Department of Medicine

Physical Medicine & Rehabilitation Scientist Profiles

Dr. Nora Cullen

Dr. Nora Cullen

Dr. Nora Cullen - focus of research Hypoxic Ischemic Brain Injury:

Team Cullen is defining the unmet needs of patients with Hypoxic Ischemic Brain Injury (HIBI).  Advancements in critical care have led to a growing number of HIBI survivors, who tend to have high long-term morbidity, are highly dependent, and are a considerable burden to the health system.  There is a need to understand outcomes and the pathway of care in order to guide healthcare services and resource allocation.  Dr. Cullen and her research team are addressing these research gaps by exploring population-level data in Ontario since 2002.  Findings reveal that the death rate among HIBI patients has decreased in the last decade. About 70-80% of patients with HIBI do not survive acute care with a higher death rate among women.  Of the survivors, less than 20% are discharged home.  While the recovery rate is slower than patients with TBI, inpatient rehabilitation is beneficial to HIBI survivors with a significant gain in functional outcome. However, only 30% are referred to rehabilitation and women are about half as likely to get rehabilitation care. HIBI survivors experience many negative consequences such as delayed discharge (50%) and a high readmission rate (40%) in acute care compared to patients with TBI. These results will inform further inquiry focusing on post-acute care service utilization.

Dr. Cullen has been awarded several grants and published several papers in peer-reviewed journals.

Three of her most recent grants are listed:

  • Cullen, Nora, Colantonio, A., Chan, V., Stock, D. A population based perspective of hypoxic ischemic brain injury in Ontario, Canada. CIHR Project Grant, $141,526 CAD. 2017/04/01 – 2019/03/31
  • Cullen, Nora, Colantonio, Angela, Alter, David, Wodchis, Walter Clinical Care Pathway and Health Service Utilization after Hypoxic-Ischemic Brain Injury in Ontario. Physicians' Services Incorporated Foundation (The) (PSI), $70,975.00 2015-2016
  • Cullen, Nora, Laurie Morrison, Damon Scales, Gustavo Saposnik, Paul Oh, Steven Brooks, Kevin Thorpe, Sandra Black.  Life After Death: A pilot study investigating whole-person recovery after out-of-hospital cardiac arrest. Heart and Stroke Foundation of Canada (HSFC), $53,884 CAD. 2013/7 - 2016/6

Find more about her publications:

https://www.ncbi.nlm.nih.gov/pubmed?term=Cullen%2C%20Nora%5BAuthor%5D

 

Dr. Dinesh Kumbhare

Dr. Dinesh KumbhareDr. Dinesh Kumbhare-focus of research Myofascial Pain Syndrome:

The focus of Dr. Kumbhare research is the development of objective, reliable biomarkers to diagnose myofascial pain syndrome. The current method of diagnosis is based upon subjective clinically derived criteria. He plans to develop biomarkers that are based upon pathophysiological principles and have imaging, neurophysiological and ultimately biochemical basis. Thus far, quantitative ultrasound techniques have been used to show excellent discriminative ability between healthy controls and participants who have myofascial pain. Further research that integrates this with clinical and neurophysiological measures is planned. This is anticipated to provide advancement in diagnosis with the proposal of new criteria based upon clinical and biomarkers. The newly developed criteria will be based upon underlying pathophysiology and have statistical/methodological rigor.  He has submitted several grants and research papers and published more than 10 papers in peer-reviewed journals in 2018.

Some published papers are listed below:

  • Upadhye S, Kumbhare D. Potential harms with long term glucocorticoid use. Amer J PM&R. 2018; 97(1):72-74. Senior Responsible Author.
  • Kumbhare D, Ahmed S, Watter S. A narrative review on the difficulties associated with fibromyalgia diagnosis. Therapeutic Advances in Musculoskeletal Disease. 2018; 10(1):13-26. Principal Author
  • Kumbhare DA, Ahmed S, Behr M, Noseworthy M. Quantitative ultrasound using texture analysis of myofascial pain syndrome in the trapezius. Critical Reviews in Biomedical Engineering. 2018; 97(1):72-74. Principal Author.

Find more about his publications:
https://www.ncbi.nlm.nih.gov/pubmed?term=Kumbhare%2C%20Dinesh%5BAuthor%5D

Dr. Paul Oh

Dr. Paul OhA new study from Toronto Rehab found that combining aerobic and resistance training provides powerful benefits to patients who are recovering from a stroke.

Recommendations for combined aerobic and resistance training for stroke survivors have been in place for years, but few research studies exist demonstrating that it actually improves recovery. Moreover, there is no compelling evidence that combined training is more effective than aerobic training alone for post-stroke recovery.

“One focus area for the research team in cardiac rehab is around exercise training models in cardiovascular populations,” says the Department of Medicine’s Dr. Paul Oh. “What type and intensity, dose and frequency are associated with optimal gains in fitness and function?”

To address this important question, Dr. Susan Marzolini, a PhD scientist at Toronto Rehab, led a team that compared combined aerobic and resistance training with aerobic training alone in a group of stroke survivors with mobility deficits.

They discovered despite being prescribed 40 per cent less aerobic training, patients who received combined training had enhanced stroke recovery and showed greater improvements in cardiorespiratory fitness, strength and lean muscle mass. In fact, the combined training group gained almost five times more muscle mass than the aerobic only group.

The findings provide scientific evidence of the benefits of supplementing aerobic sessions with resistance training and support the integration of both types of training in stroke rehabilitation programs.

This work was supported by the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, and the Ontario Stroke Network.

Citation: Neurorehabil Neural Repair. 2018 Mar;32(3):209-222. doi: 10.1177/1545968318765692. Epub 2018 Mar 30.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/29600726