Announcing C-STAR, New NIH-Funded Infrastructure Center

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The age of sensors has ushered in a new era of health data: millions can now continuously track their heart rates, breathing, sleep and steps at the click of a button. These data can then assist medical professionals as they provide personalized care to their patients.

But when it comes to their use in rehabilitation, sensors and other technologies have not yet reached their full potential, partly because our patient populations have not yet been studied.

To boost this burgeoning and vitally important field, Shirley Ryan AbilityLab has been awarded a prestigious P2C grant through the National Institutes of Health (NIH) to establish the Center for Smart Use of Technologies to Assess Real-World Outcomes (C-STAR).

One of just six centers throughout the United States, C-STAR is a joint venture between Shirley Ryan AbilityLab and Northwestern University — funded for five years through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which is part of the NIH, with additional funding provided directly from Shirley Ryan AbilityLab.

Other institutions that have been awarded P2C grants from the NIH include Brown University, the Mayo Clinic, the Medical University of South Carolina, Stanford University, Virginia Tech and the University of Texas’ Dell Medical School.

“Over the years, Shirley Ryan AbilityLab has developed a reputation in the rehabilitation field for its innovative practices related to technology use and data collection — helping clinicians and researchers leverage insights for the best outcomes,” said Arun Jayaraman, PT, PhD, director, Max Näder Lab for Rehabilitation Technologies and Outcomes Research. “Now, with C-STAR, we will teach others how to do it.”

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This NIH-designated center will not actually perform research on technology in rehabilitation; instead, its goal is to develop the next generation of rehabilitation researchers outside of Shirley Ryan AbilityLab who don’t yet have their own labs and project funding. C-STAR will focus on those who are early in their careers and give them access to the brainpower and experience of Shirley Ryan AbilityLab’s world-renowned team of experts to accelerate discoveries in the field of rehabilitation research.

“C-STAR is designed to facilitate the grooming, preparation and development of rehabilitation scientists,” said W. Zev Rymer, MD, PhD, director, Research Planning Engineering in Neuroscience, and C-STAR’s co-principal investigator. “It’s designed to identify and nurture talent to help researchers grow into successful independent scientists. First and foremost, it's about career development.”

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Interested researchers may first engage with C-STAR through NIH’s Medical Rehabilitation Resource Network (MR3).

“This network comprises national leaders in rehabilitation,” Richard L. Lieber, PhD, chief scientific officer and senior vice president, Research, and C-STAR’s other co-PI said. “If you are a young rehabilitation researcher interested in using sensors, you can log on to the NIH webpage and you will see six centers in the country, one of which focuses on sensors.”

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From there, researchers will be able to connect with the appropriate institution in a manner that meets their specific needs. Those who are just starting the process of investigating a topic will be able to attend webinars, listen to podcasts or participate in courses and workshops. For those researchers who already have viable ideas about how to use devices in rehabilitation, C-STAR will provide programs like Idea Labs (a concept originated at Shirley Ryan AbilityLab in which engineers, scientists, physicians, nurses and therapists provide critical evaluation and feedback), pilot project funding and sabbaticals to learn directly from our staff.

The sabbatical program will be led by Allen Heinemann, PhD, director, Center for Rehabilitation Outcomes Research. “We're building on our 20-plus year history of mentored postdoctoral fellowships to create shorter-term opportunities,” Dr. Heinemann said. “For the summer or a semester, we’ll match young researchers with experts in a particular area.”

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Leora Cherney, SLP, PhD, scientific chair, Think + Speak Lab, will lead C-STAR’s pilot projects. “The scope of the pilot study program is very broad,” said Dr. Cherney. “There are a lot of different technologies that could be targeted in the pilot studies: sensors, mobile phones, smartwatches, robots and exoskeletons. And the populations could include any of the patient groups we see at Shirley Ryan AbilityLab: stroke, traumatic brain injury, spinal cord injury, amputation, cerebral palsy and Parkinson’s disease.”

According to Dr. Rymer, pilot project funding for early-career researchers is a keystone of C-STAR’s mission. By supporting pilots, C-STAR will help researchers to secure additional resources in the future. “You cannot be successful with major grants from any agency without pilot data, and to get pilot data you need to have a bit of money to start,” said Dr. Rymer.

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C-STAR also will support the sharing of results generated by the center — both at future in-person presentations and symposia and through shared benchmark data sets from different patient populations.

“Let's say you're a genius in computer science in Milwaukee, and you think you can come up with a way to measure something on stroke patients,” said Dr. Lieber. “We’ll have stored datasets from sensors obtained on stroke patients that this computer scientist can use. Our competitive advantage over the rest of the world is our large number of patients. With C-STAR, we want to leverage that patient access for the rest of the world.”

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In many ways, the establishment of C-STAR at Shirley Ryan AbilityLab is a full-circle moment for our organization. Around 30 years ago, NIH was not at all involved in rehabilitation research.

That changed with the efforts of Henry Betts, MD, our organization’s former president and CEO.

“Dr. Betts was a visionary figure, without question,” said Dr. Rymer. “He understood that if rehabilitation was going to be successful, we needed to have a dedicated research arm. Through his efforts, the National Center for Medical Rehabilitation Research was created within the National Institute of Child Health and Human Development.”

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To accomplish its mission, C-STAR is divided into four cores that leverage the collective expertise of Shirley Ryan AbilityLab and affiliated institutions’ leaders: Engineering Core, Clinical Core, Outcomes Core and Implementation Science/Community Engagement Core.

The Engineering Core provides technical guidance to help researchers participating in C-STAR to assess how — not what — to measure. It will be led jointly by Levi Hargrove, PhD, director, Center for Bionic Medicine (CBM), and Eric Perreault, PhD, research scientist and chair of Northwestern’s Department of Biomedical Engineering.

Dr. Hargrove explains that engineers — even those who build technologies for people with impairments — often have little direct contact with the population they’re trying to help simply because their home institution has a limited or no clinical component.

“They haven't really been exposed to rehabilitation on the scale of what they would get here at Shirley Ryan AbilityLab,” he said. “But we have developed significant expertise over a decade in CBM on how to advance an idea or very rudimentary prototype into a more refined prototype that can be safely and effectively tested on people.”

Through the Engineering Core, researchers accessing C-STAR will receive help from those with experience taking that next step.

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The Clinical Core, led by Elliot Roth, MD, co-medical director, Brain Innovation Center, and Julius Dewald, PT, PhD, chair of Northwestern’s Department of Physical Therapy and Human Movement Sciences, will leverage more than 70 physicians and 250 therapists to help C-STAR clients determine what data they should be collecting, and how to interpret the data in relation to specific patient populations.

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The Outcomes Core is led by Dr. Heinemann and David Cella, PhD, chair, Department of Medical Social Sciences at Northwestern. It will help researchers participating in C-STAR consider all of the relevant domains that could be used to assess outcomes, and guide them to the infrastructure and tools that could be used to measure the effectiveness of new technologies in rehabilitation.

“If you can't measure it, you can't improve it,” said Dr. Heinemann.

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The Implementation Science and Community Engagement Core is led by C. Hendricks Brown, PhD, professor in the departments of Psychiatry and Behavioral Science, Preventive Medicine and Medical Social Sciences at Northwestern University Feinberg School of Medicine, and Namratha Kandula, MD, MPH, of Northwestern’s Institute for Public Health and Medicine (IPHAM) Center for Community Health. It will focus on improving health equity by reaching vested stakeholders about C-STAR’s developments in rehabilitation technologies. These diverse groups include patients, caregivers, clinicians, researchers, advocacy groups, professional societies, businesses and policymakers. Dr. Brown’s Bridges program and Dr. Kandula’s Center for Community Health will help C-STAR participants address barriers — especially in underserved communities — to accelerate the application of smart technology into practice.

Working together, C-STAR’s cores will seed Shirley Ryan AbilityLab’s reputation as a leader in all aspects of rehabilitation.

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“Traditionally, Shirley Ryan AbilityLab has been considered a global clinical expert,” said Dr. Jayaraman. “C-STAR will help deepen our reputation in research as we teach scientists and clinicians how to drive technology for better outcomes.”

And, ultimately, these advancements will benefit those who matter most: our patient populations.

“We'll know C-STAR has been successful when our nation's capacity to do high-quality rehabilitation research that incorporates sensors increases — especially research by early-career investigators who we mentored,” Dr. Heinemann said. “More research will help people with impairments live full and satisfying lives.”