NICHD research on rehabilitation medicine includes studies of the underlying biology of conditions that cause disabilities to build a knowledge base that will inform the development of appropriate interventions and therapies. This research involves both seeking a better understanding of the mechanisms of plasticity in recovery and rehabilitation and developing new and improved rehabilitative and assistive technologies.
The National Center for Medical Rehabilitation Research, within the NICHD, provides a focal point for coordinating research related to rehabilitation medicine across the NIH.
NICHD’s research efforts related to rehabilitation medicine involve the development of methods and technologies for the rehabilitation of individuals with physical disabilities resulting from diseases or disorders of the neurological, musculoskeletal, cardiovascular, pulmonary, or any other physiological system. Specifically, these activities aim to:
- Improve understanding of the pathophysiology of conditions that cause disabilities. Studies explore the biological causes and consequences of these conditions, as well as their psychological impact on patients and families, with the goal of using this knowledge to develop appropriate interventions and therapies.
- Examine the role of activity in adaptation and recovery. Researchers examine the functional mechanisms of regeneration and plasticity and their roles in the ability to relearn and adapt to lost function.
- Develop new rehabilitative and assistive technologies. NICHD-supported projects aim to improve upon existing technologies and to develop new technological approaches to restore function and improve quality-of-life in disabled individuals.
- Improve ways to measure function and outcomes. This research aims to answer how best to develop quantitative measures to better understand and evaluate the progress of either therapy or disease and injury on a patient’s functioning in light of great variability among patients. NICHD supports the development of new measurement tools and methods of soliciting information from patients about their subjective experience, as well as standardizing outcomes measurements to facilitate comparisons.
- Develop and test new approaches for the treatment of disabilities. Supported research spans the investigation of surgical rehabilitation approaches, drug interventions, prosthetic interfaces and other new technologies, and other therapeutic approaches for primary conditions and symptoms alike.
- Better understand the physiology of muscle and connective tissue. Supported studies include basic research into the mechanisms of injury and examinations of the effects of severe muscle shortening and the release of contractions.
- Identify genetic and genomic influence on outcomes. NICHD supports research into the variations in genes that affect the progression or severity of a disease or other condition, genomic studies—as of the microbiome in a certain part of the body—that can provide clues to changes in a patient’s condition, and the viability of gene therapies to prevent or slow debilitating conditions.
- Assess the social impact of injury, disease, and rehabilitation. NICHD also supports investigation into the roles of environmental and social factors in recovery from disease or injury and rehabilitation, with the aim of assessing how people are limited by disability and developing ways to improve their participation in society.
- Develop and test simulations of human motion. These sophisticated models are intended to allow investigators to analyze both “normal” and “impaired” human motion, with the ultimate aim of better assessing function, evaluating care options, and providing effective rehabilitation alternatives.
- Harness large data sets for solving rehabilitation problems. NICHD particularly seeks to encourage and train investigators in and support collaborative research projects that use bioinformatics and statistical methods to analyze rehabilitation and disability outcomes from large administrative and research datasets.
Through its intramural and extramural organizational units, NICHD supports and conducts a broad range of research projects that fall under the rehabilitation medicine umbrella, as well as research on conditions that cause disabilities. Short descriptions of these activities are included in the following sections.
Institute Activities and Advances
Several NICHD organizational units support and conduct research related to rehabilitation medicine. Some of this research aims to establish an evidence base for the development of best practices; other activities aim to improve health outcomes related to specific diseases and conditions that cause disability, such as traumatic brain injury (TBI) and stroke.
The institute's National Center for Medical Rehabilitation Research (NCMRR) fosters the development of scientific knowledge to enhance the health, productivity, independence, and quality of life of people with physical disabilities through basic and clinical research. The NCMRR also serves as the coordinating body for rehabilitation research across the NIH and seeks collaborative opportunities with other NIH Institutes.
The NCMRR supports the development and application of devices to improve the human-environment interface and to restore or enhance an individual’s capacity to function in his or her environment. This type of applied research and rehabilitation technology includes, but is not limited to, prosthetics, wheelchairs, biomechanical modeling, and other devices that aim to enhance mobility, communication, cognition, and environmental control.
The Center supports some of these activities through the Small Business Innovative Research (SBIR) and Small Business Technology Transfer (STTR) programs. For example, NCMRR recently awarded funding to IntelliWheels, Inc. , to develop ultra-lightweight, multi-geared wheels for manual wheelchairs to give users increased mobility and independence. Another NICHD-funded SBIR grant involves development and testing of an instrumented glove for rehabilitation of individuals who have lost hand function from stroke. The glove requires the user to practice gripping movements by playing a computer game.
Through its research programs, the NCMRR addresses specific issues in rehabilitation medicine:
- Research related to development or redevelopment of emotional, cognitive, and physical processes and characteristics. This work includes interventions to encourage behavioral development in children with disabilities, as well as research on behavioral plasticity. The rehabilitative technology portion supports research that applies bioengineering principles to developing assistive technology to help people with disabilities perform daily tasks and activities.
- Projects that support basic research on substrate responses to injury and on strategies to promote regeneration, plasticity, adaptation, and recovery. This research includes studies on topics ranging from activity-mediated processes, such as treadmill training and constrained-use therapy, to genomic influences on outcomes and recovery. This Program also includes research on secondary conditions, such as pain, depression, and cardiovascular dysfunction.
- Projects that involve studying how to improve recovery of abilities that can be affected by TBI and stroke, including movement, mobility, and language, as well as mental health problems. Other ongoing areas of research include studies of combinations of pharmacological, surgical, and physical therapies to improve outcomes; the effect of compensatory training for unimpaired extremities; and measuring caregiver burden at different times following a stroke.
- Research to develop rehabilitation technology for individuals with spinal cord injury (SCI) and musculoskeletal disorders such as cerebral palsy, muscular dystrophy, multiple sclerosis, arthritis, osteoporosis, and systemic lupus erythematosus.
A few advances by NCMRR-funded scientists are described in the following sections. Additional advances are available in the right column of this page.
- NCMRR-funded scientists are currently working on major breakthroughs in walking technologies for lower-limb amputees. For example, at the University of Alabama, Tuscaloosa, a muscle-actuated robotic below-knee prosthesis is being developed that will give amputees a powered ankle joint capable of better meeting the demands of human locomotion than the passive ankle joints found in current prostheses (PMID: 25571414). Scientists at Vanderbilt University are developing paired, coordinated robotic ankle and knee prostheses for bilateral transfemoral amputees. This will restore awareness and stability between the prostheses to enhance patients’ ability to walk (PMID: 25014950). At the University of Texas, scientists are studying the mechanics of falling in lower-limb amputees and designing rehabilitative interventions to prevent falls (PMID: 25797789).
- Scientists supported in part by NICHD, the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the National Science Foundation, and the Defense Advanced Research Projects Agency developed and implanted a wireless sensor into the brains of pigs and monkeys that recorded and transmitted information about brain activity for more than a year. The sensor could be used to study the brain’s muscle and movement control mechanisms in animals that are able to interact more naturally with their environments. It could also eventually be used in severely neurologically impaired patients for wireless control of prosthetics that move with the power of thought, as well as in controlling motorized wheelchairs or other assistive technologies (PMID: 23428937).
- Experts previously believed that recovery from TBI could occur only within a year after sustaining the injury. However, new findings from University of Texas at Dallas researchers indicate that a type of brain training called “gist-reasoning training” can improve cognitive performance months and even years after injury. Adolescents who experienced TBI at least 6 months prior to study enrollment completed eight, 45-minute training sessions over the course of a month. The gist-reasoning training involved reading texts and creating summaries and recalling important facts. Compared to a control group, the gist training group displayed significant improvement in several cognitive functions. The results suggest that this kind of cognitive training can be effective at improving brain functioning at 6 months and beyond the injury (PMID: 24966850).
- Researchers supported in part by NICHD reported on results from on ongoing clinical trial of a brain-computer interface called BrainGate that allows paralyzed individuals to use their thoughts to control a robotic arm that makes reach-and-grasp movements. The published report documented the ability of a paralyzed study participant to reach for and sip from a drink with no assistance. The article reported on several other tasks that the participants were able to complete. While the device requires additional testing before it can be widely used in paralyzed patients, it could eventually represent a way to restore some level of everyday function in these individuals (PMID: 22596161).
In addition to NCMRR, the several other NICHD components also address rehabilitation medicine research, including (but not limited to):
In the Division of External Research (DER), the Intellectual and Developmental Disabilities Branch (IDDB) sponsors research and research training intended to prevent and ameliorate a variety of intellectual and developmental disabilities. These efforts include support of national research networks and programs that include some rehabilitation medicine–related work: Autism Centers of Excellence (ACE) Program, the Eunice Kennedy Shriver Intellectual & Developmental Disabilities Research Centers (EKS-IDDRCs), the Fragile X Syndrome Research Center (FXSRC) Program, and the Paul D. Wellstone Muscular Dystrophy Specialized Research Centers (MDSRCs).
The DER Pediatric Trauma and Critical Illness Branch supports research that addresses the prevention, treatment, management, and outcomes of physical and psychological trauma and the surgical, medical, psychosocial, and systems interventions needed to improve outcomes for critically ill and injured children across the developmental trajectory. The Branch also focuses on the continuum of psychosocial, behavioral, biological, and physiological influences that affect child health outcomes in trauma, injury, and acute care.
In the Division of Intramural Research (DIR), the Section on Nervous System Development and Plasticity conducts research on the development of the nervous system and nervous system plasticity during fetal and early postnatal life. Studies include investigations of mechanisms of synaptic plasticity, neuron-glia signaling, development of neural precursor cells, and implications for learning and memory.
The DIR Program on Pediatric Imaging and Tissue Sciences develops and evaluates non-invasive imaging methods for assessing normal development, screening, diagnosis, and prognosis of diseases, disorders, and disabilities in pediatric populations. Studies include both basic and applied explorations of the science of tissues, physics, and imaging. The Program’s Section on Tissue Biophysics and Biomimetics invents, develops, and implements novel quantitative in vivo methods for imaging tissues and organs. For example, an ongoing study uses multimodal magnetic resonance imaging to evaluate cerebral reorganization caused by various rehabilitation approaches in children with cerebral palsy and TBI. Another line of investigation examines plasticity changes after rehabilitation in military personnel affected by TBI.
Other Activities and Advances
- Medical Rehabilitation Research Resource Network (MR3 Network)
MR3, funded through the NCMRR, the National Institute of Neurological Disorders and Stroke and the NIBIB, is a centralized medical rehabilitation research infrastructure that provides investigators with access to expertise, courses, workshops, technologies, core services, research training, pilot project funding, and collaborative, multidisciplinary opportunities. The Network currently consists of seven medical center sites across the country.
- Blue Ribbon Panel on Rehabilitation Research
NICHD convened a panel comprising 13 non-NIH scientific experts who were tasked with reviewing medical rehabilitation research within NCMRR and across NIH to identify promising research opportunities. Panel findings were released in June 2012: Blue Ribbon Panel on Rehabilitation Research at the NIH (PDF 528 KB).
- NICHD, along with the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Deafness and Other Communication Disorders (NIDCD), administers grants funded by the Foundation for the National Institutes of Health (FNIH) and the National Football League intended to answer some of the fundamental questions about TBI. These cooperative awards will allow teams of scientists to correlate brain scans with changes in brain tissue, possibly making it possible to diagnose chronic effects of TBI in living individuals.
- NICHD has also teamed up with NINDS to fund an eight-center, randomized clinical trial for the study of arm rehabilitation following stroke. Called ICARE, the trial compared an experimental upper-extremity rehabilitation protocol with usual care.
- NIH Clinical Center
At the Clinical Center, rehabilitation medicine professionals collaborate with NICHD and other NIH IC investigators in support of biomedical rehabilitation research. They initiate research in rehabilitation sciences by providing innovative rehabilitation services and developing, investigating and applying measurements and treatments of impairments, disabilities and handicaps pertaining to human function. The team also provides consultations, clinical assessments, and treatments for patients.
- NIH Pain Consortium
The consortium is an initiative consisting of representative members of most of the NIH ICs with programs related to pain, including the NICHD. The Consortium was designed to promote increased pain research across the NIH.
- From 2002 to 2012, NCMRR supported the TBI Clinical Trials Network. This network comprised eight level 1 trauma centers throughout the United States and designed and executed a clinical trial of citicoline (2,000 mg daily for 90 days) vs. placebo to treat complicated mild, moderate, and severe TBI. The Citicoline Brain Injury treatment Trial (COBRIT) was a phase III, double-blind, randomized clinical trial which ran from 2007 through 2011. The main outcome measures were functional and cognitive status, assessed at 90 days after injury using a core test battery developed by the Network. Rates of favorable outcome did not significantly differ between the treatment and placebo groups at the post-injury times evaluated. The data from the COBRIT trial are available to requesting investigators through the Federal Interagency Traumatic Brain Injury Research Informatics System (FITBIR).