This Physician Scientist Award is designed to provide rigorous scientific training in preparation for an academic career with an intensive commitment in research. This proposal combines the academic environment at the University of Pennsylvania with the clinical environment of Thomas Jefferson University Hospital (Jefferson) and the Regional Spinal Cord Injury Center of the Delaware Valley. Quadriplegia results in significant self-care and mobility deficits, and is the focus of research aimed at both preventing and ameliorating such deficits. Current tools to assess self care and mobility status in quadriplegia lack sensitivity to detect changes in function, resulting in inadequate evaluation of new treatments. The proposed course of training is designed to develop the candidate's knowledge of functional assessment scales and skills in research design and implementation in order to investigate the relationship between motor power and the performance of life activities in quadriplegic spinal cord injury (SCI). Phase I will involve intensive course work and training in clinical epidemiology in a Masters of Science program at the University of Pennsylvania School of Medicine. The candidate will gain knowledge in epidemiologic methodology and research design, biostatistics, and the development of functional assessment scales. Concurrently a number of clinical projects will be conducted at Jefferson under the direction of Gerald J. Herbison, M.D. in order to refine existing measures of muscle strength, self care abilities and mobility. The Quadriplegia Index of Function (QIF) will be modified for use as a research tool to analyze the relationship between muscle strength and performance of self care and mobility tasks. The QIF will be reduced to a small number of discriminating items. Self care and mobility tasks of the QIF will be correlated with specific motor levels of quadriplegia, after accounting for the impact of adaptive equipment, to increase sensitivity to change in function across levels. The value of myometry over manual muscle testing in relating motor power to functional activities will be investigated. Based upon information gained during Phase 1, a self care and mobility assessment scale, possibly a modified QIF, will be designed. During Phase II this scale will be evaluated for reliability, validity, and sensitivity to change in performance of self care and mobility tasks, as related to upper extremity strength in quadriplegic SCI. An improved functional assessment scale is necessary in order to address such issues as the functional implications of recent pharmacologic treatments in SCI, and the role of mechanisms of motor recovery on function. The proposed training will leave the candidate well versed in methods of assessing the functional impact and efficacy of pharmacologic, therapeutic and technologic interventions in SCI.
| Marino, R J; Goin, J E (1999) Development of a short-form Quadriplegia Index of Function scale. Spinal Cord 37:289-96 |
| Marino, R J; Shea, J A; Stineman, M G (1998) The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia. Arch Phys Med Rehabil 79:1512-21 |
