By Edelle Field-Fote, PT, Ph.D., FAPTA
Director of Spinal Cord Injury Research, Virginia C. Crawford Research Institute at Shepherd Center
As children, most of us think of scientists as people who sit around thinking up cool experiments. While thinking up ideas is a part of science the ideas don’t generally come from just sitting around. Most science is built on the work of many years of prior studies. While originality is important, a firm understanding of what we already know is a crucial foundation for future studies.
People often ask how Shepherd Center researchers decide which projects to pursue. When considering what makes a good research study, it’s often helpful to think in terms of what reviewers are looking for when they review a research proposal that has been submitted for funding. In the United States, the National Institutes of Health (NIH) is one of the major sources of research funding for studies that are intended to develop interventions for people with spinal cord injury (SCI). Because of this, the NIH review process is used as a model by numerous funding agencies and can offer some insights into what makes a strong research study.
When contemplating a research project, the first consideration is whether the proposed study is significant. In this case, significance refers to the potential significance of the solution to the identified problem. The researcher thinks about how the project tackles an issue that has limited the advancement of treatment and whether the new knowledge gained from the study will make a meaningful difference. Many researchers believe, myself among them, that the significance of the proposal is the most important consideration. No matter how innovative a project may be, if it doesn’t offer a meaningful solution to a problem that is of consequence, then the project is of questionable value.
A project may be significant even if it results in only a small improvement when it addresses a problem that is common to a large proportion of people with a specific health condition. For example, people with motor-complete SCI comprise more than 50 percent of the population of those with SCI, so an intervention that improved the ability to walk by 20 percent would have a small, but meaningful influence on a large group of people. Conversely, a project may be significant even if it only has value for a small subset of people if the impact of the outcome is likely to be large. For example, in a subset of people with SCI, spasticity severely restricts quality of life by interfering with sleep, positioning and daily functioning. Even if the population of people with severe spasticity were only 20 percent of the total population of people with SCI, if an intervention were to result in a 50 percent decrease in the severity of their spasticity, this would be a meaningful outcome.
Beyond the significance of the project, another key consideration is the innovation of the proposed project. The innovation of a project may take many different forms. It may involve testing a new theory about what causes the problem, or it may study a new method or treatment for the problem. Taking the example of spasticity, the most common antispasmodic medication in use is baclofen, which works by decreasing the activity in of spinal circuits that are overly excited in people with SCI and other health conditions such as multiple sclerosis (MS). However, new theories about the way neurons in the spinal cord are activated could result in the development of new, more effective treatments.
While innovation represents a new way of thinking about the problem or issue to be addressed, it is still important that the innovative aspects of the project are supported by information that is already available. For example, in my early studies directed at improving walking function in people with SCI, it became clear that for people with tetraplegia-impaired hand function, the use of their hands was even more important to them than walking function. In a review of previously published research, I came across studies showing brain circuits that control hand function become disorganized in people with tetraplegia. Thus, I began thinking about how targeting the brain might be effective for improving hand function in individuals with SCI. In my grant application to get funding for studies of hand function, it was necessary to demonstrate to the reviewers that the theory of retraining the brain to improve hand function was supported by previous research.
In addition to conceiving our own studies, clinical researchers at Shepherd Center are often approached by outside researchers to collaborate. In these instances, we again begin with discussions about the significance and innovation of the projects before agreeing to collaborate.
The researchers with whom we collaborate must bring their own history of successfully completing projects and have an established record of contributions to published clinical research. In addition, we discuss the proposed research approach – whether the strategy is appropriate to the goals of the study, and whether the potential obstacles have been considered and addressed. Finally, we discuss the research environment at Shepherd Center and the potential collaborating site, and whether that environment offers adequate support and resources available to successfully complete the project.
When the elements of significance, innovation, a strong research team, a solid approach and a supportive environment come together, the result is a research project that has high potential to make a meaningful impact on the lives of people with SCI. While the time to think is an important ingredient for the generation of ideas, it’s curiosity that is the key element – the “what if?” that provides the impetus to identify an intervention that will make a difference. Curiosity is the spark behind every brilliant discovery.
EDELLE FIELD-FOTE, PT, Ph.D., is the director of spinal cord injury research at Shepherd Center. She joined the staff in May 2014 after serving for 20 years as the director of the Neuromotor Rehabilitation Research Laboratory at the Miami Project to Cure Paralysis. Her research focuses on restoring motor function after spinal cord injury by making use of spinal pathways not damaged by injury.
Shepherd Center, located in Atlanta, Ga., is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury or brain injury. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation and is a 152-bed facility. Last year Shepherd Center had 965 admissions to its inpatient programs and 571 to its day patient programs. In addition, Shepherd Center sees more than 6,600 people annually on an outpatient basis. For more information, visit Shepherd Center online at www.shepherd.org