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Muscle Performance (MP) Lab


Director: Dr. Jennifer Stevens-Lapsley, PT, PhD

The mission of the Muscle Performance Laboratory is to understand the causes of lower extremity muscle weakness that impairs function in older adults.

We use a multifaceted approach to study skeletal muscle dysfunction in older adults to ultimately enhance the effectiveness of rehabilitation programs. We place considerable emphasis on developing and refining more intensive and progressive strategies for the rehabilitation of older adult populations. For example, we are conducting a clinical trial investigating whether more intensive rehabilitation after total knee arthroplasty improves outcomes without compromising patient safety. We are also investigating more intensive approaches to rehabilitation for medically deconditioned, frail older adults in numerous healthcare settings (inpatient, skilled nursing, and home health). As such, we are developing evidence to shift treatment away from generalized low intensity interventions in these settings towards evidence-based higher intensity therapies.

Tools for our research include 3 dynamometers to test lower extremity muscle strength (HUMAC NORM and KinCom), superimposed electrical stimulation for measures of central activation of muscle, electromyography, transcranial magnetic stimulation, Dual energy X-ray absorptiometry, 8-camera Vicon Motion Analysis System with 2 force platforms, and triaxial accelerometers. The laboratory is closely tied to clinical facilities in the Clinical Translational Research Center, IMAGE group, Interdisciplinary Movement Science Lab (IMSL), and Transcranial Magnetic Stimulation (TMS) Lab.

We have clinical partnerships with the University of Colorado Hospital, Colorado Joint Replacement Center at Porter Adventist Hospital, Active Motion Physical Therapy, Proaxis Physical Therapy, and Ascent Physical Therapy.

Ongoing Investigations

 

Progressive Resistance Rehabilitation Program after Total Knee Arthroplasty

The major goal of this investigation is to conduct a prospective, randomized, controlled clinical trial to evaluate the effectiveness of a progressive resistance rehabilitation program after total knee arthroplasty (TKA) compared to a traditional rehabilitation program. We assess functional mobility and musclefunction for each intervention. We also examine cortical and corticospinal mechanisms for central activation deficits to further identify the source of quadriceps muscle central activation deficits following TKA.



 

Improving activity, function and participation in medically complex skilled nursing facility residents

The major goals of this investigation are to 1) determine if high intensity resistance training and motor control based gait training is feasible in a population of medically complex older adults in skilled nursing facilities and 2) evaluate if a progressive multi-component intervention performed in skilled nursing facilities improves function more than usual care physical therapy in older adults.

 

Determination of Pain Phenotypes in Older Adults with Knee Osteoarthritis

The goal of this investigation is to better understand what causes painful knee osteoarthritis (OA) so that more effective treatment options can be developed. We will use clinically measurable musculoskeletal and non-musculoskeletal variables to explore for pain phenotypes within knee OA in older adults. We will measure variables from each of the following domains: 1) peripheral joint damage, 2) psychological distress and 3) central nervous system dysfunction.

 

Improving activity, participation, and function after acute hospitalization in older adults with multiple chronic conditions

The major goal of this multi-site investigation is to determine if a progressive multi-component intervention in a home setting, initiated upon discharge from an acute care hospital, improves function at the end of one episode of care more than documented usual care physical therapy. The proposed multicomponent intervention combines high intensity strength training, motor control based systems of gait and balance training.

 

Prognostic Modeling of functional recovery follow TKA

The primary goal of this investigation is to develop prognostic models of functional recovery following TKA in a representative clinical population. Using specific covariate measures of physical function and health status along with patient demographic information we will produce growth curves which provide patients and clinicians with an individualized prediction for the recovery of function following TKA. Ultimately, these models will be implemented and used to influence the surgical decision making process and allow for the development of an individualized approach to rehabilitation.

 

Collaborative-Care intervention to Promote Physical Activity after TKA

The goal of this investigation is to determine if real-time, user-friendly, electronic physical activity feedback combined with face-to-face group meetings can increase the amount of physical activity performed by patients after total knee arthroplasty. We assess physical activity level and functional performance before and at 3 time points after the intervention to determine both immediate and long lasting treatment effects.

 

Multi-Component Rehabilitation After THA

The goal of this investigation is to compare the efficacy, feasibility, and safety of a comprehensive, multi-component (CMC) intervention with a control (CON) intervention. The CMC intervention involves strength, neuromuscular control and functional training to improve muscle coordination around the hip and pelvis to enhance functional performance. The CON group receives education and functional training.

 

Understanding Mechanisms for Quadriceps Central Activation Deficits

The major goal of this investigation is to use transcranial magnetic stimulation measurements of motor cortex excitability to provide information regarding centrally-mediated, intra-cortical regulatory mechanisms that may contribute to our understanding of activation deficits and muscle weakness after TKA.



 

Rehabilitation outcomes following lower limb amputation

The purpose of this study is to describe functional outcomes for people with non-traumatic lower limb amputation to provide a basis for future studies to refine rehabilitation strategies.




 

Recently Completed

 

Improving Function with Weight-Bearing Biofeedback

The major goals of this study are to determine the effects of a weight-bearing biofeedback intervention on functional weight bearing asymmetry during sit to stand transitions, gait, and stair climbing as well as on functional performance and strength recovery following total knee arthroplasty.



 

Strength and Function Following Total Hip Arthroplasty

The overall goal of this longitudinal study is to determine whether adults who have undergone total hip arthroplasty (THA) for end-stage osteoarthritis have post-operative deficits in strength of the surgical lower extremity, postural control, and functional performance compared to healthy, age-matched counterparts.

 

NMES after Total Knee Arthroplasty to Counter Quadriceps Muscle Activation Deficits

The goal of this study is to assess the effectiveness of NMES on countering quadriceps activation deficits after TKA and relate acute measures of quadriceps muscle presynaptic inhibition to longer term outcomes.

In the News: University Hospital Insider article, CBS4 news story

 

Functional Outcomes Following Minimally Invasive Total Knee Arthroplasty

The goal of this study is to determine if minimally invasive TKA improves functional performance, quadriceps muscle force and activation, increases knee range of motion, and decreases post-operative pain compared to traditional TKA.

In the News: CBS4 news story

 

Limb Loading Asymmetry with Total Knee Arthroplasty

The major goals of this line of investigation are to 1) examine the presence of lower limb loading asymmetry during functional mobility tasks and 2) examine the relationships between loading asymmetry and both functional mobility and muscle strength before and after unilateral TKA.

 

 
MP Lab Staff Portrait

Lab Members

Director

Co-Director

PhD Students

Clinical Research Colleagues

Post Doctorate Fellow

  • Roger Paxton, PhD

Professional Research Assistants

  • Tawnya Downing
  • Krista Sanchez

Previous Trainees

  • Michael Bade, PT, PhD
  • Dana Judd, DPT, PhD
  • Abbey Thomas, PhD
  • Joshua Winters, PhD, CSCS

OUR COLLABORATORS

ACTIVE GRANTS

National Institutes of Health (R01-HD065900)
Progressive Rehabilitation for Total Knee Arthroplasty (7/2011-6/2013)
Stevens-Lapsley, PI
$2,469,362

National Institutes of Health (R21 AG044710)
Determination of pain phenotypes in older adults with knee osteoarthritis (8/2013-7/2015)
Stevens-Lapsley, PI
$425,740

National Institutes of Health (K23AG029978)
Early NMES to Improve Quadriceps Muscle Function After Total Knee Arthroplasty (9/2008-9/2013)
Stevens-Lapsley, PI
$716,144

American Physical Therapy Home Health Section Grant
Improving Activity, Participation and Function after Acute Hospitalization in Older Adults. (11/2012-10/2013)
Stevens-Lapsley, PI
$10,000

RECENTLY COMPLETED GRANTS

Bob Doctor Memorial Research Award;
Limb Loading Asymmetry with Total Knee Arthroplasty (1/2009-12/2012)
Stevens-Lapsley, Co-PI
$8000

Arthritis Foundation New Investigator Award
Quadriceps Muscle Function After Minimally Invasive Total Knee Arthroplasty (11/2008-10/2012)
Stevens-Lapsley, PI
$150,000

National Institutes of Health (R03AR054538)
Functional Outcomes Following Minimally Invasive Total Knee Arthroplasty (3/2008-2/2012)
Stevens-Lapsley, PI
$150,000

American College of Rheumatology New Investigator Award
Optimizing Lower Extremity Muscle Function after Total Knee Arthroplasty (completed 10/2009)
Stevens-Lapsley, PI

Foundation for Physical Therapy Pittsburgh-Marquette Challenge Grant
NMES after Total Knee Arthroplasty to Counter Quadriceps Muscle Activation Deficits (completed 8/2008)
Stevens-Lapsley, PI

GCRC Pilot and Feasibility Grant
General Clinical Research Center Pilot and Feasibility Grant (completed 6/2007)
Stevens-Lapsley, PI

RECENT PUBLICATIONS

Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength after Total Knee Arthroplasty: A Randomized Controlled Trial. Physical Therapy Journal. Feb 2012; 92(2).

Christiansen CL, Bade MJ, Judd DL, Stevens-Lapsley JE. Weight-Bearing Asymmetry During Sit-Stand Transitions Related to Impairment and Functional Mobility After Total Knee Arthroplasty. Oct 2011; 92(10), 1624-9.

Stevens-Lapsley JE, Schenkman ML, Dayton MR. Comparison of self-reported Knee injury and Osteoarthritis Outcome Score (KOOS) to objective measures of performance in patients after total knee arthroplasty. Physical Medicine and Rehabilitation. Jun 2011; 3(6):541-9.

Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010 Sep;40(9):559-67.

Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff D. Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty. Clinical Orthopaedics and Related Research, 2010 Sep;468(9):2460-8.


More Publications for Dr. Stevens-Lapsley

 

Student Awards and Recognitions

 

Andrew Kittelson, PhD student, was awarded the American College of Rheumatology Preceptorship Award and the University of Colorado Integrative physiology of aging training fellowship in 2012. In 2013 and 2014 Andrew received the Foundation for Physical Therapy Promotion of Doctoral Studies I and II scholarships and the Adopt-A-Doc Award from the APTA in 2014.


 

 

PhD student Brian Loyd received The Foundation for Physical Therapy Florence P. Kendall Doctoral Scholarship in 2013. In 2014 Brain was awarded a T32 Aging grant to work on improving prognosis for older adults undergoing TKA surgery.




 

 

Post Doctorate fellow Roger Paxton was the recipient of a T32 Aging grant that will use a collaborative care intervention to promote physical activity after Total Knee Arthroplasty. Roger also received the Clinical Translational Research Center Microgrant Award in 2014.




 

 

 

Awards Received by previous students while in training

 

PhD graduate Mike Bade was awarded the 2009 Outstanding PhD Student Award in Clinical Investigation, from the Clinical Science Program at UCD. He also received the Adopt-A-Doc Award from the APTA, Geriatrics section for 2010-2011 and the Foundation for Physical Therapy Promotion of Doctoral Studies I and II scholarship and the University Of Colorado Integrative Physiology Of Aging Training Fellowship in 2010. Mike was also a recipient of a Predoctoral T32 Aging Grant that will focus on optimizing rehabilitation following TKA.


 

PhD graduate Dana Judd was awarded the 2010 Outstanding PhD Student Award in Clinical Investigation, from the Clinical Science Program at UCD. She was the recipient of the Adopt-A-Doc Award from the APTA and received grant funding through the APTA Orthopedics Section and University Of Colorado Integrative Physiology of Aging Training Fellowship in 2012. Dana has also received an ACR REF/Abbott Health Professional Graduate Student Research Preceptorship award (2010).


 

Post-doc Abbey Thomas was the recipient of a Predoctoral T32 Aging Grant that will focus on optimizing rehabilitation following TKA.







 
 

LAB CONTACT INFORMATION

Lab Address:
   

Anschutz Medical Campus
Gersten Education Research Office
Building 500, Room Eg 308
13001 E. 17th Place
Aurora, CO 80045

Phone: 303-724-9590
Fax: 303-724-2444

Email: TKA.Study@ucdenver.edu

Anschutz Medical Campus
Clinical Translational Research Center
Leprino Office Bldg., 3rd Floor
12401 East 17th Ave
Aurora, CO 80045

    

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