School of Nursing
What are your general research interests?
My research focuses on developing and testing interventions that enable people living with Parkinson’s disease (PD) and stroke to optimize function, increase physical activity, and remain independent for as long as possible in the community setting.
What are your current projects and how are they funded? Who are your collaborators on these projects?
With funding from the Tuscany Health Care Authority in Italy, I am currently collaborating with rehabilitation expert Dr. Francesco Benvenuti to assess the adherence, safety, and satisfaction of PD patients who participate in a community exercise program.
We’ve used lessons learned from the Tuscany study to design and implement a study in Southern Delaware. I’m working with a team of researchers and clinicians from Beebe Medical Center and UD to test the effects of a community-based exercise program on function in individuals with PD and stroke.
In the first phase, we tested the feasibility and impact of a 12-week multidisciplinary exercise program. We wanted to know whether we could improve physical function (i.e., walking speed, balance, speech, cognition, etc.), activity, and quality of life by incorporating nursing, physical therapy, occupational therapy, and speech therapy techniques into an exercise program.
The formal study at Beebe is now complete, but the group has remained together, and they continue to exercise 2-3 times a week. I found through interviews that the participants valued the social benefits of exercising together—they have developed a social network of new friends who have similar issues, and they give each other invaluable support.
In the second phase of this work, we plan to continue investigating the physical benefits of the program while looking at adherence, social aspects, and cost benefits. Also, we will incorporate input from our initial participants. In this next study, we plan to include people with other diagnoses in the program, and we will likely group them according to their level of function. Also, it is not our intent to replace one-on-one therapy but rather to develop that intermediate step—a place for people to go after physical, speech, and occupational therapies are complete. Usually, patients leave therapy and go home with homework exercises, which they place on their refrigerator door and forget. We don’t want that to happen.
Recently, I have also started working with Prof. Stuart Binder-McLeod in UD’s Physical Therapy Department. He’s conducting a study on the use of fast treadmill training/functional electrical stimulation to improve walking, and I’m investigating the stroke survivors’ and their caregivers’ views of the intervention’s effect on their day-to-day lives.
I’m also working with Prof. Sunil Agrawal in mechanical engineering on the use of a vibration shoe for gait training in Parkinson’s patients. This is a joint project with the All India Institute of Medical Sciences (AIIMS) in Delhi, India. AIIMS is the premier clinic in that country, and we are honored to work with them.
What are the likely “next steps” in your work?
I plan to continue developing and testing new and innovative interventions that help people with PD improve function, increase physical activity (exercise is very important for these folks), and improve quality of their lives.
I also plan to continue development and testing of the Southern Delaware multidisciplinary exercise program and to include others (in addition to those with stroke and PD) who are at risk for functional decline. Also, we cannot forget caregivers, who are often left trying to figure out what exactly they are “supposed” to be doing for their loved ones.
Finally, I plan to explore, develop, and test interventions that address the more functionally challenged PD population such as those with balance issues or those suffering from freezing of gait (the feeling of feet being stuck to the floor). These individuals are not as likely to be considered candidates in other exercise studies.
How would you describe your work’s importance to an interested lay audience?
It’s important for PD patients to know that there are things they can do—in addition to the usual medical treatments—to optimize their independence. Exercise is very important. While most people know this, many have excuses not to exercise. We have incorporated motivational techniques and key elements of multiple disciplines and combined them into an exercise program for PD and stroke patients to help them maintain function while enjoying the company of others who are experiencing the same issues.