Past FPTR-Funding Recipient Advances Knowledge of Health Disparities Amid Pandemic

Lisa VanHoose, PT, PhD, MPH, is a physical therapist researcher, educator, and practitioner on the front lines in addressing health disparities in the current health pandemic. Though there is much more to be learned about the causes of these disparities, the evidence is clear. As with many diseases, racial and ethnic minority groups are shouldering a disproportionate burden amidst the COVID 19 health crisis.

VanHoose, an Associate Professor and Program Director in Physical Therapy at the University of Louisiana at Monrow, was recently appointed to the Health Disparities and Research subcommittee of the Louisiana COVID-19 Health Equity Task Force. The expertise that VanHoose will contribute builds on years of studying cancer-related side effects in minority cancer survivors and the physical therapy interventions that improve outcomes for these patients.

With the possibility of more frequent disruptions due to viral pandemics in the years to come, VanHoose sees a shift in research and research funding on the horizon.

“The effect is pretty evident,” says VanHoose. “For those currently conducting research, try to be as creative as possible. Moving forward, we may see funders asking for an alternative plan in the application process itself.”

VanHoose also predicts fundamental changes in physical therapy research study design. Future research will go beyond biological measures to move towards learning more about social determinants of health. These factors – including socioeconomic status, access to healthcare, location, and social support – are often predictors of outcomes along with underlying health conditions and baseline health.

While completing her PhD in rehabilitation science at the University of Kansas Medical Center, VanHoose was the recipient of the 2006 Foundation for Physical Therapy Research (FPTR) Florence P. Kendall Scholarship. She was also awarded the American Physical Therapy Association (APTA) 2009 Minority Faculty Development Scholarship. As the world moves forward with greater consideration to diversity and inclusion, VanHoose emphasizes the importance of scholarships for people from diverse backgrounds.

“Financial support that focuses on those from disadvantaged background and, even more important, scholarships that consider lived experience, are needed,” says VanHoose. She notes that this type of funding creates structural mentorship opportunities, a benefit of scholarships that VanHoose credits for helping her in her development as an independent researcher and educator.

VanHoose participated in a recent American Physical Therapy Association (APTA) Facebook live panel, “Health Disparities Brought to the Forefront as COVID-19 Spreads: What the Physical Therapy Profession Can Do.” VanHoose also recently recorded a podcast with the APTA Student Assembly addressing issues of inclusion and diversity in the profession.

Select Foundation Grants and Scholarships Awarded

Transcranial Direct Current Stimulation (tDCS) and Constraint-Induced Movement Therapy (CIMT) in Pediatric Hemiparesis

Weakness on one side of the body due to stroke or related events at or around the time of birth can affect the functional ability of an individual during childhood and throughout the lifespan. Emerging research using non-invasive brain stimulation to stimulate the involved areas of the brain has shown improvements in recovery of function. In this study, we are seeking to combine specific forms of brain stimulation and rehabilitation training in order to maximize this effect. Using transcranial direct current stimulation, brain cells that were inactive due to stroke injury have the potential to become active and contribute to improved function. This form of stimulation is painless, cost-effective, portable, and has shown no evidence of seizure or other serious adverse event. Importantly, it also has the potential to be applied in the clinical setting, simultaneous with rehabilitation training. Using a specific form of rehabilitation training called constraint-induced movement therapy, the hand that is less affected by the stroke is temporarily constrained with a solid mitten or a sling, allowing unique training of the hand which is more affected. Treatment focuses on training and activity in the more affected hand in isolation. These two forms of interventions may therefore be combined in order to investigate the potential effect of improving hand function in children with weakness due to stroke.

The long-term objectives of this study are to combine these two types of rehabilitation to investigate the benefit on hand function in children with weakness due to stroke. The translational potential of this intervention may directly impact pediatric clinical applications. The specific aims of the study are established to assess the safety, tolerability and success of the intervention in improving hand function in children with stroke. We are also assessing the feedback from the children and their caregivers as well as a cost-analysis of the intervention compared to usual and customary treatments. The research design would incorporate a 2-week camp-style setting of constraint-induced movement therapy while working with a therapist in combination with brain stimulation delivered at the beginning of each therapy session. Two groups would be established wherein all children receive therapy while one group receives an active form of tDCS and the other a sham tDCS stimulation. A therapist would perform the behavioral and brain stimulation assessments and testing, while a physician would perform medical evaluations for safety assessment. Such a team approach would advance the study toward the stated goals.

If, as physical therapists, we are able to maximize the potential recovery of a child who had a stroke early in their life the potential impact throughout their lifetime could be positively influenced. The current comprehensive cost of care for a person with cerebral palsy is estimated to be 1 million US dollars. The proposed intervention has potential to decrease cost of care through improved lifetime activity and participation.



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