Recently Added Projects

Advancing Social-communication and Play (ASAP): An Intervention Program for Preschoolers with Autism
The primary aim of the Advancing Social-communication And Play (ASAP) intervention is to promote the social-communication and play skills of preschoolers with autism spectrum disorder (ASD) being served in public preschool programs. The ASAP grant project was a four-year, multisite study funded by the Institute of Education Sciences (IES), U.S. Department of Education was to examine the efficacy of the ASAP intervention. The study, funded during the 2011-2015 school years, included 78 classrooms, and 161 children. Approximately 40 classroom teams, including several in your school district, were trained and supported by our intervention coaches during the school year as they implemented the ASAP intervention in their classrooms
North Carolina Child Development Survey Cohort 2 (FYI 3.1)
Autism Spectrum Disorder (ASD) is not formally diagnosed before a child is 2-3 years old, but research has identified a wide array of atypical behaviors that can be seen in infants who will eventually receive a diagnosis. We developed a parent-report survey called the First Year Inventory to identify these pre-diagnostic behaviors in 1-year-olds, collected a large sample of normative data, and conducted a longitudinal follow up study. Results indicated that the questionnaire does indeed identify infants who are at-risk for an eventual diagnosis of ASD. The current project updates the screening tool, now called the First Years Inventory (FYI) with modified versions of the original questions plus new questions based on recent research, and it extends the age range to 9-16 months. We have collected normative FYI data from 7,000 families in NC with an infant born in 2013, and followed these families longitudinally to collect additional data at 2 years. The current wave of data collection is to determine diagnostic outcomes for ASD at 3 years.
Real World Assessment of Dual Task Performance after Stroke
Adults with stroke have a diminished ability to walk and simultaneously perform cognitive tasks (referred to as dual-task interference). Dual-task interference is attributed to a reduction in information processing capacity. Without adequate attentional resources for concurrent performance of two tasks, individuals must make a decision about which task to prioritize. Inability to flexibly allocate attention between two concurrent tasks may be an important factor contributing to dual-task interference, with critical implications for safety. This may be especially true in the real world where there are considerably more distractions and threats to stability than in clinical settings. Most studies have examined gait and dual-task performance in the laboratory, and none have studied the ability to flexibly prioritize attention in dual-task situations after stroke. Given that dual-task interference significantly impacts gait in the laboratory, it is imperative to determine if real-world environments exaggerate interference effects on gait and dual-task performance in community-dwelling individuals with stroke. The overall objective of the proposed research is to test the hypotheses that (1) single and dual-task walking in the real world differ from that in the laboratory, (2) ability to flexibly prioritize attention during dual-tasks is impaired post-stroke and this deficit is amplified in the real world, and (3) attention allocation ability is related to both motor and cognitive abilities. Using a repeated measures design, gait and cognitive performance of 20 adults with stroke and 20 age- and gender-matched healthy adults will be assessed in single and 4 different variable-priority dual-task conditions (no-priority, gait-priority, cognitive-priority, equal-priority) in the laboratory and a real-world context (grocery store). The project will employ pioneering advances in wireless technology to examine gait outside the research laboratory, in the real world. The long term goal of this research is to develop effective interventions to improve dual-task walking and minimize locomotor disability after stroke. This innovative 2-year project is expected to uncover information about the effect of environment and attention allocation ability on dual-task performance after stroke. This knowledge is critical to the development of interventions to improve attention allocation and task prioritization during dual-tasks in complex, real world environments among community-dwelling adults with stroke.
A Multilinguistic Analysis of Spelling Errors among Children with Hearing Loss
Children with hearing loss face a variety of developmental challenges in the domains of language and literacy, including spelling. The purpose of the proposed study is to investigate the impact of linguistic sources of knowledge on spelling among children with hearing loss, utilizing a multilinguistic analytic approach that reflects recent theoretical and empirical understandings. Specifically, misspelled words generated by children in second and fourth grade during a sentence writing task will be analyzed using a framework of analysis that separately analyzes the phonological (speech sound), orthographic (written representation), and morphological (word meaning) contributions to spelling. In study 1, group differences will be examined based on hearing status (children with normal hearing vs. hearing aids) and grade level (2nd and 4th). In study 2, group differences will be examined based on device use (children with normal hearing vs. hearing aids vs. cochlear implants). The multilinguistic framework of analysis has the potential to reveal underlying linguistic causes of spelling difficulties, which could drive tailored spelling interventions for students with hearing loss, as well as other written language disorders.
Evaluation of the Defense and Veterans Brain Injury Center's Progressive Return To Activity Clinical Recommendation for Active Duty Service Members with Concussion
In 2014, the Defense and Veterans Brain Injury Center (DVBIC) released newly-developed clinical recommendations (CRs) detailing the step-wise return to unrestricted activity following mild traumatic brain injury (mTBI)/concussion. The CRs and their tools provide the medical community clear guidance for safely returning patients to pre-injury activities and more generally, for fostering positive patient outcomes. This study aims to evaluate the effectiveness and adherence to the DVBIC tools supporting the Progressive Return to Activity (PRA) clinical recommendations (CRs), and to identify the need or opportunity to revise the CRs and enhance the outcomes in patients. The target population of this prospective, multi-center study includes Service Members (SMs) who have sustained an acute mTBI/concussion within 72 hours, and primary care and rehabilitation providers working with the injured SMs. Injured SM participants will be enrolled before (Treatment As Usual, TAU/control group) or after (PRA/intervention group) providers have been formally trained on the PRA tools. For both TAU and PRA groups, data collection will occur during the initial assessment, and at 1 week, 1 month, 3 months and 6 months after injury. The PRA intervention will be evaluated through numerous measures including symptom questionnaires, rate/speed for return to full duty, and patient satisfaction and adherence questionnaires. In addition, data from provider participants will be collected through in-person semi-structured interviews at multiple time points to assess PRA CR knowledge and perception of patient change and of patient compliance. The results of this project will inform necessary improvements to the PRA clinical package to increase the effectiveness and utilization of the clinical support tools, which will ultimately improve the implementation and standardization of clinical practice for acute concussion in the Military Healthcare System.
Portable Warrior Test Of Tactical Agility - POWAR-TOTAL
This pilot project funded by NC State-UNC Rehabilitation Engineering Center is focused on testing the use of smartphone technology in place of laboratory grade accelerometry to measure movement in a military tactical maneuver. The POWAR-TOTAL assessment is derived from two high level mobility tasks that were part of a return-to-duty test battery, the Assessment of Military Multitasking Performance (AMMP). This goal of this project is to create a test procedure that uses the most sensitive aspects of two AMMP tasks measured with smart phone technology in preparation for testing of the POWAR-TOTAL in a military population.
Current Research
AHS Researchers...
SBIR: Targeted tCDS Aphasia Trial (Phase2)
The potential benefits of conventional transcranial Direct Current Stimulation (tDCS) using sponge-pad electrodes have been demonstrated in small pilot studies for motor rehabilitation after stroke and the treatment of aphasia after stroke. Unfortunately, conventional sponge-electrode montages lead to diffuse stimulation throughout cortex with less-than-optimal intensities at the desired target brain regions. In previous work, collaborators at CCNY and Soterix developed a more targeted implementation of tDCS, high-definition tDCS (HD-tDCS), tested it for feasibility, and piloted the technology in the clinical treatment of anomia in aphasic stroke survivors. The goal of this study is to determine if a Phase III efficacy clinical trial on aphasia treatment with HD-tDCS is warranted and to prepare the technology and regulatory process for such an event. In brief, the aims of the study are 1) to perform a double-blind, randomized, multicenter, sham-controlled clinical efficacy study to assess the short-term benefits of adjunctive HD-tDCS in the treatment of aphasia, and 2) to prepare the device hardware, targeting tools, and regulatory approvals for a pivotal clinical trial.
Role of Rehabilitation in Concussion Management: A Randomized, Controlled Trial
We propose a randomized clinical trial to yield preliminary data on the added benefits of active rehabilitation during recovery after sport-related concussion in professional and amateur athletes. This trial marks an international collaborative effort involving the NFL, CFL, New Zealand Rugby, American Hockey League, and academic researchers in the United States. Specific Aims: The specific technical and scientific aims of this study are to: 1. Compare the effects of a multidimensional rehabilitation protocol versus enhanced graded exertion on clinical recovery, return to play, and patient outcomes after SRC. 2. Demonstrate the safety and feasibility of active intervention protocols when introduced during the sub-acute recovery period after SRC, as part of an multidimensional rehabilitation protocol. We have chosen to intervene at the sub-acute phase based on the hypothesis that controlled and supervised activity will facilitate recovery and will result in accelerated recovery and more prepared return to participation in sport. Study Design: The proposed study design will be a cluster (sport participation group: CFL, NZ Rugby, AHL, College, High School), randomized control trial . The study will be conducted over a 36-month period with a 28-month data collection period to capture two full football seasons of data. Concussion will be defined as a change in brain function following a force to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals with measures of neurologic and cognitive dysfunction (Dept. of Defense Evidence Based Guidelines). Diagnosis of concussion will be made through a clinical exam and supported by objective measures. Historical standard of care data will be incorporated through two-years of retrospective datasets available for all cohorts included in the study.
Precursors to the Development of Anxiety Disorders in Young Children with Autism Spectrum Disorder
Anxiety disorders are extremely common among individuals with autism spectrum disorder (ASD), occurring at four times the rate of the general population. The presence of an anxiety disorder negatively affects family functioning, friendship development, and school functioning. Recent research is beginning to provide some clues regarding early risk factors for anxiety in individuals with ASD. Specifically, studies suggest that sensory over-responsivity (SOR) - a set of symptoms characterized by heightened and unusual reactivity to sensory stimuli that occurs more frequently among children with ASD than typically developing children - is associated with anxiety in individuals with ASD. We hypothesize that many of the negative outcomes associated with sensory over-responsivity (SOR), such as avoidance, aggression, and GI problems, primarily occur when SOR leads to the development of an anxiety disorder. The goal of the present research is to conduct an in-depth study of the relationship between SOR and anxiety symptoms in preschool age children with ASD, using parent report, observation, and brain-based measures (brain waves or EEG).
search term results
The Sensory Experiences Project
To examine the development, functional impact, and cause of various sensory features in children with autism, developmental delay, and/or typical development, ages 2-12 years. SEP is part of the PEARLS program (Program in Early Autism Research, Leadership and Service) at UNC.
Attention in Girls with Autism Spectrum Disorder (ASD): An Eye-Tracking Approach to Gender-Specific Circumscribed Interests
ASD is a male-dominant condition however research indicates that girls may have different phenotypic-profiles particularly in the domain of Circumscribed Interests (CI) - intense and often idiosyncratic interest held by children and adults with ASD. CI are reported in 80% of individuals with ASD, and while can represent islands of ability, limit learning and social opportunities. Eye tracking offers one way to examine the attentional mechanisms underlying CI with studies finding reduced social attention. No study has explored gender differences. As such we do not know if CI manifest differently in girls. The identification of differential attention and learning styles could inform ASD diagnosis and intervention, which are largely defined by the male-phenotype. This study uses eye tracking as a way to examine potential gender differences in attention in ASD. We are currently examining differences between girls and boys attention to two sets of visual arrays (1)High Autism Interest (HAI) items vs. Neutral items and (2)Female vs. Male Interests (based on typically developing literature). This will allow us to examine whether girls with ASD (1)have similar attentional patterns to CI (HAI images) as boys with ASD, (2)have similar attentional patterns but to different stimuli or (3)are characterized by different attentional patterns.
Early Development Project-2
Title: Efficacy of a Parent-Mediated Intervention for One-Year-Olds at-Risk for Autism (Early Development Project-2) Purpose: To assess the efficacy of an early intervention program called Adaptive Responsive Teaching in improving developmental outcomes and ameliorating symptom severity among one-year-olds at-risk for autism spectrum disorders (i.e., “autism”). Setting: The research was carried out in 6 counties in central North Carolina, with assessments conducted in local communities and the intervention provided in children’s homes. Population: Our sample of 87 randomized children/families was drawn from the population of one-year-olds > 2500 grams at birth in our catchment area, with the restriction that English was a primary language in the home. Families of children who scored at high-risk for autism on a screening tool called the First Year Inventory (Baranek et al., 2003) were invited to participate. Racially our sample of child participants was 69% White, 21% African-American/Black, 2% Asian, and 8% multi-racial. The highest education levels of the primary caregivers were: 15% high school degree or less, 18% associate’s degree, vocational program, or some college, 28% baccalaureate degree, and 39% graduate degree. Intervention tested: We tested a parent-mediated, home-based intervention called Adapted Responsive Teaching (ART), which is based on the Responsive Teaching curriculum (Mahoney & MacDonald, 2007). ART targets pivotal behaviors (i.e., early behaviors linked to the later development of more complex functions) in two key domains of social-communication and sensory-regulatory functions. An interventionist met with families for approximately 30 1-hour home visits over a period of 6-8 months to provide them with information, demonstration, and coaching on the use of responsive teaching strategies to promote targeted pivotal behaviors for their child. Responsive teaching strategies emphasize reciprocity, contingency; shared control, positive affect, and matching the child’s developmental level and behavioral style. Family action plans were formulated at the end of each session to promote the use of ART by parents during daily, routine interactions with their child. Comparison condition: ART was compared to a condition called “Referral to Early Intervention and Monitoring (REIM) in which families of eligible children are referred to community services for early intervention, with monthly monitoring via phone calls from the research staff. Primary research method: We used randomized assignment to group, with an equal probability of assignment to ART or REIM. Assessors and coders involved in pre- and posttest measures were blind to group assignment. Measures and key outcomes: We used a battery of assessments to evaluate pre- and post-intervention performance on our key outcomes of (1) social-communication and sensory-regulatory pivotal behaviors targeted in ART, (2) broader development and adaptation, and (3) autism symptom severity. In addition, we measured changes in parent responsiveness as a postulated mediator, and initial child developmental quotient (DQ) and parent stress as postulated moderators of outcomes. Data analytic strategy: We used an intent-to-treat strategy in our analyses to report our per protocol findings for this study. ANCOVAs were be used to evaluate the effects of ART on our primary outcomes, as well as the postulated moderating effects of initial child DQ and parent stress. A path analytic approach was used to test whether changes in parent responsiveness mediated outcomes. (Manuscript under review as of September, 2016.) NOTE: The data collected in conjunction with this project are currently being used to address a variety of additional research questions through secondary data analysis.
Critical Thinking in Radiologic Science Education
The purpose of this mixed method study is to examine the critical thinking disposition and perceptions of Radiologic Science students through the use of a standardized assessment and journaling exercises. The Radiologic Science student’s critical thinking deposition was assessed using the California Critical Thinking Deposition Inventory to determine the willingness and ability of the individual student to problem solve through use of critical thinking. A series of journaling assignments was the tool used to challenge the student’s abilities to think critically through substantive and meaningful reflection. The quantitative analysis was completed with the data collected using the CCTDI assessment. The qualitative portion was completed using a single-site case study method.
Effect of Mobile Electronic Device use on Learning Outcomes and Satisfaction in the Malawian Radiologic Science Classroom
Malawi is a developing country located in southeastern Africa. Health Sciences education is available in Lilongwe, Blantyre and Zomba. The specific area of interest for this proposal is for the Diploma Radiography Programme located on the Lilongwe campus of the Malawi College of Health Sciences (MCHS). The purpose of this study is to investigate and validate student acceptance of tablet devices and the impact the devices have on student affective, cognitive and psychomotor skills.
Promoting ASAP Collaboration through Technology (PACT): An Intervention Modification to Enhance Home-School Collaboration
The overall purpose of this Goal 2: Development and Innovation project is to enhance the existing Advancing Social-communication and Play (ASAP) intervention through development of a technologically supported system of home-school collaboration. ASAP was originally designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder (ASD) were trained to implement the intervention. The primary focus of ASAP is to improve the social-communication and play skills of children with ASD. Although preliminary child outcomes for ASAP appear promising, other anecdotal and empirical data demonstrate the need to better involve parents in intervention planning and implementation. Importantly, establishing effective ways to support home-school communication early on sets the stage for longer-term relationships between school providers and parents (Izzo, Weissberg, Kasprow, & Fedrich, 1999). Thus, the specific goal of this project is to develop and pilot test a responsive website as the primary method of supporting home-school collaboration. The website developed through the Promoting ASAP Collaboration through Technology (PACT) project is responsive in that it can generate individualized recommendations based on the child’s needs. The website will be able to support parents in assessing their children’s current social-communication and play skills at home, determining appropriate child goals based on the assessment, self-monitoring their implementation, and documenting child progress; also, the website will promote reciprocal communication about ASAP between parents and the school-based team. Within the context of home-school communication, parents want both informal, personal conversations with teachers as well as strategies to supplement classroom teachings at home (Wanat, 2010). The PACT project addresses both of these needs.
Behavioral Inflexibility in IDD: Outcome Measurement
This RO1 application requests funds to develop and validate a novel outcome measure targeting the behavioral inflexibility in children with intellectual and developmental disabilities (IDD). This behavioral domain encompasses a host of closely related clinical sequelae that can be profoundly disabling and are common in IDD such as (a) an overall inflexible temperament or behavioral style that underlies discrete idiosyncratic forms of repetitive and rigid behavior manifestations (e.g., inability to tolerate changes in the environment, stereotyped uses of objects); (b) associated mood and behavior problems that arise when this inflexible temperament and its manifestations cannot be accommodated; and (c) interference with learning and adaptation that stems from rigidity / inflexibility as even treatment itself can represent intrusion and change for an inflexible child (e.g., a new pill, a new therapy exercise). In recent years there have been large-scale drug trials and small behavioral trials targeting discrete behaviors that fall under the domain of repetitive inflexible behavior. However, the measures included in many of these clinical trials have little to no evidence of their ability to detect change over time. In fact, while several instruments exist that measure the discrete behavioral endpoints of this overall construct of rigidity / inflexibility, no instrument exists that adequately extends much beyond a “behavior checklist” approach. The overall objective of this application is to develop and validate a new measure, the Repetitive and Inflexible Behavior Inventory (RIBI), with the primary goal of developing a measure that is sensitive to change over time. The RIBI is designed as a parent report measure for children (ages 3 -18) with IDD. The rationale is that a novel measure is needed to (a) capture the range of repetitive inflexible behaviors that are found in children with IDD across a variety of idiopathic and genetic disorders, (b) measure the functional impact of these behaviors on the family’s daily life, and (c) detect change over time when these behaviors are the target of intervention. Thus, the specific aims of this project are to (1) examine the psychometric properties of the RIBI for children and adolescents with autism spectrum disorder (ASD), establishing reliability, factor structure, content and construct validity; (2) evaluate the RIBI’s ability to measure change over time in children with ASD; and (3) examine the psychometric stability of the RIBI when applied to children and adolescents with Fragile-X and Prader-Willi syndromes. To accomplish these aims, a multisite study will be conducted using recommended instrument development methodologies, such as focus groups, expert panels, and online surveys (n=1500). This team is in an ideal position to develop the RIBI because of our prior experience with measure development, and the conduct of clinical trials targeting repetitive inflexible behavior. The expected deliverable is an outcome measure that is appropriate for IDD populations and minimally burdensome to complete in order to be useful for multisite clinical trials.
Testing Novel Measures of Community Function and Participation in Adults with Cerebral Palsy
Cerebral palsy (CP) is the most common cause of physical disability in children, impacting approximately 1 in 500 young Australians and 2-3 in 1,000 young Americans. Most of these children live to within five years of a typical lifespan, depending on the severity of the disorder. However, after age 21 when they exit the school systems, the availability and accessibility of formalized support services significantly declines for most individuals.. There is a paucity of evidence related to health outcomes and quality of life (QoL) for individuals with CP after eighteen years of age but some evidence does suggest this gap in services when transitioning to adulthood can have a significant impact on health outcomes and QoL . Determining the degree to which adults with CP are integrated into their communities is a key to developing successful interventions as individuals and families look for involvement in the community to improve QoL when employment and education opportunities are limited. Presently, it is unknown as to which community activities adults with CP engage, where they are participating, what resources they are accessing, and what barriers they are facing. This proposal aims to utilize GPS and GIS information linked with physical activity data to compare community integration in a cohort of adults with cerebral palsy across two hemispheres with differing national healthcare systems. These two teams of experienced investigators bring diverse expertise to this project and all share the same passion to overcome the historical lack of services for this population and to develop efficacious interventions to improve health outcomes and QoL The results will inform providers in both countries about the real-time intensity and contexts of activity that define community integration and help to identify key barriers and facilitators to integration, with the ultimate goal of improving quality of life for adults with CP. In our cohort of adults who are 18-65 years, classified in GMFCS Levels I-III (n=180) we will: (1) utilize GPS and GIS mapping to measure community integration and describe the locations, activities and resources important in integration for adults with CP. (2) examine the relationship between community integration measures and individual factors of current function related to impairments and mobility, service provision, and employment status. (3) examine the relationship between community integration measures and environmental factors of accessibility to community resources and population density, and describe barriers to resources and services from the perspective of adults with CP.
Scientific Service Program for Elite Discus and Javelin Throwers
The purpose of this project is to provide biomechanical evaluation of throwing techniques to elite US discus throwers and javelin throwers. This is part of the High Performance program of USA Track & Field. We collect kinematic data for elite US athletes using three-dimensional videographic techniques, and compare their data to the data of world elite athletes, and suggest changes in throwing techniques to improve performance and prevent injury.
Immediate Effects of Repetitive Transcranial Magnetic Stimulation on Corticospinal Excitability of the Quadriceps in People with Knee Osteoarthritis
Knee osteoarthritis (OA) is prevalent and knee replacement surgeries are increasing. Quadriceps weakness is one of the most modifiable risk factors and treatments for knee OA, but strengthening efforts are limited by neural mechanisms that contribute to persistent quadriceps inhibition and pain. Interventions that affect neural mechanisms may serve as valuable adjuncts to exercise for quadriceps weakness. However, there is a considerable gap in our understanding of how to effectively treat knee OA-related quadriceps inhibition and how critical factors such as pain sensitization and catastrophizing interact with motor inhibition to influence quadriceps voluntary activation, strength, and function in knee OA. A critical first step is to establish a comprehensive infrastructure to explore factors that contribute to persistent quadriceps weakness with knee OA. The objective of this research is to overcome natural barriers to strengthening quadriceps muscles weakened with knee OA and to provide laboratory and clinical methods to evaluate deficits and treatment efficacy. Our intervention approach is innovative because repetitive transcranial magnetic stimulation (rTMS) can increase motor excitability in neurological conditions such as stroke and can relieve chronic pain, but rTMS has not been applied to rehabilitate knee OA. We hypothesize that rTMS over the primary motor cortex will increase motor excitability and interfere with the knee OA-related inhibition of maximal quadriceps contraction and reduce pain. The proposed study will initiate this research program and develop pilot statistics to facilitate the design of a large scale, prospective, randomized controlled trial of treatments that replace or delay invasive, irreversible interventions for knee OA.
Applying stance phase knee control during gait for people with stroke undergoing inpatient rehabilitation.
Improving walking ability is an important clinical goal for people with hemiparesis after stroke. Frequently after stroke, individuals walk with a slow, asymmetrical, and energy-inefficient gait. In fact, almost one third of people living at home after stroke are unable to walk unsupervised in their communities. This study intends to initiate investigation into an intervention to maximize walking recovery after stroke. Task-specific training and increased repetition of practice are essential elements to optimize walking recovery. Specificity of training and repetition promote activity-dependent plasticity of the central nervous system after stroke. Walking recovery may be maximized by providing appropriate training within the first four weeks post stroke, when potential for neuroplasticity is greatest. Sufficient, high quality movement practice is difficult to achieve for many patients during inpatient rehabilitation due to the severity of gait limitations, yet this is a critical window of time in recovery when repetitive practice is needed to maximize adaptive neuroplasticity. We hypothesize that external support to the affected lower extremity will aid task-specific, repetitive gait training after stroke. Specifically, we will test the immediate effects on gait of external support provided by a stance-control knee-ankle-foot orthosis (SCKAFO). SCKAFOs stabilize the knee in stance and provide limb advancement assistance in swing, facilitating improved gait speed and symmetry compared to walking with conventional locked-knee KAFOs and to walking without orthoses in people with chronic stroke. We expect to see that people with recent stroke walk at faster velocities and with greater stance time and step length symmetry when walking with stance control knee support than when walking without support to the lower extremity. In future studies, we expect to see that by using training SCKAFOs for gait training in short-term inpatient rehabilitation after stroke, individuals can initiate walking practice earlier and at increased intensity, duration, and number of repetitions than would be possible without a SCKAFO. This intense walking practice, in turn, is expected to promote neuroplasticity for appropriate amplitude and timing of muscle activation, resulting in a faster and more symmetrical gait pattern.
Occupational Needs of Women in the Acute Post-Operative Phase After Gynecologic Oncology Procedures
The primary treatment modality for ovarian cancer is radical surgery. Rates of post-operative morbidity (20-30%) and hospital readmission (10-15%) are high. Low QOL prior to chemotherapy (i.e. after surgery) is associated with delayed chemotherapy start, dose delays, and decreased overall survival. The quality of surgical recovery in this population is high-stakes, with an impact on the costs of hospital readmission, as well as post-operative chemotherapy receipt and survival. For women with ovarian cancer, there is currently no published literature on acute post-operative functional deficits and QOL decrements. Functional deficits and QOL are modifiable and constitute the main goals of OT. This study will be the first in this population to identify post-operative, modifiable, functional deficits. We will collect essential qualitative data to design a population-specific, evidence-based OT intervention. The goals of this work are to improve post-operative recovery in order to decrease readmission, improve QOL and ultimately decrease cost. Objective: To identify and describe the modifiable functional deficits after ovarian cancer debulking surgery at discharge. Specific aims: 1) to identify patient functional deficits; 2) to identify patient perceived functional needs and 3) to collect population-specific QOL data Research question: Do women after ovarian cancer debulking surgery have functional deficits that are modifiable with OT? Hypotheses: (1) Women after ovarian cancer debulking surgery have potentially remedial functional deficits. The proportion is unknown, but it is expected to be high. (2) The main theme of perceived functional need will be post-operative self-care. Participants will undergo OT assessment, COPM administration, and QOL survey administration by OT. The QOL surveys will include: Patient Reported Outcome Measurement Information System (PROMIS)-Global Health, PROMIS – Anxiety, Modified Work Ability Index, NCCN Symptom Distress Management Screening Tool, and the Possibilities for Activity Scale (PActS) – Gynecologic Oncology. This will occur within 24 – 48 hours of planned hospital discharge. Medical information on each patient will be abstracted from the medical record and will include: age, cancer site, procedure type, and plan for adjuvant therapy. The evaluation will also be recorded and transcribed for qualitative analysis. Using Atlas.ti software, the transcripts will be evaluated, categorized, and analyzed through an iterative process of Focused coding, In Vivo coding, Pattern coding, and Theoretical coding. The codes will be aggregated into conceptual categories to identify themes, patterns, and relationships among them. Lastly, a model for interpretation will be developed of the women’s’ post-operative experience and perceived needs. COPM scores for functional performance and satisfaction will be summed separately and reported.
Examining person and environment factors associated with community participation for adults with Autism Spectrum Disorder (ASD)
This study combines innovative Global Positioning System (GPS) and Geographic Information System (GIS) measures to describe real-time community integration activities of adults with ASD living with family or in a group home, and investigates critical person and environmental factors associated with participation. These results will be combined with adult outcome survey data to examine the role of personal factors such as motivation and skill level in a variety of areas (for example communication, vocational, social, and daily living skills) on community participation. The relationship between participation, service use, and caregiver support will also be examined.
Variation in Sweat Testing Analysis: PTC VISTA
Sweat chloride determinations are used to confirm the diagnosis of CF and also serve as a biomarker for CFTR gene function in clinical trials using protein modulation therapy. Currently, there is uncertainty surrounding the appropriate degree of change in sweat chloride concentrations which reflects a positive response to an investigational drug. Being able to assess a meaningful change is critical to the evaluation of current and future CFTR modulators. The study is a retrospective analysis of repeated sweat chloride tests performed on CF subjects enrolled in placebo arms for clinical drug trials for a nonsense mutation of CFTR. The study data are sweat chloride concentrations from 110 placebo subjects enrolled in PTC Therapeutics Inc. (Planfield NJ) clinical trials evaluating a novel drug, Ataluren. The results from the Ataluren trial will supplement the knowledge gained from the previously funded CF grant, VISTA, which examined biological and analytical variation of sweat chloride concentrations in a drug trial with a different mutation of CFTR. By comparing the results from subjects with 2 different mutations Drs. LeGrys and Moon will be able to determine if variation is similar with differing mutations. This information will be important in assessing whether or not it is reasonable to apply a universal measurement of variation in sweat chloride in clinical drug trials.
The Feeding Flock
The Feeding Flock research team is a group of clinicians and researchers dedicated to developing the science of preventing, identifying, and managing feeding difficulties in children. We are committed to partnering with families to nurture children with feeding difficulties. We have created a feeding challenges research registry to collect contact information from adult caregivers of children between 1 month and 18 years of age who have difficulty eating, and are currently recruiting participants for studies to develop parent report measures of feeding difficulties in infants and young children.
TEACCH School Transition to Employment and Post-Secondary Education Program
As the number of children diagnosed with Autism Spectrum Disorder (ASD) rises, there will be an increasingly large adult population for whom the challenges of gaining productive, long-term employment will likely overwhelm our current adult service programs. Current employment rates for individuals with ASD are low, with only 18% of young adults with ASD reported to be involved in competitive or supportive employment. Through the support of two previous community service grants, the TEACCH Autism Program created six employment skills modules targeting pivotal organizational and social-emotional skills essential to successful employment. Two modules target organization/executive function skills (approaching tasks in an organized manner, time management), two modules target social skills (asking for help, engaging in social niceties), and two modules target emotional regulation skills (accepting corrective feedback, coping with being upset in the moment). Each module integrates social skills techniques, cognitive behavioral techniques, and TEACCH structured teaching techniques. The intervention modules have received high praise from school and community-based partners. However, little data has been gathered about the effectiveness of this program in teaching employment skills to the students with ASD. The focus of the current proposal is to conduct a pilot study to examine the effectiveness of the TEACCH employment skills modules for adolescents and young adults (16-21) with ASD. Approximately 30 high school students with ASD will receive the employment skills program. Each student will receive 18 intervention sessions through their home high school. Additionally, each student will participate in a school-based employment activity to provide an opportunity to practice intervention skills in an employment setting. Employment skills will be measured before and after the intervention. We predict that the intervention will lead to increased on-task work behavior, increased job-related social skills behavior, and improved coping with corrective feedback and changes in routine within a work environment. While we are intervening with high school students, the goal is to develop a program to improve adult vocational outcomes.
Project Core
ABSTRACT Project CORE Project CORE is designed to develop products and services that support the implementation of a core vocabulary approach to augmentative and alternative communication for school-aged students with significant cognitive disabilities who also have complex communication needs. The evidence-based and empirically derived core vocabulary approach is expected to support students with significant cognitive disabilities in developing symbolic communication that can be used across contexts while supporting improved academic success. The core vocabulary approach is designed to grow with students within and across school years as educational teams used data to determine when and how to increase the complexity of the system. An iterative development cycle will be used to develop, evaluate, and revise products and services required to effectively implement the core vocabulary approach. By improving access to evidence-based, flexible, and broadly applicable core vocabulary and improving its integrated implementation in academic instruction, students with significant cognitive disabilities are expected to improve communicative competence, symbolic communication, and ELA outcomes. The Implementation Drivers approach (Blase, van Dyke, & Fixen, 2013) will guide the evaluation of the project implementation while overall project performance will be evaluated with a combination of measures of fidelity of implementation, and student communication, language, and literacy outcomes.
Perceptions of Parents of Children with Autism Spectrum Disorder about Early Intervention Services
This project examines the perspectives of parents of young children (birth to eight years) with Autism Spectrum Disorder (ASD) related to the facilitators and challenges across three key time points: between first concerns and consulting with a professional, up through the diagnosis, and through entry into early intervention. Eight focus groups (4 English speaking, 2 Spanish speaking, 2 American Indian) were conducted with 55 caregivers. Results will be helpful in addressing needs of families of children with ASD.
Patterns and Variations in Emergency Department Visits for U.S. Children with Autism: A Rural-Urban Comparison
This proposed research addresses HRSA-MCH's priority interest in health services utilization among children with autism and rural-urban differences. A recent study indicated that children with autism were more likely to visit an emergency department (ED) for psychiatric problems compared to children who don't have autism. However, no research has explored how rural-urban differences are associated with ED visits for children with autism. This proposed study intends to fill this research gap through two specific aims: 1) examine rural-urban differences in the likelihood of ED visits, child characteristics associated with visits, and clinical measures of ED visits for U.S. children with autism, based on child’s residence location in rural or urban areas, and 2) describe differences between rural and urban hospitals regarding specific reasons for using the ED, volumes of ED visits, costs and clinical measures associated with these visits for U.S. children with autism; in addition, examine the determinants of hospital ED charges involving pediatric autism diagnosis in rural versus urban hospitals. We will use the 2010 and 2011 Nationwide Emergency Department Sample (NEDS), a database maintained by the Agency for Healthcare Research and Quality as a part of the Healthcare Cost and Utilization Project. We will investigate the rural-urban differences in ED visits for children with autism, by patient residence and by hospital location, respectively. Multilevel regression models will be used to correct for the non-independence of individual-level observations nested within hospital EDs and to determine whether disparities in ED utilization exist between children with autism in rural and urban settings. The proposed study will produce insights into the development of potential measures for comparison in future studies to assess the impact of health care coverage changes on health services utilization. The enactment of ACA and the implementation of the autism insurance mandate make this an opportune time for such research. This proposal represents one of the first studies to use the largest national dataset to study rural and urban differences in the utilization of autism-related ED services among children in the United States. Health interventions and health policies should carefully consider the nature of a distinct rural challenge with respect to access and utilization of health services for rural children with autism. The findings will contribute to a better informed policy and practice regarding health care utilization among children with autism in rural and urban areas.
Improving sweat testing performance: a multi-center collaborative initiative towards earlier diagnosis of infants with CF and positive CF newborn screening tests
We aim to reduce sweat testing quantity not sufficient (QNS) rates in infants who are referred to Cystic Fibrosis Foundation Accredited Care Centers for follow-up testing after a positive newborn screening (NBS) test. It is important to do this now because there is evidence of both high QNS rates at some centers. Additionally a significant percentage of infants diagnosed with CF through the newborn screening system do not have a confirmatory sweat test reported in the first months of a CF diagnosis. Furthermore, QNS sweat tests can delay the diagnosis and treatment of infants with CF, thus reducing the benefit of newborn screening to individuals, their families, and the public health system. We hypothesize that a structured sweat test performance improvement program focused on collecting adequate sweat specimens from infants will reduce the QNS rate in newborns to less than 10% at participating CF Centers. Our specific aims are: 1. To assure that all staff who perform sweat tests, and their supervisors, receive in-depth education on optimal sweat test collection in infants. 2. To distribute andimplement the use of a Sweat Test Checklist designed to continuously refresh knowledge of optimal techniques for sweat test collection, supporting participating sites in local process improvement using the Checklist as a key tool 3. To build sustainable systems for maintenance of low sweat test QNS rates at participating sites.
Executive Function in Pediatric Hypertension
The goal of this multisite study is to investigate the relationship between primary hypertension and executive function as a novel, emerging target of hypertensive damage in children.
Autism Spectrum Disorder State Implementation Project
The goal of this project is to increase the collaboration among public and private agencies in the state of North Carolina in order to improve screening, assessment, diagnosis, and early intervention for children suspected of ASD ages birth to 5.
The importance of anterior center of mass velocity during gait on energy cost following stroke
Energy efficiency is a hallmark of healthy human walking, but can become impaired when the legs do not provide symmetric push-off. Our recent analysis of gait following stroke has identified a consistent mechanical asymmetry between the limbs, which is analogous to driving a car by alternatively slamming on the gas, then the brake with each step. Like poor gas mileage in a car, we propose that this is energetically costly to the human body, but can be fixed by providing appropriate forces to ensure smooth forward (anterior) progress of the body’s center of mass (COM). Although gait requires the COM to maintain a ‘nearly’ constant anterior speed, nearly all literature on COM movement has focused on vertical fluctuations. Here, we will address an imposed force on the COM as a potential therapeutic target to restore optimal mechanics and energetics of gait for individuals post-stroke.
Written Language Problems in MIddle School Students: A randomized Trial of thE SRSD Approach Using a Tier 2 Intervention Model
RFA Goal: Efficacy and Replication Purpose: The primary purpose of this project is to establish a stronger scientific foundation for educational practice within the writing domain by utilizing recent advances in cognitive science to examine: (1) the impact of the evidence-based Self-Director Strategy Development (SRSD) model on the written expression of middle school children at-risk for writing problems using a Tier 2 paradigm; (2) specific moderators that can influence response to intervention; and (3) given the executive function-based principles of the SRSD instructional model, whether positive effects of the SRSD intervention on writing are mediated through changes in attention/executive functions. Setting: All middle schools (3) in a single, rural/suburban public school system in North Carolina. Participants: The prospective sample will include 300 sixth grade students who are identified as At-Risk for writing problems. Students will be ascertained at the rate of 100 students each year across a three year recruitment period. Students will be determined as At-Risk if their performance on the WIAT-III Written Expression Scale falls below the 25th percentile. Interventions: We will employ the SRSD intervention model as our evidence-based framework for a randomly selected group of 150 students who are At-Risk for writing problems. Using the SRSD model in a Tier 2 framework, we will teach two specific strategies twice a week for 12 weeks for a total of 24 sessions to improve written language. Each year, this will require 10 groups comprising 5 students who will receive the SRSD intervention during the spring of their sixth grade year. This intervention will be supplemental to the regular state education curriculum. Comparison Condition: For the 150 students At-Risk for writing problems who are not randomized to the SRSD intervention, the control condition, using a free writing model, will involve the provision of supplemental writing tutoring twice a week for 12 weeks for a total of 24 sessions. This will require 10 groups comprising 5 students each year who will engage in free writing activities at the same time of year and for the same amount of time as their SRSD counterparts. This control condition will be supplemental to the regular state education curriculum. Primary Research Method: This project will employ a randomized cohort design, with a 9 month follow-up component, that will permit examination of the efficacy of the SRSD intervention model for sixth grade students at-risk for writing problems. The inclusion of a theoretically driven cognitive assessment also will allow for exploration of selected moderators and mediators of this evidence-based treatment. Randomized assignment of the At-Risk participants to treatment versus control conditions will facilitate the determination of the efficacy of the SRSD model. Measures of Key Outcomes: Students will receive multiple standardized measures of written language and assessment of selected cognitive functions (fine-motor, linguistic, attention/executive functions) in the fall of sixth grade. Selected aspects of the social environment (e.g., socioeconomic status), and associated child (e.g., reading, self-efficacy) and classroom variables (classroom climate) also will be examined as potential moderators of the treatment. Change in writing performance will be assessed using standardized tests and curriculum based measures during and following intervention, as well as at 9 months post-treatment. Data Analytic Strategy: We will use multilevel analysis of covariance to test for the presence of treatment effects post-treatment and at 9 month follow-up (Specific Aim #1), and to test for moderation effects at these time points (Specific Aim #2). Mediation will be assessed via multilevel structural equation modeling with two parallel ANCOVA models (Specific Aim #3).
Tiny Homes Community
In the United States, there is a lack of safe and affordable housing for individuals with mental illness. Consequently, on any given night, approximately 200,000 people with mental illness are homeless (U.S. Department of Housing and Urban Development, 2011). The absence of stable housing contributes to social isolation and is barrier to occupational participation and community integration. The purpose of this community-based research is to develop an affordable housing option for adults with mental illness that fosters functional independence and community participation. In a collaborative partnership with Habitat for Humanity, UNC's Center for Excellence in Community Mental Health, and UNC's School of Social Work, we have designed a 2-phased project to develop a community of Tiny Homes for adults with mental illness. In Phase 1 we will use interviews and focus groups with consumers and stakeholders to (1) test the feasibility and acceptability of this intervention and (2) explore the lived experience of residing in an adapted Tiny Home for adults with mental illness. We will also develop and test an assessment battery to measure outcomes in quality of life, community participation, recovery, and physical and mental health. We will use findings from this phase to inform the development of a community of 5 adapted Tiny Homes in Phase 2. During Phase 2 we will also measure the impact of living in an adapted community of Tiny Homes on consumers’ social participation, sense of belonging, and community integration.
Screening and Intervention to Reduce Falls in Older Adults in Primary Care
An estimated one of three adults over 65 years of age falls each year, and this proportion increases to one in two by the age of 80 years. Falls are extremely costly, both in terms of the economic burden on society and the physical, financial, and emotional toll on the individual and his/her family. By 2020, the total cost of falls among older adults is projected to reach $43 billion. According to the North Carolina Department of Health and Human Services, unintentional fall-related injuries and deaths are increasing in North Carolina, and falls are the leading cause of accidental death among older North Carolinians. Even in the absence of physical injury, a fall may induce a downward spiral of increased fear of falling, self-imposed activity restriction, functional dependence, and reduced quality of life. This project will implement a validated process to identify, risk stratify, and provide intervention for patients at risk for falls, and ultimately to decrease risk of falls and fall-related injuries among older adult patients. We will initially test implementation in the UNC Family Medicine Center (FMC) as a model to subsequently spread throughout UNC Primary Care Improvement Collaborative (PCIC) practices. The intervention will start with a defined process to identify modifiable risk factors for falls before or during an FMC clinic visit using the CDC’s validated Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. Patients who screen positive will subsequently be offered an evidence-based intervention, the physical therapist-managed Otago Exercise Program. Various methods for implementing the initial STEADI assessment will be tested, including pre-visit mailings and evaluation, in-clinic CMA evaluation (with CMA training), Epic BPA refinement, and provider training. We also will test best strategies for engaging physical therapists at point of care and through Epic referrals to facilitate implementing the second step of the intervention, the Otago program, by training therapists at three UNC outpatient physical therapy clinics. We will then disseminate these best practices through UNC PCIC and UNC outpatient physical therapy services, ultimately affecting more than 35,000 eligible patients.
Examining the relationship between accessibility to resources, service use, and community function in adults with ASD
The objective of this pilot study is to use a Geographic Information System (GIS) approach to understand how population density and accessibility to community resources relates to service use, social participation, and functional outcomes in adults with autism spectrum disorder (ASD). Examining the impact of accessibility on community function outcomes may highlight discrepancies in service availability and use by size of community (urban versus rural) and concentration of resources.
Chronic Kidney Disease in Children (CKiD)
This is a multisite study where the primary goal of this project is to investigate the growth, neurocognitive functioning, and disease progression of children with mild to moderate CKD. This is the 12th year of the study.