Researchers at the USF Health Morsani College of Medicine were awarded $5.6 million of expected funds for a 4-year study from the U.S. Department of Defense to examine why many people with Friedreich’s Ataxia (FA) go on to also develop heart disease, a major cause of death for those with FA.

Principal investigator for the USF study is Thomas McDonald, MD, professor in the Department of Internal Medicine (Division of Cardiology) and the Department of Molecular Pharmacology and Physiology in the USF Health Morsani College of Medicine. Dr. McDonald is also a researcher in the USF Health Heart Institute and director of the USF Health Cardiogenetics Clinic.

“We still don’t have a full understanding of the genetic mutation for Friedrich’s ataxia to determine why so many patients go on to get heart disease – we need to know,” Dr. McDonald said. “The physiology is not well characterized. This study will help us gain a better understanding of the basic mechanisms of the gene that carries FA, and help identify clinical predictors of the FA-associated heart disease.”

The new study dovetails with current work taking place in Dr. McDonald’s lab, including an R56 grant from the National Institutes of Health, which focuses on the fundamental mechanisms of LMNA-associated heart disease passed from one generation to the next — and what can be done to help prevent disease and its consequences.

This FA-heart disease study will follow FA patients and their parents over four years, and will involve careful clinical monitoring of heart health, examination of biomarkers, whole genome sequencing, stem cell modeling of heart tissue, and mitochondrial function studies.

From left, Dr. Kami Kim, Dr. Aarti Patel, Dr. Thomas McDonald, and Dr. Theresa Zesiewicz. Not pictured is Sami Noujaim, PhD.

Spearheading the work in the DoD study is a multidisciplinary team of USF Health experts representing cardiology, genetics, neurology, molecular pharmacology, cardiac electrophysiology and predictive modeling. The diverse expertise will help distinguish the clinical, genetic, and biological factors that contribute to cardiac disease in FA patients. Data from FA families and basic science models will be integrated with clinical data to identify unique factors in the heart that influence the cardiac phenotype and separate cardiac-specific traits from those influencing the neurological phenotype.

“Study results could lead to tools used in patient care settings to identify those FA families most at risk for cardiomyopathy and allow for potential intervention and treatment that could help delay onset of the heart disease,” Dr. McDonald said.

The USF Health interdisciplinary team for the study includes:

• Thomas McDonald, MD: clinical cardiology, molecular pharmacology and cardiogenetics (Division of Cardiology, Department of Internal Medicine, MCOM)
• Aarti Patel, MD: neurocardiogenetics and cardiac imaging (Division of Cardiology, Department of Internal Medicine, MCOM)
• Sami Noujaim, PhD: molecular pharmacology and cardiac electrophysiology (Department of Molecular Pharmacology and Physiology, MCOM)
• Kami Kim, MD: machine learning and clinical predictive modeling (Division of Infectious Diseases, Department of Internal Medicine, MCOM; Center for Global Health Infectious Diseases Research, COPH)
• Theresa Zesiewicz, MD, clinical neurology (Department of Neurology, MCOM)

Dr. Zesiewicz, professor in MCOM and director of the USF Health Ataxia Research Center, has specialized in clinical research and patient care for ataxias and other movement disorders’ for more than 20 years and is recognized as an international expert and leader in the field of hereditary ataxias. Her movement disorders clinic supports the evaluation of over 3,000 patients per year, likely the busiest in the world.

“Dr. Zesiewicz will play a vital role in recruiting research participant and in overseeing neurological assessments of patients as they are longitudinally followed in this study,” Dr. McDonald said.

The funding for the study came from the DoD through its Congressional Directed Medical Research Programs (CDMRP), a section of DoD that funds novel approaches to biomedical research. Link: https://cdmrp.health.mil/

The team will begin recruiting study participants next month.

Photo by Ryan Rossy, USF Health Communications

The research suggests Accelerated Resolution Therapy may be an option for veterans who do not respond optimally to conventional therapies endorsed by the Department of Defense and VA

Tampa, FL (Dec. 2, 2013) –Accelerated Resolution Therapy, or ART, is a brief, safe, and effective treatment for combat-related symptoms of post-traumatic stress disorder (PTSD) among veterans and U.S. service members, researchers at University of South Florida College of Nursing report in a new study. They found this newer treatment — a combination of evidence-based psychotherapies and use of eye movements — was shorter and more likely to be completed, than conventional therapies formally endorsed by the U.S. Department of Defense and the Veterans Administration.

The findings appear online today in advance of December’s print issue of Military Medicine, the international journal of AMSUS.

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Kevin Kip, PhD, FAHA, professor and executive director for the Research Center at the USF College of Nursing, led the team of scientists and clinicians who conducted the first randomized controlled trial of ART in a military population. The trial enrolled 57 service members and veterans, primarily from the Tampa Bay area.

“Based on this trial and an earlier study completed at the USF College of Nursing, we believe that accelerated resolution therapy may provide the quickest way to effectively and safely treat post-traumatic stress disorder,” Dr. Kip said. “Our goal is to obtain enough evidence and interest to warrant classifying ART as a potential first-line treatment for PTSD among both civilian and military personnel.”

“Dr. Kip’s work on this project has been phenomenal,” said Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president of USF Health, and dean of the College of Nursing. “ART has been a cornerstone of RESTORE LIVES at USF Nursing as we continue developing research and education to advance the health care received by veterans, service members and their families.”

ART works in two phases to alleviate psychological trauma symptoms and related disorders such as depression and anxiety.

The patient first visualizes in his or her mind a prior traumatic experience which typically elicits uncomfortable physiological sensations like tightness of the chest, increased heart rate and sweating.  Then, through talk therapy and a series of rapid left-to-right eye movements in which the patient follows the clinician’s hand back and forth, the sensations are minimized. In the second phase, and with similar clinician input, the patient “replaces” the distressing images they have seen with positive ones in a way that the original distressing images can no longer be accessed. ART is delivered in two to five one-hour sessions, requires no homework, and no written or verbal recall of the traumatic experience.

Diego F. Hernandez, PsyD (left), a licensed clinical psychologist, demonstrates Accelerated Resolution Therapy, as veteran Brian Anderson follows his hand movements.

“Through this therapy, we’re able to quiet down and separate physiological symptoms that come with re-envisioning a traumatic experience,” Dr. Kip said. “We can also alter or replace the traumatic images and add positive material to them. We are changing how images are remembered in the brain.”

It worked well for Brian Anderson, a former Green Beret, 10-year Army veteran and director of the Pasco County Veteran Services and Stand Down program.  He had tried an endorsed first-line PTSD treatment known as prolonged exposure therapy, which was very lengthy and worked for a while, but then symptoms like hyper-vigilance returned.

“ART changed my life,” Anderson said. “This brief therapy took the bad memories that constantly resurfaced and put them in the proper order or long-term storage; it was almost like I was thinking about a time in history. As a veteran, I would much rather go through a therapy that works, in only a few sessions, than sit through intensive and grueling sessions that last as long as 16 weeks.”

In this study, researchers compared ART to a non-therapeutic PTSD treatment called attention control (AC) regimen. Clinicians treated half of the 57 study participants (29) with ART, and the other half (28) received AC, which consisted of either physical fitness assessment and planning or career assessment and planning. After initial treatment, both groups received a three-month follow-up assessment.

“Before and after these interventions, we compared the response analyzing reductions in PTSD symptoms, depression and anxiety, and the results were very impressive,” Dr. Kip said. “In an average of less than four ART sessions, participants had very substantially reduced symptoms of PTSD, while those who received AC did not.”

After the AC regimen, all veterans had the opportunity to receive ART, and in the full study, 94 percent completed treatment. Favorable results persisted at three months.

Kevin Kip, PhD, executive director for the Research Center at the University of South Florida College of Nursing, led the team of scientists and clinicians who conducted the first randomized controlled trial of ART in a military population.

The USF College of Nursing recently began its fourth and largest ART study. Researchers will recruit 200 veterans and service members suffering from PTSD, including a high representation of those who were sexually abused or previously treated with other PTSD therapies. They will also study the cost-effectiveness of ART, and further examine how and why the therapy works.

PTSD is a prevalent, disabling disorder that can emerge following a life-threatening event or traumatic experience. Those experiences create chronic symptoms such as flashbacks, nightmares, sleep disturbances, mood swings, and loss of interest in life. According to PTSD Foundation of America, one in three troops returning from combat suffers PTSD symptoms, although less than 40 percent seek help. The organization also reports that at least five active duty military members attempt suicide every day.

“Accelerated resolution therapy is giving hope to many veterans who felt like they had no hope,” said Lt. Col. (Ret.) Lawrence A. Braue, EdD, director of the USF Office of Veterans Services. “I look forward to the day when this treatment is widely available across the country. USF College of Nursing faculty and staff genuinely care about our veterans, and that means the world to any veteran.”

For more information about ART or current studies visit USF College of Nursing’s RESTORE LIVES.

Article citation:
“Randomized Controlled Trial of Accelerated Resolution Therapy (ART) for Symptoms of Combat-Related Post-Traumatic Stress Disorder (PTSD),” by Kip, Kevin E.; Rosenzweig, Laney; Hernandez, Diego F.; Shuman, Amy; Sullivan, Kelly L.; Long, Christopher J.; Taylor, James; McGhee, Stephen; Girling, Sue Ann; Wittenberg, Trudy; Sahebzamani, Frances M.; Lengacher, Cecile A.; Kadel, Rajendra; and Diamond, David M; Military Medicine, Vol. 178, No. 12, December 2013, pp. 1298-1309(12)

-USF Health-

USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a global research university ranked 43rd  in the nation by the National Science Foundation for both federal and total research expenditures among all U.S. universities. For more information, visit www.health.usf.edu.

-RESTORE LIVES at USF NURSING-

Through ‘RESTORE LIVES AT USF: Education and Research to Rehabilitate and Restore the Lives of Veterans, Service Members and their Families’, USF College of Nursing faculty develop life enhancing treatments through nursing research, and educate nurses with the knowledge and skills specific to the needs of the military, veterans and their families. The ART study is an example of type of innovative research that the USF College of Nursing is developing to improve the health of our honored service members and veterans.

Video and photos by Andy Faza, USF College of Nursing Communications 

Media Contact:
Vjollca “V” Hysenlika, College of Nursing Communications
(813)974-2017 or vhysenli@health.usf.edu

U.S. Rep. Gus Bilirakis toured the USF School of Physical Therapy & Rehabilitation Sciences Aug. 20 as part of a visit to learn more about the University of South Florida’s comprehensive research and educational initiatives to benefit veterans and active military.

The Congressman met with physical therapy faculty members engaged in leading-edge Department of Defense-funded studies – including testing advanced prosthetics for military amputees, evaluating an exercise training regimen intended to protect soldiers against low back injury, and recruiting USF student veterans exposed to blasts while in the military but not diagnosed with traumatic brain injury, to determine whether balance, gait and hearing problems may be early signs of TBI.  He was accompanied by Lt. General Martin Steele (USMC retired), executive director of USF Military Partnerships, and William S. Quillen, DPT, associate dean of the USF Health Morsani College of Medicine and director of the School of Physical Therapy & Rehabilitation Sciences.

USF’s physical therapy school is home to a Center for Neuromusculoskeletal Research, with research sponsored by the DOD, Federal Emergency Management Agency and corporate partners, as well as support from recurring state funding.

Bilirakis, vice chair of the House Committee on Veterans’ Affairs, also met with USF President Judy Genshaft, Larry Braue, EdD, director of veterans services at USF, and several of the university’s Tillman Military Scholars, including some from the Morsani College of Medicine. USF’s college of medicine has one of the largest concentrations of Tillman scholars of any medical school in the country.

Jason Highsmith, DPT, PhD, assistant professor in the USF School of Physical Therapy & Rehabilitation Sciences, shows Congressman Gus Bilirakis a couple of the multifunctional prosthetic feet his team is evaluating as part of a DOD-funded research project.

John Mayer, DC, PhD, Lincoln College Endowed Chair in Biomechanical and Chiropractic Research, explains the project he leads investigating whether a specific exercise training regimen may protect against low back injury in combat soldiers. They study enrolled healthy medics at Fort Sam Houston, TX.

Jeannie Stephenson (left), PT, MS, instructor, and Dolly Swisher, PT, PhD, professor, demonstrate the neurocom sensory organization test that will be used to help isolate balance difficulties that may be a preclinical indicator of mild traumatic brain injury.

Seok Hun Kim, PhD, PT, assistant professor of physical therapy, is among the USF researchers involved in federally-funded research to benefit soldiers and veterans, with applications for civilian amputees as well.

L to R: Vietnam War veterans Rudy Salas and Jim Daniels, advocates of the advanced prosthetic research conducted at USF, chat with Bilirakis.

 Photos by Amy Blodgett, USF Communications & Marketing

The Department of Defense study is testing how well multifunctional prosthetic feet work for rigorous, agile maneuvers soldiers must perform on the battlefield

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Whenever he leaves for the airport on vacation, Joshua Sparling carries along a bag full of legs and feet.  There are different prosthetic components for running, others for swimming, bicycling or golfing, and yet another for everyday walking.

Sparling, 31, who lost his right leg to an improvised explosive device (IED) while serving as an Army sergeant in Iraq in 2005, has experienced the discomfort of prostheses not particularly well suited for his high-intensity athletic endeavors. So he was enthusiastic about enrolling in a U.S. Department of Defense-funded study at the University of South Florida School of Physical Therapy and Rehabilitation Sciences – traveling from Michigan to Florida to participate in the research.

The project is evaluating how well different multi-functional prosthetic feet work for rigorous and agile maneuvers soldiers must perform on the battlefield – from running and jumping to dodging, crawling and climbing.

The advanced prosthetic research involving military amputees may ultimately benefit civilian amputees with physically challenging occupations or recreational pursuits, such as firefighters, police officers, construction workers, triathletes, marathon runners or rock climbers.

“Our findings will have implications not only for the rehabilitation of soldiers who seek to stay on active duty, but also for civilians with amputations who want to participate in activities at a more intense level,” said Jason Highsmith, PhD, DPT, the USF Health assistant professor of physical therapy leading the study.  The knowledge researchers gain from evaluating high-end prostheses that can help soldiers move more efficiently across war zone terrain can also be applied to developing prosthetics “for common movements like walking or jogging at a comfortable pace,” he added.  

Army Staff Sgt. Brian Beem, a partcipant in the DOD-supported prosthetic research study, hoists himself over one of the many obstacles at the Walter C. Heinreich training site.

Beem races agains the clock to finish a course that pushed participants to complete the same physically-demanding maneuvers soldiers must perform on the battlefield.

The USF researchers enrolled 28 physically fit people in the DOD double-blind randomized trial. Half are soldiers and veterans who wear prostheses for below-the-knee amputations, the most common kind of lower limb loss. The other half are non-amputees from the local law enforcement SWAT team.

This spring, the military amputees were evaluated wearing each of three different commercially-available high-tech prostheses. The study participants were tested in USF’s Human Functional Performance Laboratory, where they walked and ran on treadmills while researchers measured performance parameters, including range of joint motion, prosthetic foot power, oxygen consumed and energy expended. At the Hillsborough County Sheriff’s Office training facility, the researchers evaluated obstacle course completion times, heart rates and perceived difficulty of performing such tactical maneuvers as charging up inclines, climbing ropes and slalom running requiring a combination of speed, agility and balance. Each participant was asked to rate the preferred prosthetic foot – both in the lab and in the field.

Non-amputees are presently completing the same testing. Researchers will compare the physical performance of the amputee group to the non-amputee control group, with the aim of identifying which prosthetic foot may be best suited for military applications.  They expect to have results by the end of this year.

Jason Highsmith (left), PhD, DPT, assistant professor of physical therapy leading the DOD study, adjusts the oxygen mask of Joshua Sparling.

In the USF School of Physical Therapy and Rehabilitation Sciences Human Functional Performance Laboratory, study participant Sparling, wearing one of the hi-tech prosthetic feet being tested, runs on a split-belt treadmill as researchers monitor his gait and various performance indicators.

Scientifically determining which prosthesis comes closest to an anatomic foot when performing battlefield maneuvers is important, Highsmith said, because a person with an amputation uses more energy than someone with a natural foot for comparable movements at the same speed.

USF’s prosthetic research has the potential to transform the lives of a growing number of young wounded warriors, like Army Staff Sgt. Brian Beem, by giving them the option of returning to active service – possibly even the war zone – if they desire and can perform the functions required by the job.

While deployed in Iraq in 2006, Beem, 35, lost his right leg below the knee following a roadside blast that claimed the life of a fellow soldier and friend.  Despite the injury, he re-enlisted for the third time November 2011 at Forward Operating Base in Frontenac Afghanistan and continued to serve his country with other Calvary scouts.  Beem, who calls himself a “career soldier,” now tests night-vision goggles, scopes and other devices at the Army’s Research and Development Center in Fort Belvoir, VA.

“I take it as a badge of pride that at one place I worked it took three months for my boss to figure out I was an amputee,” Beem said.  “It’s easy to forget you’re ‘disabled’ when the technology we have now can make the prosthesis comparable to a fully functioning foot.”

Sparling is impressed with the latest-generation prosthetics he’s been asked to help evaluate – all integrating varying degrees of rotational, shock-absorbing and energy-returning characteristics. “The advances made to this point have been pretty amazing,” he said.  “Nothing leads me to think it won’t get even better.”

Dr. Highsmith specializes in research to improve prosthetic options for those who lose limbs from traumatic injury or diseases – including soldiers and veterans reintegrating into society. He works with USF physical therapy and engineering colleagues.

USF’s Highsmith is equally impressed with the wounded warriors and veterans like Beem and Sparling who volunteered for the DOD study and push themselves to perform at levels comparable to SWAT team members without amputations.

“They’re extremely inspirational,” he said. “They’ve left parts of their bodies overseas defending our freedom… It’s personally rewarding to spend time with these heroes, hear their stories, contribute in some way to their ongoing rehabilitation, and, hopefully, we’ll find out which prosthesis works best so they can continue to stretch their limits.”

Brian Beem

Joshua Sparling

Video by Allyn DiVito, USF Health Information Systems, and photos by Eric Younghans, USF Health Communications