CEDHARS is pleased to announce the recipients of its spring 2025 pilot grant funding opportunity, “Advancing Health and Wellness in Adults or Children with Disabilities.” (Request for proposal is available for reference.)

CEDHARS’ overarching mission is to advance scientific discovery, translational research, education and engagement in the fields of disability health and rehabilitation sciences. This pilot program aims to support the advancement of disability health research, and this specific funding cycle aimed at advancing innovative research to improve the health and well-being of adults and children with disabilities. Funding is intended to support new projects or expand existing initiatives to incorporate a disability component, generating critical data to bolster subsequent external funding applications.

Applications were highly competitive and were peer reviewed using the NIH scoring framework. Four proposals were chosen for $25,000 of funding. To learn more and read the abstracts for each of the projects, click on the links below:

• Dr. Byron Lai: “Feasibility of Vigorous Extended Reality Exergaming on Cardiometabolic Health in Youth with Mobility Disabilities: A Case Series”
• Dr. Christine Loyd and Dr. Tyler Wright: “Linking the Gut Microbiome to Chronic Pain in Adults with Multiple Sclerosis (MS)-Related Physical Disability”
• Dr. Meghan Mills: “A Pilot Exploration of Healthcare Accessibility for Service Dog Handlers”
• Dr. Hao Zhang: “Opioid Use Among Medicaid Enrollees with Disabilities: A Pilot Study of Patterns, Policies, and Mental Health Comorbidities”

Feasibility of Vigorous Extended Reality Exergaming on Cardiometabolic Health in Youth with Mobility Disabilities: A Case Series

• Principal Investigator: Dr. Byron Lai, Assistant Professor, UAB/Children’s of Alabama Division of Pediatric Rehabilitation

Youth with mobility disabilities (YwMD) have no aerobic exercise options that can empower them to independently manage their body weight and composition. This places them in one of the highest risk categories out of any subgroup for cardiometabolic complications. Conventional aerobic exercises that are evidenced to improve health (e.g., walking, running, and cycling) are often not suitable for people who use wheelchairs or have mobility disabilities. This exclusion affects a large demographic of YwMD and likely contributes to their alarmingly lower physical activity levels compared to non-disabled peers. Our reviews have found no aerobic exercise intervention that has been effective in improving body weight and body composition among youth with disabilities. Given that improvements to cardiometabolic health require high volumes of exercise, there is a dire need to identify aerobic exercise options that are age-appropriate, enjoyable, accessible, and can be performed independently outside of formal therapy activities.

Recently, we piloted an extended reality (XR) exergaming program as part of an NIH R03-funded study (NCT05336227), adapting it for 32 children with cerebral palsy (CwCP) across a spectrum of abilities. Using accessible, off-the-shelf equipment and telehealth-supported physical education coaching (tele-PE), participants performed an average of 149 ± 73 min/week of seated arm exercise (69 min/week of moderate exercise) over 12 weeks. To our knowledge, this represents the highest reported volume of unsupervised home-based exercise for children with mobility disabilities in a clinical trial. While the intervention yielded promising cardiometabolic benefits, these were primarily blood-related, with no changes in body weight.

We hypothesize that achieving meaningful improvements in body composition and weight will require higher exercise intensities and durations than those prescribed in our R03 pilot, which focused on moderate-intensity exercise. In fact, all of our research in XR exergaming originated from a case study in which a participant achieved a clinically meaningful reduction in body weight after four weeks of vigorous-intensity ER exergaming (184 min/week, average heart rate ~150 bpm). Building on this finding, we now propose investigating the impact of vigorous-intensity exercise prescription using a new and engaging, accessible ER exergaming approach. This study will complement our ongoing research on moderate-intensity ER exergaming and its effects on blood-related outcomes (recent R01 application submitted).

Linking the Gut Microbiome to Chronic Pain in Adults with Multiple Sclerosis (MS)-Related Physical Disability

• Principal Investigators: Dr. Christine Loyd, Assistant Professor, UAB Department of Clinical and Diagnostic Sciences, and Dr. Tyler Wright, Assistant Professor, UAB Department of Clinical and Diagnostic Sciences

As the older adult population grows, the number of people living with a physical disability also grows. By year 2030, approximately 40% of the US population will be composed of adults aged 50y+, and Multiple Sclerosis (MS) is a significant contributor to disability in those adults. Evidence strongly suggests that physical disability places adults at increased risk of loss of functional independence, institutionalization, and of death. Further, physical disability is frequently accompanied by chronic pain, which greatly reduces quality of life, increases the likelihood of depression and anxiety, and reduces mobility.

The mechanisms underlying chronic pain in general are largely unclear, but considerable evidence supports that inflammatory pathways and epigenetic mechanisms involving microRNAs (miRNAs) are involved. Evidence also supports a role for the microbiota-gut-brain axis in pain perception. Gut dysbiosis, or an imbalance in the bacteria inhabiting the gut, can lead to a loss of alpha and beta diversity, which can alter the communication between the gut and the brain, thus affecting pain perception. Yet, the role of gut dysbiosis and miRNAs in the mechanisms underlying chronic pain among adults with an MS-related physical disability is still unclear. Identifying the relationship between the GM and pain in adults with an MS-related physical disability could provide vital information for developing targeted interventions for reducing pain and improving quality of life.

The goal of the proposed study is to examine the roles of gut microbial diversity and epigenetic regulation via miRNAs on pain among adults with MS-related physical disability. To do this, we will execute a pilot study assessing how markers of GM health relate to measures of pain among adults with an MS-related physical disability. Together, the MPIs have nearly a decade of experience studying physical disability in older adults and multiple sclerosis models, thus creating a team with both expertise and passion for helping this population have a better life. We plan to use the pilot data generated in this study to develop a larger NIH grant application.

A Pilot Exploration of Healthcare Accessibility for Service Dog Handlers

• Principal Investigator: Dr. Meghan Mills, Program Director, UAB School of Health Professions Research Collaborative

In the United States, more than one in four adults have a disability and 49.3% of people with disabilities use one or more types of assistive technology. Assistive technology, defined as an item, piece of equipment, or product that can be used to increase or maintain the ability to complete daily tasks for people with disabilities, are essential for many in enhancing independence, health, and function. Since the opening of the first guide dog school in the United States in 1929, the use of service animals, defined by the Americans with Disabilities Act (ADA) as “a dog individually trained to do work or perform tasks for a person with a disability,” has proliferated as an essential type of assistive technology.

Despite many recent calls to action by experts in the field arguing for the importance of service dogs and corresponding need for increased education and awareness by health care providers and encouraging healthcare providers to recommend and advocate for the use of service dogs in patient care, there is a serious paucity of research examining this topic. In response to the critical importance of equal access and inclusion in healthcare for all individuals with disabilities, and the limited research on healthcare accessibility for service dog handlers, we propose a one-year disability-led and community engaged pilot research project to bolster our subsequent external funding applications. In December 2024, we submitted a proposal, “Advancing Health Equity for People with Disabilities: A Mixed Methods Study on Healthcare Accessibility for Service Dog Handlers,” for external funding from NIDILRR. While this proposal is still under review, this pilot grant opportunity will enhance future external funding submissions by gathering and analyzing preliminary qualitative data and designing survey instruments to quantitatively examine the relationship between healthcare accessibility, utilization, and health for service dog handlers.

This pilot study will incorporate perspectives from both service dog handlers and healthcare providers by collecting exploratory qualitative data to assess the feasibility, design, and methodology of what will ultimately be a multiyear community engaged, mixed-methods research project. The current proposed one-year pilot study will examine the following research question: What are the main barriers and facilitators to healthcare access and utilization faced by service dog handlers?

Opioid Use Among Medicaid Enrollees with Disabilities: A Pilot Study of Patterns, Policies, and Mental Health Comorbidities

• Principal Investigator: Dr. Hao Zhang, Assistant Professor, UAB Department of Health Policy and Organization

The opioid crisis in the United States continues to be one of the most pressing public health challenges. While overdose deaths linked to opioids have declined since 2023, the current mortality rate remains nearly double the rate recorded in 2019. This persistent public health crisis disproportionately affects individuals with disabilities, who represent approximately 30% of the U.S. population. Individuals with disability bear a greater burden of opioid-related harms, experiencing significantly higher rates of opioid use, misuse, opioid use disorder (OUD), and overdose mortality compared to the general population.

Research on opioid use and outcomes among the disabled population has predominantly focused on the Medicare program due to the ease of identifying disabled individuals from Medicare claims data. Studies in this population have led to concerning findings: at least 50% of individuals with disabilities under Medicare fill at least one opioid prescription each year, and they are three times more likely to die from a fatal opioid overdose than their non-disabled counterparts. Overall, the disabled individuals account for more than 80% of all opioid overdose deaths in the Medicare population, highlighting the vulnerability of disabled individuals to opioid-related harm. However, the predominant focus on the Medicare population, particularly individuals under the age of 65 who qualify for Medicare due to a disability, is a major limitation in the current literature. This subgroup represents only about 50% of all disabled individuals in the U.S. and may not fully capture the experiences of the broader disabled population.

Medicaid, another crucial source of health coverage for individuals with disabilities, covers approximately 35% of the disabled population. Low-income individuals with disabilities who receive Supplemental Security Income (SSI) are automatically enrolled in Medicaid in most states. Those who do not meet the income eligibility may also qualify for Medicaid through other pathways such as caregivers of children or the Medicaid expansion programs under the Affordable Care Act (ACA). Medicaid beneficiaries, particularly those with disabilities, may face unique challenges related to opioid use, including higher rates of chronic pain, mental health comorbidities, and socioeconomic vulnerabilities that put them at increased risk of opioid misuse and adverse outcomes. However, despite Medicaid’s critical role in providing health coverage for this population, there has been no research to date that investigate the prevalence of opioid use, misuse, and OUD among Medicaid-enrolled individuals with disabilities.

This project will fill in this gap by conducting secondary data analysis using the national level administrative claims database for Medicaid beneficiaries, Transformed Medicaid Statistical Information System Analytic Files (TAF) 2016 to 2020. Our overarching goal is to improve understanding of the opioid use patterns, OUD prevalence, and treatment uptake among Medicaid-enrolled disabled individuals.

Read more about past funding grants and recipients.