In a study in the journal Environmental Research, researchers compared blood samples of people participating in the . The researchers found that people living in greener neighborhoods showed immune patterns consistent with lower chronic inflammation, including lower levels of several circulating immune cells linked to inflammatory activity, such as monocytes, natural killer cells, B cells and some white blood cell types.

“The study also found evidence of a shift toward a more regulated immune profile, suggesting that nearby trees and vegetation may do more than improve quality of life – they may also influence the body’s immune system in ways that support cardiovascular health,” said Daniel Riggs, assistant professor in UofL’s and first author of the study. “While the study cannot prove cause and effect, the findings add to growing evidence that greener residential environments may be an important public health resource for reducing inflammation and promoting long-term health.”

The findings provide additional support for preliminary findings from the Green Heart Louisville Project showing that people living in neighborhoods where the number of trees and shrubs was more than doubled had lower levels of a blood biomarker of inflammation than those living outside the planted areas. Those living in the greened area had 13-20% lower levels of high-sensitivity C-reactive protein (hsCRP) than those living in the areas that did not receive additional trees and shrubs. Higher levels of hsCRP are strongly associated with a risk of cardiovascular disease. Higher CRP levels also indicate a higher risk of diabetes and certain cancers.

The recent study evaluated the immune function of Green Heart Louisville Project participants based on the greenness of their residential environment prior to the addition of trees for the project.

“These studies show that greener neighborhoods don’t just look better; they appear to educate our immune system in ways that may reduce chronic inflammation and disease risk,” said Aruni Bhatnagar, director of the Envirome Institute. “They align with the Envirome Institute’s mission of identifying environmental conditions that shape human health and translating those insights into strategies for improving the health of our communities.”

UofL in partnership with The Nature Conservancy, Washington University in St. Louis, Hyphae Design Laboratory and others to study whether and how living among more densely greened surroundings contributes to better heart health.

Using the American College of Lifestyle Medicine’s culinary medicine curriculum as its foundation, the classes blend nutrition science, nutrition counseling, hands-on culinary skills and exposure to world flavors into a practical, case-based course for future physicians. Fourth-year medical students learn to translate dietary guidelines into realistic meal ideas, practice counseling language they can use in a clinical setting and prepare dishes that support common medical nutrition needs, such as cardiometabolic health and diabetes.

The course is led by Kristen Neises, director of lifestyle medicine at the UofL Trager Institute, along with Chef Nikkia Rhodes and is held at the institute’s Culinary Medicine Kitchen, which .

UofL News checked in with Charmi Shah, a fourth-year medical student who participated in the fall semester course, about her experience.

UofL News: What interested you about the culinary medicine course at the Trager Institute’s Culinary Medicine Kitchen?

Charmi Shah: I have always loved cooking and consider myself a true foodie. I grew up helping my mom in the kitchen whenever I could and have always enjoyed trying restaurants and cuisines from all over the world. So, when this culinary medicine course was offered, I immediately jumped at the opportunity. The idea of earning school credit while cooking delicious meals (and getting to eat them afterward) sounded like the perfect combination of passion and learning.

As a vegetarian, I also was especially excited knowing the meals would be plant-based. I am constantly looking for ways to increase protein intake and make healthier substitutions in my own meals, so I knew this class would offer lessons I could apply both personally and professionally. It felt like the perfect opportunity to blend something I genuinely enjoy with my medical education.

UofL News: Could you describe your experience working hands-on in the kitchen and what you learned?

Shah: Each week focused on a different cuisine or meal type, from Asian-inspired dishes to breakfast foods, bowls and even desserts. Before class, we watched instructional videos on cooking techniques and read articles or publications on relevant nutrition topics so we could come prepared for meaningful discussion at the start of the class.

During class, we split into pairs and divided up the recipes, preparing the dishes ourselves. The hands-on experience made the learning incredibly engaging. After cooking, we cleaned the kitchen together as a group and then sat down to enjoy the meal we had created. One of my favorite parts was role-playing patient scenarios, where we practiced applying what we had learned in realistic clinical conversations. It reinforced how to translate nutrition science into practical, culturally sensitive advice. And of course, taking home leftovers was an added bonus.

Beyond learning new cooking skills, I gained a deeper understanding of macronutrient balance, plant-based protein sources, portion control, and how small ingredient substitutions can significantly improve nutritional value without sacrificing flavor.

UofL News: Why do you think it is important for future health care providers to learn nutrition science?

Shah: Nutrition science is foundational to preventive medicine. Many of the leading causes of death in the U.S., including diabetes and cardiovascular disease, are strongly associated with lifestyle factors. While medications are essential in many cases, addressing diet and daily habits is often just as critical.

Exercise is important, but as many physicians emphasize, meaningful weight loss and long-term health begin with the exercise of eating first. Future health care providers must be equipped not only to diagnose and prescribe but also to provide more holistic care by guiding patients toward sustainable lifestyle improvements. Without adequate training in nutrition, physicians may feel unprepared to provide specific, actionable advice.

UofL News: How do you hope to apply these lessons in your approach to health care?

Shah: As someone planning to go into family medicine, I have a strong interest in lifestyle medicine. This course reinforced my belief that physicians should look beyond simply prescribing medications and instead consider how to empower patients to modify their daily habits.

It is one thing to tell a Hispanic patient with diabetes to “avoid sugar,” but it is much more impactful to provide culturally tailored, realistic alternatives. For example, suggesting corn tortillas instead of white flour tortillas, encouraging more beans and less processed meat, discussing portion sizes of rice or chips that may be dietary staples or offering fruit-based dessert swaps instead of traditional fried sweets like churros. These kinds of practical, culturally sensitive recommendations are far more meaningful than generic advice.

Being part of the pilot culinary medicine course felt incredibly special, and I truly believe every medical student would benefit from this experience. I hope to continue expanding my knowledge in culinary and lifestyle medicine and incorporate these lessons into my future primary care practice, helping patients see that healthy living can be both achievable and enjoyable.

Q&A by Samantha Adams

The project design, a multi-phase transformation supported by $6.75 million in combined city and state funding, features expanded sidewalks, increased tree canopy and extensive landscaping. New curb extensions will introduce seating areas and further soften the urban environment. By enhancing pedestrian infrastructure, the project aims to create a street that is safer and more welcoming to the thousands of employees, students and patients who traverse the district daily.

In collaboration with city officials and project partners Gresham Smith and Pace Contracting, LOUMED has begun project construction for the project in the 300 block of East Chestnut Street. This location allows the new work to physically and visually connect the streetscape to LOUMED Commons, a public park opened in November 2025 that converted a vacant lot into vital green space, and to enhance UofL’s Health Sciences Center.

The project is located within the study area of Greenprint, a 10-year initiative coordinated by UofL’s and its affiliated Urban Design Studio. Greenprint integrates science-based greening strategies into downtown Louisville’s growth and redevelopment, optimizing new green spaces so they can have the greatest impact on human health. The initiative links separate projects like LOUMED Commons and the Chestnut Street improvements, ensuring a shared commitment to creating a cooler, cleaner and healthier Louisville.

The Chestnut Street Improvement Project is informed by walkability studies and temperature monitoring conducted by UofL’s Center for Geographic Information Sciences (ULCGIS), which recently became part of the Envirome Institute. Using drone-mounted thermal imaging sensors to map surface temperatures across project areas, ULCGIS staff identify hot spots and provide data to help guide planting strategies that can cool the city and support healthier, more comfortable microenvironments. Researchers will continue to monitor the impact of this greening on the local microclimate and human health and comfort to develop a replicable national model for greening urban pedestrian areas in other cities.

Construction for the Chestnut Street project is proceeding in a phased approach to minimize disruption. Work on the current block is scheduled for completion later this year. Crews will then immediately begin improvements on the three subsequent blocks extending east from South Preston to South Clay streets, with the full eastern section projected to be complete in 2027.

It is the first Power 50 recognition for all three men.

Two members of the , Christopher Dischinger and John Hollenbach, also are among those recognized.

For the sixth consecutive year, Business First has published the list of 50 most influential business and civic leaders in the region. Louisville Business First selected honorees from individuals nominated by the public and those covered in the publication’s own reporting and sourcing. It does not include elected officials. The 5 on the Rise class recognizes emerging influential leaders.

Bradley assumed leadership of UofL in March after serving as executive vice president and university provost and dean of the UofL School of Dentistry. Since taking the helm at UofL, Bradley has overseen the completion of the , the opening of the Engineering Student Success and Research Building and surpassing 25,000 enrolled students for the first time in the university’s history.

In his State of the University address on Feb. 12, Bradley highlighted goals for UofL, including a focus on further improvements in enrollment, six-year retention rates, degrees offered and experiential learning opportunities. He intends to prioritize new residence halls and academic research facilities.

“I am grateful to lead this great university and amplify its positive impact on the city of Louisville,” Bradley said. “It is an honor to be recognized by Business First in the Power 50 2026, particularly after less than a year in my role as president of UofL.”

Since being named director of athletics in 2022, Heird also has had some significant wins. He hired Jeff Brohm to lead the football program and Pat Kelsey to take the reins of men’s basketball. In the 2024-25 season, ten UofL teams earned a top-25 ranking and 11 programs earned trips to the postseason. 

Under Heird’s leadership, student-athlete academic success has been a priority. Last semester closed with an overall department GPA of 3.431 — with 18 of 19 sports above 3.2. UofL athletes are also winning with a 96% graduation success rate. 

Jason Smith, chief executive officer of UofL Health, was named CEO of the health system in October after serving most recently as its interim CEO and chief medical officer. In December, he oversaw the opening of the $186 million, seven-story .

The honorees will be profiled in the March 27, 2026, print edition of Louisville Business First, and online around that time.

“We talked about policies, hardships and political instability within a country, but I was struck by how we didn’t discuss the well-being of the people who were living there,” said Limbong. “How were communities doing during these times of war, natural disasters and other atrocities?,” she wondered.

It was this desire to understand the people and root causes of issues that led the Louisville native and to study public health. 

Limbong, who will graduate with a bachelor’s degree in public health in May 2026, explored the global interconnectivity of cultures when she embarked on a month-long project in the African country of Malawi this past summer. This opportunity was led by Rochelle Holm of the Christina Lee Brown Envirome Institute.

According to the Food Agriculture Organization (FAO), Malawi’s economy is largely agricultural with more than 80 percent of the population dependent on farming. While this supports livelihoods for millions, Malawi is vulnerable to climate change and natural disasters. Unsafe drinking water, sanitation and hygiene are concerns for much of the population.

In Malawi, Limbong assisted with nutrition research by surveying hundreds of Malawian university students and staff. The aim was to see if dietary indicators can be detected in wastewater and environmental surveillance, and how that compared to what people reported. She explored her interest in food insecurity by visiting a coffee planters’ co-op and participating in a grassroots feeding program for vulnerable community members.

The ‘warm heart of Africa’: Beyond the stereotypes

Malawi is often described through a narrow lens defined primarily by economic hardship. While poverty is a reality for many, Limbong said that is not the full story. Approaching Malawi with the intention of learning from local communities, Limbong focused on listening to resident voices. Through conversations with Malawians, she began to see how limiting the dominant narrative can be.

“Malawians are resilient, brilliant, and capable,” she reflected. “They are doing their best to provide for their families and are innovative in the ways that they can be.” For Limbong, it was essential not to reduce people to their struggles alone. “I want to make sure we don’t forget people’s humanity,” she said.

In the country known as “the warm heart of Africa,” Limbong was particularly struck by the communal nature of Malawian culture. Almost every evening, she heard large groups of people gathered together singing. These moments reflected more than music. “It speaks to the community-centric nature of the people,” she explained. “I think it’s important to be fully immersed, take time to hear people’s life experiences, and to share those stories from their perspective.”

Global citizenry

Upon graduation in May, Limbong plans to continue public health at UofL and pursue a master’s degree to better understand where her gifts align with the needs of the community.

Limbong said her Malawi experience deepened her understanding of global humanitarian work as both meaningful and demanding, “This is important work and hard work,” she said. “The experience helped me examine how my own contributions can fit into the broader picture of global health.”

For Limbong, what resonated from her experience was a sense of collective humanity. “While our realities might be different, they impact one another,” she said. “We are all connected on this shared earth, and that is something I will take with me wherever I go next and whatever I end up doing.”

The Green Heart Louisville Project is a groundbreaking scientific study that is testing the hypothesis that introducing more green trees and shrubs into a neighborhood can directly lower the risk of cardiovascular disease, the leading cause of death worldwide.

“Receiving this award is a great honor not only for our investigators, but also our partners and communities,” said Aruni Bhatnagar, director of the at University of Louisville and project leader for Green Heart Louisville. “It validates years of work which has shown that thoughtfully planned greening can improve cardiovascular and community health, and it affirms that the Green Heart project is not only good science, but also a model for how to improve human health in urban environments. The recognition gives us new momentum to scale this work across Louisville and beyond.”

The Witte-Sakamoto Family Medal in City and Regional Planning was established in 2019 by William Witte, an alumnus of the Weitzman School, and his wife, Keiko Sakamoto to recognize a firm, team or professional for an exemplary plan that advances the field of plan making in at least four of the following areas: social equity, environmental quality, design, public health, mobility, housing affordability and economic development. The juries for the Witte-Sakamoto Family Medal and Prize were chaired by Megan Ryerson, UPS Foundation Chair of Transportation, chair of city and regional planning, and professor of city and regional planning and electrical and systems engineering at Weitzman.

“Green Heart Louisville exemplifies a holistic way of looking at public health – a marriage of design, planning and science to emulate,” said Fritz Steiner, dean and Paley Professor at Weitzman, and a member of the jury who selected Green Heart Louisville for the award.

Launched in 2018 by UofL’s Christina Lee Brown Envirome Institute with support from The Nature Conservancy, the study investigates whether and how living among more densely greened surroundings contributes to better heart health. The Green Heart team applied the treatment – the addition of thousands of mature trees and shrubs – to the center of a four-square-mile area in south Louisville.

The first clinical outcomes from the study, , indicate that people living in neighborhoods where the number of trees and shrubs was more than doubled showed lower levels of a blood marker of inflammation than those living in the control area. General inflammation is an important risk indicator for heart disease and other chronic diseases.

The Green Heart Project’s work to establish a scientific link between nature – specifically urban greenery – and human health is already influencing projects worldwide. The first clinical outcomes announcement garnered widespread national media attention. Many research papers, posters and talks on the project have been delivered to both scientists and laypeople since the project’s inception, and robust research and outreach for the project continues.

, an associate professor in the , and an associate professor at the , has worked decades to help individuals and families impacted by cancer. 

Schapmire was recently awarded a five-year, $1.6 million grant from NCI to lead a national training initiative aimed at transforming psychosocial and palliative care in oncology. The grant will support an intensive training and mentorship program, and 50 social workers from across the U.S. will be competitively selected each year to receive fully funded palliative oncology training and structured mentorship.

UofL News connected with Schapmire to learn more about this new innovative initiative.

UofL News: What piqued your interest in oncology social work?

Schapmire: Fresh out of my Masters of Social Work (MSSW) program at UofL in 1996, I discovered my professional calling. Working with individuals and families facing cancer opened my eyes to the profound impact that compassionate, skilled psychosocial support can have. I became deeply committed to improving the quality of life for all those affected by cancer—patients, families and care teams alike—and that sense of purpose has guided my work ever since.

UofL News: What was your response to receiving this grant?

Schapmire: I was absolutely thrilled—both personally and professionally. I felt deeply validated that the National Cancer Institute recognized oncology social workers as essential to high-quality cancer and palliative care yet often lack access to quality training opportunities compared to other disciplines. This award provides the opportunity to elevate our field’s role in transforming cancer care nationwide.

Educating Social Workers in Palliative and End-of-Life Care (ESPEC) Oncology builds on two prior NCI-funded programs at the UofL School of Medicine that advanced interprofessional palliative care education. Training 250 oncology social workers over the next five years will have a transformative impact on the quality and compassion of cancer care nationwide.

UofL News: What does this mean for patients with cancer? How can it help them and their families cope with the life transitions their diagnosis can bring?

Schapmire: This grant strengthens the ability of oncology social workers to support patients and families through every phase of the cancer journey—helping them manage distress, navigate complex decisions, and sustain quality of life even in the face of serious illness. ESPEC Oncology expands nationally what the Kent School of Social Work and Family Science at UofL has long done through its oncology social work specialization—preparing clinicians to address the full biopsychosocial, spiritual and cultural dimensions of cancer care. Together, they advance a model of compassionate, whole-person care that helps patients and families find meaning and maintain dignity throughout serious illness.

UofL News: What has been the most gratifying aspect of this project?

Schapmire: What I find most meaningful about this project is its potential for lasting, system-level impact. It isn’t just about training 250 oncology social workers—it’s about creating a national community of leaders who will return to their institutions equipped to strengthen teams, improve communication, and integrate psychosocial and palliative care principles into everyday oncology practice.

This initiative also represents the culmination of years of collaborative work with an incredible team of national experts and partner organizations, started by Dr. Myra Glajchen at MJHS Institute for Innovation in Palliative Care in New York, who share a vision for transforming the way cancer care is delivered. 

By investing in the people who provide the psychosocial and emotional backbone of cancer care, we’re not only improving patient and family experiences but also supporting the well-being and professional growth of the workforce that serves them.

ESPEC Oncology: Transforming Psychosocial and Palliative Cancer Care is accepting training program applications. For more information, email ESPECO@louisville.edu

“Fortunately, my dad pulled through, but my friend was not so lucky,” Meek said. “I learned that nurses held my friend’s phone, letting her Facetime with family after being extubated and as she passed. The kindness of nurses struck me over and over again – and solidified that nursing was my calling.”  

Fortunately for Meek, his transition from a marketing career to nursing was aided by a ’s workforce grant. A scholarship and funding support allowed him to take an accelerated path from work as a licensed practical nurse (LPN) to earning a bachelor of science in nursing (BSN). “Earning my BSN is something I knew I wanted to do, but cost and time were the initial prohibiting factors,” Meek said. “I know for certain that I would not be working on my BSN right now if it were not for this incredible scholarship opportunity.”

, the $3.9 million Health Resources and Service Administration (HRSA) grant was designed to create an accelerated LPN to BSN pathway to address Kentucky’s nursing shortage in medically underserved areas, as well as reduce financial barriers for working LPNs to advance their nursing education. 

Program helps transform student lives and communities

Enrollment soared from 24 students in the first year to 74 in the second year, and the program also has expanded from 19 to 41 Kentucky counties. Ninety-two percent of applicants and enrollees live in medically underserved areas. Based on current progress, 60 students are projected to complete a BSN degree within the next 24 months, strengthening the Registered Nurse workforce in rural and underserved communities.

“Not only are we making this program accessible to students but also having the scholarships and the stipends available has been a major factor why we have seen such growth in year one to year two,” said Heather Mitchell, project director and associate professor of nursing education. “Students are having a very positive experience and they’re going back and telling their peers.”

Through this , UofL is bringing baccalaureate education to all parts of the state and preparing nurses to serve the communities in which they live. Incorporating the best practices of online education ensures that even in the most rural and remote locations, students are able to attain the same high-quality education as someone who lives just two minutes away from UofL.

“Our students are participating in community-based experiences for the clinical education in their home areas and developing projects that directly impact those communities with tangible outcomes,” Mitchell said. 

����ֱ�� innovation through real-world scenarios

Innovation in nursing education is also a hallmark of the LPN to BSN program, including the use of simulations to expose students to scenarios they might encounter in their nursing practice. 

Through team collaboration, Mitchell, along with Simulation Director Christina Pennington, Program Director Diane Riff and Program Manager Joel Schmidt have created a simulation directory that blends academic and real-world learning. The directory includes scenarios on respiratory disease in coal regions, gun violence trauma response, mental health and homelessness, among others. 

The students aren’t the only ones to benefit from these resources. Each simulation is being embedded into RN-BSN online courses and being prepared for public release as open-source resources with full documentation, ensuring broad access. This will extend the impact to nursing programs statewide and nationally.

Mitchell said she is proud the innovative program is providing such an enriched experience for students. Schmidt agrees. “I receive comments from students about how much these scholarships and stipends mean, and how anchored in purpose these students feel for being able to go back and work in their own community. It’s something bigger than themselves.” 

Other notable events included:

• Presentations by Jewish Heritage Fund grant awardees
• The Health Equity Keynote: “From Algorithm to Bedside: Building Trustworthy AI for Health Communities”
• The Louisville Clinical & Translational Research Center Annual Symposium
• The Immersive Technology Summit at Kornhauser Library
• A series of presentations by the Center for Integrative Environmental Health Sciences
• The Christina Lee Brown Envirome Institute Health and the Environment Symposium

The Institutional Review Board (IRB) also hosted a dynamic panel discussion, “Consent to Research with Confidence: Design, Delivery and Documentation,” along with two workshops:

• “Protocol Considerations from Legal and Privacy: What to Know Before IRB Submission”
• “Fraudulent Research Participants to Return of Secondary Findings and Points in Between: Learn from the IRB”
  

  

Poster sessions showcased outstanding research contributions from across the academic community, including graduate students, medical residents and fellows, postdoctoral scholars, research staff, faculty and participants in distinction and leadership programs. Winners, listed below, were announced following the keynote address.

R!L is also proud to co-sponsor the Kentucky Science Center’s “Pulse of Surgery” Program, which engages 8th – 12th grade students in STEM fields. The program includes a live-streamed open-heart surgery and interactive sessions with health care and research professionals to explore career pathways in medicine and science.

A recording of the keynote address is available on the and are available on Flickr.

Research!Louisville 2025 Winners

Master’s Basic Science Graduate Student Award

• 1st Place: Rachel Ferrill
• 2nd Place: Kasey Kropp
• 3rd Place: Yu Tian

Doctoral Basic Science Graduate Student Award

• 1st Place: Katelyn Sheneman
• 2nd Place: Deepa Karki
• 3rd Place: Mary Nancy Walter

Engineering Co-op Student Award

• Habiba Ramy

Engineering Master Student Award

• 1st Place: Walid Mohamed
• 2nd Place: Mostafa Abdelrahim
• 3rd Place: Mohamed Khudri

Engineering Doctoral Student Award

• 1st Place: Mohamed Azam
• 2nd Place: Sienna Shacklette
• 3rd Place: Ismat Almadani

School of Dentistry Basic Science Student Award

• 1st Place: Abigail Hacker
• 2nd Place: Autumn Pipkin
• 3rd Place: Vanessa Weisshaupt

School of Dentistry Clinical/Translational Research Award

• 1st Place: Judy Alatassi
• 2nd Place: Ashley Gearlds
• 3rd Place: Rachel Pan

School of Dentistry Social/Behavioral/����ֱ��al Award

• 1st Place: Rebecca Counts
• 2nd Place: Venkat Hemant Akurati
• 3rd Place: Marciana Castillo

Rhonda A. Hoffman Medical Student Award

• 1st Place: Rebecca Duffy
• 2nd Place: Brian Hart
• 3rd Place: F. Andrea Yeargin

Postdoctoral Fellow Award

• 1st Place: Ting Wang
• 2nd Place: Easton Ford

Research Associate Award

• Sweta Ghosh

Research Staff Award

• 1st Place: Scott Garza
• 2nd Place: Ahmed Abdelbaset-Ismail

School of Medicine Medical Resident Award

• Ademilola Tejuoso

School of Medicine Clinical Research Fellow Award

• Imad Majeed

Public Health & Information Sciences Master’s Program Student Award

• Eliana Lopez Baron

Public Health & Information Sciences PhD Program Level Award

• Anika Mehta

Public Health & Information Sciences Basic Research Award

• Jennifer Tinman

Public Health & Information Sciences Research & Practice Award

• Olufunmilayo Babarinde

Faculty Award in Basic Science

• Petra Haberzettl

Faculty Award in Clinical Science

• Subathra Marimuthu

Ruth Greenberg Award for Excellence in Medical ����ֱ�� Research

• 1st Place: Joelle Hirst
• 2nd Place: Nimra Khan
• 3rd Place: LIAM Team: Kristie Vail Schultz, Mustafa Al-Kawaaz, David Neuberger and Brian Williams

Leslie Martin Medical ����ֱ�� Student Award

• Temiloluwa Haastrup

Professional & ����ֱ��al Development Award

• Marciana Castillo

Excellence in Health Disparities Research Award

• 1st Place: Gbemisola Owolabi
• 2nd Place: Sidney Johnson
• 3rd Place: Jacob Warr

Nursing Graduate Student

• 1st Place tie: Joelle Hirst and Amani Abdulabi

Nursing Graduate Student Oral Presentation Award

• Shubha Sapkota

Postdoctoral Symposium: Oral Presentation Award

• 1st Place tie: Johnnie Newton and Belinda Petri

Distinction Track Business and Leadership Award

• Wiley Cain

Distinction Track Global and Public Health Award

• Gbemisola Owolabi

Distinction Track Medical ����ֱ�� Award

• Nikita Nair

Distinction Track Physician-Scientist Development Award

• Olivia Ossege

Distinction Track Research Award

• Caroline Ploeger

Distinction Track Urban Primary Care Award

• Elizabeth Baier

By Anne Noe

Researchers in UofL’s provided a combination therapy to five children with complete paralysis. The children, ages 7-12, took part in a clinical study in which they received external electrical stimulation over the spine, combined with activity-based therapy and encouragement to consciously intend to step. During the study, the children all gained the ability to take steps and experienced unexpected improvements in sensation, bladder function, transferring and other abilities. The study was published in the.

“We have found that electrical stimulation can “charge” the spinal cord, making it possible for a paralyzed individual to step voluntarily,” said Andrea Behrman, professor in the UofL Department of Neurological Surgery and director of the Center for Pediatric NeuroRecovery, who led the study. “This ability increases over time when the stimulation is combined with locomotor training and mental intent to step.”

Stimulation + activation + intent

In the study, children who were completely paralyzed for more than a year, unable to move below their level of spinal injury, participated in a series of 60 sessions that included noninvasive, transcutaneous (through the skin) electrical stimulation of the sensory nerves to the spinal cord and specialized physical therapy.

The electrical stimulation was applied with a specially designed technique for external electrical stimulation developed by Yury Gerasimenko, now gratis professor of the UofL Department of Physiology. The technique consisted of several small stimulators, about the size of a quarter, placed on the child’s skin over the sensory nerves of the spinal cord. During the sessions, electrical stimulation was applied through the pads while the children took part in physical therapy known as activity-based locomotor training.

This therapy consists of researchers and therapy technicians manually facilitating the child’s legs in stepping motions as they lay on their side on a table with their legs suspended and also during assisted walking with part of their body weight supported over a treadmill. In addition, the children were encouraged to consciously attempt to step.

Over the course of the study, the children were able to initiate and control the stepping themselves. After various numbers of sessions, they were able to take steps over ground, voluntarily initiating the steps both with and without the stimulation present. Three to six months after the sessions were completed, all of the children still were able to take steps with and without the stimulation.

“The results we see with this study confirm what I have learned more and more over the last two decades working with children with spinal cord injury,” Behrman said. “Your spinal cord is more than a conduit or a pipeline for nervous system messages. It processes information and is smart like your brain. The spinal cord can’t decide to go to Starbucks for coffee, but it can help you with more automatic movements such as sitting up better and taking steps. It also works somewhat like a battery and needs the right charge to help produce steps and respond to therapy.”  

For many years, the medical community as a whole has believed that after injury in which communication along the spinal cord was interrupted and the patient could not move on their own, that function below the injury could never be restored. As a result, treatment for most people with complete paralysis included helping them adapt to mobility with wheelchairs and other forms of assistance.

For the parents of children participating in Behrman’s studies and clinical care, even the small gains achieved through the sessions have a significant positive impact on their child’s quality of life and often, their health.

Kalyn MacIntyre, whose son Malcolm participated in the study, said that even three years after the study concluded, he retains many of the benefits he gained from his sessions.

“He can still step on the treadmill, he can kick a ball consistently. He can now feel when he needs to go to the restroom and his overall health has been good,” Kalyn said, adding that he also has sensory gains. “I don’t know what his future is as far as walking. I just want him to be functionally capable of doing things on his own – to have more independence – and I want him to be healthy. We have more of that here because of this study.”

The personal connection

One of the most challenging aspects of the research is motivating the children during long training sessions.

“We can have the most beautifully designed study, but if a child can’t get into it and you can’t help them be successful, it will not work,” Behrman said. “You can’t just come in and say, ‘Do this 50 times.’ For each child, you must figure out how to connect with who they are.”

To engage them in the activities, Behrman and the therapists working with the children have cultivated the art of motivation by incorporating their personal interests. One child in the study was a basketball player before he was injured, so Behrman used a whistle to encourage him to go faster or drive harder, similar to when he was running drills for basketball.

For Malcolm, the research staff devised a point system to reward him for every time he was able to kick a ball. Behrman recalled one session when she told him that instead of the 10 or 20 points he received for kicking the ball off the treadmill, she would award him 10,000 points if he could kick the ball to hit a target on the opposite wall.

On the next try, Malcolm’s kick sent the ball sailing across the room, squarely hitting the target.

Previous success

Previously, researchers at UofL achieved remarkable success in restoring function to adults with spinal cord injury in studies using surgically implanted electrical spinal cord stimulators. In one study, adults who were completely paralyzed were able to take steps over ground with stimulation after a series of intensive physical therapy sessions and mental intent to take steps.

This new study shows that similar results can be achieved without the invasive procedure. In addition, the adults could only step when the stimulator was on, whereas the children in Behrman’s study were able to step long after the stimulation sessions had ceased.

For additional photos and video clips, visit . All images courtesy University of Louisville. The images with “study image” in the name were captured during the study sessions, 2021-2023.