WE ARE LEADERS SHAPING THE FUTURE OF HEALTH CARE 90°
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ASSOCIATE DEAN’S MESSAGE
WE ARE LEADERS SHAPING THE FUTURE OF HEALTH CARE PHOTO BY CHRISTINA GANDOLFO
This academic year marks the 75th year of physical therapy education at the University of Southern California. We are fortunate to have much to celebrate in our history. USC’s program has been led by giants in our field, like Helen Hislop and Jacquelin Perry, and it has been on the cutting edge of the advances in physical therapy education, research and clinical practice that have characterized the physical therapy profession’s first century in the United States. We were pioneers in moving physical therapy education first to the master’s degree and then to the DPT. We were one of the first departments to have its own PhD in physical therapy, and we led the way in establishing residency programs in academic institutions. Over the past three decades, we have built an impressive research infrastructure that focuses on the study of human movement (biokinesiology) with an emphasis on clinical application. Over the same period, we have built one of the largest faculty practices in the nation, with 50 clinical faculty practicing at three different sites. We, who are heirs to the USC Physical Therapy legacy, feel the burden of these accomplishments on our shoulders — a set of expectations that we must live up to. But, in truth, the legacy handed down to us by our predecessors is actually quite liberating. It inspires us to think in bold, ambitious terms. During recent strategic planning, we defined our vision: To transform health care by creating the future in physical therapy; and our mission: To enhance the health and quality of life of all people by advancing physical therapy education, science and practice. Launching our next 75 years with such ambitious statements initially felt presumptuous. Who are we to make such a statement about changing health care? But, in fact, we are well positioned to lead this essential and necessary transformation of health care, with more than 150 faculty, 423 students engaged in DPT, PhD and MS studies; three self-sustaining clinical practice sites; and many of the strongest researchers in physical therapy, spanning biomechanics, pediatrics, exercise science and neurorehabilitation. We are ready to accept this responsibility; indeed, we embrace it. Of course, we are not alone in seeking to achieve these goals. The leaders of the physical therapy profession understand very well the pivotal role that physical therapy can play in the necessary transformation of the health care system in the 21st century. We look forward to collaborating with educators, clinicians and scientists within and beyond physical therapy to enhance the quality of life of all people. In this booklet, we celebrate our 75 years of history in the way that we think our past leaders would most value — by providing examples of the ways that we are continuing to move the profession forward — in education, in clinical practice and in research. With appreciation for what has come before, we are laying the foundation for the next 75 years of physical therapy at USC and around the globe.
Associate Dean and Chair, USC Division of Biokinesiology & Physical Therapy
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The Digital Revolution
18 A Father’s Love
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Taking Flight
20 Let’s Play Ball
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10 Building a More Diverse Profession
22 Virtual Reality Rehab
14 Go West, Young Man
26 A Paradigm Shift?
16 What a Relief!
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EDUCATION
THE DIGITAL REVOLUTION USC is diving into the digital world, with DPT@USC, an innovative online/on-campus hybrid program that reimagines the way physical therapists are trained. BY KATHARINE GAMMON
ILLUSTRATION BY DAVE MURRAY/I2I ART USC DIVISION OF BIOKINESIOLOGY AND PHYSICAL THERAPY
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EDUCATION
WE STRIVE TO TRANSFORM HOW WE PREPARE THE NEXT GENERATION OF PHYSICAL THERAPISTS TO DELIVER THE HIGHEST LEVEL OF CARE TO SOCIETY.
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hysical therapists are in high demand — so much so that the physical therapy job market is expected to increase by 34 percent (much higher than the majority of other occupations) by 2024, the U.S. Bureau of Labor Statistics estimates. With this in mind, USC began to assess how it might expand its physical therapy program — not only to help meet the expected demand but also to ensure the profession continues to be populated by high-quality physical therapists providing patient-centered, evidence-based care. The answer came in 2015 when the division was approached by 2U, Inc., an education technology company that has worked with 24 university partners, including Harvard University, Yale University and University of California-Berkeley, to build online degree programs that are as good as or better than their traditional classroom-based counterparts. After months of careful deliberation and discussion, the division decided to move forward, launching DPT@USC, a hybrid online/on-campus program. “Our goal was to revolutionize how we educate physical therapists,” says Professor of Clinical Physical Therapy Julie Tilson. “This was our opportunity to do just that.”
NO BACK ROW TO EDUCATION Students in the new hybrid program take the same courses as the residential students — just in a different format. They study full-time, starting each week with asynchronous content — video combined with bi-directional learning materials — that after 10-minute chunks of instruction requires them to answer questions by looking for informa-
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tion on their own or by meeting with other students, which prepares them to be lifelong learners. Every week, DPT@USC students also meet with their professors in live-classroom environments. “The motto of 2U is ‘no back row’,” says Tilson, the DPT@USC program director. “You really can’t hide and not be asked questions about the material.” These meetings take place every week for every course, so on average, hybrid students spend six to eight hours with faculty members in small-group settings every week. Once or twice per semester, depending on the lab content, the hybrid students are required to travel to USC for six- to eight-day stints. On campus, they attend lab sessions, building on what they have learned. Like the residential students, they receive mentorship and practice time during the immersion where they refine and get tested on their physical skills. Over the three-year program, hybrid students are expected to be on campus approximately 60 days for hands-on clinical skills laboratories. “Online and hybrid education for graduate programs is in high demand,” says Jeremy Shane, 2U vice president and general manager. “In health and medical fields, there is tremendous opportunity to grow these programs.” While there are some other physical therapy online learning options, USC is the first research-intensive institution (and top-ranked physical therapy program) to offer a full-time entry-level doctor of physical therapy degree using a hybrid online/on-campus format. “This innovative program continues to set us apart,” Tilson says. “My hope is that in the end, we have created two very powerful mechanisms for delivering the USC DPT experience.”
EDUCATION
FAST FACTS Since the division’s founding in 1945, USC has been a leader in physical therapy research and education and has been on the edge of the most significant educational advances of the profession.
1978
USC launches its doctor of philosophy program in physical therapy, which was the first of its kind in the United States.
1984
Marybeth Brown finishes physical therapy’s first PhD program.
1992
USC establishes nation’s first post-professional transitional doctor of physical therapy program.
1995
USC’s first entry-level DPT class begin their studies. USC is one of the pioneering few to offer this degree.
1998
USC enrolls its inaugural class of orthopedic physical therapy residents. The program is the nation’s first academically based residency.
2018
USC becomes first top-ranked school to offer hybrid online/ on-campus DPT degree.
EDUCATION
G N I K A T FLIGHT
aster of nation’s first m of e on es ch un grams with USC la ogy degree pro ol si ne ki io b in science e emphasis. THY a sports scienc MICHELLE McCAR BY
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Master’s students gain real-world experience through required internships and by working directly with underserved middle and high school athletes at Downtown Los Angeles’ Flight Lab.
WE BELIEVE INNOVATIVE EDUCATIONAL MODELS PROVIDE VALUE BY PREPARING GRADUATES TO BE EXPERT PRACTITIONERS IN A DYNAMIC HEALTH CARE ENVIRONMENT.
PHOTO BY NATE JENSEN
EDUCATION
A
s technology continues to advance, so too does sports science. Today, practitioners are expected to use technology and data to improve athletic performance and reduce player injury. Translation of technology and data into more effective and efficient care for athletes requires not only foundational work that identifies appropriate applications for technology, but also a workforce of educated professionals who can implement effective technology-driven strategies, according to Susan Sigward, associate professor of clinical physical therapy. To meet the needs of the ever-evolving field, USC has developed a master’s degree in biokinesiology with a sports science emphasis. “Our traditional master’s program instructs students to become researchers, and then they typically pursue a PhD,” says Sigward, who serves as director of the new sports science program. “But with the boom in the ability to capture large amounts of data, people are looking for more master’slevel trained individuals who have expertise in areas related to sports or activity performance.”
BORN OUT OF TECH BOOM While the study of sports science has been around for many years, it wasn’t until the past 10 years that the field began to explode. “This was largely due to the development of accurate wearable devices that include GPS, accelerometry, gyroscopes, heart rate, electrocardiogram and electromyography designed to fit into small devices or fabrics with improved battery life,” says E. Todd Schroeder, associate professor of clinical physical therapy. “We now have the ability to gather
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data during practices and games, which allows us to optimize the athlete’s training to improve performance while reducing fatigue and injury.”
ONE OF THE FIRST The new master’s program was created when biokinesiology faculty members recognized the need for graduates to be able to jump right into these careers. “Many sports science programs focus on the strength and conditioning aspects of improving athlete performance,” Schroeder explains. “We wanted to offer a program that also included using new technology, data analytics and applied internships to prepare students to be a part of a comprehensive team that improves health and performance of athletes at all levels.” The program provides students with a solid understanding of physiological, biomechanical and neurological bases of movement while giving them the advanced skills necessary to excel in a specialized area related to sports and exercise. Graduates will have a theoretical and practical understanding of the concepts and tools used in sports performance assessment and interpretation with respect to injury, injury risk and optimal performance. The sports and performance science field is rapidly growing, and the outlook for jobs is bright. Possible career paths for graduates include working for companies that create sports assessment technology, working alongside professional sports teams or providing rehabilitation in an applied training or clinical setting. “Most of the people looking for this sort of education in the U.S. are enrolling in long-distance programs or going to Australia, where the modern realm of sports science started in the 1960s,” Sigward explains. “USC is one of the first programs in the United States that’s truly calling itself a graduate program in sports science.”
USC student Eric Brown measures eighth grader Jaden Rashada’s vertical jump, comparing it to top NBA players, including the gravity-defying Michael Jordan.
PHOTO BY NATE JENSEN
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EDUCATION
The student-led Physical Therapy Multicultural Leadership Alliance aims to promote diversity in physical therapy. BY MICHELLE MCCARTHY
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ou could say the physical therapy profession has a bit of a diversity problem. According to the U.S. Bureau of Labor Statistics, a mere 5 percent of all practicing physical therapists are African-American. And only 3 percent of all physical therapy students in 2018-2019 were African-American, while 6 percent were Hispanic, according to the Commission on Accreditation in Physical Therapy Education. USC’s physical therapy program scored a little higher, with 8 percent of its entering students being African-American and 20 percent Latino. In response to this inequity, a group of USC physical therapy students created the Physical Therapy Multicultural Leadership Alliance (PTMLA). The student-led organization’s goal is to educate the local community about the physical therapy profession and promote diversity within the field, with an emphasis on minority and underserved communities. “I was shocked by how minimal the minority representation was in our class,” says PTMLA Faculty Adviser Terry Richardson II. “Then I started to find out it’s not just here at USC; this is a nationwide conundrum. I felt this burn to do what I could to increase minority representation.”
YOU CAN TOO To get the message out, PTMLA members venture out into the community at least once a month, speaking at local elementary, middle and high schools, and setting up booths at college fairs, career days and various other events. What they’ve found is many kids in these areas have never even heard of physical therapy.
WE ARE COMMITTED TO BUILDING A MORE DIVERSE COMMUNITY OF FACULTY, STUDENTS AND STAFF AND TO CREATE AN EDUCATIONAL AND WORK ENVIRONMENT THAT IS TOLERANT AND INCLUSIVE.
continued on page 12 »
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EDUCATION « continued from page 11
EDUCATION
FAST FACTS EDUCATIONAL PROGRAMS DOCTOR OF PHYSICAL THERAPY 383 STUDENTS
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MASTER OF SCIENCE IN BIOKINESIOLOGY 6 STUDENTS MASTER OF SCIENCE IN BIOKINESIOLOGY WITH SPORTS SCIENCE EMPHASIS 8 STUDENTS DOCTOR OF PHILOSOPHY IN BIOKINESIOLOGY 26 STUDENTS NEUROLOGIC PHYSICAL THERAPY RESIDENCY 3 RESIDENTS ORTHOPEDIC PHYSICAL THERAPY RESIDENCY 11 RESIDENTS PEDIATRIC PHYSICAL THERAPY RESIDENCY 2 RESIDENTS SPORTS PHYSICAL THERAPY RESIDENCY 3 RESIDENTS SPORTS PHYSICAL THERAPY FELLOWSHIP 1 FELLOW
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he thing about kids from minority backgrounds is that a lot of times they don’t think they can reach higher education,” former PTMLA president Jessica Nguyen says. “So we go out there and tell them, ‘Look, we are from minority backgrounds, and we are pursuing higher education and careers in the health profession, and you can, too.’” PTMLA also focuses on educating from within by hosting a speaker series that is open to anyone on campus. Physical therapists from underrepresented backgrounds are invited to give talks and presentations that help students become more knowledgeable as clinicians. “As an Asian woman, I might not understand African-American or Hispanic populations, but through the speakers and the experiences we have in PTMLA, I’m able to get a better understanding,” Nguyen says. Former PTMLA Vice President David Tang says the rapidly changing demographics in the United States call for a physical therapy workforce that mirrors its patient population. “We work directly with the people, and there are so many ethnicities and cultures, so it’s important we can engage with them.” There were approximately 75 members in PTMLA this year, the group’s largest number yet. Richardson says having a group like this is important because it provides an opportunity for people to find common ground, to learn about other cultures or ethnicities. “We all have a specific lens through which we see the world,” he says. “Sometimes it’s difficult to step outside of our frame of reference and have a better understanding of what someone else has experienced.”
“We are from minority backgrounds, and we are pursuing higher education and careers in the health profession, and you can, too.”
“I think it’s important for people like me to serve as an example so [underrepresented boys and girls] can see this is a possibility for them, too.”
—JESSICA NGUYEN, DPT STUDENT
—CHRIS FLOYD, DPT STUDENT
“We all have a specific lens through which we see the world. Sometimes, it’s difficult to step outside our frame of reference .” —TERRY RICHARDSON II, PTMLA FACULTY ADVISER
“Everyone deserves a chance to do something they love. If physical therapy is that career choice ... they should be able to be a part of it.”
“We work directly with the people, and there are so many ethnicities and cultures, so it’s important that we can engage with them.”
—JESSICA GOYTIZOLO, DPT STUDENT
—DAVID TANG, DPT STUDENT PHOTOS BY HANNAH BENET
EDUCATION
EDUCATION
FAST FACTS
GO WEST, YOUNG MAN Xavier University of Louisiana visiting scholar Keairez Coleman serves as the prototype for a new partnership meant to diversify student body.
There are 146 FACULTY MEMBERS at the USC Division of Biokinesiology and Physical Therapy.
As part of a researchintensive university, we have 34 ACADEMIC FACULTY MEMBERS, who are regularly contributing to physical therapy’s evidence base.
62 PERCENT of our academic faculty members have PhDs. The national average is 45 percent, according to the Commission on Accreditation in Physical Therapy Education.
We have 9 CATHERINE WORTHINGHAM FELLOWS on our faculty, giving us the highest concentration in the nation.
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BY YASMINE PEZESHKPOUR Keairez Coleman is a pioneer, blazing what will become a well-worn trail between Xavier University of Louisiana and the University of Southern California. The visiting scholar from XULA, a historically black college in New Orleans, was at USC during the summer of 2018 as part of the McNair Scholars Program, a government initiative meant to increase the number of graduate students from traditionally underrepresented populations. But the visit also represented a prototype for a program the division has begun to better diversify its student body. “We ultimately want our profession to represent our patient population in every facet,” says XULA alumnus and Instructor of Clinical Physical Therapy Terry Richardson II. “We’re the number one physical therapy program in the country, and Xavier is the number one school for placing African-Americans in health professions schools, so it seems like a natural partnership.” The program is meant to create a pipeline for XULA students to complete their prerequisite courses, gain valuable hands-on experience and develop mentoring relationships with Trojan faculty members. Like Coleman, future XULA visiting scholars will audit classes as well as shadow researchers, physical therapists and physical therapy students to better understand physical therapy education. Promising XULA scholars will apply for the early assurance program, which grants them a place in the DPT class so long as they are committed to a physical therapy career and have maintained a 3.2 GPA. Once selected, the students will begin receiving mentorship and individualized attention from USC faculty members to help them maintain academic success and become leaders in their field. “I feel that this experience will be a critical point in my career journey,” Coleman said, before his visit. “I hope to gain as much knowledge as possible and use this experience as inspiration for future endeavors.”
U SC DIVISION OF BIOKINESIOLOGY AND PHYSICAL THERAPY
PHOTO BY HANNAH BENET USC DIVISION OF BIOKINESIOLOGY AND PHYSICAL THERAPY
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PATIENT CARE
What aWHAT A RELIEF ! RELIEF USC physical therapists put their hands to work, providing relief from headaches. BY KATHARINE GAMMON
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F
or years, Noya Wang struggled with headaches. The pain would radiate from the back of her head and was often accompanied by neck and shoulder pain. “Some days are better than others, and sometimes it’s more in the head, and others its more in the neck,” she says. “In general, I feel really tense in the neck area, and the back of my head is always achy.” The headaches were making her unhappy. Though they didn’t often interfere with daily activities, the headaches did add a patina of pain to everything she did. On bad days though, Wang wasn’t able to hold her head straight and only felt better when she lied down. Desperate for relief, she tried a variety of treatments, including medication, massage and acupuncture — but all to no avail. REMARKABLE RESULTS In 2015, she found her way to Erica Sigman, assistant professor of clinical physical therapy, who also treats patients with headache and jaw pain at USC Physical Therapy, the division’s faculty-run practice. USC Physical Therapy offers a headache management program, in which board-certified neurologic and orthopedic physical therapists work alongside specialists from the USC Headache and Neuralgia Center to create individualized treatment programs for headache sufferers. While physical therapy is more likely to be associated with therapy for knees rather than heads, it’s gaining recognition as a treatment for headaches,
Sigman says. The process begins with a medical history evaluation as well as a thorough assessment, which serve as the basis for a comprehensive, evidence-based treatment plan. During Wang’s first appointment, Sigman measured her range of motion, assessed the joints of her neck and checked the strength of her postural muscles. Sigman says physical therapists have the unique ability to identify postural and cervical contributing factors to a patient’s headache. Once patients understand their triggers and postural factors, they can better prevent headaches from occurring. During a therapy session, Sigman usually begins with manual therapy to the thoracic spine. “That’s a safe place to start,” she says. “Then I might look and see if the patient presents with myofascial trigger points, because those can refer pain to the head.” Sigman will use manual therapy, ice massage and/or cupping to work on those trigger points. She then might work her way down the cervical spine, at times with manual therapy, but always working to strengthen the deep neck muscles. The results were remarkable, Wang says. “With every therapy, my baseline pain has gotten better,” she says. “It’s one of the most effective things I’ve tried for my headache.” Wang says physical therapy at USC is her personal happy place. “The care is beyond excellent. It’s way beyond my expectation. From the moment I walk in, people say hi to me; it’s full of love and energy. I can’t expect anything better than that.”
PATIENT CARE
FAST FACTS USC has a comprehensive clinical practice that provides high-quality physical therapy services to the surrounding community and serves as a hub for clinical education of students and clinical research by the division faculty. There are 50 CLINICAL FACULTY MEMBERS practicing across all three sites of USC Physical Therapy, the division’s faculty-run practice.
SERVICES OFFERED CANCER CARE CONCUSSION DIZZINESS AND BALANCE REHABILITATION FACIAL NERVE DISORDERS HEADACHE AND TMJ MANAGEMENT HEART AND LUNG CARE INPATIENT SERVICES NEUROLOGIC REHABILITATION ORTHOPEDIC REHABILITATION PAIN MANAGEMENT PELVIC HEALTH PERFORMING ARTS REHABILITATION SPORTS REHABILITATION WOUND MANAGEMENT
PATIENT CARE
A Father’s Love
USC physical therapist helps Shaun Kalpakoff prolong the onset of ALS symptoms, giving the single father precious time to play with his 10-year-old son. BY STEPHANIE CORRAL
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PHOTO BY NATE JENSEN
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seems like every week Shaun Kalpakoff discovers there’s something new he can no longer do without assistance. The 37-year-old single father is one of an estimated 20,000 Americans who live with amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disease that kills motor neurons. Also known as Lou Gehrig’s disease, ALS causes a person’s muscles to weaken and atrophy, ultimately leading to paralysis. As the disease advances, a person loses the ability to walk, speak, swallow and eventually breathe. Life expectancy varies from person to person, but according to the ALS Association, half of people diagnosed with ALS live at least three years or more after being diagnosed; 20 percent live up to five years or more.
STAYING INDEPENDENT LONGER “Physical therapy improves the quality of life for individuals with ALS,” Instructor of Clinical Physical Therapy Nora Darakjian explains. “It allows them to stay independent for as long as possible.” Kalpakoff credits Darakjian with helping him stay mobile by recommending equipment, such as ankle foot orthoses and canes, and teaching him energy conservation techniques and postural management tips.
“She gives me a lot of ideas and things to do at home,” Kalpakoff says. Darakjian is currently focused on optimizing Kalpakoff’s respiratory function and posture to help manage his neck and back pain. “We want him sitting and standing up tall in all his photographs with friends and family,” she says.
SPENDING TIME WITH LOVED ONES For Kalpakoff, spending quality time with the people he cares about has become his top priority, especially his 10-year-old son, Ashton. Despite his physical limitations, Kalpakoff and his son still find ways to have fun. “Everywhere we go, we kind of have an adventure,” Kalpakoff says. On Sept. 7, 2018, Kalpakoff made his condition public on Facebook. Among his reasons for doing so, he wrote, was Ashton. “When I watch my son Ashton make good choices and be kind to others, I get this feeling that cannot be explained,” he wrote. “He ... keeps me focused, positive and willing to do whatever it takes. I sincerely hope each and every person who reads this message has someone — not something — that fulfills that feeling. If you don’t, I challenge you to go out and find that person.”
WE ARE COMMITTED TO CONTINUOUS LEARNING AND TRANSFORMATION TO ENHANCE HUMAN HEALTH AND QUALITY OF LIFE.
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RESEARCH
LET’S PLAY BALL 20
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UCL injuries are on the rise in college baseball pitchers. One USC researcher hopes to prevent them altogether. BY MICHELLE McCARTHY
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aseball fans are likely familiar with the phrase “Tommy John surgery.” While pitching for the Los Angeles Dodgers in the 1970s, John underwent the first surgery of its kind to repair damage to his elbow. The technical name for the procedure is ulnar collateral ligament (UCL) reconstruction surgery. UCL injury has been occurring more frequently in college baseball athletes, especially pitchers, in the past decade, and Professor Lori Michener is hoping one day to prevent it altogether. “The UCL is the ligament on the inside of your elbow that helps to stabilize the inside of your elbow joint,” Michener explains. “Elbow torque (rotational force) occurs during pitching. The higher that torque goes, the more pressure it will put on that elbow ligament. If there’s too much pressure on the UCL, it can tear.” The injuries are happening more frequently, most likely because pitchers are constantly striving to throw faster. But why do they occur in some pitchers and not others? That’s one of the issues Michener and her team will investigate in their study. “We think it’s because of the factors being used to create ball velocity, which are strength and control of the legs through the trunk, through the shoulder and to the hand,” she says. “We’re trying to understand how physical factors — a pitcher’s strength, range of motion and ability to control his motion — can mediate that force on the elbow.”
COULD INJURY BE PREVENTED WITH EXERCISE? Participating in the study are 150 pitchers from three universities, including USC, the University of Oregon and the University of California, Los Angeles. Michener and her team will be running these pitchers through a battery of tests, including measuring the amount of torque at their elbow when they throw a baseball, the strength and control of their core and legs, shoulder range of motion and how well they can sense the position of their joints. “The hypothesis is that players who have a lower elbow force while they’re pitching and a set ball velocity compared to the pitchers who have a higher force at the same ball velocity will have better physical factors (i.e. better strength, better ability to produce and use that strength and better range of motion and position sense),” Michener says. “They’re able to mediate and control the force that goes to the elbow during throwing.” “You see this in younger kids when they’re throwing,” she adds. “They try to use their shoulder and elbow to get the ball where they want it to go, versus trying to use their entire body so it’s a fluid, low-force motion by the time it gets to the elbow and there’s less force imparted to the elbow.” Michener hopes to identify the physical factors that have the best ability to keep elbow torque lower while retaining the same velocity. That will give college medical professionals the tools to develop exercises to address any deficits.
WE SEEK NEW KNOWLEDGE AND UNDERSTANDING OF COMPLEX BIOLOGICAL AND PSYCHOSOCIAL MECHANISMS. WE TRANSLATE KNOWLEDGE INTO ADVANCES IN PRACTICE.
RESEARCH
PhD student Julia Juliano demonstrates REINVENT, a VRbased intervention that could help stroke survivors regain use of their limbs by retraining damaged neural circuits to function.
PHOTO BY NATE JENSEN
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VIRTUAL REALITY REHAB
BY KATHARINE GAMMON
Assistant Professor Sook-Lei Liew is exploring new brain-computer interfaces that connect survivors of stroke to the immersive world of virtual reality. For people recovering from a stroke, even the simplest motions can become a struggle. To lift a hand, for example, requires a signal from the brain that travels down the arm to the hand. That’s a lot of moving parts — and when something is damaged, it makes regaining those skills a slow process. That could all change, though, with the help of some innovation and advances in virtual reality. It was at an industry-academic conference that Assistant Professor Sook-Lei Liew became interested in how VR might be used for health care purposes. Liew, who had already been working on brain-feedback interfaces for stroke rehabilitation, began digging into existing research. One study she found showed that if you give someone an avatar with long arms in the virtual world, they interact with the real world as if they had long arms. The effect even lasts for 10 to 15 minutes after a person removes the VR headset. And another study showed if you give someone a child-like body in VR, that person starts to have more child-like features in the real world. That made Liew wonder something that would change her work forever: “If you give someone a healthy body in VR, will that help them recover their health?”
MOTHER’S SEWING MACHINE Most brain-computer interfaces use functional magnetic resistance imaging (fMRI), a huge and expensive technology that measures brain activity by detecting changes associated with blood flow. “The problem is that it’s really hard to travel to an fMRI machine if you have a severe stroke,” Liew says. “Typically you can’t drive, and your mobility is impaired.” That made it all the more vital to get the device to people, rather than have people come to the tool. continued on page 24 »
RESEARCH
Projected behind Sook-Lei Liew and Julia Juliano are the images seen inside the VR headset. PHOTO BY NATE JENSEN
« continued from page 23
BY DEVELOPING AND INTEGRATING NEW TECHNOLOGIES, WE LEVERAGE THE POWER OF THESE INNOVATIONS TO BETTER MEET THE NEEDS OF STUDENTS, PATIENTS, THE PROFESSION AND SOCIETY. 24
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The team built a prototype, using a laptop computer, an off-the-shelf VR rig, a $9 swim cap and an opensource brain-computer interface electroencephalogram (EEG) system. Liew used her mother’s sewing machine to connect the electrodes to the cap. The whole system costs less than $5,000. It’s called REINVENT: Rehabilitation Environment using the Integration of Neuromuscular-based Virtual Enhancements for Neural Training.
HOW IT WORKS This is how it works: The system uses virtual reality as well as brain and muscle sensors to show arm
RESEARCH
FAST FACTS Our faculty members conduct research in the areas of musculoskeletal biomechanics, motor behavior and neural control, exercise science and muscle research and motor development.
Last year, we received $1.6 MILLION from foundations and federal funding agencies, including the National Institutes of Health.
Our faculty members authored 80 PEERREVIEWED PUBLICATIONS in 2018.
Our 15 research laboratories occupy MORE THAN 14,000 SQUARE FEET. and hand movement in the virtual world when the patient has used the correct brain and muscle signals even if the patient cannot move his or her arm or hand in the real world. Over time, they can train the damaged circuits to work again. “Most of the demonstrated uses for VR are gaming or entertainment right now,” Liew points out. “But the future has got to include VR for healthcare, too.” “The area where VR is the most useful is where it allows us to do things we can’t otherwise do.” That could include, for example, immersive worlds to distract people while they’re getting chemotherapy in the hospital. “It’s a way to take your body out of a situation,” Liew says.
For MORE THAN A QUARTER CENTURY, groundbreaking studies of normal and pathological gait have been carried out at the Jacqueline Perry Musculoskeletal Biomechanics Research Laboratory.
Other unique areas of study include PELVIC PAIN SYNDROME, WALKING REHABILITATION AFTER STROKE and INJURY PREVENTION IN BASEBALL PITCHERS.
RESEARCH
A PARADIGM SHIFT? Assistant Professor James Finley has been awarded a National Institutes of Health grant to better understand walking rehabilitation for survivors of stroke. BY JOHN HOBBS Every 40 seconds, someone in the United States has a stroke. And while it is the fifth leading cause of death in America, it is often more disabling than it is fatal. Physical therapy for stroke survivors can often mean treatment focused on correcting walking asymmetries (such as a limp) so that the individual can walk in an observationally normal way. But is this best rehabilitation strategy? That’s what Assistant Professor James Finley aims to investigate in a new study that was recently awarded a $1.6 million grant from the National Institutes of Health. The study will examine the advantages and disadvantages associated with restoring symmetry in the walking patterns of survivors of stroke. Using a device to measure oxygen consumption, treadmills meant to elicit a stumble response and a motion capture system to record it all, Finley hopes to better understand how correcting gait asymmetries impacts energy efficiency and fall risk. “One thing we would like to do is assess the individual and find the focus areas for how to rehabilitate them,” Finley says. “How can we help an individual
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reduce energetic costs so they can walk longer distances? Can we train people to have a walking pattern that would lower their risk of falling?”
CHANGING THE PARADIGM? Finley’s findings could change the paradigm for how survivors of stroke are treated and help physical therapists better personalize walking rehabilitation. For the study, Finley will partner with a professor from the USC Viterbi School of Engineering to develop computer models of walking in people post-stroke. “One of the most exciting parts of this work is that there are computational techniques that we can leverage to observe a behavior and ask questions like, ‘What is the relative contribution of different factors to that behavior,’” Finley says. “‘How much might this walking pattern be meant to maximize stability?’ Or ‘how much might be driven by energetic costs?’” The long-term goal is to develop predictive models to be able to determine what walking patterns might be best for a survivor of stroke, he adds. “Ultimately, we want to improve people’s quality of life by giving them increased mobility,” Finley says.
RESEARCH
An infant’s leg movements are recorded at the Development of Infant Motor Performance Laboratory as part of research meant to detect neurodevelopmental disabilities earlier.
FAST FACTS USC is dedicated to advancing the science behind the physical therapy profession. Our 15 research labs cover a myriad of research areas, impacting individuals across the human lifespan.
LABS The APPLIED MATHEMATICAL PHYSIOLOGY LABORATORY performs basic science and translational research focused on the neural mechanisms for muscle activation, engineering of non-invasive systems to study human motor function and neuromuscular chronic pain disorders. The BICE CLINICAL RESEARCH CENTER is a specially designed facility for testing human research subjects and patient. This center supports the division’s extensive clinical research trials program. The BRAIN-BODY DYNAMICS LABORATORY is dedicated to understanding the biomechanics, neuromuscular control and clinical rehabilitation of human mobility, with an emphasis on dexterous hand function. The CLINICAL BIOMECHANICS ORTHOPEDIC OUTCOMES LABORATORY’s goal is to better understand the biomechanics and control of shoulder movement to optimize shoulder performance and enable the diagnosis, rehabilitation and treatment outcomes for patients with shoulder disorders.
PHOTO BY NATE JENSEN
RESEARCH
LABS
(continued) The CLINICAL EXERCISE RESEARCH CENTER’s mission is to promote health and rehabilitation using exercise as a stimulus to elucidate the mechanisms and define adjunctive therapy by which people will optimally adapt, heal and overcome debilitating disease or injury.
The LOCOMOTOR CONTROL LABORATORY seeks to understand how walking is controlled and adapted in both the healthy and injured neuromuscular system. Ultimately, the goal of the lab’s work is to design novel, effective interventions to improve walking ability in individuals with nervous system damage.
The COMPUTATIONAL NEURO-REHABILITATION LABORATORY aims to understand and enhance motor learning, especially after a stroke. It focuses on computational models of motor learning and neural plasticity in healthy and lesioned brains and optimization of learning via adaptive practice schedules in healthy and stroke subjects.
The MOTOR BEHAVIOR AND NEUROREHABILITATION LABORATORY is an interdisciplinary research initiative, focused on understanding control, rehabilitation and recovery of goal-directed movements that emerge from a dynamic brain-behavior system in brain-damaged conditions.
The DEVELOPMENT OF INFANT MOTOR PERFORMANCE LABORATORY studies the development of human action during infancy and early childhood, with a goal for early identification and rehabilitation of infants at risk for neurodevelopmental disabilities. The HUMAN PERFORMANCE LABORATORY investigates typical and impaired mechanics as they pertain to safe and optimal participation in sports and physical activities. The lab’s research focuses on prevention and rehabilitation of knee injuries in active individuals. The INFANT NEUROMOTOR CONTROL LABORATORY studies the development of neural control of movement during infancy and evaluates interventions for neural and functional development in infants with or at risk for developmental disabilities. The INSTITUTE FOR SENIOR GOLF SCIENCE’s mission is to develop evidence-based, safe and effective golf training programs for seniors to expand golf participation among older adults and underrepresented groups (veterans and people with disability).
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The MUSCULOSKELETAL BIOMECHANICS RESEARCH LABORATORY is dedicated to the biomechanical investigation of movement and musculoskeletal disorders, interventions and adaptations. The NEURAL PLASTICITY AND NEUROREHABILITATION LABORATORY aims to enhance neural plzzasticity in a wide population of individuals to improve their quality of life and engagement in meaningful activities. The NEUROPLASTICITY AND IMAGING LABORATORY investigates brain-behavior relationships during motor skill learning and motor control in both non-disabled and brain-injured individuals using transcranial magnetic stimulation.
PhD student Sonja Fenske demonstrates brain activity measurement while undergoing noninvasive brain stimulation as part of the research taking place at the Applied Mathematical Physiology Laboratory.
PhD student Sungwoo Park prepares a study to measure the metabolic cost of walking in people post-stroke as part of research taking place in the Locomotor Control Laboratory.
PHOTOS BY NATE JENSEN
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