PRINCIPAL INVESTIGATOR

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

SZU-PING LEE, PhD, PT, a clinically trained physical therapist, plays a critical role as a rehabilitation researcher deeply embedded in the O&P community. An associate professor in the Department of Physical Therapy at the University of Nevada, Las Vegas (UNLV), he teaches several O&Pthemed courses to the doctor of physical therapy (DPT) students. He also is the local coordinator for the Las Vegas Amputee Support Group, affiliated with the Amputee Coalition.

Approximately 150 students are currently seeking DPT degrees at UNLV where Lee teaches the Prosthetics & Orthotics Lecture and Laboratory course. He also conducts amputee rehabilitation research in collaboration with local O&P clinics, rehabilitation hospitals, and the U.S. Department of Veterans Affairs Southern Nevada Healthcare System. Born and raised in Taiwan, Lee completed his undergraduate studies in physical therapy at the National Yang-Ming University in Taipei before moving to the United States at age 26. He earned his master’s degree in human performance and biomechanics from the University of Florida, followed by his doctorate in biokinesiology from University of Southern California, Los Angeles, in 2012.

“I am trained as a physical therapist and biomechanics researcher interested in human movement as related to rehabilitation,” Lee explains. He was introduced to O&P by a former professor, the late Edward Neumann, CP, who taught in UNLV’s Department of Civil and Environmental Engineering Department for years before becoming a certified prosthetist at age 55. “He made me realize that O&P has a lot of engineering and technical developments,” Lee explains, “so perhaps someone should also look at the human factor that is equally important in rehabilitation after amputation.”

Seeing the Patient Behind the Device Lee focuses his career on investigating the learning of motor skills after limb loss. “While I appreciate the advancements in prosthetic technology, it is important not to forget the human factor,” he says. “After all, a prosthetic device is a tool still controlled by a person to accomplish what he or she wants to do. Just like mastering any tool or skill, there is a learning process,” which may be complicated by factors such as

age, level of amputation, complexity of the device, psychosocial factors, and presence of other medical conditions. “If physical therapists and prosthetists can understand how best to facilitate learning,” says Lee, “it will definitely lead to faster recovery and better function.” Lee keeps the patients in mind as he investigates three different lines of O&P-related research. First, he studies orthopedic problems associated with limb loss—for example, knee pain and back pain. He has published several papers on this topic, including one studying patellar tendon morphology in transtibial amputees using a prosthesis with a patellar tendon-bearing feature. He found the results of this study to be especially intriguing. “People with below-the-knee amputations still have their knees, and these joints can still hurt,” he explains. “We showed that wearing a prosthesis that puts pressure around the knee can alter the structure of the knee tendon, when compared to nonamputees.” Second, Lee focuses on health disparities associated with limb loss. In this arena, he has studied how socioeconomic status affects access to physical therapy, capacity to perform physical activity, and fear of falling among the limb loss population. He is particularly proud of the work currently under review by Prosthetics & Orthotics International. In this study, his team showed that financial difficulty can negatively impact long-term high-level functioning after amputation. (“High-level functioning” means being a mother or going to work, not just something simple like moving one’s leg or walking, according to Lee.) He hopes that payors and health policy makers will consider these factors when determining reimbursement. Finally, Lee studies motor skill learning among limb loss patients. He is part of an ongoing five-year investigation, funded by the National Institutes of Health, assessing how limb loss and chronic diabetes affect learning of motor skills such as balance and fall arrest. “Hopefully we will have some interesting results soon,” he says. Szu-Ping Lee, PhD, PT, assists Bree, a Certified Peer Visitor who has hip disarticulation, in trying rock climbing.

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Much of Lee’s work is designed to improve the quality of life among older amputees. “Younger people or children always figure things out. It is much harder for someone who is older,” he explains. “However, 70 percent of amputations are due to diabetes or other vascular problems typically seen in older folks. I think the challenges that are unique to them should be studied.” Lee plans to dedicate his research career to focusing on this population. He is optimistic that his work will help highlight factors related to improving patient function, and that it will help justify specific care services or devices. He also is working on developing assessment tools for secondary conditions, such as back pain, that will one day be useful in early identification and treatment of low back pain in people with limb loss.

Lee expects to see more researchers studying the human aspect of rehabilitation in the coming years. He has noticed an uptick in studies related less directly to the prosthetic devices, and focusing more broadly on issues such as rehabilitation, health disparity, and secondary medical problems. Promoting Collaborative Healthcare Lee spends much of his instructional time at UNLV teaching students about the benefits of mutual understanding between healthcare fields such O&P and PT. “Our DPT students are training to become physical therapists. For them, the emphasis of my teaching is interdisciplinary collaboration and communication with O&P professionals. If they learn only one thing in my class, I hope that is how to effectively communicate with O&P professionals so we work together to help patients,” he says. The DPT students also have an opportunity to become involved in clinical research relating to amputees. Lee also works with PhD students. “They receive rigorous training in study design, biomechanical methods, and findings dissemination. Currently two of my PhD students and a postdoctoral scholar are doing very exciting research related to the limb loss population,” he says.

Beyond teaching responsibilities, Lee enjoys his community organizational role at the Las Vegas Amputee Support Group. “Seeing the people in the community gives meaning to my teaching and research. My friends often give me new research ideas,” he explains. In that capacity, he regularly plans and participates in workshops such as Amputee Coalition’s Certified Peer Visitor training and adaptive activities for limb loss patients. Lee himself enjoys hiking and rock climbing— endeavors he usually undertakes with his wife, who also is a physical therapist. “The area around Las Vegas is an amazing outdoor playground,” he says. Lee hopes to inspire more individuals in a variety of disciplines to more closely study rehabilitation among amputees—particularly older patients. Says Lee, “I think it is very exciting that so many good researchers are passionate about helping persons with limb loss.” Notable Works Szu-Ping Lee, PhD, PT, is the author or presenter of dozens of peer-reviewed articles and conference presentations. Some of his most impactful contributions include the following: • Ciccotelli, J., Damele, M., Gross, R., Robina, R., Lee S.P. “Lumbopelvic Muscle Performance and Cross-Sectional Area in Individuals With Unilateral Above-the-Knee Amputation: Implications for Low Back Pain.” Proceedings of the American Physical Therapy Association Combined Sections Meeting, Washington D.C., 2019. • Ho, K.Y., Evers, M., Kellogg, J., Teter, K., Lee, S.P., Chang, Y.J., Bashford, G. “Patellar Tendon Morphology in Transtibial Amputees Utilizing a Prosthesis with a Patellar-Tendon-Bearing Feature.” Nature Scientific Reports, 9(1): 1-7, 2019. • Lee, S.P., Chien, L.C., Chin, T., Fox, H., Gutierrez, J. “Financial Difficulty After Amputation Is Associated With Perceived Health and Well-Being in Community-Dwelling Persons With Lower Limb Loss.” Prosthetics & Orthotics International (in review). • Shih, H.T., Lee, S.P. “Effect of Age and Body Mass Index on Mobility in Middle to Older Age Adults With and Without Lower Limb Amputation.” Proceedings of Annual Meeting of American Society of Biomechanics, Rochester, MN, 2018. Lee, far left, during an Amputee Coalition Certified Peer Visitor training session in 2019

42 APRIL 2020 | O&P ALMANAC PHOTO: Szu-Ping Lee, PhD, PT

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