Alexander Aruin -- Rehabilitation research training to enhance functional performance in MS/ Anticipatory postural control in individuals with multiple sclerosis.
Dr. Alexander Aruin, recently discussed his two National MS Society grant-funded research projects. As an expert in the field, he is an exemplary mentor for young trainees. He is currently a Professor of Physical Therapy, Bioengineering, and the Director of the Knecht Movement Science Laboratory at the University of Illinois at Chicago, and a Professor of Physical Medicine & Rehabilitation at Rush University, Chicago. His research on postural control is very intuitive and innovative and he hopes that his work here will inspire others to optimize therapy and rehabilitation in patients with MS. Dr. Aruin received his Ph.D. in Medical Cybernetics from the Moscow Institute of Artificial Organs and Transplantation in 1978 and a DSc (Ph.D.) in Biomechanics from the Latvian Institute of Traumatic Injuries and Orthopedics in 1990. He has co-authored more than 150 referred papers, two monographs, and 44 patients in the fields of neuromuscular disorders, rehabilitation, biomechanics, and motor control.
Could you please describe an overview of the work you are doing with both grants and explain the purpose of your research?
The first grant – “Rehabilitation research training…” – is what I like to call a “Training Grant.” It is awarded to train future researchers who will work with individuals with MS. It is designed so that a mentor or group of mentors will guide a talented and promising young researcher who is interested in continuing his/her career in rehabilitation of individuals with MS. It is a five-year grant, which I started on two years ago. We conducted a national search and a candidate was selected, his name is Mohan Ganesan. To be eligible for selection, one had to have a recent Ph.D., have an interest in rehabilitation of individuals with MS, and to have shown productivity in prior publications/research. We received more than 20 applications, shaved that down to three finalists, and then choose Maxan. He has his Ph.D. in neurophysiology, is a physical therapist, has done studies with patient populations, and is currently working on a research project that he developed which focuses on the role of specialized training in improvement of postural control in individuals with MS, which is different than my other grant-funded research.
The second grant is a “pilot grant” to study a novel idea/approach; it is focused on the investigation of anticipatory postural control in individuals with MS. What this is, is that when a person comes across a perturbation – in this case a perturbation refers to a disturbance of one’s balance by an external factor. When we perform any movement or need to move/lift something, our brain deals with two types of postural adjustments in order to keep balance, anticipatory and compensatory. Imagine that you are in a crowded space, and someone suddenly shoves you, what do you do? You need to restore balance. If the perturbation is expected and its magnitude is not large, restoring balance is as easy as contracting some muscles and leaning to one side. If the magnitude is large, you will need to take a step or two to restore balance. This type of reaction that our brain uses is called “compensatory postural adjustment.” The efficiency of compensatory postural adjustments depends on whether the brain uses another type of adjustment, called “anticipatory postural adjustment,” and this occurs before the actual perturbation happens. If I know I will get hit/shoved, my brain will send signals to some of my muscles, to activate them in advance so that I am better prepared. So, in a sense, anticipatory postural adjustments are a “first line of defense” in controlling someone’s balance. And because of the consequences of MS, these anticipatory adjustments are not as strong as in a person without MS. As a result, individuals with MS might experience difficulties in maintain their balance. If we learn more about anticipatory postural adjustments in MS, we would be able to optimize balance rehabilitation for people in need.
How did you come up with this proposal for your research?
Grant 1: I was involved in a number of projects, including training young scientists and graduate students, and I decided that my expertise in rehabilitation and training of graduate students could be of great benefit. I also believed that it would be a great way of giving back to society. Then I prepared the proposal and submitted the grant.
Grant 2: This proposal was a basic logical continuation of our current and past work with compensatory and anticipatory postural adjustments that we have been conducting for the past 15 years. During this time we came to learn a great deal about the field. So to me it was a logical continuation to expand this line of research to a population of patients that might benefit in the future from scientific knowledge about their ability to generate and utilize anticipatory postural adjustments.
What effect will this work have of MS if proven successful?
The training grant will eventually produce one or two qualified, new researchers who will focus on studies of rehabilitation issues in individuals with MS. These researchers will be able to enter this field with experience, drive, and passion. There is always a need for new talent. With bright new minds looking in on an issue, there is always a possibility for growth, expansion, and innovation. Then, these new researchers will hopefully become experts in the field and will train new young and bright minds, and the cycle will continue.
We will hopefully produce preliminary data for future research and studies, involving more patients, more experimental conditions, and a possibility of improving the two components of postural control.
What other work have you done pertaining to MS?
I have done some research in investigating how patients with MS control their grip force. If you need to lift an object or grab something, your grip force is needed in order to preform those tasks. We have seen that elderly people use excessive grip force typically when not needed just in case they are to drop the object. We have also seen that other patients with neurological impairments use excessive grip force, and we demonstrated that with MS patients. These patients have problems modulating grip force during movement, so their brain sends signals to the muscles in the hands to provide more force just in case. During the research we found that if the person involves the other hand by putting an index finger on the wrist of the hand that is used to lift an object, they no longer use excessive force because with the other hand in action, they can better optimize their performance. We have published two papers in clinical journals – Clinical Neurophysiology and Neuro-Rehabilitation and Neuro-repair.
How did you first get connected with the National MS Society?
I started working with MS patients around 1993-1994, developing a portable technique for recording their gait at home, and later communicating the Greater Illinois Chapter with which I have a very good relationship. I started going to research symposiums, and other meetings; my team and I have participated in Walk MS, we volunteer, and then I participated in conferences on a review panel for reviewing grant application. The first grant I received from the National MS Society was on grip-control, and that was in 2006.
Why have you chosen to work with a disease such as MS, and why is this work important to you?
There are two main reasons for my work with MS – professional and personal. Professional, because I find the disease and the work I do with it extremely interesting and challenging. It is not yet clear to us what the reasons are for the onset of the disease, and its symptoms and consequences vary so much across patient populations. Just because two people have MS doesn’t mean that those two will go through the same disease process, that they will receive the same medication/rehabilitation, or that their challenges facing the disease will be similar at all. From a personal point of view, I had a young relative, a brilliant and productive professor who was living with MS. His disease played a role in my decision to help the National MS Society to accomplish their mission of creating a world free of MS.
Where are you in your research process?
Grant 1: the grant provides support for one trainee per year. I proposed that there will be two of them that will spend two or three years in the program. Mohan will be working here for another 12 months or so, and then we will begin the search process again. It takes about three months to find the correct trainee.
Grant 2: I would say that we have almost completed everything we need to do for the study. We have collected the data, and the grant period is almost over. At this time we are at the manuscript writing phase, documenting our progress and findings, and then we will publish the study outcome in a clinical journals so that others benefit from our work. We hope that in the next couple of months, the paper will be submitted. We plan to present our results at one of the upcoming conferences.
What other projects are you currently working on, or is this your sole project?
There are several projects in the lab right now; some are more clinical while others are more focused on basic scientific research. One of the projects that I believe has great potential is a research on the restoration of ambulation – walking ability – in Stroke patients. Patients who have suffered from a stroke frequently walk asymmetrically and their gate is off balance. The reason for this is that after the stroke, the muscles on the side of the body that the stroke affected become weaker and as a result, patients lean mostly on their health side. We teach these patients a very specialized technique for walking and maintaining balance: we apply what we call a “compelled body-weight shift approach.” Basically, we put an extra inch on the insole of shoe of the healthy side and let physics do the rest. They will be forced to use more of the weaker muscles in order to improve walking and gain balance.
What are your thoughts on current MS research?
I think that the recent advances in drug therapy are very promising. For example, a drug called “Ampyra” allows for MS patients to be more mobile and walk with more ease, and there are other drugs that are at the marketing stage, and it is very interesting to see how people can benefit from the drugs. My personal involvement in MS rehabilitation tells me that something more can be done with optimizing the way in which individuals with MS can be treated. Designing new rehabilitation approaches would be another promising direction of helping people with MS. The disease is extremely diverse, so the treatment has to be individualized to cater to each patient’s needs.
When do you predict you will have results on your projects?
As I said before, for the anticipatory postural adjustment grant, we are almost done, and we have seen very promising data that correlates with our reason for research. For the other grant, it is an ongoing project. We won’t know until the training time for these researchers is over. Assimilation is a very important part of the project, not only does the trainee need to learn how to conduct research, but he/she has to be trained to be able to write manuscripts, present results, communicate with others researchers, and ultimately find new promising avenues of rehabilitation research. This is the goal of the grant.
Do you hope to do further work with MS and the National MS Society?
Yes, of course. I am frequently coming up with new ideas and proposals for research and submitting them to the National MS Society and other foundations as will. And I do particularly enjoy working with MS, so I do see myself in the future continuing this activity. I hope that through the current and new research projects, we will be able to learn more about the disease. I certainly will do my part to optimize my research and obtain new data to benefit those affected by the disease.
Interview conducted by Elliot Gutman, Marketing Intern, National MS Society, Greater Illinois Chapter