Project Title: Cerebral Networks of Locomotor Learning in Older Adults
Faculty Mentor’s Name: David Clark
Student Name: Rodeania Peart
Research Project Description:
As individuals age, they often face increased difficulty with locomotion, especially more complex walking tasks such as obstacle crossing (Shumway-Cook et al., 2007; Clark et al., 2014). This is due to a lack of consistent practice of these complex walking tasks, in conjunction with deficits in brain structure (Rosano et al., 2007; Nadkarni et al., 2013) and the integrity of brain networks due to age (Geerligs et al., 2015; Sala-Llonch et al., 2015) Through neurorehabilitation, it is possible to partially recover walking function in older adults, however major and persistent improvements are elusive. An important part of neurorehabilitation is motor learning (Kitago et al., 2013), which is the enduring change in the ability to perform a motor task due to practice or experience. Unfortunately, it is not practical to deliver a sufficiently intensive motor learning intervention, due to time and cost demands. There is a need for research to develop strategies to enhance motor learning of walking in order to improve the effectiveness of neurorehabilitation.
Significance regarding aging Veterans
Individuals with walking deficits display higher rates of morbidity and mortality, increased amounts of hospitalizations, poorer quality of life and are less likely to remain independent within the community (Branch et al., 1982; Lonergan et al., 1991; Guralnik et al., 1993; Hirvensalo et al., 2000; Khokhar et al., 2001; Shumway-Cook et al., 2002; Lampinen et al., 2003; Shumway-Cook et al., 2003; Newman et al., 2006; Fielding et al., 2011). Walking related disability is present in a high proportion of the older adult population, including an estimated 30% of individuals aged 60-69, 40% of individuals aged 70-79 and 55% of individuals age 80 or older (Seeman et al., 2010). Preserving walking function has become a major public health priority because it would significantly reduce healthcare costs and improve quality of like for many older Americans and their families (Hoffman et al., 1996). As reported by the Center for Diseases Control and Prevention, each year over 2.8 million elderly adults are treated in emergency departments for fall related injuries and over 800,000 are hospitalized.
One group of people who are at particularly high risk of age-related walking deficits are Veterans, due to the fact that approximately 67% of Veterans are 55 or older according to Census data from 2018. In the US, the population of older adults is expected to increase to 88.5 million by 2050, which would more than double the current number 0f 38.7 million. This shift in the age of veteran and civilian populations emphasizes the necessity of interventions that facilitate physical independence. Preserving walking function is important to well-being and has major fiscal and pragmatic implications of the VA Health Care System.
Significance regarding motor learning to clinical rehabilitation
The ability to learn or adapt motor behavior is a key component of the varied range of skilled actions in daily human behavior. For example, older adults may be faced with the challenges of learning to use assistive devices, driving a new or modified vehicle, relearning self-care (e.g. bathing) following an injury or adapting to a new living environment. Arguably, the most important of all motor skills is walking. Major factors that contribute to walking deficits in older adults include a lack of continued practice of complex walking tasks, deficits in brain structure (Rosano et al., 2007; Nadkarni et al., 2013) as well as integrity of brain networks, (Geerligs et al., 2015; Sala-Llonch et al., 2015) both related to age. Neurorehabilitation can help to preserve or enhance walking function, However, a large challenge for this field is how to produce beneficial and lasting changes in the brain, supportive of behavioral improvements. In order to produce such changes, one would need intensive and repetitive task practice. Within this lies the importance of motor learning, the cornerstone of neurorehabilitation (Kitago et al., 2013). Motor learning is defined as an enduring change in the ability to perform a motor task due to practice or experience. Even in the most ideal of clinical settings it is usually not practical to dedicate sufficient time and costs to delivering optimally intense motor learning interventions. An urgent need exists for new approaches to enhance motor learning. This will help improve the effectiveness and efficiency of rehabilitation by contributing to timely increases in task repetition, intensity and complexity, all of which are critical components for rehabilitation gains. Through the identification of adjuvant therapies and the understanding of mechanistic factors that enhance learning we will be able to develop more potent clinical rehabilitation intervention.
Project Title: Coping with COVID-19: Impact on technology use, mobility, food security, depression and social isolation
Faculty Mentor’s Name: Todd Manini
Student Name: Adam Wolach
Research Project Description:
Public health responses to COVID-19 have been swift and highly impactful to the lives of most people across the globe. Given the increased susceptibility with increasing age, older adults may be both physically, socially and psychologically impacted to a greater degree than other age groups. It is commonly known that older adults are more likely to acquire Coronavirus and suffer more severe illnesses with infection. Public health measures of quarantine and social distancing have appeared to make a difference in contraction rates.
However, these public health activities have other consequences – many negative, but some positive adaptations may occur too. To investigate these impacts, Dr. Manini proposes to remotely survey older adults about their behaviors, social activities, food security, depression, technology use, and mobility patterns prior to and after the COVID-19 outbreak. He will also ask about practicing COVID-19 precautions during the outbreak. This survey knowledge will be critical for targeting educational, policy and behavioral interventions designed to regain and/or modify their life activities post-COVID-19.
Specific to the MSRP, the candidate will use this survey to investigate the anecdotal observations of a decreasing presentation of acute disease, such as myocardial infarction, to emergency rooms and hospitals since the pandemic began.1 The American College of Emergency Physicians provides guidance on symptoms for which emergency presentation is appropriate 2 and ignoring those symptoms, particularly in regards to acute coronary syndrome (ACS), already presents a major obstacle to treatment.3 Many patient beliefs that can lead to delay, such as affordability, lack of insurance, or beliefs regarding self-management have been investigated on patients who ultimately chose to seek care,4 yet these methods are limited in the setting of acute conditions in which mortality depends on the timeliness of presentation. Additionally, disparities between genders and race in decision making have been identified prior to the pandemic which may carry into the current situation.5 Dr. Manini’s broader survey provides a timely platform to investigate these issues in a large and vulnerable population.
- Hsieh P. Do Not Delay Urgent Medical Care Due To The COVID-19 Coronavirus Pandemic. Forbes. Accessed May 6, 2020. https://www.forbes.com/sites/paulhsieh/2020/04/20/do-not-delay-urgent-medical-care-due-to-the-covid-19-coronavirus-pandemic/
- Know When to Go Overview. Accessed April 13, 2020. http://www.emergencyphysicians.org/article/know-when-to-go/know-when-to-go-overview
- DeVon HA, Hogan N, Ochs AL, Shapiro M. Time to Treatment for Acute Coronary Syndromes: The Cost of Indecision. J Cardiovasc Nurs. 2010;25(2):106-114. doi:10.1097/JCN.0b013e3181bb14a0
- Lozano K, Ogbu UC, Amin A, Chakravarthy B, Anderson CL, Lotfipour S. Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital. The Journal of Emergency Medicine. 2015;49(2):203-210.e3. doi:10.1016/j.jemermed.2015.03.019
- Rosenfeld AG. Treatment-Seeking Delay Among Women With Acute Myocardial Infarction: Decision Trajectories and Their Predictors. Nursing Research. 2004;53(4):225–236.
Project Title:Inter-relationships between ecologically assessed pain and mood.
Faculty Mentor’s Name: Todd Manini
Student: Torie Livingston
Research Project Description:
Over the past two decades, ecological momentary assessment (EMA) as a means to collect data has been garnering more popularity in the clinical healthcare setting. It involves the repeated sampling of patients’ behaviors and experiences on the spot, in their natural environments. EMA provides real-time assessments that, in-turn, minimize recall bias, increase ecological validity and generalizability, and provide a more detailed look at the with-in person relationships of various factors contributing to one’s overall health and wellness. In a 2017 survey conducted by Transcend Insights, Humana’s population health management company, 64% of 2,597 adults said that they already use digital devices to manage their health and 71% believe that their doctors should have access to this information to improve patient care. As EMA becomes more widely used and technology becomes more wearable (smartwatches), the idea of providing patient-centered care that is less intrusive, more detailed, and customizable is a real possibility.
Affect as it relates to pain intensity is an area of research that can greatly benefit from the use of self reporting via EMA. Both psychopathology and pain research heavily rely on static retrospective self reporting that can sometimes be inaccurate and fail to capture the hourly and daily fluctuations within an individual’s life. In the last 20 years there have been studies that examined the relationship between affect and pain intensity via EMA. However, little to none have attempted to attain EMA via the latest available wearable technology and software. This study will aim to capture a detailed picture of the within-person relationship between affect and pain intensity with EMA (three times daily) via use of a novel smart watch application and server called ROAMM (Real-time Online Assessment and Mobility Monitor).