Jefferson Health Corporation

HEALTHY START INITIATIVE-ELIMINATING RACIAL/ETHNIC DISPARITIES

PSYCHOLINGUISTIC ANALYSIS OF APHASIC SYNDROMES

RYAN WHITE TITLE III FUNDING: EARLY INTERVENTION SERVICES

RYAN WHITE TITLE III FUNDING: EARLY INTERVENTION SERVICES

EINSTEIN HEALTHCARE NETWORK- ADOLESCENT AND ADULT SBIRT - BEFORE THE PANDEMIC, THE CITY OF PHILADELPHIA HAD HIGH RATES OF SUBSTANCE USE AND REPORTS OF POOR MENTAL HEALTH. WHILE IT WILL BE SOMETIME UNTIL THE FULL EFFECTS OF COVID ARE KNOW, WE EXPECT SIGNIFICANT INCREASES IN THE NEED FOR SERVICES. PHILADELPHIA RANKS AMONG THE WORST OF ALL LARGE CITIES IN BINGE DRINKING, TOBACCO USE AND SUBSTANCE USE. THE CITY IS CONSIDERED THE EPICENTER OF THE NATION'S OPIOID EPIDEMIC WITH THE HIGHEST RATE OF OVERDOSE DEATHS OF ANY BIG CITY IN AMERICA. THE PRIMARY GOAL OF THIS PROJECT IS TO IDENTIFY AND EFFECTIVELY INTERVENE WITH ADOLESCENTS AND ADULTS WHO ARE AT MODERATE TO HIGH RISK FOR PSYCHOSOCIAL OR HEALTH CARE PROBLEMS RELATED TO THEIR ALCOHOL, TOBACCO, OR SUBSTANCE USE. TO ACHIEVE THIS GOAL WE HAVE THE FOLLOWING OBJECTIVES: INCREASE THE NUMBER OF COMMUNITY SETTINGS WHERE SBIRT IS PROVIDED; DEVELOP A QUALITY IMPROVEMENT PLAN TO ENSURE MODEL FIDELITY ACROSS ALL SITES; INCREASE THE NUMBER OF UNIQUE POPULATION GROUPS RECEIVING SERVICES INCLUDING ADOLESCENTS, PREGNANT WOMEN, INTERCONCEPTION WOMEN AND UNDERSERVED PRIMARY CARE PATIENTS. THIS PROJECT WILL SERVE 219,678 UNDUPLICATED INDIVIDUALS OVER FIVE YEARS. EINSTEIN HEALTHCARE NETWORK IS A PRIVATE, NON-PROFIT MULTI FACILITY NETWORK SERVING ONE OF THE MOST DISADVANTAGED POPULATIONS IN THE NATION. EINSTEIN IS CONSIDERED A PRIVATE HEALTHCARE SAFETY-NET, BEARING A LARGE SHARE OF RESPONSIBILITY FOR CARING FOR THE POOR AS MEASURED BY SERVICE TO MEDICARE, MEDICAID AND UNINSURED. EINSTEIN'S MISSION IS WITH HUMANITY, HUMILITY AND HONOR, TO HEAL BY PROVIDING EXCEPTIONAL HEALTHCARE AND EDUCATION FOR AS MANY AS WE CAN REACH.

EFFICACY AND MECHANISMS OF VIRTUAL REALITY TREATMENT OF PHANTOM LEG PAIN - PROJECT SUMMARY LIMB LOSS DUE TO AMPUTATION IS A COMMON PROBLEM, OCCURRING IN NEARLY 2 MILLION PEOPLE IN THE US. APPROXIMATELY 90% OF INDIVIDUALS WITH LIMB AMPUTATION EXPERIENCE THE PERSISTENT SENSATION OF THE MISSING EXTREMITY, KNOWN AS A PHANTOM LIMB, AND UP TO 85% EXPERIENCE PERSISTENT AND DEBILITATING PAIN IN THE MISSING LIMB, TERMED PHANTOM LIMB PAIN (HEREAFTER PLP). WE PREVIOUSLY DEMONSTRATED THAT VIRTUAL REALITY (VR) WITH ACTIVE LEG MOVEMENTS AND VISION OF A VIRTUAL LIMB SIGNIFICANTLY REDUCE PHANTOM LIMB PAIN IN SUBJECTS WITH BELOW THE KNEE AMPUTATIONS. THE WORK PROPOSED HERE HAS SEVERAL OBJECTIVES. IN SPECIFIC AIM 1 WE WILL RANDOMIZE 40 SUBJECTS WITH PLP TO TREATMENT WITH OUR ACTIVE VR OR A COMMERCIALLY AVAILABLE VR PAIN TREATMENT (COOL!). IN SPECIFIC AIM 2 WE PROPOSE TO DEVELOP A HOME INTERVENTION FOR PLP USING THE INTERVENTION (ACTIVE VR OR COOL!) THAT IN SPECIFIC AIM 1 PROVED TO BE MOST EFFICACIOUS. IN SPECIFIC AIM 3 WE WILL OBTAIN MULTIMODAL ULTRA-HIGH RESOLUTION (7T) MRI IMAGING IN SUBJECTS WITH PLP BEFORE AND AFTER TREATMENT, AND NORMAL SUBJECTS WITHOUT AMPUTATION; WE WILL ALSO ATTEMPT TO DEVELOP IMAGING BIOMARKERS THAT PREDICT EFFICACY OF TREATMENT. IMAGING STUDIES WILL ADDRESS A NUMBER OF CONTROVERSIES REGARDING THE NEURAL BASIS OF PLP AND EXPLORE HUMAN NEUROPLASTICITY MORE GENERALLY. FINALLY, IN SPECIFIC AIM 4 WE PROPOSE TO DETERMINE FACTORS THAT COULD BE USED IN A CLINICAL BIOMARKER-BASED ALGORITHM TO PREDICT RESPONSE TO HOME-BASED VR TREATMENT. USING CLASSIFICATION AND REGRESSION TREE (CART) ANALYSIS WITH THE DATA FROM AIM 2, WE WILL IDENTIFY BEHAVIORAL AND NEUROANATOMIC FACTORS THAT PREDICT TREATMENT RESPONSE. BY THE END OF THE GRANT PERIOD, WE WILL HAVE DETERMINED THE RELATIVE EFFICACY OF TWO VR TREATMENTS FOR PLP, ASSESSED THE FEASIBILITY AND EFFICACY OF A LOW-COST HOME-BASED TREATMENT, DETERMINED THE NEUROANATOMIC CHANGES ASSOCIATED WITH TREATMENT RESPONSE USING ADVANCED METHODS, AND EXPLORED THE BEHAVIORAL AND NEUROIMAGING BIOMARKERS PREDICTING TREATMENT RESPONSE. THESE DATA WILL PROVIDE A CRITICAL STEP TOWARD CLINICAL IMPLEMENTATION OF A VR TREATMENT PROTOCOL FOR PLP AND WILL ADVANCE THEORETICAL UNDERSTANDING OF THE MECHANISMS AND FUNCTIONAL NEUROANATOMY OF PLP.

HEALTHY START INITIATIVE-ELIMINATING RACIAL/ETHNIC DISPARITIES

MECHANISTIC AND NEUROANATOMIC BASES OF DISPARITY BETWEEN ARM CAPACITY AND USE IN STROKE - PROJECT SUMMARY MORE THAN 750,000 INDIVIDUALS IN THE U.S. HAVE A STROKE EACH YEAR, AND AS MANY AS 94% OF STROKE SURVIVORS EXHIBIT REDUCED USE OF ONE ARM, WITH ADVERSE CONSEQUENCES FOR DISABILITY, CAREGIVER BURDEN, AND QUALITY OF LIFE. APPROXIMATELY 40%-80% OF INDIVIDUALS WHO FAIL TO USE THE AFFECTED ARM IN DAILY LIFE POSSESS ADEQUATE SENSORY- MOTOR CAPACITY TO DO SO. THE DISPARITY BETWEEN ARM USE AND CAPACITY (I.E., USE/CAPACITY DISPARITY -- UCD) OCCURS ACROSS A BROAD SPECTRUM OF SENSORY-MOTOR SEVERITY AND IS A PERPLEXING AND URGENT PROBLEM IN NEURO- REHABILITATION. PERHAPS IN PART BECAUSE UCD LIES AT THE INTERFACE OF SENSORY-MOTOR PROCESSING AND COGNITIVE/AFFECTIVE PHENOMENA, NO PAST RESEARCH HAS ASSESSED ITS UNDERLYING MECHANISMS OR NEUROANATOMIC BIOMARKERS. GIVEN ITS PREVALENCE, AN UNDERSTANDING OF THE MECHANISMS OF UCD ACROSS A RANGE OF SEVERITY IS REQUIRED TO DEVELOP TARGETED TREATMENTS TO AMELIORATE THE DISORDER. MOREOVER, INDIVIDUALS WITH STROKE ARE RARELY ASSESSED FOR THE PRESENCE OF UCD, IN PART BECAUSE SUCH ASSESSMENT IS CHALLENGING. THE PROPOSED RESEARCH WILL ADDRESS THESE GAPS IN OUR KNOWLEDGE AND CAPACITY BY TESTING THE PREDICTIONS OF 3 HYPOTHESES OF THE MECHANISMS UNDERLYING UCD: THE SENSORIMOTOR, ATTENTION, AND APATHY/MOTIVATION ACCOUNTS. IN AIM 1 WE WILL ADMINISTER A TARGETED BATTERY OF SENSORIMOTOR AND NEUROPSYCHOLOGICAL TESTS TO TEST THE PREDICTIONS OF EACH OF THE 3 HYPOTHESES IN A SAMPLE OF 100 MILD TO MODERATE LEFT- AND RIGHT-HEMISPHERE CHRONIC STROKE PATIENTS. WE WILL DETERMINE THE ASSOCIATION OF THESE MEASURES AS WELL AS DEMOGRAPHIC AND STROKE-RELATED VARIABLES WITH UCD. AIM 2 WILL USE ADVANCED NEUROIMAGING METHODS WITH DATA FROM RESTING-STATE FUNCTIONAL MAGNETIC RESONANCE IMAGING TO DEVELOP IMAGING BIOMARKERS ASSOCIATED WITH UCD. IN AIM 3 WE WILL VALIDATE A NOVEL VIRTUAL REALITY ASSESSMENT TOOL TO RAPIDLY AND RELIABLY EVALUATE UCD. IN ADDITION TO ITS CLINICAL UTILITY, THE TASK ENABLES BUILT-IN ASSESSMENT OF THE ATTENTION HYPOTHESIS BY DETERMINING WHETHER UCD IS INFLUENCED BY ATTENTIONAL TASK DEMANDS. BY THE END OF THE GRANT PERIOD, WE WILL HAVE DETERMINED THE DEMOGRAPHIC, SENSORIMOTOR, NEUROPSYCHOLOGICAL, AND NEUROANATOMICAL FACTORS THAT PREDICT UCD AND VALIDATED A CLINICALLY-USEFUL VR ASSESSMENT TOOL. GIVEN THE LIMITED KNOWLEDGE BASE IN THIS AREA, THIS COMPREHENSIVE RESEARCH WILL PAVE THE WAY FOR DEVELOPMENT OF TREATMENTS TARGETED TO UNDERLYING MECHANISMS AND ENHANCED IDENTIFICATION OF AT-RISK INDIVIDUALS.

THE MOSS TRAUMATIC BRAIN INJURY MODEL SYSTEM

DISABILITY AND REHABILITATION RESEARCH PROJECTS

ANGER SELF-MANAGEMENT IN POST-ACUTE TRAUMATIC BRAIN INJURY: CLINIC TRIAL

PRIMARY CARE TRAINING AND ENHANCEMENT - LANGUAGE AND DISABILITY ACCESS - REFLECTING THE POPULATION OF PHILADELPHIA, THROUGH THEIR AMBULATORY AND INPATIENT ROTATIONS, OUR RESIDENTS HAVE HAD SIGNIFICANT EXPOSURE TO PERSONS WITH LEP AND DISABILITY BUT SPECIFIC TRAINING IN LANGUAGE AND DISABILITY ACCESS (LDA) HAS NOT BEEN FORMALIZED. THE NEED TO FORMALIZE THIS TRAINING IS URGENT. THE CURRENT AND FUTURE HEALTHCARE WORKFORCE MUST HAVE THE PROPER TRAINING AND SUPPORT TO EFFECTIVELY TREAT THEIR PATIENTS. TO MEET THIS NEED, THE PURPOSE OF THIS PROJECT IS TO INCREASE ACCESS TO QUALITY PRIMARY CARE SERVICES IN DUAL FOCUS AREAS FOR PERSONS WITH LEP AND/OR DISABILITIES BY PREPARING FACULTY AND RESIDENTS IN INTERNAL MEDICINE TO ADDRESS THE UNIQUE NEEDS OF THEIR PATIENTS BY PROVIDING A COLLABORATIVE, FULLY INTEGRATED TRAINING EXPERIENCE IN AN URBAN, UNDERSERVED AREA. TO FULFILL THIS PURPOSE OUR OBJECTIVES ARE: 1. INCREASE THE NUMBER OF INTERNAL MEDICINE RESIDENTS WHO ARE TRAINED TO PROVIDE CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES TO INDIVIDUALS WITH LEP AND/OR INDIVIDUALS WITH PHYSICAL DISABILITIES AND/OR INTELLECTUAL AND/OR DEVELOPMENTAL DISABILITIES (IDD); 2. DEVELOP AND IMPLEMENT A CULTURALLY COMPETENT DIDACTIC AND CLINICAL CURRICULUM TO EDUCATE 120 INTERNAL MEDICINE RESIDENTS OVER THE FIVE-YEAR PROJECT PERIOD TO CARE FOR INDIVIDUALS WITH LEP AND/OR INDIVIDUALS WITH PHYSICAL DISABILITIES AND/OR IDD. 3. PROVIDE OPPORTUNITIES FOR CLINICAL TRAINING IN COMMUNITY-BASED SETTINGS WHERE 120 INTERNAL MEDICINE RESIDENTS CAN CARE FOR INDIVIDUALS WITH LEP AND/OR INDIVIDUALS WITH PHYSICAL AND/OR IDD.

POSTDOCTORAL TRAINING IN TRANSLATIONAL NEUROREHABILITATION RESEARCH

UNDERSTANDING ACTION SELECTION IN THE TOOL USE NETWORK

AFFORDABLE CARE ACT: PRIMARY CARE RESIDENCY EXPANSION

RESEARCH METHODS FOR COGNITIVE REHABILITATION

PERCEPTUAL MOTOR INTERACTION TO IMPROVE BIMANUAL COORDINATION AFTER STROKE

UNDERSTANDING THE CONCEPTUAL-MOTOR INTERFACE

HOME-BASED MIRROR THERAPY FOR TREATING HEMIPARESIS IN STROKE PATIENTS

THE MOSS TRAUMATIC BRAIN INJURY MODEL SYSTEM

STRONG START FOR MOTHERS AND NEWBORNS

DISABILITY REHABILITATION RESEARCH PROJECTS

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - DISABILITY AND REHABILITATION RESEARCH PROJECTS

FIELD INITIATED

DISABILITY AND REHABILITATION RESEARCH PROJECTS

EFFICACY AND OPTIMIZATION OF SPEECH ENTRAINMENT PRACTICE FOR PEOPLE WITH APHASIA - PROJECT SUMMARY AMONG THE 795 000 AMERICANS WHO HAVE A STROKE EACH YEAR, ABOUT 84 000 EXPERIENCE CHRONIC APHASIA—AN IMPAIRMENT OF LANGUAGE PRODUCTION, AND OFTEN TO A LESSER EXTENT, COMPREHENSION, THAT CAN SEVERELY IMPACT THE QUALITY OF LIFE FOR PEOPLE LIVING WITH APHASIA AND THEIR FAMILY MEMBERS. RESEARCH HAS SHOWN THAT PEOPLE WITH CHRONIC APHASIA CAN BENEFIT FROM TREATMENT, BUT SIGNIFICANT COMMUNICATION CHALLENGES OFTEN PERSIST BEYOND CONCLUSION OF THERAPY. THIS PROJECT AIMS TO TEST AND DEVELOP A PROMISING TREATMENT TECHNIQUE, TERMED SPEECH ENTRAINMENT, TO ENHANCE TREATMENT OUTCOMES FOR PEOPLE WITH APHASIA. SPEECH ENTRAINMENT REFERS TO SPEAKING IN UNISON WITH A MODEL SPEAKER BY IMITATING THE MODEL IN REAL TIME. RESEARCH HAS SHOWN THAT SPEECH ENTRAINMENT IS A GROUND-BREAKING TECHNIQUE FOR PROMPTING CONNECTED SPEECH IN PEOPLE WITH APHASIA. EVEN THOSE WHOSE INDEPENDENT SPEECH IS LIMITED TO A FEW SINGLE WORDS MAY BE ABLE TO INCREASE THEIR SPEECH OUTPUT MANY-FOLD IN A SPEECH ENTRAINMENT CONTEXT. THIS IMMEDIATE STIMULATION EFFECT IS WELL-DOCUMENTED. WHAT REMAINS POORLY UNDERSTOOD IS WHETHER PRACTICING SPEECH PRODUCTION ALONG WITH AN ENTRAINMENT MODEL WILL ENHANCE INDEPENDENT SPEECH AT A LATER POINT IN TIME WHEN THE ENTRAINMENT SUPPORT IS REMOVED. IN ADDITION, CONDITIONS THAT OPTIMIZE OUTCOMES AND CHARACTERISTICS OF THOSE WHO BENEFIT HAVE NOT BEEN INVESTIGATED BEYOND THE IMMEDIATE STIMULATION. THUS, THIS PROJECT AIMS TO (1) EXPERIMENTALLY ESTABLISH THE DIRECT EFFECT OF SPEECH ENTRAINMENT PRACTICE ON INDEPENDENT SPEECH PRODUCTION POST-TREATMENT, (2) IDENTIFY CONDITIONS THAT ENHANCE TREATMENT BENEFITS, AND (3) DEFINE THE COGNITIVE-LINGUISTIC AND NEUROANATOMIC PROFILES THAT ARE ASSOCIATED WITH A POSITIVE TREATMENT RESPONSE. THESE AIMS ARE ADDRESSED IN A WITHIN-SUBJECT EFFICACY STUDY, WHERE 40 PEOPLE WITH APHASIA PRODUCE DIFFERENT STORIES WITH ENTRAINMENT SUPPORT. SPEAKING WITHOUT ENTRAINMENT IS EVALUATED ONE DAY BEFORE AND ONE DAY AFTER SPEECH ENTRAINMENT PRACTICE. DIFFERENT PRACTICE STORIES WILL BE RANDOMIZED WITHIN PARTICIPANTS TO THREE EXPERIMENTAL CONDITIONS TO ASSESS THE EFFECT OF TREATMENT (TRAINED VS. UNTRAINED), TRAINING SCHEDULE (MASSED VS. DISTRIBUTED PRESENTATION OF STORIES), AND ENTRAINMENT MODALITY (PRACTICE WITH AUDITORY-ONLY OR AUDIOVISUAL MODEL). CORRECT INFORMATION UNITS PER MINUTE FOR EACH STORY WILL BE TALLIED TO EVALUATE THE DIFFERENCES BETWEEN CONDITIONS AND THE ASSOCIATIONS WITH PATIENT CHARACTERISTICS. FOR CONSISTENCY WITH PRIOR RESEARCH, NUMBER OF DIFFERENT WORDS PER MINUTE WILL SERVE AS A SECONDARY OUTCOME. THE PROPOSED RESEARCH ADDRESSES A CLINICAL NEED BY TESTING AND OPTIMIZING A PROMISING TREATMENT TECHNIQUE FOR ENHANCING APHASIA REHABILITATION. IN ADDITION, THIS STUDY SERVES AS PILOT RESEARCH FOR A SUBSEQUENT R01 GRANT. GUIDED BY THE FINDINGS FROM THIS STUDY, THE SUBSEQUENT CLINICAL TRIAL ESTABLISHES THE EFFICACY OF SPEECH ENTRAINMENT PRACTICE IN A FULL-SCALED TREATMENT STUDY, IMPLEMENTED AT INTENSITIES THAT ARE DESIGNED TO TEST LONG-TERM BENEFITS.

DELINEATING THE IMPACT OF RETRIEVAL PRACTICE IN APHASIA

VICTOR CENTER HEALTH PROMOTION AND EDUCATION PROGRAMS FOR THE PREVENTION OF AUTOS

HEALTHY TOMORROWS PARTNERSHIP FOR CHILDREN PROGRAM

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

TEMPORAL PATTERNS OF PARTICIPATION RESTRICTIONS AND DEPRESSION SYMPTOMATOLOGY AFTER TRAUMATIC BRAIN INJURY

COORDINATING TWO ARMS FOR FUNCTION: CONTRIBUTION OF TASK GOALS AND UNIMANUAL IMPAIRMENTS

ASSESSING AN ANIMAL-ASSISTED TREATMENT PROGRAM FOR ADULTS WITH APHASIA: THE PERSONS WITH APHASIA TRAINING DOGS PROGRAM

RYAN WHITE TITLE III HIV CAPACITY DEVELOPMENT AND PLANNING GRANTS

RYAN WHITE HIV/AIDS PROGRAM PART C EIS COVID-19 RESPONSE

DENTAL REIMBURSEMENT PROGRAM - THIS PROJECT WILL REIMBURSE A PORTION OF UNCOMPENSATED DENTAL CARE COSTS.