Friday, March 14, 2025
3/14/2025
We are excited to present this proposal to renew the University of Pittsburgh Model Center on Spinal Cord Injury (UPMC-SCI). This proposal builds on our work as a SCI Model Systems Center over the past 20 years. We have consistently focused our research on improving outcomes for individuals living with SCI through assistive technology (AT), concentrating on the wheelchair. This focus, which we retain in the current proposal, has allowed us to make substantial contributions that impact patient care. While we have made gains, there is still work to be done with addressing gaps in training and service provision and improving equity in AT. While there are individuals who will walk following SCI, the majority (60%) will use a wheelchair as their primary mode of mobility. Without proper training in wheelchair skills these individuals will be at greater risk for injury, less independent, and have limited participation. Our site-specific project, Increasing Access to Wheelchair Skills Training (SKILL), will focus on addressing barriers to wheelchair skills training. SKILL will determine the effectiveness of remote training for both clinicians (Aim 1) and wheelchair users (Aim 2). The remote nature of the training will allow us to recruit nationally, and we will add a specific focus of targeting individuals in rural areas who may face the largest barriers with accessing training. The train-the-trainer intervention (Aim 1) has as its goal to improve the quality-of-care in both inpatient and outpatient settings by arming clinicians with the knowledge of how to teach wheelchair skills, an area lacking from most therapy curriculums. Our intervention will build upon our previous work by capturing changes in the quality and quantity of wheelchair skills training clinicians provide following the intervention. Clinicians will complete remote training in their practice setting using online materials and synchronous video exchange. Because we know that barriers will still exist for accessing in-person training for individuals with SCI (transportation, cost, therapy visit limits, etc), we will also investigate the effectiveness of a direct-to-user remote training that leverages peer coaches (Aim 2) to remotely train individuals living with SCI. Community-based peer-led interventions can fill an important gap in service provision. As people with lived experience with SCI, peers can simultaneously fill multiple roles include educator, supporter, facilitator, and coach. For wheelchair users the remote training intervention will be home-based and include the above components as well as live 1:1 video conferencing with a trained peer coach. For the past four SCIMS cycles, UPMC-SCI has led a module focused on equity and AT- EQuATe. With a continued emphasis on AT and disparities in provision, this cycle we will expand our focus in three ways. First, we will investigate the type and amount of wheelchair training users receive. This data will completement SKILL and provide insight into service provision, a key factor in mobility-related outcomes. Second, we will ask participants about use of and barriers to access of smart home technologies like Google Home or Amazon Alexa link devices. This category of AT has the potential to drastically improve accessibility for individuals living with SCI but has not been studied in this population. Lastly, we will expand our investigation into disparities to include gender identity and sexual orientation as well as geographic location (rural vs urban). Our Team will continue collaborative, management and dissemination activities from previous cycles that have led to us being a leading center. For example, during the last cycle we led production of a SCIMS Hot Topics Module. Our collaborative products developed with the MSKTC have been viewed or downloaded by nearly 95,000 individuals. In this past cycle, (>25%) of articles accepted for the end-of-cycle SCIMS were led by UPMC-SCI authors.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).