Aug 17, 2017, in General News
Five-year PCORI contract is largest single award in USC Chan Division history
More than half of America’s 1.4 million nursing home residents have Alzheimer’s disease or dementia. On any given day in any of the thousands of nursing homes across the country, medications need adjusting and activities require adapting as residents are monitored for changes.
But when compounded by disrupted routines, communication difficulties and under- or over-stimulating environments, these diseases can often result in disruptive behaviors like aggression and agitation. If left untreated, such behaviors can contribute to adverse events such as accidental falls, resident altercations and injuries to staff.
To manage these progressive, fluctuating and unpredictable symptoms, patients are often treated with antipsychotic medications, many of which have serious side effects including death. As a result, agencies including the Centers for Medicare and Medicaid Services are eager for ways of enhancing quality and safety with patient-first approaches that don’t depend on medications.
This is the unique challenge — managing disruptive behaviors while maximizing residents’ safety, abilities and quality of life — facing both families and care providers including physicians, nurses, psychologists, social workers, speech-language pathologists, physical therapists and occupational therapists.
“There are two predominant non-pharmacological approaches to nursing home services for residents with dementia — a multidisciplinary model whereby providers each approach their client’s needs from a discipline-specific lens, versus a more coordinated interdisciplinary team model where there is this shared language and plan of care,” said Natalie Leland, associate professor at the USC Chan Division of Occupational Science and Occupational Therapy. “We know that both models have been independently shown to yield benefits, we’re just not sure which is more effective and under what circumstances.”
At least, not yet.
Thanks to a new multimillion-dollar research award, Leland and a team of researchers including co-principal investigator Felicia Chew, vice president of clinical services at Genesis Rehab Services, will begin comparing the effectiveness of the two approaches with the hopes of demonstrating a difference between the two.
Leland’s $4.7 million study, entitled “Optimizing Care for Patients with Dementia: A Comparison of Two Non-Pharmacological Treatment Approaches,” will be funded by the Patient-Centered Outcomes Research Institute. PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. Results published by PCORI-sponsored studies often influence reimbursement and coverage decisions made by Medicare and other insurers.
During the five-year project, Leland, Chew and their team will randomly implement either the more parallel multidisciplinary approach or the more team-based interdisciplinary approach at 80 nursing home facilities located in 10 geographic regions across the United States. Collaborators will include additional researchers at USC, Thomas Jefferson University and the University of Pittsburgh, as well as a diverse advisory committee.
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
Leland, an occupational therapist and gerontology researcher who also holds a joint faculty appointment at the USC Davis School of Gerontology, will be looking at differences between the models with respect to the amount of off-label antipsychotic medications dispensed to residents as well as the numbers and frequencies of disruptive behaviors and the impact on fellow residents, staff and families.
“This is a key clinical dilemma facing nursing home staff trying to weigh the benefits and drawbacks of alternative non-pharmacological approaches to best caring for their residents,” Leland said. “Transforming the quality of dementia care in America’s nursing homes is fundamentally about improving quality of life for patients, their families and their advocates.”
Lifestyle treatment for chronic pain management improves quality of life, confidence and function
A new study from the USC Chan Division of Occupational Science and Occupational Therapy shows that lifestyle-based occupational therapy treatment significantly improves the experiences of people living with chronic pain.
“Having quantitative evidence for occupational therapy’s effectiveness in chronic pain management is really valuable,” said Ashley Uyeshiro Simon BA ’08, MA ’10, OTD ’11, the study’s lead author and an assistant clinical professor at the USC Chan Division.
Uyeshiro Simon and her colleague, associate clinical professor Chantelle Collins BS ’07, MA ’08, OTD ’09, analyzed data gathered from people who completed a round of outpatient Lifestyle Redesign at the USC Occupational Therapy Faculty Practice. Lifestyle Redesign is an individualized treatment process through which an occupational therapist and patient focus together on weekly topics such as physical activity, body mechanics and planning for pain flare-ups. Week by week, the therapist guides the patient through exploring a given problem, gaining motivation, identifying potential solutions and building healthy habits and daily routines.
The study, which was published in the latest issue of the American Journal of Occupational Therapy, found that the Lifestyle Redesign treatment significantly improved patients’ quality of life, confidence and functional abilities. The most common diagnoses in this study included lumbar back pain, complex regional pain syndrome and myalgia including fibromyalgia.
“These types of diagnoses are long-term, difficult to manage and can’t just be fixed quickly,” Uyeshiro Simon said. “It’s in these types of cases, where the physician scratches their head without an immediate solution, that our lifestyle-based intervention can really help.”
The study is believed to be the first of its kind to directly demonstrate quantitative positive effects of a lifestyle-based treatment model delivered exclusively by occupational therapists. Although occupational therapy literature has discussed issues surrounding chronic pain since the early 1980s, a 2011 review found little evidence for occupation-based practice in chronic pain and a heavy reliance on evidence developed in disciplines outside of occupational therapy.
Uyeshiro Simon sees the study as an important contribution to expanding the profession’s body of evidence and to supporting occupational therapy practitioners in a variety of healthcare settings.
“A lot of occupational therapists work in chronic pain without realizing it — you might not be labeling it ‘chronic pain’ but you are still treating a person’s pain from an occupational perspective.”
Outcomes research is also frequently used to support claims for reimbursement from third-party payers like insurance companies, and lifestyle-based treatments can be incorporated into treatment plans for patients with chronic pain even if that pain is secondary to their primary reason for referral to occupational therapy.
With more than 100 million Americans living in chronic pain — a statistic that is intimately tied to what the Centers for Disease Control and Prevention calls an ongoing “epidemic” of nationwide opioid medication overdoses — the study affirms the value of lifestyle-based treatments as part of a multidisciplinary care plan to successfully manage chronic pain.
“The annual costs of pain management, both from direct medical expenses and from lost workforce productivity, run in the hundreds of billions of dollars,” Uyeshiro Simon said. “We’ve shown that occupational therapy can ease that burden by helping to improve everyday function and quality of life, one patient at a time.”
Jun 21, 2017, in General News
By Miriam E. Tucker/Medscape
An occupational therapy intervention can help improve HbA1c and improve quality of life in young adults with diabetes, new research finds.
Results from the randomized, controlled Resilient, Empowered Active Living (REAL) diabetes study were presented June 11 here at the annual meeting of the American Diabetes Association (ADA) 2017 Scientific Sessions by Beth Pyatak, PhD, who is both an occupational therapist and a certified diabetes educator at the University of Southern California, Los Angeles.
Occupational therapists are generally thought of in a rehabilitative context, but “It’s an emerging practice area within the past 10 years or so to focus on chronic disease management,” Dr. Pyatak told Medscape Medical News, explaining that the main goal of occupational therapy (OT) is to help people accomplish their daily tasks, of which diabetes management involves many.
Jun 13, 2017, in General News
Assistant professor Sook-Lei Liew MA ’08, PhD ’12 is exploring new brain-computer interfaces that connect stroke survivors to the worlds of tech and medicine.
By Katharine Gammon
For people recovering from a stroke, even the simplest motions can become a struggle. To lift a hand, for example, requires a signal from the brain that travels all the way down an arm to the hand. That’s a lot of moving parts — and when something is damaged, it makes regaining those skills an arduous and slow process.
That could all change, though, with the help of some innovation and advances in virtual reality.
It was almost by chance that USC Chan researcher Sook-Lei Liew started thinking about virtual reality. She was a neuroscientist; so was her husband. When she became a USC faculty member in 2015, her husband got a job in the Mixed Reality Lab at the Institute for Creative Technologies — and, between the two, a brain trust was born between VR and stroke rehab.
For Liew, the light bulbs really started to flash when she attended the Neurotech conference — a big industry-academic partnership featuring the latest in tech advances. Liew had already been working on stroke rehab for awhile and worked on brain-feedback interfaces — devices that essentially allow patients to see what is going on inside their brains.
At the Neurotech conference, something clicked.
“There was a lot of tech, but not a lot of science behind it,” says Liew, who also has joint appointments with the USC Division of Biokinesiology and Physical Therapy and the Department of Neurology and the Mark and Mary Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine of USC.
Liew started to dig into VR research and found some fascinating studies about bodies inside a VR system. One study showed that if you give someone an avatar with long arms in the virtual world, they interact with the real world as if they had long arms. The effect even lasts for 10 or 15 minutes after a person removes the VR headset.
And another study showed if you give someone a child-like body in VR, that person starts to have more child-like features in the real world.
That made Liew wonder something that would change her work forever: “If you give someone a healthy body in VR, will that help them recover their health?”
She launched a project in January 2016, submitting a grant proposal to the American Heart Association and receiving $150,000 to explore the possibility of a VR brain-computer interface to treat stroke survivors. She and her partners (initially her husband but then other researchers) wanted to create something that was low-cost and portable. Her lab, the Neural Plasticity and Neurorehabilitation Laboratory, was home base for the work.
Most brain-computer interfaces used functional magnetic resistance imaging (fMRI), a huge and expensive technology that measures brain activity by detecting changes associated with blood flow. “The problem is that it’s really hard to get somewhere if you have a severe stroke,” Liew says. “Typically you can’t drive, and your mobility is impaired.” That made it all the more vital to get the device to people, rather than have people come to the tool.
The team built a prototype, using a laptop computer, an off-the-shelf VR rig, a $9 swim cap and an open-source brain-computer interface electroencephalogram (EEG) system. Liew used her mother’s sewing machine to connect the electrodes to the cap. The whole system costs less than $5,000. It’s called REINVENT: Rehabilitation Environment using the Integration of Neuromuscular-based Virtual Enhancements for Neural Training.
This is how it works: The system uses virtual reality as well as brain and muscle sensors to show arm and hand movement in the virtual world when the patient has used the correct brain and muscle signals even if the patient cannot move his or her arm or hand in the real world. Over time, they can train the damaged circuits to work again.
So far, the system has only been tested on healthy older adults, but, in the next six months, it will be tested on people recovering from a stroke.
Ryan Spicer, a programmer analyst on the project, pointed out that older adults are generally a population that isn’t thought of as VR adopters — but some of them were very interested. The initial results showed that the healthy older adults were happy to use VR. Spicer says that, in the future, the activities and art could be tailored to each person’s interests.
The team demonstrated the project at the South by Southwest festival earlier this year, and the experience was mind-bending for Liew. “Our booth was across the hall from NASA, and they had a Mars habitat. Whereas we had a system that was sewed together with my mom’s sewing machine,” she says, with a laugh.
Still, she says they received great feedback during the conference. Out of 38 VR demonstrations, REINVENT won a special prize: Special Jury Recognition for Innovative Use of Virtual Reality Technology in the Field of Health.
“Most of the demonstrated uses for VR are gaming or entertainment right now,” Liew points out. “But the future has got to include VR for healthcare too.”
Liew is certain to play a role in shaping the future, thanks to a new federally funded grant that she received in March. The $530,000 award from the NIH National Institute of Child Health and Human Development will fund Liew’s “Big Data Neuroimaging to Predict Motor Behavior After Stroke” study.
Liew and her team will apply advanced computing techniques to a very large database of brain images and behavioral information gathered from thousands of participants worldwide. The ultimate goal is to reveal neural and behavioral biomarkers hidden within the “big data” in order to better predict stroke recovery potential and to personalize rehab treatments. The four-year project will be funded through 2020.
Are people in the future going to be controlling houses and cars with their brains? Liew thinks it’s unlikely. “If you can use your hands, your brain has lots of experience telling your hand to manipulate things,” she says. “The area where VR is the most useful is where they allow us to do things we can’t otherwise do.” That could include, for example, immersive worlds to distract people while they’re getting chemo in the hospital. “It’s a way to take your body out of a situation,” Liew says.
David Krum, a computer scientist on the team, agrees.
“Everyone is excited about entertainment, but there are other uses for VR,” he says. “A lot of companies are more interested in monetizing games. Some of these other applications are a really important social good, but the economics of it are different.”
Liew sees VR as a true interdisciplinary venture: “It’s a blend of tech, industry, science and the clinic,” she says. “It really takes it to a whole new level.”
May 10, 2017, in General News
Alison Cogan MA ’12, PhD ’17 may be a civilian but she deeply appreciates the social and family life of military servicemembers.
Not only is her brother an active duty Marine, Cogan’s dissertation for the occupational science PhD degree she will receive this Friday during the 75th annual commencement ceremony of the USC Chan Division of Occupational Science and Occupational Therapy focused on ways to optimize participation of servicemembers after mild traumatic brain injury.
“I’ve seen how families are affected by the deployment cycle, and the reintegration and readjustment process that follows,” says Cogan, who hails from Philadelphia. These issues, of course, become more complex with brain and bodily injuries.
Cogan will soon begin a two-year Veterans Affairs Advanced Fellowship in Polytrauma/Traumatic Brain Injury at the Washington DC VA Medical Center. There she will hone her skills with using large research databases, building towards her goal of becoming a funded, independent career researcher. Thanks to USC Chan, she’s well on her way.
“USC has given me so many tangibles and intangibles,” Cogan says. “I have learned how to be productive in ways that really matter, from faculty members who know what it takes to be successful.”