilitation. These research efforts have in many ways changed the face of how these injuries are understood and treated.

“When I started at Shepherd Center, there were three things I knew had to come together – great clinical care, education of our patients and professionals, and research,” says David Apple, M.D., medical director emeritus. “I called it the three-legged stool and, without the research arm, we wouldn’t be where we are today.”

Together, he and Lesley Hudson, MA, co-project director for the Southeastern Regional SCI Model System at Shepherd Center, have overseen and celebrated the achievements of the clinical research program since its early days.

From its humble beginnings, the now full-fledged Virginia C. Crawford Research Institute attracted $4 million in external funding in 2014 and has garnered both national and international acclaim.

The research program has spanned all aspects of neurorehabilitation, including quality-of-life issues. Investigations that once centered primarily on methods to improve function and walking ability – including functional electronic stimulation and body-weight supported treadmill training – have expanded to include cutting-edge robotic assistive devices and use of a patient’s own cells to promote SCI recovery. Researchers are increasingly testing ways to stimulate anatomic changes in individual patients with the hope of finding a cure for paralysis.

The Early Days

By all accounts, the 1982 federal designation of Shepherd Center as a model of SCI care by the U.S. Department of Education’s National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) helped put the hospital on the map.

“It was this award – initially $250,000 each year – that paved the way for the research program,” Hudson says. “It served as the platform from which future research activities developed.”

This pivotal first grant came just seven years after Shepherd Center opened its doors, and it provided the seed money and momentum needed to launch a robust scientific program, Dr. Apple explains.

“It was a big achievement because there were only 18 awards with 50 or more applications from centers that had far more years in the field,” he says. “It gave us credibility in the SCI community and the funds to pursue research projects, and out of this grant grew a research department in a non-university setting, which is difficult to do.”

It helped open the door to programs such as:

• Recreation therapy
• Peer support
• Return to work assistance programs
• Outdoor adventure skills learning
• Life satisfaction and life expectancy (many patients have been followed for more than 35 years, giving unprecedented data to researchers)

By 1985, the Clinical Research Department was formally established at Shepherd Center. The SCI model system grant has been consecutively renewed for 34 years, amassing $17 million in federal funds. The program has also evolved to include pioneering research on therapies for acute and traumatic brain injury and multiple sclerosis.

Cutting-Edge Research with an Eye Toward Clinical Care

Because Shepherd Center deals with less red tape than most academic-based SCI research programs, ideas for research projects can get off the ground more quickly. As a result, tested strategies and technologies may make their way into the clinic faster and start benefiting patients sooner.

“People in the field who visit Shepherd Center often make a point of asking me, ‘You do realize this is not the routine?’” Hudson says. “There is a real appreciation that what we do has practical application, and it is mirrored in our patient care delivery.”

And it hasn’t happened by chance. There has been a conscious effort through the years to maintain a synergy between the clinical and research arms of Shepherd Center’s work, Hudson says.

“It all fits together like puzzle pieces as opposed to operating in parallel silos where clinical care delivery and research don’t intersect,” she adds. “We have grown, and we have had great success, but we’ve never lost sight of this interconnectedness. We knew from the start that if we lost that, our patients would ultimately pay the price.”

Efforts to study and design a vocational program to help people with SCI return to work are just one example.

“Whether work is being a mom, a student or a bread winner, getting back to these activities post-injury is an important goal for leading a meaningful life,” Dr. Apple says.

Expanding Reach and Reputation

Through the years, the Institute has initiated single and multi-center, collaborative investigations and has partnered with such institutions as the University of Georgia, Georgia Tech, Emory University, Vanderbilt University and Harvard University.

More recently, exoskeleton research began with the Vanderbilt collaboration and a partnership with Parker Hannifin Corporation and has allowed researchers to refine a robotic exoskeleton called Indego that may soon make its commercial debut. The device, worn on the outside of the body, operates in either partial- or full-assist mode depending on the user’s ability and gives new freedom to those with limited mobility. Because Shepherd Center was able to provide a real-world test ground with input from patients, the improved product is intuitive to use, lighter, and easier to get on and off.

Some other clinical research highlights include:

• Implanting a device to allow patients who rely on a ventilator to breathe without this assistance for periods of time
• Investigating how functional electronic stimulation can improve function and strength, including unbraced standing and short distance walking
• Studying how the Lokomat, a robotic treadmill, can improve movement
• Using stem cells to promote recovery
• Testing how a button placed on a person’s tongue can help control a computer, the bladder, wheelchair movement and other activities
• Refining patient and family education, transition services and peer support to be more patient-centered and how this might reduce hospital readmissions and improve quality of life

A major draw to working with and funding research at Shepherd Center has been the sheer volume of patients treated for spinal cord injury every year and the fact that only a small percentage of funds awarded go to operational overhead.

“The past 30 years have been a period of exciting growth and development as Shepherd Center has nurtured its research program to keep pace with its nationally recognized excellence in patient care,” Hudson says.

What’s remarkable is the depth of longitudinal data collected from patients who have now returned to life in their communities for more than 30 years. Shepherd has maintained a dialogue with these people over time, and their insights have been a source for many research project ideas.

Jess Crawford, son of Virginia C. Crawford for whom the research institute was dedicated in 1996, says he is proud of his mother’s early and long involvement with Shepherd Center, especially that she designated her donation to further developing the research program.

“The research being done is so broad in scope, and it’s ultimately what will push treatments forward,” he says. “It directly benefits patients and their families.”

Dr. Apple says he is interested to see how evolving technologies and the mapping of the human genome will shape future studies.

“Combining genetic manipulation with ongoing scientific breakthroughs to reduce the effect of the injury may eventually lead to a cure for SCI and other neurological disease,” he says.

In addition to Hudson, current directors of the Institute include Mike Jones, Ph.D., Deborah Backus, PT, Ph.D., Issi Clesson, RN, MSCN, Edelle Field-Fote, Ph.D., PT, Julie Gassaway, RN, MS, and Ron Seel, Ph.D.

Key Milestones in the Research Program’s History:

• 1982 – Shepherd Center is named to the Model Spinal Cord Injury System Program by the National Institute on Disability and Rehabilitation Research.
• 1985 – The Clinical Research Department is officially established.
• 1994 – Shepherd Center holds its first Research Day on Feb. 18 to showcase its staff’s work. Regional researchers from other institutions and Shepherd clinicians attend.
• 1995 – Shepherd Center researchers and Harvard Medical School began the Shepherd/Harvard MS Research Initiative.
• 1996 – The Virginia C. Crawford Research Institute was dedicated and was able to significantly expand thanks to a $3 million donation.
• 2000 – Shepherd becomes one of the first treatment centers to use the implantable Baclofen pump to control SCI-related spasticity.
• 2001 ­­– Launch of a biomedical research and education initiative to study central nervous system injuries in partnership with the University of Georgia
• 2003 – AXIS Newsletter begins publication by the SCIMS program to disseminate research findings.
• 2006 – First diaphragmatic pacing system (DPS) device is implanted in a patient with SCI at Shepherd
• 2011 – Shepherd competes successfully for a 7^th SCIMS grant
• 2012 – Hulse Spinal Cord Injury Lab opens its doors
• 2013 – Shepherd Center begins testing Indego, a new powered exoskeleton device designed to assist walking in people with spinal cord injury and other mobility-limiting conditions. It is developed by Parker Hannifin Corporation in collaboration with Vanderbilt University.

Written by Amanda Crowe, MA, MPH