New Directions: Combining health with research
Bill Tomich weighs in at UM’s New Directions Wellness Center. As physical therapy Associate Professor James Laskin walks him over to an unweighting system, he explains that the University photographer is going to be taking his photo. “Yeah, yeah, yeah,” Tomich says.
Laskin is conducting a study to determine the effects of unweighting people with disabilities as they walk on a treadmill. The harness, controlled through a pneumatic ram and a computerized “scale,” lifts the subjects slightly to simulate weight loss while they walk. The Pneumex system was purchased with a grant from the Christopher Reeve Foundation in 2004.
Tomich has a brain injury and has visited New Directions for several years. He usually exercises 30 minutes
on a treadmill, and Laskin says he’s seen real improvement in Tomich’s gait over the years.
Wellness program coordinator Molly Blair and Laskin fasten him into the machine’s harness, insert a snorkel-like mouthpiece and attach a nose clip. Analyzing the amount of oxygen Tomich consumes as he walks will allow them to quantify his caloric expenditure.
Tomich walks for five minutes at his usual 2.5-mile-per-hour pace to get his heart rate into a steady state, then gets a 5-minute break. Blair says, “His heart rate is incredible – 125.
They unweight him by 5 percent, then 10 percent, with a break in between. Each time his heart rate and oxygen consumption decrease. After the third 5-minute set, Blair says, “Awesome, Bill. Want to sit and rest for a minute?”
“Yeah, yeah, yeah,” he answers. They take 15 percent off – about 45 pounds. “You guys are goofballs,” Tomich says before they re-insert the oxygen collection apparatus. He resumes his pace. His heart rate continues to fall over the course of the tests.
Finally, Tomich is done. They remove the mouthpiece, nose clip and harness. “You’re a rock star, Bill,” Blair says.
Later Laskin explains the test’s purpose is to determine how unweighting affects energy expenditure and heart rate. Results are similar to those of a test completed on people without disabilities.
Previously he found that there was a significant decrease in heart rate and oxygen consumption between full weight-bearing and 5 percent and 10 percent unweighted, as well as a difference between 10 percent and 15 percent unweighted. Laskin has found that able-bodied adults need to exercise another minute for every 10 minutes at 5 percent unweighted to burn as many calories as they do walking with their full weight.
Like the general population, many people with disabilities would benefit from weight loss. When they use the unweighting system, they often can exercise longer without fatigue or pain. There also is a decreased risk of falling.
“I need to know what the consequences of energy expenditure are when we unweight them so I can prescribe effectively,” Laskin says.
Besides its use in research, Laskin and other physical therapists use the unweighting system to help people walk more efficiently. They are able to analyze clients’ gait disturbances and help them normalize gait patterns, as well as work on balance.
Laskin plans to do another study after this one that will involve disability-specific control groups walking on the treadmill and experimental groups performing the same program while unweighted. He will monitor improvements in exercise tolerance and changes in fitness levels over a 12-week period to quantify any benefits the unweighted group experiences.
The current study is one of five Laskin is conducting. He came to UM in 1998 and has built the New Directions program from the ground up. It started as a demonstration project of the Rural Institute on Disabilities, with an original mission to increase the health and fitness of people living with a disability
or chronic pain.
In the early years Laskin became aware of secondary conditions many people with disabilities face, such as depression, isolation, poor nutrition and lack of exercise. He and others developed the Living Well with a Disability health promotion curriculum as a response.
Today New Directions is a cross-disciplinary hotbed, involving students and interns studying physical therapy, education, business, human biology, psychology, social work, health promotion and nursing. Nursing students from tribal colleges have interned at the center. New Directions also serves about 130 people from the Missoula area. Clients are evaluated by a physical therapist and then helped to establish an exercise routine on one or several of the sleek machines at the center, many of them obtained through grants and donations. They pay a monthly sliding fee based on income, with the average monthly fee at $14.
In urban areas, people like Laskin researching health and fitness for individuals with disabilities are able to attract a large number of people with a particular disability or a disease-specific problem for a research study. Things are different in rural areas. Laskin uses research, teaching and service to the community in a “cross-disability” approach. It has made New Directions a model program for hospitals and physical therapy practices in rural areas.
The Courage Center in Minneapolis is modeled on New Directions, and the Lake Shore Foundation in Birmingham, Ala. – a leader in urban-area care – partners with New Directions in developing several research and training programs.
Today, Jerome Longpre is getting fitted with an array of straps and metabolic data collection gear – a heart rate monitor, accelerometers on his hips, both ankles and wrists – and a mask to collect his expired breath.
In this study Laskin hopes to learn which accelerometers on which ankles, wrists or hips are reliable predictors of physical activity. The “gold standard” for this type of work is oxygen consumption, which will be used to compare how well accelerometer monitoring works with people with locomotor disabilities. Laskin uses the Actical™ – a powerful accelerometer that monitors and quantifies rates and intensity of activity for up to 60 days.
Actical monitoring on able-bodied people is being used to determine how sedentary or active a person is and what sorts of activities might be useful to increase physical health and conditioning.
Laskin’s pilot study will provide baseline data for how an accelerometer could be used to monitor the activities of people with disabilities.
By learning which location on the body provides consistent data, Laskin will be able to compare and predict energy expenditure in different activities. His previous work has shown that the able-bodied equations to predict energy expenditure are not appropriate for people with disabilities. He hopes eventually to write new equations for people with disabilities. “The end goal is to use the Actical as a tool to motivate and assess behavior change,” Laskin says.
Working with Dan Heil, associate professor of health and human development at Montana State University, and Curtis Noonan, associate professor in UM’s Center for Environmental Health Sciences, Laskin plans to publish a paper on this pilot study.
The research involves five activities – lying down (to determine baseline physical parameters), standing, vacuuming a carpet, a leisurely 6-minute walk and a brisk 6-minute walk.
Longpre, who had a stroke a few years ago, gamely completes the cycle of activities. This is his third and last trip to the wellness center for this study. Each of the 20 participants will do the cycle three times, Noonan will crunch the data gathered by Laskin and Heil, and they will have a baseline study.
Laskin removes the mask and monitoring gear from Longpre, who looks a little relieved. “Now it’s time for your physical therapy,” Laskin says. Longpre isn’t quite ready to get up. He notes his day began with a swim class at the pool at Missoula’s Community Medical Center. He enjoys the class because they keep the pool warm “and everyone’s as much a geek as I am,” he says. He moved to Missoula last year because he wanted to have better access to places like New Directions.
Soon he’s up and heading for physical therapy. Asked what he thinks of being a research subject, he says, “If he can use me, why not?”
— By Joan Melcher
Grant funds high-tech therapy bike
A new $18,000 grant from the Christopher Reeve Foundation to UM’s School of Physical Therapy and Rehabilitation Science allows wheelchair users with poor or no sensation in their legs to ride a stationary reclining bicycle.
With the grant the school purchased an Ergys 2, the same bike model that Reeve rode in his rehabilitation. The bike provides functional electrical stimulation to muscles disconnected from the brain through spinal cord injuries. The stimulation moves muscles in the leg to pedal the bike.
James Laskin, director of New Directions, says the system uses electrical current delivered by electrodes attached to three main muscle groups on each leg. The electrodes are connected to a sophisticated computer that gives direction to the muscles much like a brain would in a person without an injury.
“Just because the spinal cord has been damaged and there is a disconnection between your muscle and your brain, there’s still a connection between the muscle and the spinal cord,” Laskin says.
He says the bike is a great way for patients with spinal cord injuries, multiple sclerosis, spinal meningitis, stroke or brain injuries to keep up on their lower-body exercise and receive the basic benefits of exercise, such as lower blood pressure and heart rate and control of blood sugar.
The bike is being used for research and to teach physical therapy students.
Laskin says he has been offered a research contract from the maker of the bike, Therapeutic Alliances Inc.
— By Joan Melcher
Bill Tomich uses an unweighting system while being monitored by UM physical therapy Associate Professor James Laskin and a student.
|Laskin points out data on the Ergys 2 computer screen to Mark Cash, who regularly does an hour-long ride on the bike.