Physical Activity

 

Dr. Ann M. Spungen
Associate Director, VA RR&D National Center of Excellence
for the Medical Consequences of Spinal Cord Injury
Jame J. Peters VAMC, Bronx, New York
(718) 584-9000 x5814
ann.spungen@va.gov

Dr. Spungen began her career as an exercise physiologist. While pursuing her Master of Science degree in Exercise Physiology from the University of Pittsburgh, she worked at the Rehabilitation Institute of Pittsburgh to obtain real world experience. After graduating Magna Cum Laude in 1986, she had the opportunity to work as an exercise physiologist at Moss Rehabilitation Hospital. In 1988, she worked in industry as a clinical specialist to instruct hospital staff on sophisticated medical equipment, including computerized pulmonary laboratories and metabolic measurement carts. In 1990, she left industry to pursue a career in medical investigation.

Since 1990, Dr. Spungen has been an integral part of the Spinal Cord Damage Research Center, and its subsequent productivity and success.  With her excellent organizational abilities, an ever growing knowledge of study design, and impressive technical skills, she assisted in many aspects of the Center’s development. While working closely with Dr. Bauman, Director of the Center, to rapidly build the research unit, Dr. Spungen also obtained a doctoral degree in Applied Physiology with a minor in Statistics from Columbia University. As the Center expanded, Dr. Spungen naturally assumed the role of its Associate Director. Within the past few years, Dr. Spungen has become an authority on exoskeletal-assisted walking devices and was responsible for leading the work that demonstrated that this groundbreaking technology resulted in improvement in quality of life and the health of those with a spinal cord injury.

Since 2001, she has been an Associate Professor of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. While assisting with the administration of the Spinal Cord Damage Research Center, she served from 2003-2011 as a co-chairperson on a VA Cooperative Study entitled “Anabolic Steroid Therapy on Pressure Ulcer Healing in Patients with Spinal Cord Injury.”

Dr. Spungen is also a peer reviewer for the Department of Veterans Affairs Rehabilitation Research and Development Merit Review Program, Congressionally Directed Medical Research Program for the Department of Defense, and the Craig H. Nielson Foundation. She is an author of more than 120 peer-reviewed articles, review articles, and book chapters that address deleterious body composition changes, pulmonary pathologic changes, pressure ulcer healing, disordered sugar and cholesterol metabolism, adverse hormonal changes, exercise physiology, and exoskeletal-assisted walking in persons with spinal cord injury. Dr. Spungen has reviewed for several journals in topics ranging from physiology, medicine, rehabilitation medicine, to neurology.

Dr. Spungen is also the Associate Director of the Veterans Affairs Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury. She is the Principal Investigator for the Physical Activity and Quality of Life Program in the Spinal Cord Damage Research Center. Currently, many of her studies address the training and health benefit of using an exoskeletal-assisted walking device. Dr. Spungen was just awarded a VA Cooperative Study that will test the safety and efficacy of the ReWalk exoskeleton in the home/community setting at 10 VA medical centers throughout the nation. Although not an explicit purpose of this study, this work by its very nature will serve to propel VA healthcare workers across the country to learn to use this technology and be able to train Veterans with spinal cord injury, which should expedite the availability of these devises to Veterans anywhere in the United States.

The success of Drs. Spungen and Bauman for the nationally and internationally recognized Spinal Cord Damage Research Center has brought them national attention after having been awarded the 2014 Samuel J. Heyman Service to America Medal in Science and the Environment for their research to improve the health and quality of life for persons with spinal cord injury.

Program goals (Lay)
After spinal cord injury, it is commonly appreciated that most persons lose muscle control in their legs and can no longer walk. Although initially physically and emotionally catastrophic, the loss of gait is generally accepted by most individuals with the passage of time. However, several secondary medical changes occur, some life-threatening after the injury, which markedly reduce quality of life. Some of these secondary health problems include bladder and bowel dysfunction, an asthma-like condition of the lungs and the inability to clear lung secretions, low blood pressure, inability to regulate body temperature when exposed to either cold or hot environmental temperatures, adverse soft tissue body composition changes with the loss of muscle and gain of fat, nerve pain, sleep disorders, metabolic disturbances of sugar and fat metabolism, and a higher risk of cardiovascular disease. These adverse health changes may result in increased negative emotional responses because of the inability to cope, not with paralysis, but with the secondary medical events that occur after spinal cord injury.

In order to provide a better quality of life for individuals with spinal cord injury, Dr. Spungen and her team have been studying exoskeletal-assisted walking devices to improve health and quality of life.  Although not everyone will be able to walk with sufficient proficiency with these devices to use as a form of mobility, data collected has proven useful for a better understanding of the safety and efficiency of such a therapeutic approach. Instructing patients to use the exoskeleton-assisted walking device and guiding them through indoor and outdoor environments is standard training for its use in the home/community setting. The preliminary findings from Dr. Spungen’s work suggest that exoskeletal-assisted walking results in an improvement in body composition, general health, and quality of life.

Program goals (Scientific)
In 2011, exoskeletons became available in the United States in an institutional setting for persons with spinal cord injury.  Dr. Spungen quickly ascertained the potential value of having a device that was capable of over ground, independent walking for those with spinal cord injury.  She and her team have been studying the safety and efficacy of this class of devices for institutional and community-based exoskeletal-assisted walking, and the potential medical benefits and improvements in emotional well-being that result from using these devices on a regular basis. From the pilot studies, preliminary findings suggest that more than half the users with spinal cord injury are able to walk (using the Exoskeletal-Assisted Walking Device) at least 0.30-40 m/s, a speed that is adequate for walking in the community.  Many of the participants to date, have reported improved bowel function, reduced pain and spasms, better sleep, more energy during the day, and a better overall sense of well-being.  Preliminary findings suggest improved body composition with loss of fat tissue mass and gain of muscle tissue. There is also better seated balance when in a wheelchair, which permits greater function and independence.  It should be cautioned that not all persons with spinal cord injury are eligible for using these devices and not everyone who uses them has all of the aforementioned described benefits. 
Dr. Spungen is currently directing a three-site, multi-center ongoing study funded by the Department of Defense that includes the James J. Peters VA Medical Center (JJPVAMC, Bronx, NY) as the lead site with the University of Maryland Rehabilitation and Orthopaedic Institute (UMROI) and the Kessler Institute for Rehabilitation (KIR) as additional study sites (more information can be found at clinicaltrials.gov NCT02314221).


 

Research

Relevant Publications

  1. Yang A, Asselin P, Knezevic S, Kornfeld S, Spungen AM.  Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015;21(2):100–109. doi: http://dx.doi.org/10.1310/sci2102-100.

http://www.ncbi.nlm.nih.gov/pubmed/26364279

  1. Asselin P, Knezevic S, Kornfeld S, Cirgnigliaro C, Agranova-Breyter I, Bauman WA, Spungen AM.  Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. JRRD 2015, 52(2):147-158. 

http://www.ncbi.nlm.nih.gov/pubmed/26230182

  1. Tulsky DS, Kisala PA, Tate DG, Spungen AM, Kirshblum SC.  Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale.   J Spinal Cord Med. 2015 May;38(3):288-302. PMID: 26010964.

http://www.ncbi.nlm.nih.gov/pubmed/26010964

  1. Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Z Kalpakjian C, W Choi S, Jette AM, Forchheimer M, Cella D.  Overview of the Spinal Cord Injury - Quality of Life (SCI-QOL) measurement system.  J Spinal Cord Med. 2015 May;38(3):257-69. PMID:  26010962.

http://www.ncbi.nlm.nih.gov/pubmed/26010962 

  1. Spungen AM, Adkins RH, Stewart CA, Wang J, Pierson RN Jr, Waters RL, Bauman Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. WA. J Appl Physiol. 2003 Dec;95(6):2398-2407

http://www.ncbi.nlm.nih.gov/pubmed/12909613 

  1. Spungen AM, Wang J, Pierson RN Jr, Bauman WA.  Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury. J Appl Physiol. 2000 Apr;88(4):1310-5. PMID: 10749824

http://www.ncbi.nlm.nih.gov/pubmed/10749824