LEE DIBBLE

Current Research Interests and Contributions to Science:

1. Use of Wearable Technologies to Quantify Disability in Mobility Disorders. Wearable technologies that measure ambulatory activity or movement coordination provide an emerging opportunity to understand how deficits in body structure and function may affect individuals’ ability to utilize their movement skills during movement activities required for their participation in daily life. My colleagues and I were among the first to utilize measures of ambulatory activity in a longitudinal fashion to track the decline in ambulatory activity in individuals with PD. Our work has provided a more sensitive picture of the accumulating loss of participation in ambulatory activity that is not effectively measured by in-clinic assessments. More recently, we have been one of the first research groups to utilize wearable sensors to measure alternations in head and trunk coordination during community ambulation tasks in individuals with vestibular loss. Our findings have influenced research groups examining the effects of rehabilitation interventions to include wearable sensors and measures of body movement during daily life activities into their outcomes. Our work has motivated additional research nationally and internationally to examine the utility of such measurements.

Key publications:
a. Cavanaugh JT, Gappmaier VO, Dibble LE, Gappmaier E. Ambulatory activity in individuals with multiple sclerosis. J Neurol Phys Ther 2011;35(1):26-33.
b. Paul SS, Lester ME, Walther RG, Shelton C, Gurgel RK, Dibble LE. Head Kinematics and Head-Trunk Coordination in People with and Without Vestibular Hypofunction. JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1008-1014. PMID: 28859201
c. Paul SS, Dibble LE, Walther RG, Shelton C, Gurgel RK, Lester ME. Reduced purposeful head movements during community ambulation following unilateral vestibular loss. Neurorehabil Neural Repair. 2018 Apr-May;32(4-5):309-316. PMID: 29676210
d. Loyd BJ, Dibble LE, Weightman MM, Pelo R, Hoppes CW, Lester M, King LA, Fino PC. Volitional Head Movement Deficits and Alterations in Gait Speed Following Mild Traumatic Brain Injury. J Head Trauma Rehabil. 2023 May-Jun 01;38(3):E223-E232. PMID: 36731009.

2. Exercise and Parkinson Disease (PD). Pharmacological and surgical treatments for PD do not adequately address many of the symptoms of the condition. As such, additional approaches to the management of PD symptoms and related disability are needed. Exercise may be one such approach. Our group was the first to test the safety, feasibility, and efficacy of high intensity eccentric resistance training in PD. Our pioneering work with eccentric resistance training demonstrated that resistance training was safe and that persons with PD retain neuromuscular adaptability in response to anabolic stimuli. In studies performed without and with manipulation of dopamine replacement medication status, our work repeatedly demonstrates the benefits of resistance training for improving strength, reducing bradykinesia, as well as improving gait, balance, and motor sign severity. Our findings have been central to the inclusion of resistance training as a core component in the published Clinical Practice Guidelines for Rehabilitation in PD. Our work has motivated additional research nationally and internationally to examine the role of long-term resistance training. In addition, we have more recently joined forces with other research groups to perform large trials of the disease modifying benefits of long term aerobic exercise for people with PD.  The CYCLE II Trial examines the effectiveness of a 12 month home based aerobic cycling program in individuals with mild to moderate PD while the SPARX3 Trial examines the effectiveness of an 18 month areobic treadmill program in individuals with de novo PD.  Lastly, with colleagues at the Cleveland Clinic, we were recently funded by the NIH for the GEARS Trial which examine the influence of genetics on the response to 12 months of aerobic cycling training.

Key Publications:
a. Dibble LE, Hale T, Marcus RL, Gerber JP, Lastayo PC. The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson's disease. Arch Phys Med Rehabil, 2006 87(9),1280-2. PMID: 16935068
b. Dibble LE, Hale TF, Marcus RL, Droge J, Gerber JP, LaStayo PC. High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson's disease. Mov Disord. 2006 Sep;21(9):1444-52. PMID: 16773643
c. Dibble LE, Hale TF, Marcus RL, Gerber JP, LaStayo PC. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. Parkinsonism Relat Disord. 2009 Dec;15(10):752-7. PMID:19497777

d. Dibble LE, Foreman KB, Addison O, Marcus RL, LaStayo PC. Exercise and medication effects on persons with Parkinson disease across the domains of disability: a randomized clinical trial. J Neurol Phys Ther. 2015 Apr;39(2):85-92. PMID: 25742370

e. Alberts JL, Rosenfeldt AB, Lopez-Lennon C, Suttman E, Jansen AE, Imrey PB, Dibble LE. Effectiveness of a Long-Term, Home-Based Aerobic Exercise Intervention on Slowing the Progression of Parkinson Disease: Design of the Cyclical Lower Extremity Exercise for Parkinson Disease II (CYCLE-II) Study. Phys Ther. 2021 Nov 1;101(11) PMID: 34363478

3. Exercise / Vestibular Rehabilitation for Individuals with Multiple Sclerosis. People living with multiple sclerosis (PwMS) experience a wide variety of symptoms including dizziness and imbalance which contribute to activity and participation limitations and an increased risk for falls. Our research has examined gaze and postural stability function in PwMS providing insight into gaze stability deficits, postural stability deficits and the ability of PwMS to benefit from rehabilitation targeted at this impairments. Our research has contributed to the body of knowledge that poor gaze stability and postural control, if correctly diagnosed, may be effectively managed using specialized physical therapy interventions.

Key Publications:
a. Garg H, Dibble LE, Schubert MC, Sibthorp J, Foreman KB, Gappmaier E. Gaze stability, dynamic balance and participation deficits in people with multiple sclerosis at fall-risk Anat Rec (Hoboken). 2018 May 5. PMID:29729209
b. Van Liew C, Dibble LE, Foreman KB, Peterson DS. Change in ‘First-Trial’ Performance After Protective Step Practice in People with Multiple Sclerosis. Clin Biomech. 2021 Aug 13;88:105448. doi: 10.1016/j.clinbiomech.2021.105448. Epub ahead of print. PMID: 34418821.
c. Loyd BJ, Agnew L, Fangman A, Thackeray A, Peterson D, Schubert M, Dibble LE. Characterizing Gaze and Postural Stability Deficits in People with Multiple Sclerosis. MS and Related Disorders. Mult Scler Relat Disord. 2021 Aug 14;55:103205. PMID: 34438218.
d. Wagner AR, Grove CR, Loyd BJ, Dibble LE, Schubert MC. Compensatory Saccades Differ for Those with Vestibular Hypofunction and Multiple Sclerosis Pointing to Unique Roles for Peripheral and Central Vestibular Inputs. J Neurophysiol. 2022 Sep 7. PMID: 36069428.
e. Loyd BJ, Fangman A, Peterson D, Gappmaier E, Thackeray A, Schubert MC, Dibble LE. Rehabilitation to Improve Gaze and Postural Stability in People with Multiple Sclerosis: A Randomized Clinical Trial. Neurorehabilitation Neural Repair 2022 Sep 13:15459683221124126.
f. Weston A, Hoppes C, Dibble LE, Loyd BJ.  People with Multiple Sclerosis and Unilateral Peripheral Vestibular Loss Demonstrate Similar Alterations in Head and Trunk Turning Kinematics Compared to Healthy Controls.  Gait Posture. 2023 Sep;105:132-138. PMID: 37562112.

g. Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res. 2024 Jul;242(7):1797-1806. PMID: 38839617.

4. Natural History of the Progression of Disability in Parkinson Disease. The trajectory of mobility loss and disability progression following PD diagnosis are unclear because few have taken the time to examine it with valid and reliable measures. In order to understand the role of physical activity in modifying disease trajectory, it is necessary to have some understanding of the natural history in the absence of rehabilitation interventions. With colleagues from around the US, I coordinated a large, multi-site longitudinal cohort study of people with PD, demonstrating that walking and balance measures are more sensitive to change over time than gold standard measures typically used to gauge disease severity. In addition, we also showed that assessment at six-month intervals is key to best predicting falls as PD progresses. In part due to these findings, Quality of Care Recommendations now recommend people with PD be evaluated every six months for a balance, gait, and fall risk evaluation. This data is used to provide estimates of average change in function over time and explain factors that are predictive of different rates of decline and provides critical natural history data to help determine the effectiveness of exercise interventions.

Key Publications:
a. Dibble LE, Cavanaugh JT, Earhart GM, Ellis TD, Ford MP, Foreman KB. Charting the progression of disability in Parkinson disease: study protocol for a prospective longitudinal cohort study. BMC Neurol. 2010 Nov 3;10:110. PMID:21047426
b. Duncan RP, Cavanaugh JT, Earhart, GM, Ellis TD, Ford MP, Foreman KB, Leddy AL, Paul SS, Canning CG, Thackeray A, Dibble LE. External Validation of a Simple Clinical Tool Used to Predict Falls in People with Parkinson Disease. Parkinsonism Relat Disord. 2015 Aug;21(8):960-3. PMID: 26003412
c. Ellis TD, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Thackeray A, Thiese MS, Dibble LE. Identifying clinical measures that most accurately reflect the progression of disability in Parkinson disease. Parkinsonism Relat Disord. 2016 Apr;25:65-71. PMID: 26876037
d. Paul SS, Thackeray A, Duncan RP, Cavanaugh JT, Ellis TD, Earhart GM, Ford MP, Foreman KB, Dibble LE. Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis. Arch Phys Med Rehabil. 2016 Mar;97(3):372-379. PMID: 26606871

5. Motor Learning in Aging and Disease. The ability to learn, re-learn, or refine motor skills forms the foundation of any successful neurorehabilitation program. With aging and over the course of PD, postural control declines yet the facilitators and barriers to the acquisition of improved postural competence are not clear. Our work examines postural skill acquisition using a combination of kinematic and kinetic analysis techniques, and has demonstrated that persons with PD and aged individuals are able to improve their postural skills with appropriate dosages of practice. Our work has shown that the rate of skill acquisition is slowed and that the ability to retain these skills is degraded. We are currently examining the impact of medication and the level of cognitive function on acquisition and retention of postural tasks. Our results shed light on the ability of people at fall risk to improve their postural control and decrease their fall risk. These results inform the dosages of practice that should be provided to address postural control difficulties in people at risk for falls. 

Key Publications:
a. Jessop RT, Horowicz C, Dibble LE. Motor learning and Parkinson disease: Refinement of movement velocity and endpoint excursion in a limits of stability balance task. Neurorehabil Neural Repair. 2006 Dec;20(4):459-67. PMID: 17082501
b. Schaefer SY, Dibble LE, Duff K. Efficacy and Feasibility of Functional Upper Extremity Task-Specific Training for Older Adults With and Without Cognitive Impairment. Neurorehabil Neural Repair. 2015 Aug;29(7):636-44. PMID: 25416739
c. Paul SS, Olivier GN, Lohse KR, Walter CS, Schaefer SY, Dibble LE. Dopamine replacement medication does not influence implicit learning of a stepping task in people with Parkinson’s disease. Neurorehabil Neural Repair. 2018 Dec;32(12):1031-1042. PMID: 30409107

d. Paul SS, Dibble LE, Peterson DS. Motor learning in people with Parkinson's disease: Implications for fall prevention across the disease spectrum. Gait Posture. 2018 Mar;61:311-319. PMID: 29413803.
e. Olivier GN, Paul SS, Walter CS, Hayes HA, Foreman KB, Duff K, Schaefer SY, Dibble LE. The feasibility and efficacy of a serial reaction time task that measures motor learning of anticipatory stepping. Gait Posture. 2021 May;86:346-353. PMID: 33857800

6. Postural Control and Fall Risk Measurement Tools for Clinical Practice and Research. Having evidence-based tools for evaluation and measurement of patient progress are essential to successful clinical practice and provision of the best possible patient care. Studies that compare different measures head to head to determine their reliability, validity, sensitivity, specificity, and prognostic utility are critical to inform clinicians and researchers of which measures are best. I have focused my work on examining tests of postural control and fall risk that can be used clinically. By comparing these tests to gold standards and instrumented measures, my colleagues and I have published recommendations for which tools may be best suited for research and/or clinical practice involving patients with Parkinson disease (PD),multiple sclerosis (MS), and vestibular dysfunction. The Functional Gait Assessment and the Mini-BESTest are now widely used and our works establishes these tests as accurate and valid choices for assessment of postural control and fall risk in those with PD and are cited frequently. Clinicians and researchers now use a set of core measures of gait and balance that are supported by evidence from this work. In addition, clinicians have a greater appreciation of important factors (medication status, combined interpretation of tests) that must be considered when using these tests.

Key Publications:
a. Foreman KB, Addison O, Kim HS, Dibble LE. Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing. Parkinsonism Relat Disord. 2011 Mar;17(3):166-71. PMID: 21215674
b. Dibble LE, Lopez-Lennon C, Lake W, Hoffmeister C, Gappmaier E. Utility of disease-specific measures and clinical balance tests in prediction of falls in persons with multiple sclerosis. J Neurol Phys Ther. 2013 Sep;37(3):99-104. PMID: 23872680
c. Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, Ruzicka E, Goetz C, Stebbins G, Martinez-Martin P, Schrag A; Movement Disorders Society Rating Scales Committee. Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations. Mov Disord. 2016 Mar 4. PMID: 26945525
d. Thorman IB, Loyd BJ, Clendaniel RA, Dibble LE, Schubert MC. The minimal clinically important difference for gait speed in significant unilateral vestibular hypofunction after vestibular rehabilitation. J Otol. 2023 Jan;18(1):15-20. PMID: 36820158

e. Weightman MM, King LA, Fino PC, Dibble LE, Pelo R, Michielutti PG, Richard H, Parrington L, Lester ME, Hoppes CW. Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores for Concussion. Mil Med. 2024 Feb 27;189(3-4):e714-e720. PMID: 37856171.

Complete List of Published Work in My Bibliography
https://www.ncbi.nlm.nih.gov/myncbi/leland.dibble.1/bibliography/public/