Current Research & Training Projects

Wellons RD, Duhe SE, MacDowell SG, Oxborough S, Levitzky EE, Hood AJ, Watlington P.  Vestibular rehabilitation delivered via telehealth vs. in-person equally effective at dizziness symptom reduction.  Poster at the International Conference for Vestibular Rehabilitation. October 15, 2022, Minneapolis, MN.
Purpose/Hypothesis: This study compares the effectiveness of Vestibular Rehabilitation (VR) delivered via telehealth (TH) compared to traditional in-clinic setting at reducing dizziness symptoms in individuals with vestibular disorders (IVD).

Participants: Participants were 51 IVD without orthopedic or other neurologic impairment impacting mobility (female N=37; male N=13) ages 20-89 (average=57.38  ± 16.97 years) who completed VR.

Methods: This study used a quasi-experimental design using data obtained via retrospective chart review. Participants were distributed into groups based on frequency of TH visits: No TH (NT), <50% treatment sessions via TH (<50% TH), and ≥50% treatment sessions via TH (≥50% TH). Dizziness symptoms pre-post VR was measured using the Dizziness Handicap Inventory (DHI) scores and analyzed via One-way Analysis of Variance (ANOVA).

Results: The 51 participants were distributed into three groups: NT N=31, <50% TH N=8, and ≥50% TH=12.  All groups demonstrated statistically significant gains from the beginning to end of VR, with NT group improving 24.7 points (p=0.0001), <50% TH improving by 33.8 points (p=0.0064), and ≥50% TH  improving by 24.5 points (p=<0.00001).  There was no statistically significant difference between all three groups at the beginning or end of VR.

Conclusions: The results of this study suggest that dizziness symptoms experienced by IVD improve equally if care is delivered via TH or in-person.  Future research should determine if gait and balance abilities benefit equally as well when VR is delivered via TH compared to in-person.

Clinical Relevance: VR delivered via TH addresses many common barriers to in-person care, including accessibility, time, and financial. Evidence demonstrating equivocal outcomes in dizziness symptom reduction with VR delivered in-person compared to TH may allow IVD experiencing barriers to in-person VR care to receive and befit equally from VR using TH.

Wellons RD, Duhe SE, MacDowell SG, Hodge A, Oxborough S, Levitzky EE.  Estimating the minimal clinically important difference for balance and gait outcome measures in individuals with vestibular disorders.  Journal of Vestibular Research.  2022. doi: 10.3233/VES-201630
Background: Vestibular Rehabilitation Therapists (VRT) utilize outcome measures to quantify gait and balance abilities in individuals with vestibular disorders (IVD). The minimal clinically important difference (MCID) in gait and balance outcome measures for IVD is unknown. 

Objective: The purpose of this study is to estimate the MCID of the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) using distribution and anchor-based methods relative to the Dizziness Handicap Inventory (DHI) in IVD.

Methods: Data were collected using a retrospective chart review from two outpatient Vestibular Rehabilitation (VR) clinics. Data included demographic characteristics, diagnosis, VR course, and pre and post outcome measures including DHI, ABC, FGA, and GS. The DHI was used to classify subjects as “responders” or “non-responders” in order to calculate MCID values.

Results: The total number of subjects analyzed for each outcome measure was 222 for the ABC, 220 for FGA, and 237 for GS. Subjects made statistically significant improvements in ABC, DHI, FGA, and GS (p<0.001) from pre to post VR. The MCID calculated for ABC, FGA, and GS using the anchor-based approach was 18.1%, 4 points, and 0.09 m/s respectively. The MCIDs calculated using distribution-based approach for the ABC ranged between 7.5%-23.5%, FGA ranged between 1.31-4.15 points, and GS ranged between 0.07 m/s-0.22 m/s.

Conclusions: The anchor-based calculations of the MCID of 18.1%, 4 points, and 0.09 m/s for ABC, FGA, and GS respectively for IVD should be used over distribution-based calculations. This is due to strength of DHI as the anchor and statistical analysis. VRT and researches can use these values to indicate meaningful changes in gait and balance function in IVD. 

Keywords: Minimal Clinically Important Difference, Activities-specific balance confidence Scale, Functional Gait Assessment, Gait Speed, Vestibular Disorders

Wellons RD et al. Investigating health disparities in Vestibular Rehabilitation. Presented at the American Physical Therapy Association Combined Sections Meeting.  February 4, 2022.  Received Award for Best Vestibular Rehabilitation Poster.

Objective: The purpose of this study is to identify whether health disparities (HD) exist in Vestibular Rehabilitation (VR) between individuals who identify as Caucasians versus racial-ethnic minorities (REM). 

Methods: This study was a retrospective chart review of individuals with vestibular disorders who attended outpatient VR. Data recorded included age, gender, ethnicity, vestibular diagnosis, VR interventions, and pre-post outcome measures such as Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC), Gait speed (GS), and Functional Gait Analysis (FGA). Chi-squared tests, one-tailed, and two-tailed t-tests (α= 0.05) were utilized to compare Caucasian and REM groups.

Results: Three hundred and forty three charts (N=343) met inclusion/exclusion criteria. All subjects, Caucasian, and REM groups made statistically significant improvements on DHI, ABC, FGA, and GS from beginning to end of VR, with improvements on . REM demonstrated higher scores DHI (48.13 vs. 39.29, p=0.01) and lower ABC scores (50.60% vs. 63.32%, p<0.001) at VR evaluation compared to Caucasians. REM averaged less VR sessions (5.66 vs. 6.66, 0=.03) over a shorter period of time (8.70 vs 10.65 weeks, p=0.03) compared to Caucasians. All interventions were delivered equally except for lower extremity strengthening which was delivered more often to the Caucasian group (p=0.01) and sensory integration which was delivered more often to the REM group (p=0.01). There were no statistically significant differences in DHI, ABC, FGA, and GS scores between Caucasians and REM at discharge.

Conclusions: Data from this study suggests that HD may exist in VR in duration of treatment, number of treatment sessions, and initial DHI and ABC scores.

Impact Statement: VR was able to equalize HD which exist between REM and Caucasians at the start of VR in this sample. VR therapists should work with public health and policy researchers to address access to VR because individuals from REM will receive significant benefit when they attend VR.

Title: Power Training Combined with Interval Treadmill Training to Improve Walking Activity in Cerebral Palsy.

Project Director / Principal Investigator: Noelle G. Moreau, PhD, PT

Project Dates: 07/04/18 – 07/31/23

Funder: (NIH / NICHD)  R01 HD091089-01A1

Goal: To determine the immediate and retention effects of power training combined with interval treadmill training (PT3) on functional walking capacity in ambulatory children with CP. To identify key muscular mechanisms with this type of training, we will examine quadriceps muscle performance and architecture. Using coordinate data from global position system (GPS) combined with accelerometry, we will directly measure the effects of treatment on community-based walking activity and participation captured in real-world settings.

Title: Short-Burst Interval Treadmill Training to Improve Community Walking Activity and Mobility in Cerebral Palsy

Project Director / Principal Investigator: Noelle G. Moreau, PhD, PT

Project Dates: 06/15/19 – 05/31/24

Funder: (NIH / NICHD)  R01 HD098270-01

Goal: To determine the effect of short-burst interval LTT versus traditional treadmill training with body weight support on the primary outcomes of walking performance and capacity, and secondary outcome of daily participation in children with CP. Using coordinate data from global position system (GPS) combined with accelerometry, we will directly measure the effects of treatment on community-based walking activity and participation captured in real-world settings.

Title: An Individualized Multimodal Intervention for Bone and Muscle Health in Pre-Adolescents with Cerebral Palsy: Promoting   Healthy Transitions into Adulthood

Project Director / Principal Investigator: Noelle G. Moreau, PhD, PT

Project Dates: 1/01/20 – 12/31/22

Funder: Academy of Pediatric Physical Therapy (Planning Grant)

Goal:  The purpose of our planning proposal is to systematically develop a sound multi-site, multi-modal intervention study that is attractive to external funding agencies and to prepare multiple sites to conduct all procedures.

Title: MicroRNAs as Key Regulators of Gene Expression in Skeletal Muscle of Children with CP

Project Director / Principal Investigator: Noelle G. Moreau, PhD, PT

Project Dates: 12/31/20 – 12/31/22

Funder: Academy of Pediatric Physical Therapy

Goal:  The purpose is this pilot study is to test the overall hypothesis that muscle enriched microRNAs (myomiRs) that regulate skeletal muscle regeneration, extracellular matrix remodeling, and muscle growth are dysregulated in children with CP and that an intensive exercise training program will improve the expression of these myomiRs.

Title: Examination of a Power Leg Press (PLP) Test in Cerebral Palsy: Reliability, Sensitivity to Change and Functional Significance

Project Director / Principal Investigator: Noelle G. Moreau, PhD, PT / Mattie Pontiff, DPT

Project Dates: 01/01/20 – 6/30/22

Funder: Academy of Pediatric Physical Therapy (Mentored Grant)

Goal:  Experiments were conducted to develop and evaluate the psychometric properties of a novel muscle power test for those with Cerebral Palsy (CP), and to explore the relationships between lower extremity power and muscle structure, activity and participation. The three aims of this project were: 1) Determine the test-retest reliability and sensitivity to change of a PLP test to assess LE muscle power in individuals with CP. 2) Examine the relationship between LE muscle power production during a PLP test with muscle architecture and walking capacity in individuals with CP. 3) To determine whether LE muscle power measured with the PLP test or with isokinetic dynamometry is a better predictor of function in individuals with CP.

Title: Dysregulation of Skeletal Muscle Mitochondrial Function following Critical Illness: A Translational Approach

Project Director: Luther C. Gill, PhD, DPT

Project Dates: 08/2018 – open ended

Abstract: Bioenergetic failure is a significant clinical consequence of sepsis-induced critical illness and is characterized by reduced skeletal muscle mitochondrial density, and mitochondrial dysfunction. Given the morbidity and mortality associated with severe skeletal muscle weakness, early identification and targeted intervention are paramount. Moreover, identifying reliable biomarkers associated with skeletal muscle mitochondrial dysfunction may improve targeting of future rehabilitative strategies. MicroRNAs—a small class of non-coding RNAs about 22 nucleotides long, plays a significant role in skeletal muscle mitochondrial regulation, differentiation, proliferation, and apoptosis. Early activation of mitochondrial biogenesis is associated with survival and improved physical function in critically ill patients. Physical rehabilitation has the potential to ameliorate sepsis-induced myopathy by improving skeletal muscle mitochondrial function. Further, physical rehabilitation stimulates skeletal muscle satellite cell proliferation a critical step in skeletal muscle growth and regeneration.  The objective of the study was to determine:

  1. The impact of critical illness on skeletal muscle (limb and diaphragm) mitochondrial microRNAs.
  2. The impact of physical rehabilitation on ameliorating skeletal muscle (limb and diaphragm) mitochondrial dysfunction.