Our lab investigates lower extremity musculoskeletal impairments due to diabetes and its complications. We seek to understand the pathophysiology of these impairments to develop targeted interventions. Our goals are to improve the detection of early structural and functional effects of disease, improve the rate of recovery of clinically meaningful outcomes, and prevent or reduce the impact of secondary injuries and chronic conditions.
Preventing Non-traumatic Lower Extremity Amputations (NLEA)
Individuals with diabetic neuropathy and chronic kidney disease are 15x more likely to have a NLEA compared to someone with diabetes alone. However, a critical gap remains in our understanding of the predisposing factors to NLEA in this high-risk patient population. Our methodology combines high-resolution peripheral quantitative computed tomography (HR-pQCT), motion capture, pedography, actigraphy, and functional testing. We seek to identify candidate markers capable of early identification of those at risk of NLEA, prior to irreversible deterioration.
Reducing the Risk of Frailty and Osteoarthritis in Diabetic Kidney Disease (DKD)
Sarcopenia, frailty, and osteoarthritis are common in individuals with diabetes who have reached end-stage renal disease. In spite of this, the temporal nature and extent of muscle and cartilage deterioration - especially in the mild and moderate stages of kidney disease - is still unknown. This study exists at the intersections of metabolic, renal, and musculoskeletal health, leveraging advanced MRI techniques and functional testing. We seek to determine how stage of DKD affects key clinical metrics and identify predictors of early cartilage deterioration.
Restoring Movement Pattern Symmetry after Total Knee Arthroplasty (TKA)
Atypical movement patterns persist after unilateral TKA, which may be limiting recovery of strength and function. It is possible that these atypical movement patterns are also predisposing the non-surgical knee to osteoarthritis (OA) development and progression. As part of an ongoing RCT incorporating biofeedback to normalize movement patterns, we are using quantitative MRI techniques to assess early biochemical changes in cartilage degeneration prior to morphological or clinical changes. We seek to determine if this innovative rehabilitation paradigm can prevent cumulative musculoskeletal stresses that negatively impact long-term function and OA progression.
Understanding Health Disparities and Inequities in Physical Therapy
Recognizing health disparities and inequities in rehabilitation and working to ameliorate them is one of the major tenets of the American Physical Therapy Association. Our studies in this area have spanned multiple clinical populations, including chronic low back pain, diabetes, chronic kidney disease, and adhesive capsulitis. We are leveraging de-identified electronic medical record databases to create cohorts for observational studies, particularly for comparative effectiveness and quality improvement purposes.
