2023-24 AHPRC RESEARCH PILOT AWARDEES

PI: Dr. Allison Hyngstrom, Chair and Associate Professor of Physical Therapy; 

Co-PI: Dr. Matthew Durand, Assistant Professor of Physical Medicine and Rehabilitation, Medical College of Wisconsin

Award Year: 2018-2019

Abstract: After stroke, the nervous system cannot fully activate the affected musculature which leads to force generating deficits and changes in the vascular response to exercise. These impairments contribute to increased muscle fatigability (the acute, exercise induced reaction in force) post stroke which limits task endurance for activities such as walking. The purpose of this study is to examine if a non-invasive intervention, called ischemic conditioning (IC), can improve muscle fatigability through increased neural activation of the paretic leg musculature and the peripheral vascular response to exercise. Briefly, IC is a non-invasive stimulus which is triggered by using a blood pressure cuff to briefly occlude blood flow to the tissue of interest (the paretic leg), making the tissue transiently ischemic. In healthy individuals, the IC stimulus is known to increase the excitability of motor systems and improve arterial endothelial cell function and local regulation of blood flow, but the effects of IC in individuals with stroke are unknown. In 15 individuals with chronic stroke, we will measure sub-maximal knee extension contraction task duration at baseline and in response to a single session of IC or IC Sham. Interpretive measures of knee extensor strength, muscle activation, the regulation of peripheral blood flow to the knee extensors, and popliteal artery endothelial function will also be made. Compared to baseline and IC Sham measurements, we anticipate that IC will improve neuromuscular fatigability (increased task duration) and will be accompanied by increased strength, magnitude of muscle activation, and peripheral blood flow and endothelial function. Our interdisciplinary and interinstitutional team will be the first to quantify the effects of IC, a non-invasive, cost-effective intervention, on motor and vascular function in chronic stroke. Future studies conducted at the AHPRC will investigate the neural and humoral mechanisms of IC and the efficacy of IC compared with other walking adjuncts. 

PI: Dr. Kathleen Lukaszewicz, Clinical Assistant Professor of Physical Therapy 

Co-PI: Dr. Jonathon Senefeld, Postdoctoral Research Associate, Exercise Science, Physical Therapy

Award Year: 2018-2019

Abstract: Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by hyperglycemia with an increasing prevalence worldwide. Exercise is the cornerstone of management of T2D and is most efficacious if applied during the prediabetes stage when glycemia is elevated below the diabetic threshold. Adherence to exercise training is commonly limited in clinical populations due to excessive fatigability during exercise. Our laboratory demonstrated that across the diabetic spectrum, from prediabetes to T2D, people with this disease have greater fatigability of lower limb muscles than controls. In a study of only people with T2D, greater exercise fatigability was associated with reduced blood flow to the exercising muscle. Thus, our working hypothesis is that vascular dysfunction limits blood flow delivery during exercise causing greater fatigability in both people with T2D and in people in the earliest disease stage (i.e. prediabetes). Aim 1 will compare leg blood flow in response to a dynamic fatiguing task of the lower limb in people across the spectrum of the disease, including age and BMI-matched controls, people with prediabetes and diabetes. Aim 2 will assess vascular reactivity of small skeletal muscle arterioles extracted from human muscle biopsies to make a direct measurement of the ability of the blood vessel to respond to stimuli that would normally occur during exercise. This is a unique technique only performed on human muscle tissue by one other laboratory worldwide with the current body of knowledge on blood flow mechanisms relying on indirect assessments in vivo. By using isolated human arterioles from skeletal muscle, we can chemically manipulate the tissue in ways not possible in vivo. These outcomes will provide necessary pilot data for a clinical trial that can be conducted in the AHPRC and will translate into the development of exercise programs specific to the needs of people with T2D and prediabetes. 

PI:  Dr. Robert A. Scheidt, Professor of Biomedical Engineering

Co-PI: Dr. Carolyn Smith, Clinical Assistant Professor of Physical Therapy 

Co-PI: Dr. Lee Ann Mrotek, Research Professor of Biomedical Engineering

Co-PI: Dr. James B. Hoelzle, Professor of Psychology

Award Year: 2018-2019

Abstract: Sport-related concussion (SRC) transiently degrades memory and attention, which can lead to persistent cognitive and sensorimotor performance deficits. Near-term objectives of our research are to: (1) understand how SRC impacts the neural mechanisms of sensorimotor memory and attention that enable skilled motor performance; (2) quantify how those mechanisms change over time; and (3) develop a quick, sideline test of SRC severity that cannot be intentionally falsified. Long-term, we seek to apply our results to optimize SRC recovery on an individual-by-individual basis by applying physical and mental exercise as medicine. 

This project will achieve three objectives addressing the AHPRC's special emphasis on concussion research while fostering a new collaboration between Biomedical Engineering's Neuromotor Control Laboratory, Psychology's Neuropsychology and Personality Laboratory and MU Athletics. Objective 1 establishes partnership with MU Athletics to evaluate the sensorimotor and cognitive performance of concussed student-athletes using procedures based on those established by our prior work. This partnership will be built on respect for the student-athletes, their time, and their academic and athletic obligations. Objective 2 will enhance the sensitivity and efficiency of our procedures by integrating a novel and cognitively-challenging movement task that also permits streamlining of data collection. Objective 3 will establish the validity of the sensorimotor concussion testing by verifying our assertion that our novel test of SRC severity cannot be intentionally falsified. This work is timely and necessary  because current sideline and clinical assessments of SRC lack sensitivity and validity. 

The proposed work is important because it fills a knowledge gap related to how sensorimotor memory and attention recover in the days immediately following SRC. It is also important because we will test the extent to which baseline results of our novel assessment of concussion severity can be intentionally manipulated to mask SRC severity. 

PI: Dr. Kristof Kipp, Associate Professor of Exercise Science 

Co-PI: Dr. Janelle Cross, Assistant Professor of Orthopaedic Surgery, Medical College Of Wisconsin

Co-I: Dr. Iqbal Ahamed, Professor of Mathematics, Statistics, & Computer Science

Co-I: Dr. Gary Krenz, Professor of Mathematics, Statistics, & Computer Science

Co-I: Dr. Dong Hye Ye, Assistant Professor of Electrical and Computer Engineering

Co-I: Dr. Yaguang Zhu, Assistant Professor of Communication Studies 

Award Year: 2018-2019

Abstract: Two major goals of sports training and competition are to optimize athlete performance and minimize risk of injury. The goals of this project are to leverage player-tracking and wearable technologies to 1) compare player-tracking data against biomechanical loads experienced by the body, 2) compare longitudinal player-tracking data against seasonal changes in objective and subjective measures of physical function, and 3) investigate different models used to evaluate longitudinal changes in player-tracking data and objective and subjective measures of physical function. The first goal of this project will answer whether trunk-mounted accelerometer data adequately reflects the impact loads borne by the lower extremity during a variety of movement tasks. The second goal of this project will help determine whether player-tracking data can be used to predict current and future knee joint function and pain in male and female athletes. The third goal will provide a distinct set of evidence-based guidelines that prescribe best practices for calculating and analyzing longitudinal player-tracking data for the purposes of optimizing competition performance and minimizing risk of injury.

PI: Dr. Rachel Bollaert, Clinical Assistant Professor of Physical Therapy

PI: Dr. Praveen Madiraju, Associate Professor of Computer Science

Co-PI: Dr. Zeno Franco, Associate Professor of Family and Community Medicine, Medical College of Wisconsin

Co-PI: Dr. Iqbal Ahamed, Chair and Professor of Computer Science

Co-PI: Dr. Katinka Hooyer, Assistant Professor of Family and Community Medicine, Medical College of Wisconsin

Award Year: 2019-2020

Abstract: The US Department of Veterans Affairs indicates that around 12% to 30% of veterans have post-traumatic stress disorder (PTSD) resulting from combat trauma. A PTSD diagnosis increases the propensity to engage in high-risk behaviors, including alcohol/substance abuse, increased rates of health-care utilization, and higher rates of diabetes, obesity, and metabolic syndrome. A well-established body of research suggests that regular exercise will improve PTSD symptoms. However, evidence specific for veterans with PTSD is limited, especially randomized controlled trials (RCTs) of exercise intervention studies that include both aerobic and resistance exercise modalities. Further, the existing studies have been limited to older veterans and have not assessed a full range of physiological variables, such as body composition, blood pressure, cardiorespiratory endurance, muscular strength, and physical activity. Hence, the goal of this study is to evaluate the feasibility and efficacy of a 10-week exercise intervention for veterans with PTSD by assessing a range of physiological and psychological variables. The study aims to:

1. Conduct a focus group with community-dwelling veterans to better understand overall wellness and physical activity goals and to establish relationships with the Milwaukee area veteran community.
2. Assess physiological (e.g., body composition, blood pressure, cardiorespiratory endurance, muscular strength, and physical activity) and psychological (e.g., mental health, cognition, quality of life, self-efficacy for exercise) variables in veterans with PTSD.
3. Evaluate the feasibility and efficacy of a 10-week aerobic and resistance exercise RCT in veterans with PTSD on physiological and psychological variables.

Dr. Jenya Iuzzini-Seigel, assistant professor of speech pathology and audiology 

Dr. Sam Nemanich, assistant professor of occupational therapy  

Michael Danduran, clinical associate professor of exercise science

Award Year: 2021-2022

Abstract: Communication and movement coordination problems affect up to ~10% of children. While rehabilitation therapies are often effective, they can be costly in time and money. Anything that can enhance treatment outcomes and efficiency will provide a benefit to the children and families coping with these immense challenges. As exercise has been shown to induce widespread physical and cognitive improvements, it may be just what is needed to optimize treatment outcomes in children. The current study represents the next step in our program of research to optimize treatment programs for children with communication and motor disorders. We will investigate the effects of a 6-week motor training intervention on physical and cognitive performance in a sample of school-aged children from the general population, assessing a greater breadth of sensitive and specific outcome measures than have been previously studied in connection with exercise in children. This work represents an essential step in establishing efficacy of this intervention and refining our protocol before testing it on children with communication and motor disorders who have minimal time to spare given their typically intense and frequent involvement in speech, occupational and physical therapy. Motor training exercise targets coordination, agility, and balance and is expected to induce positive neural change and growth in the brain’s cerebellum. Here we will monitor language, cognitive, and motor learning outcomes as these are most likely to improve with motor training exercise given their shared reliance on this part of the brain. If the cerebellum grows from our exercise program, we anticipate seeing growth in these specific learning domains as well. The Milwaukee Jewish Day School will serve as the study site. We will recruit 20 children aged 7-10 years. Using a cross-over design, participants will be randomized to an immediate or delayed exercise intervention group; the delayed intervention group will receive exercise training 6 weeks after the immediate group. Speech and motor outcomes will be assessed at baseline, 6, 12, and 18 weeks. We expect that this research will reveal benefits of this type of training in typically developing children, providing further support for different types of exercise programs in the schools. The preliminary results from this pilot work will also be used to develop a larger clinical intervention trial that tests the effects of exercise in children with specific speech, language, and motor developmental diagnoses. The long-term goal of this research is to develop optimally effective treatments to maximize outcomes and quality of life for the millions of children with communication and motor impairments and their families. 

Dr. Sarah Grace Dalton, assistant professor of speech pathology and audiology 

Dr. Allison Hyngstrom, department chair and professor of physical therapy   

Dr. Matthew Durand, associate professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin

Award Year: 2021-2022

Abstract: Aphasia is a language impairment that impacts over two million adults in the United States and leads to decreased quality of life and participation. Stroke is the most common cause of aphasia, and many adults with aphasia experience co-occurring impairments of cognition, sensation, motor, and/or vision. Ischemic conditioning is a vascular stimulus that is believed to engage the autonomic nervous system, effecting both cardiovascular and nervous systems. Thus, ischemic conditioning may allow researchers and clinicians to target multiple domains of impairment simultaneously, increasing the rate at which patients see improvement, and potentially increasing the overall recovery achieved. In this study, we will investigate the effects of one and six sessions of bilateral upper limb ischemic conditioning on language, cognitive, and motor functions in individuals with aphasia. IC sessions will be completed over the course of two weeks. We expect that motor changes will be observed following a single session of ischemic conditioning, and motor, language, and cognitive changes will be observed following six sessions. For individuals with aphasia, recovery is often slow and effortful but identifying intervention techniques that can improve recovery trajectories will have a positive impact on quality of life and participation in meaningful activities, while reducing the economic and societal impacts of aphasia. 

Dr. Lee Za Ong, assistant professor of counselor education and counseling psychology  

Dr. Karisse Callendar, assistant professor and online clinical mental health counseling coordinator for the Department of Counselor Education and Counseling Psychology

Award Year: 2021-2022

Abstract: This research project aims to evaluate the effectiveness of student-athletes’ peer support competency training and mindfulness technique and how it effects their peer support skills and mental health. Although peer support is widely utilized as a mental health promotion method on campuses, the appropriate competency training of peer educators remains inadequate. Peer educators continue to face challenges with the lack of understanding of the role of being a peer educator, the lack of knowledge in mental health resources, inadequate peer support skills, and burnout that leads to poor mental health. This is an interdisciplinary collaboration project between Athletics Department (AD) and Counselor Education and Counseling Psychology (CECP). In Marquette University, student athletes peer support is offered through the Athletic Department’s Student Health Allies & Peer Educators (SHAPE) program that operated by the student-athletes. This project will provide a peer support competency training to the SHAPE participants to improve their peer support skills while integrating mindfulness technique to promote their mental health. The competency and mindfulness training includes four 90-minutes sessions of peer support competency skills and mindfulness training, weekly check-in of SHAPE participants using an online tool called “SHAPE Cheq”, and program evaluations using assessment instruments and a focus group. The outcome will be measured quantitatively and qualitatively. The hypothesis is that the competency and mindfulness training will effectively improve the SHAPE participants’ peer support skills, mental health, and mindfulness. 

Dr. Sheila Schindler-Ivens, associate professor of physical therapy  

Dr. Brian Schmit, professor and Hammes Family Chair of the Joint Department of Biomedical Engineering 

Dr. Philip Voglewede, associate professor of mechanical engineering  

Dr. Kristof Kipp, associate professor of exercise science

Award Year: 2021-2022

Abstract: The goal of lower limb rehabilitation after stroke is recovery of independent, goal-directed locomotion. Few stroke survivors achieve this goal. Suboptimal recovery is due to the serious and intransigent nature of movement impairments caused by stroke and a scarcity of impactful therapies. Our lab has developed a novel exercise intervention called CUped (pronounced cupid, like the Roman god) to address barriers to recovery and improve stroke rehabilitation. CUped is so called because it compels use of the paretic limb during movements that resemble pedaling. It addresses 3 key impairments that limit recovery: reduced muscle output, inappropriate muscle timing, and abnormal interlimb coordination. CUped employs an adaptive, proportional controller (i.e., a motor under feedback control) to ensure that training is always performed at a challenge point helpful for motor learning. Exercise is done while sitting which offers a feasible approach to high volume, active, task specific practice that is imperative for recovery of lower limb movement. The purpose of the work described here is to determine the extent to which CUped fulfils its design specifications and improves lower limb function post-stroke. We will examine the extent to which CUped improves paretic muscle output and interlimb coordination, for whom, and under what conditions. We will also examine the effects of CUped on overground walking.

Toni Uhrich, clinical assistant professor of physical therapy in the College of Health Sciences and director of the Human Performance Assessment Core

Dr. Paula Papanek, professor of physical therapy in the College of Health Sciences and director of the exercise science degree program

Lauren Opielinski, research assistant of exercise science

Award Year: 2022-2023

Abstract: The Six Minute Walk Test (6MWT) is a standard test in clinical and research settings to assess aerobic fitness. It involves covering as much distance as possible in the allotted time by walking around a set of cones 30 meters apart (~100 ft in a long hallway). Increases in the distance indicate improved fitness or in a clinical setting a decreased distance would mean a worsening disease condition. The use of a long hallway can be a hindrance to this test. Using a standard treadmill to measure distance in 6 minutes has the disadvantage of forcing/constraining a specific pace. A non-motorized treadmill, in which the person freely chooses the pace and can speed up or slow down with ease, would overcome this disadvantage. The Curve (Woodway, Waukesha WI) is such a treadmill with the added advantage of keeping precise distance metrics. The purpose of this project is to compare the 6MWT distance on the Curve (a self-propelled treadmill) against the the overground traditional method around cones, providing validation for the use of the Curve and a regression equation to predict 6MWT distance if they are different. A secondary purpose is to assess the viability of middle-aged and older people’s comfort using a self-propelled treadmill. Using the procedures from the traditional 6MWT, 150 individuals (30 years or older) will perform two 6MWTs using the traditional method (around cones) and on the Curve treadmill with time in between to return to their resting heart rate and blood pressure. Order will be randomized. The primary outcome is distance in six minutes, although perception of effort and feelings about using the Curve treadmill will also be tracked. Distance in 6 minutes will be compared between two walking conditions for validity (regression equations). Conducting this comparison methodological research study to understand validity using the Curve would impact the fitness and clinical field to allow for more 6MWTs to be conducted in a variety of settings and avoid that hindrance of space that is an issue in clinics or fitness facilities. In addition, the Curve treadmill automatically tracks, thus reducing chance of error (in lap counting and measurement distance). Investigators within the AHPRC (or elsewhere) could use the equipment and regression equation when collecting data or in proposals for grant support.