Research

At the Mount Sinai Spinal Injury Cord Program we provide persons with new or longstanding spinal cord injury (SCI) with opportunities to participate in clinical trials of new drugs and interventions that may lessen the impairment, or increase a person’s ability to function independently.

For more than 20 years, our program has participated in the trials of most new SCI drugs, including Sygen (GM 1), 4-Aminopyridine (4-AP), and HP184. We have participated in the use of biologic therapies for the treatment of SCI, including implanting neutrophils (Proneuron) and stem cells (StemCells) into the spinal cord.  Our staff and faculty also conduct research on various aspects of SCI treatments and outcomes, collaborating with prominent researchers in the United States and around the world. A portion of our research is funded by the U.S. Department of Health and Human Services National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR); sponsors of other projects include pharmaceutical industry and non-profit organizations.

We work closely with the National Center for the Medical Consequences of Spinal Cord Injury at the James J. Peters VA Medical Center. Investigators in this center have academic appointments within the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. We have co-located a Cardiovascular/Autonomic Lab, directed by Jill Wecht, EdD, and a Robotic Exoskeleton Lab, directed by Ann Spungen, PhD and Tsai Chung-Ying PT, PhD, on the same floor as the inpatient rehabilitation unit.

A home evaluation is the process of documenting dimensions of rooms and hallways, door widths, and obstacles to prepare for a person to return home from inpatient rehabilitation. Currently, clinicians ask a patient’s family member to complete a home evaluation on a paper form. Based upon the information collected, the therapist orders necessary DME, which may include a bed, a manual or power wheelchair, a commode, and tub bench to encourage as much independence as possible. If a home evaluation is not accurate, or not completed, the person may receive equipment that is unusable. Smart technology can make home evaluations easier to complete and provide clinicians with more accurate and reliable measurements. This research project develops, tests, and disseminates an efficient and accurate home evaluation method that uses a mobile application (app) installed on a smart phone or tablet to create a precise floor plan. Once the app user creates the floor plan, the user or a therapist can ‘fit’ objects that represent various DME from a database in the app on to the floor plan and make appropriate recommendations.

This project, funded by the Craig H. Neilsen Foundation, is a continuation of a one-year pilot project in which we partnered with a mobile app developer, Sensopia, to adapt their existing app, MagicPlan, to perform home evaluations. We developed the DME database so that it is accessible through drop-down menus. Going forward, we will expand the database, develop, and test on-line educational modules for the app. To test the educational modules, we will develop questionnaires to determine which method app users prefer. Initially, the educational modules is tested by clinicians and family members of patients at Mount Sinai. Then, we will test use of the app for home evaluation with four rehabilitation facilities located around the country and with a local community-based non-profit organization involved with care in the home for persons with disabilities. This feedback will help us develop the final versions of the education modules which will be built into the mobile app and made available for general use. These additions will allow the mobile application to be self-sustainable without the need for further intervention by the development team.

Thomas Bryce, MD is the principal investigator of this project.

Subcutaneous (under the skin) administration of botulinum toxin A (BoNT) has been reported in the literature to decrease neuropathic pain in patients with a variety of conditions, including postherpetic neuralgia, posttraumatic/postoperative neuropathy, and diabetic neuropathy. Animal studies have demonstrated that BoNT has a significant effect on both the peripheral and the central nervous system. The current study is a randomized double blinded placebo controlled crossover study in which 32 people with at level SCI (neuropathic) back pain will receive either subcutaneous normal saline (placebo) or botulinum toxin injections. The procedure is performed in an outpatient clinic setting at Mount Sinai Hospital with follow-up (office visit, telephone, or internet email follow up) at 2, 4, 8, and 12 weeks post-injection. Subjects will then be crossed over. Those who received placebo will get BoNT and vice versa. We will follow all patients every four weeks for an additional four weeks to determine the magnitude and duration of pain relief.

Thomas Bryce, MD is the principal investigator of this project.

If you have a spinal cord injury and back pain and are interested in participating, contact Ajax Yang at ajax.yang@mountsinai.org or call 857-222-2264 for more information.

The Mount Sinai Spinal Cord Injury Model System of the Department of Rehabilitation Medicine provides a regional multidisciplinary system of care that includes a number of innovative clinical programs for people with spinal cord injury (SCI) in the New York City metropolitan area. The system contributes longitudinal data about persons with SCI to the SCI National Database. The National Database includes more than 30,000 individuals. Persons with acute injury who are enrolled in a Model System can remain in the database and contribute to our knowledge of SCI throughout their lifetime. Investigators perform approximately 300 follow-up interviews per year at Mount Sinai.

The objectives of the Mount Sinai Spinal Cord Injury Model System focus on improving the quality of life of persons with SCI through:

  • State-of-the-science clinical care
  • Innovative research
  • Multi-platform extensive dissemination of research results and other information on SCI to consumers and professionals

The comprehensive clinical program consists of:

  • NYC Emergency Medical Services, ensuring the early and safe extrication of individuals with SCI from the injury site, pre-hospital care, and rapid transport to a trauma center
  • Emergency department and acute medical/surgical care units within the Mount Sinai Health System, including the Mount Sinai Morningside Trauma Center
  • Comprehensive CARF-accredited SCI acute inpatient and outpatient rehabilitation services taking place within a 25-bed SCI inpatient rehabilitation unit (serving 60 patients with traumatic SCI each year) and a large outpatient area. Core rehabilitation services include physical therapy, occupational therapy, speech-language pathology, social work, peer mentoring, outreach coordination, rehabilitation psychology, therapeutic recreation, and vocational rehabilitation.

The research program of the Mount Sinai Spinal Cord Injury Model System aims to improve the quality of life for SCI survivors by developing effective treatments of post-SCI secondary conditions.

Current projects include:

  • A local randomized clinical trial that will evaluate the impact of a standardized protocol compared to usual care to manage low blood pressure in inpatient rehabilitation, in order to improve participation in rehabilitation activities.
  • Participation in three collaborative module research projects with other model systems currently these include Pain Module, Equate Module and Residential Instability Module

Dissemination activities include a monthly e-newsletter, Spinal Connections; accessible web-based information; journal publications; presentations at international, national, regional, and local meetings; and involvement of consumers through a Community Advisory Committee.

Thomas Bryce, MD is the principal investigator of this project.

As patients spend less time in inpatient acute rehabilitation, it is increasingly critical to focus on the essentials. Patients must participate in their prescribed therapeutic plans to improve their outcomes. Hypotension, which is common among SCI patients, can limit optimal participation in rehabilitation units, especially among people with higher level lesions. Our goal with this study is to compare anti-hypotension treatment initiated based on blood pressure threshold regardless of symptoms, to usual care of symptomatic hypotension during acute rehabilitation following SCI. We will use a two-group randomized design. We will randomly assign participants to either the blood pressure threshold treatment group or the usual care group. The usual care group will receive blood pressure management according to the current practice on the SCI Rehabilitation Unit. Those in the blood pressure threshold treatment group will receive blood pressure management, regardless of symptoms, to maintain systolic blood pressure between 111 mmHg and 135 mmHg for males and 101mmHg to 135 mmHg for females for the duration of their inpatient time. We will look at differences in therapy time spent actively involved; time spent out of blood pressure normotensive range; symptoms of hypotension or hypertension, and cerebral blood flow.

Jill M Wecht, EdD is the principal investigator of this model system project.

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