Shepherd Center Research Program Serves as A Model Program of Success
Thirty years of research at Shepherd Center have brought clinical and technological innovation for people with disabilities.
For more than 30 years, Shepherd Center’s research program has had one guiding vision – to fine-tune and discover new and better ways to help patients regain function, maximize recovery and return to a meaningful life.
Like Shepherd Center as a whole, the research program once solely focused on investigating rehabilitation for spinal cord injury (SCI), thanks to the federally funded Spinal Cord Injury Model Systems grant. Now, research also focuses on multiple sclerosis (MS), acute and traumatic brain injury, stroke, and technology to support independent living regardless of disability.
“We are fortunate to have a very eclectic mix of different programs that try to stay on the cutting edge of everything, which is very unifying,” says Edelle Field-Fote, Ph.D., PT, director of SCI research. “But the focus of each program is very different because of the disparate needs of the patient communities we serve.”
Research conducted at Shepherd Center has helped advance the field and bring new rehabilitation techniques, devices, investigational medications, and transition and other services to patients. In 2014 alone, the hospital’s research program attracted $4 million in external funding, not including sponsored clinical trials.
“The program has become the envy of many other hospitals and is routinely sought after by pharmaceutical and device companies – not only because of our ability to recruit and retain patients, but also because of our expertise,” says Mike Jones, Ph.D., founding director of the Virginia C. Crawford Research Institute at Shepherd Center.
Shepherd Center’s rehabilitation research program distinguishes itself from most other such programs by how well it is integrated into clinical care, Dr. Jones notes.
“There is a lot of synergy, and we aren’t doing ‘academic’ research for the sake of doing research,” Dr. Jones says. “What we investigate or test has to have fairly immediate and direct relevance for clinical practice.”
As a result, patients benefit from very early access to innovative treatment and rehabilitation techniques. On the other side, the clinic is, in a sense, an incubator for research ideas and hypothesis-generating inquiries.
“One informs the other,” says Deborah Backus, Ph.D., PT, director of MS research for the Eula C. and Andrew C. Carlos Multiple Sclerosis Rehabilitation and Wellness Program. Dr. Backus and her team are validating – in a real-world setting – the importance of exercise, general health and wellness in managing MS. Historically, clinicians believed people with MS should limit their activity, but it seems that doing so may instead worsen issues of pain and fatigue.
“We want to know what is really possible for these patients, especially those who use a wheelchair, and put this knowledge into clinical practice as soon as we can,” Dr. Backus says.
She notes that Shepherd Center’s Upper Extremity Rehabilitation Clinic is another example of the symbiotic relationship between research and clinical care. New data is helping researchers understand how the upper limbs recover and can best be rehabilitated following SCI.
From its earliest days, the research program at Shepherd Center has served as the test bed for many of the clinical practices that are now standard at the hospital. Examples include the vocational and peer support services.
Other examples include early testing of a telemedicine program that quickly evolved into the Marcus Community/Bridge Program and has since served as a springboard for Shepherd’s wireless technology program. That effort, a collaboration with the Georgia Institute of Technology, is now the Wireless Rehabilitation Engineering Research Center (RERC). It is in its 15th year of funding and recognized as a leader on issues and solutions related to the accessibility and usability of mobile wireless products and services by people with disabilities.
Today, Shepherd Center is systematically revamping its patient education and peer support program. As researchers validate different strategies for arming patients with the information and skills they need to manage their injury, clinicians immediately integrate them into clinical practice.
Another strength of Shepherd Center’s research is that studies are often patient-centric and conceived with an eye toward the return home.
Ron Seel, Ph.D., O. Wayne Rollins Director of Acquired Brain Injury Research at Shepherd Center, and his team have built an entire program around issues of safety following traumatic brain injury (TBI) – an effort that emerged directly from feedback provided by patients and caregivers at an advisory board meeting in 2007.
“These researchers have developed what I think will become the definitive assessment tool to identify the extent to which individuals are at a high safety risk and need supervision,” Dr. Jones says. The team is also evaluating an intervention to help identify potential hazards and mitigate risks.
“We are able to provide actionable treatment recommendations based on this assessment tool,” Dr. Seel says. “Most academic medical centers are not connected to a community-based rehabilitation program, and that affords us the opportunity to focus on transition-type assessments, programs and interventions, which are critical to maintain improvements patients make during more acute rehabilitation.”
Dr. Field-Fote agrees.
“People lose the gains they’ve made in rehabilitation if they don’t have the opportunity to continue the level and type of activity they were doing when they get home,” she says. “It’s like anything: If you don’t practice the piano, can’t expect to be a good piano player.”
Dr. Field-Fote’s prior studies on restoring walking and hand function after SCI have been funded by the National Institutes of Health (NIH). She recently secured a grant from the NIH to evaluate the dose-response of whole-body vibration on walking function. Her future research is poised to examine whether adding brain stimulation to hand training can measurably improve hand function in certain patients. In these studies, she has specifically selected a type of stimulation that is widely available in clinics, and if found to be effective, could easily be made available for home use.
“While I’m all for technology, the truth is that only a limited number of people will have access to advanced technology in the clinic, and even fewer will have access to it in the home,” Dr. Field-Fote says. “So while technology is exciting, there are many lower-tech approaches that are just as effective, and so it’s also important to advance our understanding of those approaches, as well”
Dr. Jones notes, “We are trialing everything that might be relevant and lead to improvements for walking recovery, and we have so many tools at our disposal.”
Ismari Clesson, RN, MSCN, CCRP, director of clinical research, and her team of researchers coordinate and oversee more than two dozen industry-sponsored clinical trials, totaling almost $1 million a year in external funding. Clesson has streamlined and standardized protocols to be topnotch.
Of course, at the center of Shepherd Center’s efforts – and its successes – are its culture and people.
“I think we have the right people leading our various research programs,” Dr. Backus says. “It’s not just about getting research done, but fulfilling our mission.”
And as Dr. Seel’s project shows, patients and families play a defining role, too.
“Shepherd Center is a close community – not only the people who work here, but former patients who routinely reach out to participate in research activities to help others,” Dr. Field-Fote says. “That is very unique and important to the success of our research program.”
For more information about the research being done at Shepherd Center, visit shepherd.org/research.
Written By Amanda Crowe, MA, MPH
Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 740 inpatients, nearly 280 day program patients and more than 7,100 outpatients each year in more than 46,000 visits.