What are your general research interests?
My general research interest lies in understanding how various factors, such as mechanical loading and nutrition, affect skeletal development. I am particularly interested in how these factors affect the skeletal development of children with disorders associated with a high risk for fracture, such as cerebral palsy and osteogenesis imperfecta.
Because children with cerebral palsy have limited participation in physical activity, they lack the mechanical stimulus needed for adequate development of their bones. Children with osteogenesis imperfecta have reduced and abnormal collagen production, which leads to the formation of smaller bones that are brittle and easily fractured.
What are your current projects and how are they funded?
In a project funded by the National Institutes of Health we are studying the effect of Botox, a neurotoxin, on the bone development of children with cerebral palsy. Recent animal studies suggest that the muscle paralysis caused by Botox leads to bone loss.
While this is potentially problematic because Botox is commonly used to treat muscle spasticity in children with cerebral palsy, it is also possible that Botox leads to an increase in physical activity which has a positive effect on bone. In the same project, some of the children will receive a daily low-magnitude vibration treatment in addition to Botox.
Therefore, if bone loss does occur with Botox treatment, we’d like to know if vibration is an effective countermeasure. There is evidence that low-magnitude vibration treatment can increase bone mineral density and improve bone structure in children with cerebral palsy, as well as postmenopausal women and young women with low bone mass.
We are also studying the effect of low-magnitude vibration treatment on bone development and fracture risk in children with a mild form of osteogenesis imperfecta. Bisphosphonates are commonly used to reduce fractures in children with this disorder; however, because the long-term effect of bisphosphonate use in children is unknown, there is considerable interest in identifying a nonpharmacological treatment.
Who are your collaborators on these projects?
On the Botox/vibration project involving children with cerebral palsy, my primary collaborators include Dr. Freeman Miller, an orthopaedic surgeon at the Nemours/A.I. duPont Hospital for Children, and Dr. Mary Barbe, a professor at the Temple University School of Medicine.
On the vibration project involving children with osteogenesis imperfecta, my primary collaborators are Dr. Michael Bober, a medical geneticist, and Dr. Richard Kruse, an orthopaedic surgeon, at the Nemours/A.I. duPont Hospital for Children.
What are the likely “next steps” in your work?
Both of our current studies are pilot projects that we hope will lead to larger clinical trials. We are also working to expand our research in children with cerebral palsy and osteogensis imperfecta to examine other aspects of their health.
How would you describe your work’s importance to an interested lay audience?
Cerebral palsy and osteogenesis imperfecta are understudied disorders. If we show that a simple nonpharmacological treatment can improve their bone structure and reduce their fracture rate, it may have important clinical application in the future.