Researcher Engineers – drive to develop stroke therapies toolbox

By Kevin S. Abel

When Steven Kautz went college he planned to major in geophysics and work for aResearch1major oil company. But that all changed when he discovered his passion for research and understanding how the human body moves.

Kautz, who laughs that he loves research but not in geophysics, began studying the biomechanics of pedaling in elite cyclists earning his Ph.D. as a Biomedical Engineer in Neuroscience – Dynamics/ Controls with a goal of translating his field of study into therapies for stroke victims.

He began his 19-year VA career at the Palo Alto VA Rehabilitation Research and Development Center – one of the original R&D Centers of Excellence – studying how one leg’s movement influences the other leg. From there Kautz went to the Gainesville VA and University of Florida to work in the VA Brain Rehabilitation Research Center of Excellence. Today he is a Research Career Scientist with the Charleston VA and Chair of the Medical University of South Carolina’s Department of Health Sciences and Research overseeing the human performance lab. There he is continuing his work to understand quantitatively how people move in order to provide proven treatment options to clinicians to help stroke victims regain as much movement as possible.

“We’re in the buckle of the stroke belt,” Kautz explained when discussing the magnitude Research2of the work done in the human performance lab. Stroke is the third leading cause of death in the United States with 137,000 deaths according to the Centers for DiseaseControl and Prevention. The South Carolina Department of Health and Environmental Control reports this state consistently ranked first or second from 1983 to 2004 for highest mortality rate in the country due to stroke. Stroke remains the third leading cause of death in South Carolina resulting in 2,460 deaths in 2007. With thousands more living with the effects of a stroke, Kautz and his team’s research is even more important.

The goal is to give clinicians a better theoretical framework to understand what happened because of the stroke, and a therapies and measurements toolbox related to that framework of proven interventions that yield results for improving various movement deficiencies in stroke victims.

 Sound complicated? It is.

“We really don’t have good enough measures of how people move and what might be wrong,” said Kautz. “In stroke if you need to walk better they (therapists) will be doing multiple things but there is no proven system of therapies that will work. There is no detailed data on knowing why an improvement occurs.”

But Kautz plans to change that. He breaks his research down this way.

The first goal is to understand how the underlying systems that control movement are affected by the stroke. These systems include the spinal cord that is more like a computer than a wire coming down from the brain, according to Kautz.Research3

“When you’re walking you need the right activation descending from the brain to the spinal cord where the neurons that control walking are located,” he explained. Stroke research participants normally have full behavioral measurements taken in the human performance lab to get a baseline. Measurements include how limbs move, force applied, muscle groups used independently, and metabolism measures.

Then interventions such as the amount of support provided by the harness, speed of the treadmill, or assistance moving the limb are applied to get the patient to practice proper movement with the therapist. Once the “best” movement is found variables are introduced to see what makes that movement possible. Detailed engineering analysis is then conducted to understand effectiveness of intervention or treatment options.

Kautz says the primary focus of the research is to get stroke rehabilitation tools in the clinicians’ hands.

“It’s been great for me (as an engineer) to be in a place where most of my counterparts are clinical,” he said. He appreciates the perspectives that the physical and occupational therapists who work in the lab with him bring to the investigations.

They are now working to establish a clinical integration group made up of therapists from the VA and community hospitals to present the research to them and then learn what other questions the therapists need answered to treat their patients.

In the future, Kautz and his team hope to see the human performance lab become a VA Center of Excellence for stroke research.

VA-ResearchPublished Winter 2012 – Department of Veterans Affairs