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From research to reality


Table of Contents

From research to reality

ICARE means “Now you can”

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Head tracking: Connecting to the world

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Safe laser unlocks communication

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First Hope: Promoting independence 24/7

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Maximizing outcomes while minimizing injuries

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Student involvement energizes Institute

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Advancing critical research

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Clinical research collaborators

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adonna Rehabilitation Hospital is a pioneer of rehabilitation care and research. Since 1958, Madonna has pushed the boundaries of expectations, helping people overcome disabling illness and injury to achieve a level of independence they — or their doctors — may have thought impossible. Instead of waiting for the next breakthrough in rehabilitation, Madonna developed the Institute for Rehabilitation Science and Engineering to make it happen. Under the leadership of Judith M. Burnfield, PhD, PT, the Institute team collaborates across academic fields and industries to create solutions and possibilities for those with stroke, traumatic brain injury, spinal cord injury, amyotrophic lateral sclerosis (Lou Gehrig’s Disease), diabetes or Guillain Barré, among other disabling conditions. Through research-driven studies and applied technology, the Institute is helping individuals achieve greater independence, a better quality of life and a longer life expectancy. The Institute embodies a culture of hope and a passionate commitment to lifelong learning. Top students from across the country are recruited to develop their academic potential and pursue answers to rehabilitation challenges under the mentorship of Dr. Burnfield and other leading researchers. This nurturing environment, engaging persons of all abilities, serves as a catalyst for change in thought and practice at the national level. The Institute selects the most promising students from universities across the country to advance their intellectual growth and hone their research skills by working closely with lead researchers in the Institute’s three Centers of Excellence. Many of these students have earned prestigious scholarships, graduate assistantships and awards after their Madonna internships. Research in the Institute bridges health, academic, business, governmental and disability communities to foster collaborations that produce innovative and measurable results. Institute researchers contribute their expertise through authoring books,


papers, articles and posters. Institute personnel are soughtafter presenters at national and international conferences, building relationships and sharing knowledge around the globe. The Institute is a living lab, meaning patients may serve as volunteer subjects, guiding the direction of project development. This is where research transforms into reality. Inspiration is abundant at Madonna. It’s in the joy shared as a young child relearns to say “I love you, Mom,” or in the first steps taken by a man who was bedridden following a stroke. Every patient is a person with hopes and dreams and value to contribute. Madonna’s Institute team is devoted to turning those hopes and dreams into reality.

The Madonna Model An integrative focus guiding treatment and research Team Performance Clinical Decision Support

Patient/Family Engagement

Program Evaluation

The Institute for Rehabilitation Science and Engineering includes three core research Centers of Excellence: • Movement and Neurosciences: Conducts biomechanical, physiological and neurocognitive research to enhance the independence and quality of life of persons with and without disabilities by improving their ability to move, walk and exercise. Research in the Movement and Neurosciences Center is facilitated by a state-of-the-art Gait and Motion Analysis Lab, including 12 Oqus digital infrared cameras, four force platforms, a 16-channel surface electromyography system, a computerized pressure-mapping system for the feet, a metabolic cart for assessing movement efficiency and a Biodex system for quantifying strength. • Communication: Develops and improves technology and treatment strategies to benefit individuals with complex communication disorders. The Communication Center research specializes in assistive technology, augmentative and alternative communication, telehealth and motor speech disorders. • Clinical Informatics: Advances rehabilitation science and practice by developing innovative applications of information technology to enhance rehabilitation processes and outcomes.

Therapeutics

Participation

Technology Living Setting

©2007 Madonna Rehabilitation Hospital

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ICARE means “Now you can”

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alking and staying physically fit are important goals for individuals with weakness, numbness, balance problems and/or those recovering from a disabling injury or illness. Yet these conditions make it difficult for people to easily access and use fitness equipment in the community. Fitness equipment is generally made for a healthy, athletic population and fitness center trainers rarely have the expertise to help those with physical limitations. High tech resources often used during medical rehabilitation, such as robotic gait retraining devices and functional electrical stimulation bicycles, are seldom available

in the community. This prevents many individuals from benefiting from continued cardiovascular fitness and walking practice after formal rehabilitation ends. The lack of usable and accessible equipment is unfortunate because exercise helps to prevent or delay the onset of other chronic conditions, such as diabetes or metabolic syndrome. Physical activity is as good for the mind and spirit as it is for the body, helping prevent further declines associated with an inactive lifestyle. Dr. Burnfield, Institute director, led a group of researchers in Madonna’s Movement and Neurosciences Center of Excellence, as well as colleagues from University of Nebraska–Lincoln and Creighton University, to address the need for an inexpensive and accessible tool to help individuals with physical disabilities improve walking and cardiovascular fitness. With funding from a $600,000 grant awarded by the National Institute on Disability and Rehabilitation Research, the team designed the Intelligently Controlled Assistive Rehabilitation Elliptical (ICARE) trainer and therapeutic program.

The ICARE design, based on ergonomic and biomechanical analyses of 130 individuals with and without disabilities, includes an automatically controlled motor to assist leg movements, a bench, stairs, pedal adaptations, grab bars and integrated body weight support system. This system is a tremendous advance over standard ellipticals, since it is easily accessible and provides customized assistance for clients with weakness, joint pain or movement limitations. The ICARE is currently being used in Madonna’s inpatient and outpatient settings, as well as at ProActive, the hospital’s medically based health and fitness facility. The goal is to commercially produce and market ICAREs, resulting in expanded opportunities to enhance walking and fitness for people of all abilities at a reasonable price. “The ICARE is the first innovation ever developed that promises to be an affordable method of making cardiovascular exercise available to people with disabilities in a community setting,” said Marsha Lommel, president and CEO of Madonna.

(Back, L to R) Peter Yu Shu, PhD, Adam Taylor (Front, L to R) Thad Buster and Judith Burnfield, PhD, PT


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Head tracking: Connecting to the world

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esearchers in the Communication Center of Excellence are developing and evaluating more effective methods of head tracking for patients who cannot use their hands to control computers and other communication devices. Head tracking systems use infrared cameras that can read reflective markers placed on the user’s forehead. The markers enable the system to track where the user’s head is moving and translate that movement into cursor control on a computer or communication device. Madonna patients with mobility limitations volunteered to field test the AccuPoint head tracker, developed by InvoTek, Inc. This collaborative project, funded by a Small Business Innovation Research (SBIR) grant through the National Institutes of Health (NIH), focused on developing this unique technology, which enables patients with even miniscule head movements to use a computer to communicate. Users can access all elements of the Internet, such as e-mail, social networking sites, computer games, blogs and support group forums. They can also use computer software to write letters, create photo slideshows, track their household finances and perform any other function that can be done with a mouse and keyboard. Susan Fager, PhD, assistant director of the Communication Center of Excellence, is a coinvestigator of another SBIR project, along 4

John Baker and Susan Fager, PhD, use the head tracker.

with Invotek, Inc., and the State University of New York—Buffalo, to further integrate head tracking with eye tracking technology. This unique technology will allow even the most severely injured patients at Madonna, and across the nation, to access computers so they can communicate and participate in the world around them. AccuPoint head tracker


Safe-laser keyboard unlocks communication

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imple and effective communication solutions are essential in medical and hospital settings, especially with patients whose communication ability has been severely limited by a traumatic brain injury, stroke or other neurological impairment. The Safe-laser keyboard provides an easyto-use device for patients, caregivers, staff, and family to support communication for those who are non-speaking. Developed by Invotek, Inc. through a Small Business Innovation Research (SBIR) grant, and field-tested and refined at Madonna, the Safelaser keyboard incorporates an eye-safe laser pointer that the user can attach to a headband or other body part, such as their arm or foot.

team focused on developing technology that was not only user-friendly, but also simple and reliable for caregivers and staff to setup and maintain. The research team examined the experiences of patients using this technology within Madonna and across the nation. The results validate the Safe-laser keyboard’s

effectiveness for a variety of people with different diagnoses. Young children and adults with brain injuries were easily able to move the laser light to communicate through the keyboard. It can be used by those very early in recovery and by individuals who just need a simplified solution for communication in critical care/medical settings, such as the acute care hospital or long-term nursing care.

Left: Susan Fager, PhD Right: Safe laser technology is easy to operate, even for a child, yet offers sophisticated options to enhance adult environments.

The user points at a tablet keyboard to spell and access full messages, such as “I am feeling good today,” or may point to objects in their environment to indicate their wishes, such as pointing to a shaded window to request having the shade pulled up. This collaborative project succeeded with the expertise of Dr. Fager, David Beukelman, PhD, senior researcher of the Communication Center of Excellence, and Tom Jakobs, president of Invotek, Inc. The

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First Hope: Promoting independence 24/7

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magine a world where you can’t move a muscle, or you can’t speak a word and the only way you can communicate is by blinking your eyes. That is too often the reality for persons recovering from catastrophic injury or illness. Now imagine a world where despite those severe disabilities, you can control the temperature in your room, answer the phone or access the Internet. This soon will be the reality for these same patients thanks to new ground-breaking research and development activities at Madonna. Madonna’s First Hope Initiative will radically advance care that individuals receive beginning with their very first days in rehabilitation. According to Institute Director Dr. Judith Burnfield, the ultimate goal of the First Hope Initiative is to seamlessly integrate technology across the rehabilitation environment to break down barriers in communication, environmental control and independence frequently experienced by adults and children with severe physical disabilities caused by spinal cord injury, stroke or traumatic brain injury. The research team is collaborating with clinicians, patients, academic colleagues and private industry to develop affordable technology packages that maximize

individuals’ ability to control their environment (lights, TV, phone, windows, bed, etc.), communicate their needs and engage in therapeutically meaningful activities 24 hours a day, seven days a week from the first day of inpatient rehabilitation. The team’s goals are to help individuals see how much they can do from day one of rehabilitation and ensure that affordable options are available to help smooth the transition back into their homes. “It is common for patients recovering from a catastrophic illness or injury to feel isolated and depressed as they face new limitations. The greater independence offered by the First Hope Initiative will enable patients and their families to focus more fully on rehabilitation, and in turn, maximize progress and outcomes during this critical recovery period,” Dr. Burnfield said. The First Hope Initiative was funded through the FY 2010 appropriations process as one of U.S. Sen. Ben Nelson’s priority projects. The research team expects that the First Hope Initiative will serve as a national model that can be used by other rehabilitation facilities around the country. “It is our vision that control, independence and quality of life will no longer be the end goals of a successful rehabilitation program,

“The First Hope Initiative will inspire a belief that the life that has just been saved by medical advances is also a life well worth living.” 6

Above: Steve Kiene and his team from Nebraska Global collaborated with the Institute to develop a prototype computer-based therapeutic exercise module. Right: Judith Burnfield, PhD, PT, director of Madonna’s Institute, shows guests the First Hope Initiative room where patients can control their environment with minimal movement and engage in computer-based therapeutic activities 24/7.

but instead, the starting point as individuals enter their hospital room for the first time,” Dr. Burnfield said. “By eliminating unnecessary barriers to independence, the First Hope Initiative will inspire a belief that the life that has just been saved by medical advances is also a life well worth living.”


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Maximizing outcomes while minimizing injury

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elping patients relearn to stand and walk represents some of the most essential responsibilities of physical therapists and therapy assistants in the rehabilitation setting. Yet, the day-to-day workload associated with sit-to-stand transfers and gait training can place rehabilitation clinicians at risk for injury.

On average the therapist advanced the limb 25 times per minute at the slowest speed and almost 50 times per minute at the fastest speed. In the case of a 200-pound patient, that is equivalent to repeatedly lifting a 35-pound object 500 to 1,000 times per session.

Madonna research indicated situations where the therapist was working at 100 percent of his or Studies reveal that physical her muscle’s capacity during the therapists report a significant majority of the patient’s walking number of work-related cycle. This measure helps explain musculoskeletal disorders. One year the results of a Madonna survey incidence rates exceed 20 percent. in which 75 percent of therapists Prevalence rates over a lifetime reported that they stopped a range from 55 to 91 percent. treadmill training session Although the low back is “Madonna is the first to quantify the muscular effort exerted due to their own fatigue most frequently impacted, clinicians also experience by clinicians as they repeatedly move the hemiparetic limb.” and/or pain rather than the patient’s need to rest. injuries in the upper back, According to Dr. Burnfield, despite numerous neck, wrist and hand. studies highlighting the beneficial impact Understanding the amount of muscle of this intervention on patient outcomes, stress caused by this type of therapeutic One of the most demanding therapies for “Madonna is the first to quantify the rehabilitation is the first step in developing a clinician to deliver is partial body weight muscular effort exerted by clinicians as they alternative methods of clinical practice for support treadmill training (PBWSTT). This repeatedly move the hemiparetic limb.” the PBWSTT. therapy is an option for patients working to regain walking ability. During this therapy, a In a study funded in part by the Dana and Dr. Burnfield plans future work focused patient using a treadmill is supported by an Christopher Reeve Foundation, Madonna on trunk and shoulder muscles of overhead harness. Physical therapists often researchers assessed the demands clinicians. “It is imperative to enhance our manually lift, advance and stabilize the experienced in the elbow flexors of a understanding of unique demands placed on weakened leg during each stride, which can single clinician delivering PBWSTT. The rehabilitation physical therapists and how mean lifting up to 30 pounds, hundreds of therapist was exposed to repetitive forces clinical outcomes can be maximized while times per session. during assisted lower limb advancement. minimizing injury,” Dr. Burnfield said.

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Student involvement energizes Institute

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ne of the most distinctive experiences available to students is the opportunity to participate in an integrated clinical and research project with Madonna’s Institute for Rehabilitation Science and Engineering. Groundbreaking technology, combined with a strong research and clinical team, form the backbone of our three centers of excellence. The Research Institute has pioneered clinical affiliations and research internships with top universities. Students from leading programs across the country are involved in unique, 16-week hybrid rotations that include a split between inpatient rehabilitation and clinical research. Dr. Burnfield serves as a mentor for these students and helps them to appreciate both the art and science of their profession.

Housing Madonna Rehabilitation Hospital is pleased to offer student housing at a discounted rate. The unit is located on Madonna’s campus less than one block from the main hospital building. It features five bedrooms, three baths, a full kitchen, dining room, living room, recreation and study space, free laundry and free off-street parking. The unit is fully furnished. All utilities, including Wi-Fi, are included in the affordable monthly rate.

Interviews Interviews are required for students who are interested in applying for a rotation. Madonna makes final decisions regarding student placement with emphasis on those students expressing goals and objectives similar to our core values and expertise. If you are a student interested in completing a rotation at our facility, please check with your school first to verify that there is an established contract.

“My experience at Madonna has allowed me to learn from professional researchers and utilize state-of-the-art equipment. I love being able to see how my research impacts the people who need it.” — Derek Shafer, Student Biological Systems Engineering University of Nebraska—Lincoln

For more information contact: Judith M. Burnfield, PhD, PT

Director, Institute for Rehabilitation Science and Engineering Director, Movement and Neurosciences Center Clifton Chair in Physical Therapy and Movement Science Institute for Rehabilitation Science and Engineering 10

Phone: 402.483.9669 FAX: 402.486.8629 E-mail: jburnfield@madonna.org Web: www.madonna.org/research_institute


The Institute for Rehabilitation Science and Engineering Student Interns

Institute Team

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Advancing critical research at Madonna “The sky is the limit on who and how many would benefit from experiencing all that Madonna’s Research Institute has to offer within the clinical environment, as well as the real-world environment of being at home. You have every right to utilize ‘world-class’ in your Madonna vocabulary as it correctly describes the level at which we strive for and have attained.” — Daniel J. Tomes, MD Neurological and Spinal Surgeon

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he Institute for Rehabilitation Science and Engineering was established at Madonna in 2001 through the philanthropic support of visionary individuals, corporations and foundations. Research initiatives, endowed research positions, cutting-edge equipment and student stipends continue to be funded by gifts to the Madonna Foundation. Gifts support the research agendas of the Movement and Neurosciences Center of Excellence, the Communication Center of Excellence and the Clinical Informatics Center of Excellence. Additionally, the Madonna Foundation has recently established the “First Hope Equipment Fund.” Gifts to this fund provide adaptive equipment to patients as they discharge back to their home communities.

For more information contact: The Madonna Foundation

Phone: 402.483.9524 E-mail: foundation@madonna.org 12

There are many ways to help advance the critical research conducted at Madonna: • Learn more about the research through a personal tour of the Institute. • Invite friends and colleagues for a tour of the Institute. • Volunteer for a research study. • Make a gift in support of one of the Centers of Excellence or the First Hope Equipment Fund. • Provide scholarship funds for student researchers. • Contribute to a particular research project. • Endow a research position in the Institute. • Make a planned gift to ensure life-changing research initiatives for the future.


Clinical research collaborators Madonna clinicians contribute to rehabilitation education and research on a local to global scale. Sara Bills, PT, DPT, GCS Tricia Bruha RN, BSN, CRRN Lisa Butler, PT, DPT, GCS Michelle Claycomb, PT, MSPT Laura Corbridge, PT, NCS Michelle Crouse, MPT/ATP Amy Goldman, PT, DPT Mark Hakel, PhD, CCC-SLP Ricque Harth, M.Ed. CCC-SLP Sonya Irons, PT, DPT, CCS Adam T. Kafka, MD Jackie Krason RN, BSN, CRRN Brooke Murtaugh, OTD, OTR/L, CBIS Paul Nathenson, CRRN, HN-BC, MPA Amy Nordness, PhD, CCC-SLP

Kilee R. Oetjen, PT, DPT, CPST Paula Ray, PsyD Stacy Reichmuth OTR/L, C/NDT Roger Riss, PsyD, FACPN Kathy Schmidt, OTR/L *Bill Shuart, PhD Teresa Springer, MS CCC-SLP Lori Terryberry-Spohr, PhD, ABPP Linda Storz, OTR/L, CDRS Diane Ulmer, OTR/L Cheryl Wagoner, MS CCC-SLP Patricia Walker, DPT Rebecca Wills BA, LRCP-NPS Carrie Windhorst, MS CCC-SLP

*Chair, Madonna Rehabilitation Hospital Institutional Review Board


Scan this code with your smartphone to learn about technology at Madonna or visit http://bit.ly/madonnatechnology.

5401 South Street Lincoln, Nebraska 68506 402.483.9504 www.madonna.org/research_institute


Madonna Rehabilitation Hospital Institute Booklet