Physical Medicine & Rehabilitation Scholarly Activity

The Department of Physical Medicine & Rehabilitation supports scholarship in a variety of venues.  The majority of the Department’s scholarship is educationally or clinically based and relates to function, disability, neurophysiology, technology, quality, and health and wellness. Faculty is encouraged to engage in clinically based research and other scholarly activity. Resident physicians are required to complete at least one approved project during their 3-year training program that results in an accepted platform/poster presentation with a PM&R national professional society, publication, educational module, quality improvement activity, or other scholarly product.  Departmental support is provided for these activities (e.g., modest start-up funds, networking for national and local experts, travel/room for presentations at regional and national meetings).

Research Program

Departmental research is supported through federal agencies, industry, and other sources.  Long-standing themes of inquiry are in the areas of aging with and secondary conditions associated with disability, the health of women with disability, traumatic brain injury and concussion, and health and wellness for people with disability.

Research in Progress

Disability Research and Dissemination Center (DRDC)
This cooperative agreement with National Center for Birth Defects and Developmental Disabilities (NCBDDD) is a multi-institutional resource for the disability science and research community and beyond. The primary purpose of DRDC is to expand NCBDDD’s capacity to support research and training, and to disseminate evidence-based practice related to birth defects and developmental and other disabilities ( External Icon). SUNY Upstate Medical University is the site for the Education Core (Margaret Turk, PM&R) and Evaluation Core (Christopher Morley, Family Medicine), with University of South Carolina (USC) housing the Administrative and Research Cores and American Association for Health and Disability (AAHD) housing the Dissemination Core.
CDC; 1U01DD001007-01
Co-PIs: Suzanne McDermott, PhD (USC) / Margaret A. Turk, MD (SUNY Upstate) / Roberta Carlin, JD (AAHD)

Upstate outputs to date: Systematic search and reviews (Healthy Weight Measurement in Disability, manuscript in preparation; Hypertension Management in Adults with Intellectual and Developmental Disability, in use for claims data analysis and planned publication); Spina Bifida Association (SBA) workplan for development of an expanded Spina Bifida Clinical Care Network; analysis of Spina Bifida claims data re: urologic care with Division of Human Development and Disability’s Rare Conditions team (manuscript published); support and mentoring for a 2-year fellow within the Learn the Signs, Act Early program at NCBDDD; Disability and Health Branch (DHB) program evaluation with multiple stakeholders and quantitative/qualitative methods (manuscript in preparation); Disability Medical Home exploration; Disability and Public Health Fellowship at Upstate (1-9/2016)    
2012 – ongoing
Mann JR, Royer JA, Turk MA, McDermott S, Holland MM, et al.  Inpatient and emergency room visits for adolescents and young adults with spina bifida living in South Carolina.  PM&R, 7(5): 499-511.

Cognitive Assessment in Concussion
Through a joint collaboration, a tablet-based concussion assessment system has been developed that includes assessment of concussion symptoms, cognition, balance (instrumented with an accelerometer), and a dual-task (balance and cognition assessment). Motion Intelligence LLC is seeking FDA approval.  Using this previous work as a base, the new focus is to develop another tablet-delivered cognitive task that incorporates a dual task paradigm that may be more sensitive to concussive injury.

Motion Intelligence LLC
Brian Rieger, PhD – Principal Investigator
Claudine Ward, MD – Co-Investigator

Pupil characteristics after acute mild traumatic brain injury
Welch Allyn has joined with the Upstate Concussion Program to investigate the association of pupillary responsiveness and status with cognitive changes or other symptoms associated with concussion.  Present data collection is in 2 populations:
        - concussed versus orthopedic injury subjects presenting to the Upstate
          Emergency Department;
        - pre- post fight in amateur MMA fighters

Welch Allyn
Brian Rieger, PhD – Principal Investigator

Objective Brain Function Assessment of mTBI from Initial Injury to Rehabilitation and Treatment Optimization
This multi-center trial examines the effectiveness of the Ahead Concussion Assessment System®, a new portable, hand-held device to objectively assess brain function and potentially identify changes related to mild traumatic brain injury.  This device allows the collection of data from electroencephalogram, neurocognitive testing and balance testing.  Sophisticated magnetic resonance imaging including diffusion tensor imaging techniques will also be incorporated for analysis.

BrainScope Company, Inc. [771750-5]
Christopher Neville, PhD, PT- Principle Investigator
Claudine Ward, MD, Physical Medicine and Rehabilitation- Co-Investigator
Kalliopi Petropoulou, MD, Radiology- Co-Investigator
Brian Rieger, PhD, Physical Medicine and Rehabilitation- Co-Investigator

2015 – ongoing

Development and Implementation of a Survey for Adults with Spina Bifida
This project is an outgrowth from the DRDC and earlier work with SBA.  SBA has contracted with Upstate to develop, implement, analyze, and publish information about the health of adults with spina bifida.  A growing proportion of the Spina Bifida population has changed from a pediatric focus, to an adult focus and concentration on chronic needs – yet there has been no systematic collection of information about the health needs of these adults.  Planned implementation of Phase 1 is early 2016, and Phase 2 fall, 2016. 

2015 – ongoing

Contract with SBA, supported by CDC funding
Christopher P. Morley PhD: PI – Family Medicine and Public Health
Margaret A. Turk MD: Co-Investigator – PM&R

Concussion and Brain Injury (Brian Rieger PhD; Claudine Ward MD)

Multi-method assessment of the effects of mild traumatic brain injury in adolescents: Mapping Indicators of abnormality and recovery: Evaluation of cognitive, emotional, and EEG measures in students with prolonged academic difficulties during recovery from concussion; data collection and analysis.

Neurophysiology (Patrick [Yu] Zhu MD; Robert Weber MD)
•     C7 root transposition, serial studies of sacrificed and accepting side
•     Electrodiagnostic techniques related to radiculopathy or neuropathy diagnoses,
       affect of environmental changes on nerve conductions
•     Recruitment patterns in disease conditions, UMN vs. LMN

H-Reflex To S1-Root Stimulation Improves Utility For Diagnosing S1 Radiculopathy. Clin Neurophysiol. 121 (2010) 1329-35.
2) Wu XD, ZhuY, Chen WJ, Jin X, Tsai N, Huang HY, Jiang JY, Zhu DQ, Li PY, Weber R, Yuan W, Chen HJ. Somatosensory evoked Potentials from S1 nerve root stimulation Euro Spine J. 2011: 20 (10): 1613-9
Proximally Evoked Soleus H-Reflex To S1 Nerve Root Stimulation In
Sensory Neuronopathies (Ganglionopathies).  Muscle Nerve (2013):814-6. .
4) ZHENG CJ, ZHU Y, LU F, XIA X, JIN X, WEBER R, JIANG J. Diagnostic Advantage Of S1 Foramen-Evoked H-Reflex For S1 Radiculopathy In Patients With Diabetes Mellitus. Int J Neurosci 2013 Nov;123(11):770-5.
5) ZHENG CJ, ZHU Y, LV F, MA X, XIA X, WANG L,JIN X, WEBER R, JIANG J,ANUVAT K. Abnormal Flexor Carpi Radialis H-Reflex As A Specific Indicator Of C7 As Compared With C6 Radiculopathy. J Clin Neurophysiology (2014):529-34.
6) ZHENG CJ, ZHU Y, JIN X, LU Z, XIA XL, ZHU DQ, WEBER RJ, DORRI MH, JIANG, JY. Potential Advantages of the H-Reflex of the Biceps Femoris-Long Head in Documenting S1 Radiculopathy. J Clin Neurophysiology 2014; 31: 41-47.
7 Hua XY, Yan QQ, Li TT, Zheng MX, Shen YD, Jiang S, Zhu Y, Xu JG, Gu XD, Xu WD (2015). Contralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury. NEUROSURGERY; (76):187-195.
8) Jun-Tao Feng*a, MD; Yi Zhu*a, MD; Xu-Yun Huaa MD, PhD; Yu Zhu a, MD, Yu-Dong Gua, MD; Jian-Guang Xua MD, PhD; Wen-Dong Xua,b,c MD, PhD. Diagnosing neurogenic thoracic outlet syndrome using the triple stimulation technique. 2015 Clinical Neurophysiology, Accepted for publication, Online avaiable June 2015
9) ZHENG CJ, ZHU Y, JIN X, LU Z, JIANG, JY, WEBER RJ, - Prevalence of Tarsal Tunnel Syndrome in Patients with Lumbosacral Radiculopathy. Euro Spine J. 2015 (In press)

Case reports (PM&R faculty and residents, Upstate medical students)
Various clinically relevant topics, submitted to/accepted by PMR-related professional societies.
Medical Student Summer Clinical Externship case report posters, supported by Association of Academic Physiatrists and SUNY Upstate PM&R.

Systematic searches and reviews (Margaret A. Turk, MD; Lynne Logan PT PhD)
•  Sleep Quality following Stroke (completed, poster presented)  
•  Measurement of healthy weight for people with disability (report accepted by NCBDDD; manuscript in preparation re: inaccuracy of BMI for people with disability)
•  Hypertension measurement and medication adherence for people with intellectual and developmental disability (report accepted by NCBDDD; manuscript in
•  Disability Education in Health Professions (poster accepted, manuscript in preparation)
•  Health of children and adults with spina bifida; goal of guideline development (In association with Spina Bifida Association; David Kanter MD, Lynne Logan PT
   PhD, Margaret Turk MD)

Spinal Cord Injury Medicine (Gizelda Casella MD)
•    Pressure ulcer management – new techniques
•    Obesity in SCI

Completed Research Projects

WalkAide compared to AFO in Stroke
Randomized Trial of the Innovative Neurotronics WalkAide Compared to Conventional AFO in Stroke is a multi-center clinical trial of WalkAide, a superficial nerve stimulator orthosis (FES) vs. brace, using functional scales tools, gait analysis, and standardized questionnaires to determine safety and effectiveness.
Innovative Neurotronics, Inc
Co-PIs: Margaret A. Turk, MD /Lynne Romeiser Logan, PT, PhD / Claudine Ward, MD
Completed 2013
1) Bethoux F, Rogers HL, Nolan KJ, Abrams GM, Annaswamy T, Turk MA, et al. Long-term follow-up to a randomized controlled trial comparing peroneal nerve functional electrical stimulation to an ankle foot orthosis for patients with chronic stroke. Neuorehabil and Neural Repair, on-line 2-4-2015 
doi: 10.1177/1545968315570325
2) Bethoux F, Rogers HL, Abrams GM, Annaswamy T, Brandstater M, Turk MA, et al. The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke: a randomized controlled trial. Neurorehabil and Neural Repair, 2014; 28(7):688-697.

Cortical Stimulation following Stroke
Multicenter RCT that evaluated safety and effectiveness of cortical stimulation in the treatment of upper extremity hemiparesis for adult stroke survivors at least 4 mos from acute stroke, comparing implanted cortical stimulation + therapy to therapy only, using functional outcomes measures.
Northstar Neuroscience, Inc      
Charles Hodge MD (Neurosurgery) – Principal Investigator
Margaret A. Turk, MD (PM&R) – Co-Investigator                                                              
Completed 2007

Osteoporosis Among Women and Girls with Mobility Impairments
Epidemiologic study to identify the prevalence, risk factors, and developmental factors through DEXA scans and surveys.        
CDC; R04/CCR218783-02  
Margaret A. Turk, MD (PM&R) – Principal Investigator
Completed 6/2004

Health Promotion for Women with Disabilities in Mobility: Project W.E.A.L.T.H.
Determined the effectiveness of traditional health promotion strategies for women with disabilities and further identified the importance of social support for behavior changes. 
CDC; R04/CCR214128-01
Margaret A. Turk, MD (PM&R) – Principal Investigator
Completed 3/2001
1) Turk, MA (2004). Health care challenges for clinicians and clinical researchers. In Wellner’s Guide to the Care of Women with Disabilities, Wellner SL & Haseltine F (eds), Philadelphia: Lippincott Williams & Wilkins.
2) Turk MA. Scandale J. Rosenbaum PF. Weber RJ. The health of women with cerebral palsy. Physical Medicine & Rehabilitation Clinics of North America. 12(1):153-68, 2001.
3) Turk, MA.  “The Impact of Disability on Fitness in Women: Musculoskeletal Issues” in The Health of Women with Physical Disabilities: Setting the Research Agenda for the 90s, Krotoski, D., Nosek, M., Turk, MA (editors),  Paul H. Brookes Publishing Co., Baltimore, 1996; 407 - 418.

Secondary Conditions in Cerebral Palsy
Defined secondary conditions and health issues in adults with CP
CDC; R04/CCR208516           
Margaret A. Turk, MD (PM&R) – Principal Investigator
Completed 2/1997
1) Turk MA. Health, mortality and wellness issues in adults with cerebral palsy. Devel Med & Child Neurol, 51(Suppl4), 23-28, 2009.
2) Turk MA. “Secondary conditions and disability” in Disability in America: A New Look.  Field MJ, Jette AM, Martin L (eds), The National Academies Press, Washington DC, 2006.
3) Turk, MA.  “Outcomes Measurement:  Developmental Disabilities Issues”  in Outcomes Measurement Research in Rehabilitation:  Setting the Agenda, M Fuhrer, PhD (ed), Paul H. Brookes Publishing Co., Baltimore, MD, 1996.
4) Turk, M.A., “Attaining and Retaining Mobility:  Clinical Issues”, in Secondary Conditions in Spina Bifida and Cerebral Palsy  Conference Proceedings, 1994.
5) Turk, M.A., Machemer, R.H., “Cerebral Palsy in Adults Who Are Older”, in  Aging and Developmental Disabilities - An In-Service Curriculum, Machemer, R.H., Overeynder, J.C. eds., University of Rochester, Rochester, New York, 1993.
6) Overeynder, J., Turk, M.A., Dalton, A., & Janicki, M.P. “I’m Worried About the Future: The Aging of Adults with Cerebral Palsy”, NYS Developmental Disabilities Planning Council Workgroup on Aging and Cerebral Palsy, Albany, New York , 1992.

Pediatric Rehabilitation
Pilot: Muscle Spasticity Assessment through mfMRI
Assessment of mfMRI as a quantifying tool in spasticity measurement and effect of interventions
Lori Ploutz-Snyder PhD (Syracuse University, Exercise Science) – Principal Investigator
Margaret A. Turk, MD (PM&R) – Co-Investigator
Completed 2007
Ploutz-Snyder LL. Clark BC. Logan L. Turk M.  Evaluation of spastic muscle in stroke survivors using magnetic resonance imaging and resistance to passive motion. Archives of Physical Medicine & Rehabilitation. 87(12):1636-42, 2006.
PhD Thesis: TES in Children with Disabilities
Assessment of the affect of threshold (sub-sensory) electrical stimulation with mfMRI, MRI, biodex, and functional measures
Lynne Logan PT, PhD candidate – Principal Investigator
Margaret A. Turk, MD (PM&R) – Co-Investigator
Partial Body Weight Support in Children with Cerebral Palsy
Assessment of harness effect in children with CP engaged in PBW
V. B. Unnithan PhD (Syracuse University, Exercise Science) – Principal Investigator
Margaret A. Turk, MD (PM&R) – Co-Investigator
Lynne Logan PT – Co-Investigator
Completed 2003
Unnithan VB, Kenne EM, Logan L, Collier S, Turk MA. The effect of partial body weight support on the oxygen cost of walking in children and adolescents with spastic cerebral palsy. Pediatric Exercise Science, 2006; 17:11-21.

Other Scholarly Activity

The broad base of Physical Medicine and Rehabilitation provides many opportunities for inquiry, education development, self-assessment, quality improvement and patient safety, lifelong learning, professionalism, and practice improvement.  Faculty and residents are encouraged to engage in existing programs or processes or to develop unique projects that are meaningful and can be completed within a specific time-frame.