Carolinas HealthCare System
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Physical Medicine and Rehabilitation

Research Summary

Carolinas Rehabilitation (CR) is one of the largest and busiest centers in the Southeast that provides comprehensive, multidisciplinary, treatment for patients with brain injury, stroke, spinal cord injury, other neurological disorders, cancer, amputation and musculoskeletal disorders through both inpatient care and outpatient clinics. The mission of our research is to promote clinical excellence, optimize outcomes, determine patient and family needs, and develop and improve treatments. We conduct research aimed at improving function and community participation, while increasing our knowledge of recovery and obstacles to recovery. Research is an integrated part of our clinical care and resident education.

Some of the key research programs include: The Carolinas Traumatic Brain Injury Model System, TBI Project STAR, TBI Practice-Based Evidence, SCI Rehab Outcome Project, Amantadine Minimally Conscious Project.

Traumatic Brain Injury Model System
The Traumatic Brain Injury (TBI) Model System Project at Carolinas Rehabilitation is one of 14 centers nationally funded through the Department of Education's National Institute on Disability Rehabilitation Research. The TBI Model System includes a national database and collaborations that allow us to learn about long-term outcomes and problems facing individuals with TBI. The project follows individuals with TBI from the time of injury for a lifetime in an effort to improve TBI care through research. More than 7,000 individuals have been enrolled and data that spans beyond 15 years post-injury has been collected. The TBI Model System also makes it possible for persons with TBI to participate in local research studies that are important and relevant to them. Research conducted through the TBI Model System project at CR have studied such important brain injury-related issues as: family needs; depression; venous thromboembolism; changes over time; substance abuse' outcome measurement; defining vocational rehabilitation treatments; gender differences; medical issues; predicting outcomes and quality of life; community services to assist families; personal digital assistant to increase function; post-acute therapy: cost, efficacy, and satisfaction; contracture management and outcomes for those who don't receive rehabilitation. A major focus of investigation has been on post-traumatic irritability. Post-traumatic irritability is a significant long-term problem in patients with TBI. Current investigations of irritability include two randomized, double-blind, controlled drug studies of carbamazepine and amantadine hydrochloride to ascertain whether these medications can reduce the frequency and severity of irritability and alleviate caregiver distress. CR is also studying irritability through a Participatory Action Research approach. This study actively involves individuals with TBI and their families in a rigorous effort to decipher the complex traits of irritability. It is expected that the findings from this study will lead to a better understanding of the triggers and progression of irritability in order to develop more effective treatment plans. The Carolinas TBI Model System Project is designed to provide education to our consumers with brain injury and local and national providers to improve care for individuals with brain injury.

Traumatic Brain Injury Project STAR
TBI Project STAR is a state-funded, community-based demonstration program that serves individuals affected by TBI by providing information about brain injury, linking to community resources and opportunities, offering educational training and community program development. The program works to facilitate involvement of individuals with TBI in their community, through referral programs and community program development. In this study, pertinent information from individuals and families affected by TBI and service providers is collected through focus groups and surveys. Brain injury-related issues studied include barriers to community participation, sports concussion awareness, community opportunities utilized, and use of state-funded services. Researchers analyze results from these to develop a better understanding of how state-provided services and community agency collaborations can meet the needs of individuals with TBI. 

TBI Practice-Based Evidence
TBI-Practice-Based Evidence is a study funded by the National Institutes of Health that aims to determine the components of inpatient rehabilitation that have the greatest impact on TBI outcomes. With this knowledge treatments may be developed, refined and tested, to result in improved outcomes following TBI. The participating sites are: Ohio Regional TBIMS at The Ohio State University, Carolinas Rehabilitation, Mount Sinai Medical Center, National Rehabilitation Hospital, Shepherd Center, LDS Hospital Rehabilitation Center, Rush University Medical Center, Brooks Rehabilitation Hospital, Loma Linda University Rehabilitation Institute, Montreal Rehabilitation Institute and Toronto Rehabilitation Institute.

SCI Rehab Outcome Project
A variety of rehabilitation treatments and treatment approaches exist that are aimed at improving the outcomes for individuals with spinal cord injury (SCI). However, it is not yet known which ones are most effective, or best for a particular outcome. To help provide the best possible rehabilitation after SCI, it is important that we examine how our services impact outcomes after discharge and use this information to maximize the quality and effectiveness of our programs. As part of our efforts to advance the field of rehabilitation, CR is participating in the SCI REHAB Study--a groundbreaking investigation that will examine the impact of inpatient rehabilitation on outcomes one year after traumatic SCI. This research is funded by the National Institute on Disability and Rehabilitation Research as a supplement to the Spinal Cord Injury Model System grant funding. The study has three primary goals:

  1. To identify relationships between individual characteristics of people with SCI (level or completeness of injury, age, health, etc.) and rehabilitation outcomes,
  2. To determine which medical and rehabilitative treatments/services produce the best outcomes,
  3. To examine how individual characteristics and treatments interact with one another to affect outcomes.

A total of six rehabilitation centers are participating in the study: Craig Hospital in Denver, CO, which serves and the lead center; Carolinas Rehabilitation in Charlotte; Mount Sinai Hospital in New York, NY; Rehabilitation Institute of Chicago; Shepherd Center in Atlanta; and National Rehabilitation Hospital in Washington, DC. 

Amantadine Minimally Conscious and Vegetative State Project
Funded by the National Institute on Disability Rehabilitation and Research, this project aims to determine the efficacy of amantadine hydrochloride at improving outcome from minimally conscious and vegetative states resulting from TBI. This is a randomized, controlled trial that takes place in the inpatient acute rehabilitation setting. The study's principal investigator is Joseph Giacino, PhD, at JFK Neuroscience Institute, and locally, at Carolinas Rehabilitation, the lead investigator is Flora Hammond, MD.

Contact Information

Carolinas Rehabilitation Research
Research Office: 704-355-1525
Dept PM&R: 704-355-9330; 704-355-0709 Fax
1100 Blythe Blvd.
Charlotte, NC 28203

Make a donation

You may make a tax-deductible contribution to the Rehabilitation Research and Education Fund. Donations may be mailed to:

Rehabilitation Research and Education Fund
c/o Carolinas HealthCare Foundation
P.O. Box 32861
Charlotte, NC 28232

For more information, call 704-355-4048 or visit Carolinas HealthCare Foundation.

Faculty Research Interests

William Bockenek, MD
PM&R Chair
Spinal Cord Injury & Primary Care Research

Dr. Bockenek is Medical Director of Carolinas Rehabilitation and Chair of the Department of Physical Medicine and Rehabilitation at Carolinas Medical Center. His area of research interests are in primary care for persons with disability, medical education, as well as, persons with spinal cord injury, including neurologic recovery, spasticity and pain management. He is involved nationally with the American Board of Physical Medicine and Rehabilitation, the American Paraplegia Society, and the American Academy of Physical Medicine and Rehabilitation.

Recent Publications

Harrington A, Blount P, Bockenek WL.Hetertopic Ossification. In: Clinical Physical Medicine:Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd Edition. Frontera W, Silver J, Rizzo T, eds. Elselvier Publishers. (in press)

Lavis T, Scelza W, Bockenek WL.Cardiovascular Health and Fitness in Persons with Spinal Cord Injury. In: Physical Medicine and Rehabilitation Clinics of North America. Goldstein B, Hammond M, eds.2007; 18; 2: 317-331.

Kirksey KM, Bockenek W.Neuropathic arthropathy. Am J Phys Med Rehabil 2006; 85: 862. [PMID: 16998436]

Jett PL, Bockenek W, Coumas J.  Solving a common shoulder problem. Am J Phys Med Rehabil 2005; 84: 648. [PMID: 16034236]

Bockenek WL, DeJong G, Lanig I, Friedland M,  Mann N. Primary Care for Persons with Disability. Physical Medicine and Rehabilitation: Principles and Practice. DeLisa JA, Gans BM, Walsh NA, eds. Lippincott Williams&Wilkins.  Philadelphia. 2004

Mark A. Hirsch, PhD
Motor Behavioral Neuroscientist

Dr. Hirsch is particularly interested in research on the effect of high intensity, task-related training on persons with Parkinson's disease (PD).  As a career goal, he works to build on prior research on the effect of high intensity resistance training and balance training on the cardinal signs and symptoms of PD and translate what is learned from these studies to community-based exercise programs. He plans to develop studies to assess the long-term effect of community-exercise program participation on neurodegeneration. To achieve this goal, Dr. Hirsch will collaborate with other researchers throughout the country and around the world with similar interests. In addition, Dr. Hirsch is also interested in extending his current research on the association between political participation and disability in persons with traumatic brain injury to other populations and especially on research studies that utilize community-based participatory paradigms. Further research interests are in biomechanics of postural control and gait, functional neuroimaging, motor recovery and objective assessment of a variety of physiological phenomena in the neuromuscular and musculoskeletal systems in pediatric, adult and geriatric populations.

Recent Publications

Hirsch MA, Hammond FM, Hirsch HVB. From research to practice: Rehabilitation for persons with Parkinson's disease. Topics in Geriatric Rehabilitation 2008; 24: 92-98. [Abstract]

Westhoff B, Petermann A, Hirsch MA, Krauspe R. Computerized gait analysis in Legg Calve Perthes disease-Analysis of the frontal plane. Gait Posture 2006; 24: 196-202. [PMID: 16226031] 

Lehman DA, Toole T, Lofald D, Hirsch MA.Training with verbal instructional cues results in near-term improvement of gait in people with Parkinson's disease. J Neurol Phys Ther 2005; 29: 2-8. [PMID: 16386155]

Hirsch MA, Westhoff B, Haupenthal S, Krauspe R, Hefter H.  Association of botulinum toxin injected into the arm on gait in adults with stroke. Mov Disord 2005; 20:1014-1020. [PMID: 15858801]

Hirsch MA, Toole T, Maitland CG, Rider R.  The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease.  Arch Phys Med Rehabil 2003; 84: 1109-1117. [PMID: 12917847] 

Current, Recent and Pending Grant Support

Grant Title: Voting Empowerment Study among Persons with TBI
Funding Agency:NIH (NICHHD, NIMH) (R21 HD055202-01)
Role: Principal Investigator
Years: 2007-2009

Grant Title: Post-TBI Irritability & Aggression: An Evidence-Based Approach to Management
Funding Agency:NIDRR (H133A070042)
Role: Co-investigator
Years: 2007-2012

Grant Title: Traumatic Brain Injury Model System
Funding Agency:NIDRR (H133A21943-16)
Role: Co-investigator
Years: 2002-2007

Maureen Nelson, MD
Pediatric Research

Maureen R Nelson, MD, received her medical degree from the University of Illinois, then did her internship and residency in Physical Medicine & Rehabilitation at the University of Texas Health Science Center at San Antonio and fellowship in Pediatric Rehabilitation at the Alfred I. DuPont Institute. Her expertise lies in the areas of brachial plexus palsy and pediatric electrodiagnosis. Her research interests include brachial plexus palsy, including use of electrical in treating it, and nutritional impact in children post-trauma.

Recent Publications

Murphy K, Pico E, Wunderlich C, Driscoll S, Moberg-Wolff E, Rak M, Nelson MR: Musculoskeletal Medicine. In: Alexander MA(Ed): Pediatric Rehabilitation: Principles & Practice, Hanley & Belfus, pending publication.

Nath RK, Shenaq SM, Laurent J, Lee R, Nelson M: Secondary Reconstruction in Obstetric Brachial Plexus Injuries. In: Midha R and Zager E(Eds): Master Cases in Neurosurgery: Peripheral Nerve Surgery, Thieme Medical Publishers, pending publication.

Nath RK, Shenaq SM, Laurent J, Lee R, Nelson M: Neurotization in Brachial Plexus Injury. In: Midha R and Zager E(Eds): Master Cases in Neurosurgery: Peripheral Nerve Surgery, Thieme Medical Publishers, pending publication.

Nelson MR: Birth Brachial Plexus Palsy.  In: Maria BL (Ed): Current Therapy in Child Neurology, 4th Edition, BC Decker, pending publication.

Sumich AI, Nelson MR, McDeavitt JT: Traumatic Brain Injury: A Pediatric Perspective. In: Zasler, Katz & Zafonte (Eds.): Brain Injury Medicine: Principles & Practice, Demos Medical Publishing, New York, New York, 2007.

Vu Nguyen, MD
Stroke Research

Dr. Nguyen has been a strong proponent of education and research throughout his career. His presentations and publications span two decades. His previous interests range from homelessness to brain injury prevention to post-stroke shoulder neuromodulation. Currently, his research is focused on botulinum toxin safety.


Vish Raj, MD
Physiatrist
Oncology Rehabilitation Research

Dr. Raj is director of the cancer rehabilitation program at Carolinas Rehabilitation. His primary areas of interest in research are related to functional outcomes in cancer patients, novel methods to approach cancer fatigue, and the treatment of neurological deficits in brain and spinal tumor patients. Dr. Raj completed his training at the Baylor College of Medicine, where he spent extensive time at the M.D. Anderson Center for Cancer Care. He also remains active in the cancer special interest group of the American Academy of Physical Medicine and Rehabilitation.

Recent Publications

Raj VS, Rintala DH. Perceived preparedness for physiatric specialization and future career goals of graduating postgraduate year IV residents during the 2004-2005 academic year. Am J Phys Med Rehabil 2007; 86: 1001-1006.  [PMID: 18090441]

William Scelza, MD
Spinal Cord Injury Research

Dr. Scelza completed his medical training at Case Western Reserve University in Cleveland. He then went on to complete his residency in Physical Medicine & Rehabilitation at the University of Michigan. Dr. Scelza has also completed a fellowship in Spinal Cord Injury Medicine at the Kessler Institute for Rehabilitation and holds board certification in Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine, and Electrodiagnostic Medicine. Dr. Scelza is the Director of the Spinal Cord Injury Rehabilitation program at Carolinas Rehabilitation. He is involved with a number of national organizations and has a number of publications in the field of Spinal Cord Injury. He has interests in research related to exercise, recreation, and sports as well as lifelong care of those with spinal cord injuries. These interests stem from personal experiences as Dr. Scelza himself has lived with a spinal cord injury since the age of 17.

Recent Publications

Scelza WM, Brammer CM. Back Pain in People with Disabilities. In Haig AJ and Colwell MO (eds): Back Pain. Philadelphia, PA: American College of Physicians Press (In Press).

Lavis TD, Scelza WM, Bockenek WL. Cardiovascular health and fitness in persons with spinal cord injury. Phys Med Rehabil Clin N Am 2007; 18: 317-331. [PMID: 17543775]

Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale. J Spinal Cord Med 2007; 30: 131-139. [PMID: 17591225]

Scelza WM, Kirshblum SC, Wuermser LA, Ho CH, Priebe MM, Chiodo AE. Spinal cord injury medicine. 4. Community reintegration after spinal cord injury. Arch Phys Med Rehabil 2007; 88: S71-S75. [PMID: 17321852]

Scelza WM, Kalpakjian CZ, Zemper ED, Tate DG. Perceived barriers to exercise in people with spinal cord injury.  Am J Phys Med Rehabil 2005; 84: 576-583. [PMID: 16034226]


Colleen A. Wunderlich, MD
Pediatric Research

Colleen A. Wunderlich, MD, MSc received her MD and MSc from the St. George's University School of Medicine, then did her internship in the Combined Internal Medicine and Pediatrics at Overlook Hospital in Summit, N.J. She completed her residency in Physical Medicine & Rehabilitation at the University of Minnesota and fellowship in Pediatric Rehabilitation at the Medical College of Virginia/Virginia Commonwealth University and Children's Hospital of Richmond. Her research interests include cerebral palsy, traumatic brain injury, Duchenne's Muscular Dystrophy and other neuromuscular diseases.

Recent Publications

Murphy K, Pico E, Wunderlich C, Driscoll S, Moberg-Wolff E, Rak M, Nelson MR: Musculoskeletal Medicine. In: Alexander MA(Ed): Pediatric Rehabilitation: Principles & Practice, Hanley & Belfus, pending publication.

Wunderlich CA, Pariseau C, Willis JH, Reddy M, Bodurtha J. The role of pediatric Physical Medicine and Rehabilitation in the national Leadership Education in Neurodevelopmental Disabilities (LEND) Program: the Virginia experience. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach 2007; 1: 37-45. [Abstract]

Wunderlich CA, Krach LE. Gram negative meningitis and infection in individuals treated with intrathecal baclofen for spasticity: a retrospective review. Dev Med Child Neurol 2006; 48: 450-455. [PMID: 16700935]

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