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Investigations in Human Movement with James Chang, PT, Ph.D.

Nearly half a world away from his birthplace, Dr. Shuo-Hsiu “James” Chang is making a mark in the science of physical medicine and rehabilitation through studies that investigate ways to improve human movement. An assistant professor of PM&R at UTHealth’s McGovern Medical School, Dr. Chang is administrative director of the NeuroRecovery Research Center, which forms the umbrella for eight independent laboratories at TIRR Memorial Hermann where researchers collaborate on basic science studies and clinical trials.

The eldest of three boys, Dr. Chang was born in Taipei, Taiwan, in 1975. Throughout elementary school, junior high and high school, he kept his sights set on college. “In Taiwan everyone who wants to continue their education at the college level takes a two-day national exam. If you have good scores, you can choose to study medicine,” he says. “I had a particular interest in rehabilitation, which at that time was not a well-developed discipline in Taiwan. The only degree available was a bachelor’s.”

With high scores on the placement test, Dr. Chang was accepted to Kaohsiung Medical University in Taiwan and graduated in 1997 with a bachelor of science in physical therapy. After working as a physical therapist at a private clinic in Taipei and later at a regional teaching hospital in Lotung, he was accepted to the master’s degree program at the University of North Carolina at Chapel Hill and moved to North Carolina in 2000. Focused on human movement science, he received his master’s degree in 2003 and his doctorate in 2007.

After finishing his Ph.D., Dr. Chang moved to Baltimore to wait for his girlfriend – who is now his wife – to finish her doctorate. “I was looking at postdoctoral programs and my wife’s mentor at the University of Maryland moved to Iowa and offered her a position,” he says. “In order for her to accept, I had to find a post in Iowa. My mentor was a National Institutes of Health researcher in neuromuscular control and adaptation. Luckily he took me on as a fellow, so my wife and I moved to Iowa together as postdoctoral fellows.”

Almost two years of postdoctoral work in neuromuscular control at the University of Iowa led to an opportunity to pursue further postdoctoral work in neurorehabilitation in the department of Physical Medicine and Rehabilitation at McGovern Medical School in Houston, where Sheng Li, M.D., Ph.D., an associate professor of PM&R and attending physician at TIRR Memorial Hermann, was looking for a postdoctoral research associate.

“At the time Sheng was running a small research lab, and TIRR Memorial Hermann and UTHealth were trying to develop a research center,” he says. “We had similar research interests, and I was attracted by the opportunity to work in the Texas Medical Center.”

After two years of study with Dr. Li, Dr. Chang accepted a position as an investigator with Gerard Francisco, M.D., clinical professor and chair of the department of PM&R at UTHealth and chief medical officer and director of the NeuroRecovery Research Center at TIRR Memorial Hermann. In 2015, Dr. Chang joined the UTHealth PM&R faculty, and in 2016 he was unanimously recommended for promotion from investigator to scientist on the TIRR Memorial Hermann Research Council by the TIRR Research Leadership Group. The designation “scientist” indicates that a researcher has made substantial contributions to several research projects and is advancing toward working as an independent clinical investigator. The researcher must also demonstrate a distinguished record of research accomplishment, contribution to the research mission of TIRR Memorial Hermann and a commitment to improving care for persons with disabilities.

Dr. Chang is currently conducting a study on the use of a lower-extremity exoskeleton to promote walking in patients with multiple sclerosis (MS). “Impairment of the ability to walk independently is a significant consequence for people with MS,” he says. “Limitations in mobility mean restrictions in these patients’ ability to perform routine activities at home, at work and in the community. It requires a greater expenditure of energy for people with MS to walk, which contributes to fatigue and promotes a sedentary lifestyle. Both of these factors are associated with secondary health deterioration and compromised quality of life.”

With a $44,000 grant from the National Multiple Sclerosis Society, Dr. Chang and his team are investigating the hypothesis that study participants will be able to walk using the exoskeleton and that after training, they will be able to continue walking with minimal to moderate assistance. They are also collecting data comparing the physical and cognitive demands of walking over ground with and without the exoskeleton.

“Gait training is important for people with MS, but their progress is often limited by the severity of their disease and their inability to perform traditional strengthening exercises,” Dr. Chang says. “Wearable lower-extremity exoskeletons were originally developed to help people recovering from spinal cord injury and stroke return to mobility. We expect they will also help patients with MS.”

Dr. Chang is riding the wave of the emerging integration of robotic technology into rehabilitation, particularly robotic exoskeletons that use the patient’s movement to control externally powered gait, providing therapists with more options to help patients increase health and participation in life after illness or injury.

“Most importantly, the assistance provided by wearable robotic exoskeletons may reduce energy expenditure during walking and allow people with MS to recover some degree of independent walking in a more efficient way,” he says. “This can have a profound impact on quality of life.”

The study, which will enroll 10 participants, began in June 2015 and will end in March 2017. “I’m always interested in new ways to help patients with neurological conditions return to normal life and do what they love to do,” he says. “Participation in a clinical trial is a synergistic relationship. We help them improve their quality of life, and they help us find answers to our research questions. It’s a generous gift on their part. What I hope to see is a smile on their faces and confirmation that they feel better after completing the study. That’s the important part.”