Samuel Nemanich 鈥� Assistant Professor of Occupational Therapy in the College of Health Sciences; Director of the Pediatric Neuroscience and Movement Lab
Abstract: Learning and maintaining age-appropriate motor skills establishes a foundation for healthy development. Motor performance is an observable outcome of an action, such as the speed or accuracy. In contrast, motor learning is the ability to acquire and retain new motor skills through practice and is not directly observable. Importantly, motor learning is supported by brain areas that develop abnormally in preterm children, such as the cortico-striatal and cortical-cerebellar pathways. In addition to atypical brain development, other factors such as age and sex can affect motor development and potentially motor learning. Furthermore, task-specific practices of visuomotor skills, such as when playing video games, may impact a child鈥檚 visuomotor abilities and thus their learning of these types of skills. The current proposal represents the next step in an ongoing NIH-funded research study investigating motor learning differences in children. We will investigate differences in motor learning by age, sex, and frequency of videogame use with a sample of school-aged children from the general population. This research will work to fill the current gap in knowledge of how a child鈥檚 motor learning compares to their motor performance, and how these processes contribute to overall all motor development. The data for the proposed project will extend the work on an on-going R03 grant. Participants include 39 typically-developing, term born children aged 5-8 years as part of a cross-sectional multi-visit observational design. In the proposed pilot study, an additional 25 participants will be enrolled to evaluate age and sex effects with sufficient statistical power. The motor learning task will be assessed on three separate visits (Day 1, Day 2, and Day 7) to assess learning and retention. Motor learning will be examined using controlled psychophysical tasks. We have created a straightforward yet challenging visuomotor task on an iPad that will test learning a new mapping between joystick and cursor movement. Motor performance will be evaluated with strength, dexterity, and bimanual coordination tests. We expect that this research will reveal relationships between different demographic qualities (age, sex, videogame use) and motor learning abilities in typically developing children. The preliminary results from this analysis will also be used to further explore how impaired motor learning may be part of a broader deficit in synaptic plasticity and learning. The long-term goal of this research is to develop effective interventions in which motor learning may be enhanced to improve developmental outcomes in children at risk for motor delays.
Ischemic Conditioning Improves Leg Function Post Stroke
PI: Dr. Allison Hyngstrom, Chair and Associate Professor of Physical Therapy;
Co-PI: Dr. Matthew Durand, Assistant Professor of Physical Medicine and Rehabilitation, Medical College of Wisconsin
Award Year: 2018-2019
Abstract: After stroke, the nervous system cannot fully activate the affected musculature which leads to force generating deficits and changes in the vascular response to exercise. These impairments contribute to increased muscle fatigability (the acute, exercise induced reaction in force) post stroke which limits task endurance for activities such as walking. The purpose of this study is to examine if a non-invasive intervention, called ischemic conditioning (IC), can improve muscle fatigability through increased neural activation of the paretic leg musculature and the peripheral vascular response to exercise. Briefly, IC is a non-invasive stimulus which is triggered by using a blood pressure cuff to briefly occlude blood flow to the tissue of interest (the paretic leg), making the tissue transiently ischemic. In healthy individuals, the IC stimulus is known to increase the excitability of motor systems and improve arterial endothelial cell function and local regulation of blood flow, but the effects of IC in individuals with stroke are unknown. In 15 individuals with chronic stroke, we will measure sub-maximal knee extension contraction task duration at baseline and in response to a single session of IC or IC Sham. Interpretive measures of knee extensor strength, muscle activation, the regulation of peripheral blood flow to the knee extensors, and popliteal artery endothelial function will also be made. Compared to baseline and IC Sham measurements, we anticipate that IC will improve neuromuscular fatigability (increased task duration) and will be accompanied by increased strength, magnitude of muscle activation, and peripheral blood flow and endothelial function. Our interdisciplinary and interinstitutional team will be the first to quantify the effects of IC, a non-invasive, cost-effective intervention, on motor and vascular function in chronic stroke. Future studies conducted at the AHPRC will investigate the neural and humoral mechanisms of IC and the efficacy of IC compared with other walking adjuncts.
The Role of Vascular Dysfunction in Fatigue in Adults with Prediabetes and Type 2 Diabetes
PI: Dr. Kathleen Lukaszewicz, Clinical Assistant Professor of Physical Therapy
Co-PI: Dr. Jonathon Senefeld, Postdoctoral Research Associate, Exercise Science, Physical Therapy
Award Year: 2018-2019
Abstract: Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by hyperglycemia with an increasing prevalence worldwide. Exercise is the cornerstone of management of T2D and is most efficacious if applied during the prediabetes stage when glycemia is elevated below the diabetic threshold. Adherence to exercise training is commonly limited in clinical populations due to excessive fatigability during exercise. Our laboratory demonstrated that across the diabetic spectrum, from prediabetes to T2D, people with this disease have greater fatigability of lower limb muscles than controls. In a study of only people with T2D, greater exercise fatigability was associated with reduced blood flow to the exercising muscle. Thus, our working hypothesis is that vascular dysfunction limits blood flow delivery during exercise causing greater fatigability in both people with T2D and in people in the earliest disease stage (i.e. prediabetes). Aim 1 will compare leg blood flow in response to a dynamic fatiguing task of the lower limb in people across the spectrum of the disease, including age and BMI-matched controls, people with prediabetes and diabetes. Aim 2 will assess vascular reactivity of small skeletal muscle arterioles extracted from human muscle biopsies to make a direct measurement of the ability of the blood vessel to respond to stimuli that would normally occur during exercise. This is a unique technique only performed on human muscle tissue by one other laboratory worldwide with the current body of knowledge on blood flow mechanisms relying on indirect assessments in vivo. By using isolated human arterioles from skeletal muscle, we can chemically manipulate the tissue in ways not possible in vivo. These outcomes will provide necessary pilot data for a clinical trial that can be conducted in the AHPRC and will translate into the development of exercise programs specific to the needs of people with T2D and prediabetes.
Recovery from Concussion: Longitudinal Tracking of Sensorimotor Adaptations in Student Athletes
PI: , Professor of Biomedical Engineering
Co-PI: Dr. Carolyn Smith, Clinical Assistant Professor of Physical Therapy
Co-PI: Dr. Lee Ann Mrotek, Research Professor of Biomedical Engineering
Co-PI: Dr. James B. Hoelzle, Professor of Psychology
Award Year: 2018-2019
Abstract: Sport-related concussion (SRC) transiently degrades memory and attention, which can lead to persistent cognitive and sensorimotor performance deficits. Near-term objectives of our research are to: (1) understand how SRC impacts the neural mechanisms of sensorimotor memory and attention that enable skilled motor performance; (2) quantify how those mechanisms change over time; and (3) develop a quick, sideline test of SRC severity that cannot be intentionally falsified. Long-term, we seek to apply our results to optimize SRC recovery on an individual-by-individual basis by applying physical and mental exercise as medicine.
This project will achieve three objectives addressing the AHPRC's special emphasis on concussion research while fostering a new collaboration between Biomedical Engineering's Neuromotor Control Laboratory, Psychology's Neuropsychology and Personality Laboratory and MU Athletics. Objective 1 establishes partnership with MU Athletics to evaluate the sensorimotor and cognitive performance of concussed student-athletes using procedures based on those established by our prior work. This partnership will be built on respect for the student-athletes, their time, and their academic and athletic obligations. Objective 2 will enhance the sensitivity and efficiency of our procedures by integrating a novel and cognitively-challenging movement task that also permits streamlining of data collection. Objective 3 will establish the validity of the sensorimotor concussion testing by verifying our assertion that our novel test of SRC severity cannot be intentionally falsified. This work is timely and necessary because current sideline and clinical assessments of SRC lack sensitivity and validity.
The proposed work is important because it fills a knowledge gap related to how sensorimotor memory and attention recover in the days immediately following SRC. It is also important because we will test the extent to which baseline results of our novel assessment of concussion severity can be intentionally manipulated to mask SRC severity.
Optimizing Performance and Minimizing Risk of Injury in Student-Athletes
PI: Dr. Kristof Kipp, Associate Professor of Exercise Science
Co-PI: Dr. Janelle Cross, Assistant Professor of Orthopaedic Surgery, Medical College Of Wisconsin
Co-I: Dr. Iqbal Ahamed, Professor of Mathematics, Statistics, & Computer Science
Co-I: Dr. Gary Krenz, Professor of Mathematics, Statistics, & Computer Science
Co-I: Dr. Dong Hye Ye, Assistant Professor of Electrical and Computer Engineering
Co-I: Dr. Yaguang Zhu, Assistant Professor of Communication Studies
Award Year: 2018-2019
Abstract: Two major goals of sports training and competition are to optimize athlete performance and minimize risk of injury. The goals of this project are to leverage player-tracking and wearable technologies to 1) compare player-tracking data against biomechanical loads experienced by the body, 2) compare longitudinal player-tracking data against seasonal changes in objective and subjective measures of physical function, and 3) investigate different models used to evaluate longitudinal changes in player-tracking data and objective and subjective measures of physical function. The first goal of this project will answer whether trunk-mounted accelerometer data adequately reflects the impact loads borne by the lower extremity during a variety of movement tasks. The second goal of this project will help determine whether player-tracking data can be used to predict current and future knee joint function and pain in male and female athletes. The third goal will provide a distinct set of evidence-based guidelines that prescribe best practices for calculating and analyzing longitudinal player-tracking data for the purposes of optimizing competition performance and minimizing risk of injury.
Exercise for Veterans with Post-Traumatic Stress Disorder
PI: Dr. Rachel Bollaert, Clinical Assistant Professor of Physical Therapy
PI: Dr. Praveen Madiraju, Associate Professor of Computer Science
Co-PI: Dr. Zeno Franco, Associate Professor of Family and Community Medicine, Medical College of Wisconsin
Co-PI: Dr. Iqbal Ahamed, Chair and Professor of Computer Science
Co-PI: Dr. Katinka Hooyer, Assistant Professor of Family and Community Medicine, Medical College of Wisconsin
Award Year: 2019-2020
Abstract: The US Department of Veterans Affairs indicates that around 12% to 30% of veterans have post-traumatic stress disorder (PTSD) resulting from combat trauma. A PTSD diagnosis increases the propensity to engage in high-risk behaviors, including alcohol/substance abuse, increased rates of health-care utilization, and higher rates of diabetes, obesity, and metabolic syndrome. A well-established body of research suggests that regular exercise will improve PTSD symptoms. However, evidence specific for veterans with PTSD is limited, especially randomized controlled trials (RCTs) of exercise intervention studies that include both aerobic and resistance exercise modalities. Further, the existing studies have been limited to older veterans and have not assessed a full range of physiological variables, such as body composition, blood pressure, cardiorespiratory endurance, muscular strength, and physical activity. Hence, the goal of this study is to evaluate the feasibility and efficacy of a 10-week exercise intervention for veterans with PTSD by assessing a range of physiological and psychological variables. The study aims to:
Motor Training to Improve Cognitive-Linguistic and Motor Learning Function in Typically-Developing Children
Dr. Jenya Iuzzini-Seigel, assistant professor of speech pathology and audiology
Dr. Sam Nemanich, assistant professor of occupational therapy
Michael Danduran, clinical associate professor of exercise science
Award Year: 2021-2022
Abstract: Communication and movement coordination problems affect up to ~10% of children. While rehabilitation therapies are often effective, they can be costly in time and money. Anything that can enhance treatment outcomes and efficiency will provide a benefit to the children and families coping with these immense challenges. As exercise has been shown to induce widespread physical and cognitive improvements, it may be just what is needed to optimize treatment outcomes in children. The current study represents the next step in our program of research to optimize treatment programs for children with communication and motor disorders. We will investigate the effects of a 6-week motor training intervention on physical and cognitive performance in a sample of school-aged children from the general population, assessing a greater breadth of sensitive and specific outcome measures than have been previously studied in connection with exercise in children. This work represents an essential step in establishing efficacy of this intervention and refining our protocol before testing it on children with communication and motor disorders who have minimal time to spare given their typically intense and frequent involvement in speech, occupational and physical therapy. Motor training exercise targets coordination, agility, and balance and is expected to induce positive neural change and growth in the brain鈥檚 cerebellum. Here we will monitor language, cognitive, and motor learning outcomes as these are most likely to improve with motor training exercise given their shared reliance on this part of the brain. If the cerebellum grows from our exercise program, we anticipate seeing growth in these specific learning domains as well. The Milwaukee Jewish Day School will serve as the study site. We will recruit 20 children aged 7-10 years. Using a cross-over design, participants will be randomized to an immediate or delayed exercise intervention group; the delayed intervention group will receive exercise training 6 weeks after the immediate group. Speech and motor outcomes will be assessed at baseline, 6, 12, and 18 weeks. We expect that this research will reveal benefits of this type of training in typically developing children, providing further support for different types of exercise programs in the schools. The preliminary results from this pilot work will also be used to develop a larger clinical intervention trial that tests the effects of exercise in children with specific speech, language, and motor developmental diagnoses. The long-term goal of this research is to develop optimally effective treatments to maximize outcomes and quality of life for the millions of children with communication and motor impairments and their families.
Effects of Ischemic Conditioning on Language, Cognitive, and Motor Outcomes in Persons with Chronic Aphasia
Dr. Sarah Grace Dalton, assistant professor of speech pathology and audiology
Dr. Allison Hyngstrom, department chair and professor of physical therapy
, associate professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin
Award Year: 2021-2022
Abstract: Aphasia is a language impairment that impacts over two million adults in the United States and leads to decreased quality of life and participation. Stroke is the most common cause of aphasia, and many adults with aphasia experience co-occurring impairments of cognition, sensation, motor, and/or vision. Ischemic conditioning is a vascular stimulus that is believed to engage the autonomic nervous system, effecting both cardiovascular and nervous systems. Thus, ischemic conditioning may allow researchers and clinicians to target multiple domains of impairment simultaneously, increasing the rate at which patients see improvement, and potentially increasing the overall recovery achieved. In this study, we will investigate the effects of one and six sessions of bilateral upper limb ischemic conditioning on language, cognitive, and motor functions in individuals with aphasia. IC sessions will be completed over the course of two weeks. We expect that motor changes will be observed following a single session of ischemic conditioning, and motor, language, and cognitive changes will be observed following six sessions. For individuals with aphasia, recovery is often slow and effortful but identifying intervention techniques that can improve recovery trajectories will have a positive impact on quality of life and participation in meaningful activities, while reducing the economic and societal impacts of aphasia.
Student Health Allies & Peer Educators Competencies and Mindfulness Training and Its Effect on Their Mental Health
Dr. Lee Za Ong, assistant professor of counselor education and counseling psychology
Dr. Karisse Callendar, assistant professor and online clinical mental health counseling coordinator for the Department of Counselor Education and Counseling Psychology
Award Year: 2021-2022
Abstract: This research project aims to evaluate the effectiveness of student-athletes鈥� peer support competency training and mindfulness technique and how it effects their peer support skills and mental health. Although peer support is widely utilized as a mental health promotion method on campuses, the appropriate competency training of peer educators remains inadequate. Peer educators continue to face challenges with the lack of understanding of the role of being a peer educator, the lack of knowledge in mental health resources, inadequate peer support skills, and burnout that leads to poor mental health. This is an interdisciplinary collaboration project between Athletics Department (AD) and Counselor Education and Counseling Psychology (CECP). In 向日葵视频, student athletes peer support is offered through the Athletic Department鈥檚 Student Health Allies & Peer Educators (SHAPE) program that operated by the student-athletes. This project will provide a peer support competency training to the SHAPE participants to improve their peer support skills while integrating mindfulness technique to promote their mental health. The competency and mindfulness training includes four 90-minutes sessions of peer support competency skills and mindfulness training, weekly check-in of SHAPE participants using an online tool called 鈥淪HAPE Cheq鈥�, and program evaluations using assessment instruments and a focus group. The outcome will be measured quantitatively and qualitatively. The hypothesis is that the competency and mindfulness training will effectively improve the SHAPE participants鈥� peer support skills, mental health, and mindfulness.
CUped: A New Method for Using Exercise As Medicine After Stroke
Dr. Sheila Schindler-Ivens, associate professor of physical therapy
, professor and Hammes Family Chair of the Joint Department of Biomedical Engineering
Dr. Philip Voglewede, associate professor of mechanical engineering
Dr. Kristof Kipp, associate professor of exercise science
Award Year: 2021-2022
Abstract: The goal of lower limb rehabilitation after stroke is recovery of independent, goal-directed locomotion. Few stroke survivors achieve this goal. Suboptimal recovery is due to the serious and intransigent nature of movement impairments caused by stroke and a scarcity of impactful therapies. Our lab has developed a novel exercise intervention called CUped (pronounced cupid, like the Roman god) to address barriers to recovery and improve stroke rehabilitation. CUped is so called because it compels use of the paretic limb during movements that resemble pedaling. It addresses 3 key impairments that limit recovery: reduced muscle output, inappropriate muscle timing, and abnormal interlimb coordination. CUped employs an adaptive, proportional controller (i.e., a motor under feedback control) to ensure that training is always performed at a challenge point helpful for motor learning. Exercise is done while sitting which offers a feasible approach to high volume, active, task specific practice that is imperative for recovery of lower limb movement. The purpose of the work described here is to determine the extent to which CUped fulfils its design specifications and improves lower limb function post-stroke. We will examine the extent to which CUped improves paretic muscle output and interlimb coordination, for whom, and under what conditions. We will also examine the effects of CUped on overground walking.
Comparison of Six-Minute Walk Test Distance Using the Standard Protocol and on a Woodway Curve Treadmill
Toni Uhrich, clinical assistant professor of physical therapy in the College of Health Sciences and director of the Human Performance Assessment Core
Dr. Paula Papanek, professor of physical therapy in the College of Health Sciences and director of the exercise science degree program
Lauren Opielinski, research assistant of exercise science
Award Year: 2022-2023
Abstract: The Six Minute Walk Test (6MWT) is a standard test in clinical and research settings to assess aerobic fitness. It involves covering as much distance as possible in the allotted time by walking around a set of cones 30 meters apart (~100 ft in a long hallway). Increases in the distance indicate improved fitness or in a clinical setting a decreased distance would mean a worsening disease condition. The use of a long hallway can be a hindrance to this test. Using a standard treadmill to measure distance in 6 minutes has the disadvantage of forcing/constraining a specific pace. A non-motorized treadmill, in which the person freely chooses the pace and can speed up or slow down with ease, would overcome this disadvantage. The Curve (Woodway, Waukesha WI) is such a treadmill with the added advantage of keeping precise distance metrics. The purpose of this project is to compare the 6MWT distance on the Curve (a self-propelled treadmill) against the the overground traditional method around cones, providing validation for the use of the Curve and a regression equation to predict 6MWT distance if they are different. A secondary purpose is to assess the viability of middle-aged and older people鈥檚 comfort using a self-propelled treadmill. Using the procedures from the traditional 6MWT, 150 individuals (30 years or older) will perform two 6MWTs using the traditional method (around cones) and on the Curve treadmill with time in between to return to their resting heart rate and blood pressure. Order will be randomized. The primary outcome is distance in six minutes, although perception of effort and feelings about using the Curve treadmill will also be tracked. Distance in 6 minutes will be compared between two walking conditions for validity (regression equations). Conducting this comparison methodological research study to understand validity using the Curve would impact the fitness and clinical field to allow for more 6MWTs to be conducted in a variety of settings and avoid that hindrance of space that is an issue in clinics or fitness facilities. In addition, the Curve treadmill automatically tracks, thus reducing chance of error (in lap counting and measurement distance). Investigators within the AHPRC (or elsewhere) could use the equipment and regression equation when collecting data or in proposals for grant support.
Physical Activity Patterns and Sex Differences in Adolescent Athletes: A Pilot Study
Jacob Capin - Assistant Professor of Physical Therapy in the College of Health Sciences; Director of Life After Sports Trajectories (LAST) Laboratory
Jena Heck Street 鈥� Physical Therapist, Research Technician in the LAST Lab
Kaycee Glattke - Postdoctorate Research Associate in the LAST Lab
Award Year: 2023-2024
Abstract: Recent literature suggests that male elite athletes have higher sedentary behavior patterns compared to nonathletes. This trend is concerning as greater sedentary behavior is negatively associated with several long-term health factors, such as increased risk of cardiovascular disease, obesity, and all-cause mortality, even in the presence of high physical activity. Limited research focuses on elite or college athletes; however, whether youth athletes engage in high sedentary behavior is unknown. The purpose of this study is to assess physical activity and sedentary behavior patterns in adolescent athletes by 1) comparing physical activity patterns and sedentary behaviors via continuous objective accelerometry in male and female adolescent athletes versus controls and 2) comparing physical activity patterns and sedentary behaviors in adolescent athletes across different training days (i.e., competition, practice, and rest days). We will recruit high school basketball players, club volleyball players, and healthy, non-athlete controls. We will complete testing sessions in the community, at the location of the programs鈥� practices. On-site testing will include anthropometrics, surveys, body composition (via bioelectrical impedance), and a functional test (i.e., vertical jump test). Participants will also wear an activPAL activity monitor continuously for 14 days. This study will determine physical activity and sedentary behavior differences in adolescent athletes compared to controls, in addition to sex differences and differences between training days. As our team is experienced in testing at the AHPRC and with using activPAL activity monitors, this study will also determine the feasibility of testing in the community. This pilot study will be a key first step to acquire preliminary data needed to create a competitive grant to secure extramural funding for a larger study focusing on overall health and long-term implications of sport participation in youth and adolescent athletes.
Validation of Remote-Synchronous and Remote-Asynchronous Physical Performance-Based Outcome Measurement
Daniel Pinto - Assistant Professor of Physical Therapy in the College of Health Sciences
Iqbal Ahamed - Professor of Computer Science in the Klingler College of Arts and Sciences
Kieran Mullen - Graduate Assistant of Physical Therapy; Exercise and Rehabilitation Science Master鈥檚 Student
Award Year: 2023-2024
Abstract: Performance-based outcome measures are used by the clinical and research community to identify health risks, assess change in physical function over time, and assess the success of treatment. With the onset of COVID-19, remote assessments were sought as alternatives to in-person testing, however there is sparse literature on the validity of remote performance-based outcome measurement to assess physical function. The literature is limited to small cohort studies and none take advantage of novel comparison of agreement methodology. In this study, we propose to validate the remote assessment of the 4-meter walk, timed up and go, and five repetition sit to stand assessments. The validation of these measures is needed to reflect a post-COVID-19 world where people can perform most of their daily tasks from the comfort of their homes. Asking people to participate in studies outside of their home may be perceived as an additional barrier to research participation 鈥� the research community must continue to adapt to this changing world. In Aim 1 we will conduct a comparison of agreement study using in-person assessment collected in a research facility and remote assessments performed asynchronously and synchronously. Aim 1 will provide validity estimates for remote physical performance measurement and provide confidence estimates around their accuracy. Aim 2 will be used to assess participants鈥� acceptance of all three forms of assessment and to assess how a future software designed to support self-assessment of physical performance can optimize acceptability and use of these measures. This research is important to establish the validity of screening procedures that can reflect the way in which people live and work. The results of these assessments are especially relevant to older and rural populations that are often more socially isolated. The measurements can help identify individuals with an increased risk of experiencing a fall at home where most falls occur. It promises to help screen older adults for fall-prevention training as well as increase the accessibility of clinical research to rural populations.
Muscle Contributions to Cardiac Function and Exercise Abilities in Patients with Fontan
Michael Danduran - Clinical Associate Professor of Exercise Science in the College of Health Sciences
Salil Ginde 鈥� Medical College of Wisconsin
Award Year: 2024-2024
Abstract: Where significant enhancements in surgical repair and treatment have increased the lifespan in children with congenital heart disease (CHD) the optimal expression of 鈥渓iving鈥� comes with consideration of the physical, mental, and social aspects of health. It is well known that physical activity in childhood not only enhances physical well-being, but it also has significant effects on mental health and socialization. It is recognized that children with CHD have reduced physical capacity when compared to children without. The reasons for this are multifactorial and include the notable physiologic manifestations of altered cardiopulmonary physiology, but also include patient and parental insecurities, mixed messages from care providers, concerns from schools/coaches, and finally a lack of understanding about the importance of meeting developmental milestones. The development of a program that addresses these potential barriers associated with physical activity in young children with CHD may provide significant benefits. MIKEs HEART program has been designed to assess physical activity in children with a multi-dimensional approach that will not only include traditional aspects of fitness but also focus on developmental movement patterns and potential barriers such as pain and impaired quality of life. We aim to recruit 100 subjects (50 CHD and 50 controls) within the funding cycle. Each participant will undergo measures of fitness that include assessment of their heart and lungs, muscle strength and size, balance and coordination, and assessments of quality of life and pain. The outcomes from these measures will be used to create a tool that will guide interventions and allow for targeted patient education and reassurance regarding physical activity and exercise. While we cannot create a world where CHD fails to exist, we hope to create a world where we can maximize 鈥渓iving鈥� by empowering young children with CHD and their families to engage in routine physical activity, seek healthy lifestyles, and life without fear.
