Communication Sciences Research Center
The Communication Sciences Research Center (CSRC) conducts and coordinates research in language, reading and hearing difficulties in children. It includes the Hearing and Listening Center (HEAL) and the Reading and Literacy Discover Center (RLDC), and incorporates additional research for the Divisions of Audiology and Speech Language Pathology.
RLDC frames reading as a public health issue and works in close collaboration with other Cincinnati Children's Hospital Medical Center ventures in literacy through the Division of General and Community Pediatrics. Integrating research, including brain imaging and novel methods, to teach and monitor book reading with data from a clinical assessment and intervention service, RLDC follows children’s reading and reading disorders from basic mechanisms through to clinical outcome. Dr. John Hutton, MS, MD, delivered important research showing that children’s books can be informative and reduce harm (Hutton, JS; Acad Pediatr, 2017), as well as boosting children’s and caregivers literacy skills. Dr. Hutton recently launched a clinical trial of a novel, app-based approach to promoting greater parent-child engagement during reading funded by philanthropic gifts to the Reach Out and Read national office. In collaboration with Dr. Tzipi Horowitz-Kraus, PhD, he also explored the brain regions activated and connected in association with early book reading and listening to stories (Hutton, JS; J Pediatr, 2017) and time spent reading compared to screen-based media. Another study, led by Dr. Horowitz-Kraus, found that mother’s reading fluency associates with greater functional brain connectivity in their 4 year-old daughters learning to read. This led to the inclusion of maternal fluency in an evolving brain model of child language and literacy development (Horowitz-Kraus, T; Brain Cogn, 2018). Drs. Hutton and Horowitz-Kraus received several grants in support of this work, including a prestigious National Institutes of Health (NIH) R01 award. On the clinical side, led by Dr. Jayna Schumacher, MD, and Kimberly Rotundo, MEd, we are busy compiling a research database to analyze results received from literacy assessments provided by RLDC from more than 1,000 children.
A newly formed center (HEAL), led by Dr. Lisa Hunter, PhD, FAAA, will serve as a focus for hearing research conducted in the labs of Dr. Hunter, and Dr. David Moore, PhD, and for translation of the research directly into the Cincinnati Children's Division of Audiology. Initially, there are two new clinics in the planning stage. An auditory neurodevelopmental clinic will deliver an assessment protocol based on the latest, most sensitive methods for detecting hearing loss in children, and on studies showing the intimate relation between cognition and hearing in childhood listening problems (Moore, DR; Ear Hear, 2018). A second, neonatal screening clinic aims to develop neonatal hearing screening 2.0. Dr. Hunter’s work provides a strong influence to this to improve sensitivity of objective inner ear measures, such as otoacoustic emissions (Hunter, LL; Ear Hear, 2018). In the future, start-up projects will influence this so that optically monitor movement in babies as a measure of sound detection, and studies of hearing and language in premature children being undertaken collaborative by Drs. Moore, Hunter, and Dr. Jennifer Vannest, PhD, together with colleagues in the Cincinnati Children's Division of Neonatology. Dr. Hunter is aspiring to obtain a new grant this year, through Decibel Therapeutics, to study mobile hearing testing for drug-induced hearing loss in cystic fibrosis. Dr. Moore received a grant from the Oticon Foundation to assess a new hearing aid algorithm for separating target speech from noise. Drs. Moore, Hunter, and Vannest also receive support by an NIH R01 award.
Dr. Vannest joined CSRC this year as a new core faculty investigator. She is currently completing mid-career training as a speech / language pathologist. This year, she focused on how cognition and communication skills, and the brain mechanisms underlying them, alter in children with epilepsy (Fujiwara, H; Acta Neurol Scand, 2018) and during language development (Youssofzadeh, V; Human Brain Map, 2018). Collaboration with researchers studying language recovery after stroke yielded new information about how specific intervention approaches (transcranial magnetic stimulation, constraint-induced therapy, alternative / augmentative communication) improve language recovery and change brain mechanisms underlying language.
Nursing Research
Dr. Nancy Daraiseh, PhD, established for the first-time, the feasibility and sustainability of active injury surveillance of healthcare providers including the collection of near-miss and psychological injuries through her publication entitled, “Enhancing the detection of injuries and near misses among patient care staff in a large pediatric hospital".
The research of Dr. Barbara Giambra, PhD, RN, CPNP, focuses on the communication behaviors of providers and families of children with chronic conditions, and their impact on the family’s ability to manage the child’s care. Recently, she published a coding scheme based on her theory of shared communication that quantifies those communication behaviors. She published a novel method for identifying children with tracheostomy and ventilator dependence in administrative data that will enable outcomes research for this vulnerable population.
Dr. Sandra Staveski, RN, PhD, CPNP-AC, completed two epidemiologic studies on delirium after pediatric cardiac surgery (including a 27 center one-day, point prevalence study) and three studies on home care education for parents of postoperative cardiac surgery patients. Funding for each of these studies comes from internal, foundation, and Center for Clinical and Translational Science and Training grants. In FY2018, Dr. Staveski published an international survey of delirium care and management practices after cardiac surgery, a randomized control trial of the impact of massage and reading on children’s pain after cardiac surgery, and several papers related to pediatric cardiac surgery from the global health perspective. Her work has the potential to minimize the harm children experience in hospital and at home.
Dr. Heather Tubbs-Cooley, PhD, RN, supports the identification of systems factors that impede nurses’ adherence to safety guidelines in the neonatal intensive care unit, with the goal of developing interventions for evaluation in future work. Her latest study is a unique collaboration between nursing and industrial systems engineering, and has an outstanding potential to reduce harm by improving the work of nurses. NIH funding supports this study (1R21HD084863).
Occupational Therapy and Physical Therapy Research
The Division of Occupational Therapy and Physical Therapy continues to pursue lines of research with the vision to be the leader at improving child health through the systematic generation, adoption and rapid integration of rehabilitation knowledge in order to promote healthy behaviors, engagement in valued activity and improved quality of life. In FY 18, the focus continues to be on four strategic goals: 1) Improve outcome, cost and value for patients with neuromuscular and developmental disorders seeking rehabilitation services; 2) Early detection and intervention for infants at risk for cerebral palsy; 3) Become an international leader in the rehabilitation management of patients with mild traumatic brain injury; and 4) Reduce anterior cruciate ligament reinjury rates after discharge from physical therapy.
Dedicated to achieving these goals are the following investigators:
Dr. Karen Harpster, OT, PhD, focuses on implementation of novel therapeutic interventions for infants and children with neurodevelopmental conditions such as cerebral palsy, cortical visual impairment and autism.
Dr. Amy Bailes, PT, PhD, focuses on intervention dose and quality improvement with a particular emphasis on identification of aspects of physical therapy intervention associated with best outcomes for individuals with cerebral palsy.
Dr. Jason Long, PhD, focuses on using biomechanical measures to understand the relationships between neuromuscular and orthopedic impairment, movement abnormalities, and outcomes following surgical or conservative interventions.
Dr. Jen Angeli, PT, PhD, focuses on health services work related to patient-centered goal setting. Her efforts led to the development of a large and successful menu of health wellness services in this area.
Dr. Mark Paterno, PT, PhD, focuses on improving outcome after ACL reconstruction through the identification of novel treatment intervention and systems of care focused on optimization of recovery after surgical management of ACL injury.
Central to these goals, the division published over 24 peer reviewed manuscripts in high impact journals such as the American Journal of Sports Medicine, Journal of Bone and Joint Surgery, Disability and Rehabilitation, Clinical Biomechanics, Sports Health, American Journal of Occupational Therapy, Archives of Physical Medicine and Rehabilitation, and the Journal of Orthopaedic and Sports Physical Therapy. Division investigators successfully procured internal funding, as well as extramural funding, from the National Institutes of Health (NIH) and various foundations. In recognition of outstanding work, our clinical scientists received several prestigious honors, including the 2018 STOP Sports Injury Award and the annual American Orthopaedic Society for Sports Medicine (AOSSM) meeting.
Pharmacy Research
Defining Drug Delivery Barriers in Diffuse Intrinsic Pontine Glioma
Dr. Timothy Phoenix, PhD, joint member of Research Patient Services at Cincinnati Childrens and the University of Cincinnati James L. Winkle College of Pharmacy, received a grant from the Department of Defense (DoD) to continue his work on pediatric brain tumor – vascular interactions. The Career Development Award, from the Peer Reviewed Cancer Research Program at the DoD, will investigate differences in blood-brain barrier function, specification, and drug penetration in diffuse intrinsic pontine gliomas (DIPGs). This study will characterize blood vessel properties at the molecular level, providing an atlas of vascular function in DIPG tumors, and test the ability of a new targeted therapy (Ribociclib) to penetrate into these difficult to treat tumors. Dr. Phoenix hopes these studies will contribute to upcoming phase 1 clinical trials at Cincinnati Children's, and provide new therapeutic options for these deadly pediatric brain tumors.
Pharmacogenetics
As part of a training grant funded by the Research in Patient Services, Dr. Laura Ramsey, PhD, is studying how genetic variants in two drug metabolizing enzymes influence the response to neuropsychiatric medications in children. Dr. Ramsey is also studying pharmacogenomics of the drug methotrexate (through her pre-clinical study funded by the Center for Pediatric Genomics (CpG) and as part of a clinical trial now enrolling patients (PROMOTE). Through a collaboration with Vanderbilt University Medical Center, she leads a study to survey pediatric hospitals for usage of medications with pharmacogenetic guidelines. Dr. Ramsey led the development of a consensus guideline for the use of glucarpidase to treat / prevent methotrexate-induced acute kidney injury incorporated into the standard of care for acute lymphoblastic leukemia patients enrolled on Children’s Oncology Group clinical trials. Invited speaker, she gave presentations to the Children’s Hospital Association Annual Leadership Conference, Precision Genomics Midwest, Duke Center for Applied Genomics & Precision Medicine Forum, Implementing Genomics in Practice (IGNITE) Network’s Quarterly Meeting and Clinical Informatics webinar, Cincinnati Children's Grassroots Genomics and Genomic Discovery & Translation Seminar, and the Center for Pediatric Genomics Research in Progress seminar. She received an appointment as the Pharmacogenomics Community Vice Chair for the American Society for Clinical Pharmacology & Therapeutics.
