Listening to music has been shown to engage multiple brain regions, and rhythm and music have been employed in therapies around the world for many years. Aphasia is a language impairment that may occur after a stroke or other brain injury, and the MossRehab Aphasia Center is a world leader in studying and treating aphasia.
The Aphasia Center has developed a program called Musical Mondays during which people living with aphasia come together to listen to music, share information and stories, explore different types of music, sing, and play musical instruments.
Philadelphia Public station WHYY recently interviewed Aphasia Center scientists, staff, and members in a segment on the Musical Mondays Program as part of its “You Oughta Know” series. As Aphasia Center Speech Language Pathologist Roberta Brooks explains, the goals of the program are “to provide opportunities for socialization, to allow people to share their love of music, [and] give people another forum for practicing communication skills and listening skills.”
The MossRehab Aphasia Center is a collaborative effort between MRRI scientists and MossRehab clinicians that helps to address the long-term communication and psychosocial needs of people living with aphasia. The Center provides outstanding treatment, resources, programming, peer support, and opportunities to participate in cutting-edge rehabilitation research.
In 1992, Myrna F. Schwartz, PhD, co-founded Moss Rehabilitation Research Institute with former MRRI Director John Whyte, MD, PhD. As head of MRRI’s Language and Aphasia Laboratory, she directed a multi-disciplinary research program dedicated to the study of aphasia and its treatment. Dr. Schwartz’ research was continually funded by the National Institutes of Health for over 30 years.
Dr. Schwartz is one of the world’s most influential researchers of aphasia. Over the course of her career, she’s collaborated with and mentored some of the brightest minds in language and aphasia research. She has published well over 100 peer-reviewed scientific articles and has directly or indirectly helped diagnose and treat hundreds of patients recovering from stroke and other types of brain injury.
Early in her career, Dr. Schwartz worked with renowned scientists Dr. Eleanor Saffran and Dr. Oscar Marin at Johns Hopkins University. Their work centered on advancing a cognitive neuropsychological approach to the study of aphasia and language. The basic idea was that intensively studying individuals with aphasia to identify which aspects of language are disrupted versus preserved can reveal the underlying neurocognitive architecture for language. By going a step further and relating specific deficits in individuals to where they have damage in the brain after stroke, scientists can draw conclusions about brain-behavior relationships. Schwartz’s pioneering research laid new groundwork for how to apply general models of cognition to understand aphasia and likewise use the study of aphasia to inform models of cognition.
As an Institute Scientist at MRRI, Dr. Schwartz was integral to establishing the Institute’s Research Participant Registry, which is a HIPAA compliant, research recruitment infrastructure that permits tracking individual research volunteers over time to study them again and again. At MRRI, the Schwartz lab oversaw the collection of an extensive battery of neuropsychological tests on a large sample of people with aphasia. This provided foundational data for studies using a ‘case series’ approach. Case series is a powerful investigatory method in which theoretical constructs are derived that best capture behavioral variability across participants. This work produced seminal papers co-authored with leaders in related scientific disciplines, including prominent cognitive scientist Gary Dell, PhD, at the University of Illinois at Urbana-Champaign. Dr. Dell and Dr. Schwartz’s research on large case series of people with aphasia advanced the two-step interactive theory of lexical access, a scientifically rigorous computational model that explained abilities for word production in a broad range of people with aphasia and normal speakers. This theory remains one of the most influential in the study of language production, with the original papers garnering nearly 1,000 citations collectively.
More recently, in collaboration with local scientists including Dr. Branch Coslett, MD, PhD at the University of Pennsylvania, Dr. Schwartz conducted a series of investigations into the neuroanatomical correlates of word production. These studies involved large groups of people with aphasia, and they used state-of-the-art imaging techniques to link damaged areas in the brain to specific deficits in word production. Essentially, this lesion-analysis technique permits users to map theory-informed components of word production to the brain. These ground-breaking studies were published in highly-regarded, influential scientific journals including Brain and Proceedings of the National Academy of Sciences of the United States.
One of Dr. Schwartz’ lifelong passions is helping people with aphasia and their caregivers live life to the fullest. To this end, Dr. Schwartz helped found the MossRehab Aphasia Center. One of the first in the country, the Center provides support for people with aphasia and their caregivers. Its mission is to enhance life participation of people with aphasia by providing social opportunities, advanced assessment, and interventions to improve personal and environmental factors. Today, there are many aphasia centers throughout the country, dedicated to helping people with aphasia maintain a high quality of life despite chronic language problems.
A major focus of Schwartz’ work was to develop theory-grounded approaches to treatment. Among her clinical contributions, Dr. Schwartz and her colleagues developed a treatment protocol called Mapping Therapy, which is used to treat agrammatic aphasia, and the Philadelphia Naming Test, which helps identify the type of aphasia a patient has and can measure recovery over time. She and her colleagues also developed MossTalk Words, an evidence-based computer-assisted treatment program that people with aphasia and other language disorders can use in their home to supplement traditional speech therapy.
Myrna F. Schwartz continues to be involved in aphasia research in an emeritus role from California. She provides ongoing mentorship to junior scientists at MRRI, and she is active in organizations dedicated to raising awareness of aphasia and providing life-long support to individuals with aphasia. Her many contributions to aphasia research and treatment have left a lasting impact on the field, and Dr. Schwartz’ legacy will continue to drive aphasia research at MRRI and around the world.
We recently caught up with Donald Thomas, who participated in research at MRRI. Donald sustained a traumatic brain injury (TBI) in 2001 as a passenger in a motor vehicle collision. Afterward, he found himself staying home more and getting less enjoyment out of life. When he learned about an opportunity to participate in a research project evaluating a treatment for anxiety and depression after TBI, he leaped at the chance. “I decided to volunteer for two reasons. First, I thought it would help bring me back into the world after feeling ‘boxed in’ after my injury. I also wanted to help others who are dealing with the same problems that I am.”
The treatment program evaluated in this study is based on Behavioral Activation (BA). BA is a treatment approach that encourages gradual, scheduled increases in rewarding activities. The theory behind BA suggests that depression and anxiety will diminish as individuals experience more enjoyment and accomplishment by increasing their participation in rewarding activities. Prior research has shown that BA is a particularly well-suited approach for activity restrictions due to medical conditions, such as TBI.
Amanda Rabinowitz, PhD, Director of the Brain Injury Neuropsychology Lab, is leading this ongoing randomized controlled trial. Participants are assigned to one of two 8-week variants of BA. One BA treatment includes a single face-to-face session with a therapist followed by weekly text-messages. In the other BA treatment, participants have weekly sessions with a therapist—6 in person and 2 by telephone. Both treatments incorporate mobile technology. Some participants download a smartphone app that they use to monitor their mood and activities, and all receive personalized text messages. Text messages either take the form of timely reminders of activities that have been scheduled, or “implementation intention” statements that are designed to help them recognize opportunities to participate in valued activities. At the midway point and again at the end of treatment, we measure participants’ depression, anxiety, and quality of life, their exposure to environmental reward, and community participation. We then follow-up with participants two months after they have completed treatment to learn whether or not they have continued using the skills and strategies they learned in treatment.
BA resonated with Donald. Before his injury, Donald worked for the School District of Philadelphia as a teacher’s assistant in Pre-Kindergarten classrooms, a position he held for twenty-one years. He was also a trustee for his church and managed their finances. After his TBI, Donald’s life changed in many ways. For example, he no longer works outside of the home. “For some reason, I felt like I was out of the world. There was a comfort zone that I was in, but I needed to broaden my horizons.”
At the start of the study, Donald didn’t know what to expect, “Sometimes people treat you like a child when you’ve had a brain injury, but the people at MRRI made me feel very comfortable. They asked for my feedback and wanted to know how I was feeling.” Donald learned that his experiences were actually very common after brain injury. He began making plans to try new things, such as a trip to New York City. “I was paranoid to go by myself, [but] my study therapist helped me organize my thinking. I took a train to New York by myself, and I never would have done that before.”
Donald was excited to share his accomplishments with the study team, “even if I didn’t get everything accomplished, I could tell them I tried. They showed a lot of encouragement.” Months after completing the study, Donald still draws strengths from what he learned participating in the program. “That was one of the goals, spreading my wings a little bit. Participating in this study showed me that I could do it.”
Today, Donald finds joy managing his household, growing vegetables and flowers in his garden, and cooking – macaroni and cheese is his specialty. Donald continues to work for his church as a volunteer, and he helps with a program that brings prepared meals to those in need in the community. He is grateful for the research that is being done at MRRI. “If you have a physical ailment, people can often see it right away. A mental disability, like TBI or stroke, may cause a lot of pain, but you don’t see it. However, it’s just as important as suffering with physical pain. The research at MRRI is important because they are addressing issues that people can’t see.”
Because of the dedication of research participants like Donald, scientists at MRRI are able to make great strides in understanding how people recover following traumatic brain injury and in developing new treatment approaches. We are currently halfway through this clinical trial, and we look forward to analyzing the data and reporting our results in 2022.
Aphasia impacts more than two million people in the U.S. alone. During National Aphasia Awareness month, MRRI is pleased to highlight the outstanding scientists, clinicians, and staff of the MossRehab Aphasia Center. The Center brings together leading researchers and expert clinicians within the region’s only top 10 U.S. rehabilitation hospital to address the long-term communication and psychosocial needs of individuals with aphasia. Through our Center, we provide individuals with aphasia and their co-survivors with resources, support, treatment, and opportunities to participate in research.
In collaboration with community members with aphasia and their families, Myrna Schwartz, PhD, and Ruth Fink, MA, CCC-SLP, founded the Center in recognition of the fact that lifelong recovery is possible and that social rehabilitation is a crucial part of that process. Opened in 1996, it was the second aphasia center in the U.S. and the third in North America. Through the Advanced Clinical Therapy Program, the Activities Center, and ongoing innovation in research, the MossRehab Aphasia Center provides a spectrum of services in a supportive and inclusive environment.
The Constance Sheerr-Kittner Conversation Cafés are a cornerstone of our Center’s programming. A small, but growing, evidence base indicates that those with aphasia who participate in conversation groups experience increases in both functional communication effectiveness and psychosocial wellbeing or quality of life. Funded by an Albert Einstein Society Research Grant, a longitudinal pilot study examining these outcomes with new Conversation Café members is in the final stages of data collection. During weekly Conversation Cafés, people with aphasia engage in sharing stories, daily experiences, and topical discussions and debates. These meetings are facilitated by a speech-language pathologist and provide an environment conducive to practicing communication strategies. Most importantly, Conversation Café participants have the opportunity to develop friendships that extend beyond the physical boundaries of the Center.
Maintaining these relationships is even more critical in the face of the COVID-19 quarantine, which can only serve to exacerbate the social isolation experienced by many people with aphasia. In recognition of the need to continue providing this critical support, even from a distance, the Center has transitioned to virtual group meetings. Under the auspices of the United States Department of Health and Human Services guidelines for telehealth during COVID-19, MossRehab Aphasia Center speech-language pathologist, Karen R. Cohen, MSPA, CCC-SLP, facilitates virtual conversation groups five times weekly, as well as a virtual Talking Book Club, providing a venue for members to continue socializing, share their experiences, and receive essential language and communication practice. In collaboration with Center director, Sharon M. Antonucci, PhD, CCC-SLP, our Outreach Administrative Coordinator / Member Liaison Nikki Benson-Watlington has created aphasia-friendly pictorial guides demonstrating how to download and access the virtual platform as well as suggestions for maintaining security online. Ms. Benson-Watlington reached out to every member individually to confirm they were able to access the technology and to walk them through any necessary problem-solving.
Feedback thus far demonstrates the importance of keeping these connections strong.
“Thanks so much for this morning. I think the Zoom went very well and although [he] doesn’t talk too much; I know he is really delighted to see everyone. Please stay well.” – MossRehab Aphasia Center Co-survivor
“Wow. Today was great! [He] had a real nice time. And, as always, I enjoyed it too.” – MossRehab Aphasia Center Co-survivor
“This is just outstanding. I love that we can do this. You have no idea what this means to him, and us, really…” – MossRehab Aphasia Center Co-survivor
The MossRehab Aphasia Center team is dedicated to embracing technology to address the needs of our community and deliver innovative programs to people with aphasia. These statements from co-survivors are a testament to the impacts that resources and support from our Center are providing participants during this difficult time. Having been in the vanguard of Aphasia Center programming, the MossRehab Aphasia Center continues to provide outreach, advocacy, and education, advancing knowledge and putting that knowledge into action every day for people with aphasia, their families, and the broader community.
Jane suffered a stroke that impacts the sensation, strength, and dexterity of one of her arms. She worked hard in inpatient neurorehabilitation, and assessments showed that her capacity to use the arm greatly improved. When she returned home, however, her spouse noticed that she continues not to use the affected arm much in daily activities, preferring to rely on the other arm or to ask others for help. In fact, over time her use of the affected arm actually seemed to be decreasing.
One of the most challenging aspects of neurorehabilitation of stroke is that many individuals with adequate sensory-motor recovery and capacity to use their impaired arm do not actually do so.
Instead, there is a maladaptive pattern of over-use of the relatively intact arm, resulting in a vicious cycle in which the affected arm loses the gains that resulted from neurorehabilitation. Can we identify the factors that make people likely to show this pattern of non-use?
One obvious factor might be the ability level of the affected arm: people clearly favor their less-impaired arm if the impaired arm is particularly limited. Working with a team from University of Southern California (USC), the MRRI Cognition and Action Lab headed by MRRI Associate Director Laurel Buxbaum, PsyD, performed a study showing that even when the severity of arm impairment is taken into account, a second factor—sustained attention – plays an important role in determining whether individuals are likely to use that arm.
The researchers suggest that this pattern fits with the importance of sustained attention and ability to expend effort in a variety of cognitive and motor tasks, and with the idea that arm use occurs on the basis of an implicit cost-benefit analysis. In individuals who have suffered a stroke, the reduced sensory-motor capacity of the impaired arm requires extra sustained attention and effort to overcome. That is, movement comes at a greater “cost”. At the same time, however, the stroke diminishes the ability to deploy attention and effort. “To shift the cost-benefit relationship”, says Dr. Buxbaum, “we need to increase the degree to which use of the impaired arm is associated with reward”.
Neurorehabilitation programs can shift the cost-benefit relationship to favor arm use in a variety of ways. Some direct ways including “gamifying” arm use via virtual reality and other motivating games, or allowing accumulation of points or rewards for arm use. In addition, therapists can use goal-setting, peer support groups, family involvement with goals, and frequent check-ins to boost the reward associated with using the impaired limb. In fact, therapies that have been associated with such benefits (sometimes termed “transfer packages”) have generally been more successful than those that do not.
Dr. Buxbaum and her colleagues from USC recently published a peer-reviewed study on the factors determining non-use in the journal Neurorehabilitation and Neural Repair. Along with MRRI Institute Scientist Shailesh Kantak, PhD, the researchers are in the process of developing a funding proposal for follow-up research.
In May, we were pleased to highlight the important contributions of our scientists and staff members engaged in exceptional stroke research as part of National Stroke Awareness Month. We published several new stroke-related posts on the MRRI blog, including:
We would like to take a moment to congratulate Laurel Buxbaum, PsyD, Dylan Edwards, PhD, and Erica Middleton, PhD, all of whom were authors on new research papers published or accepted for publication in peer-reviewed journals last month. In addition, we are excited to announce that Amanda Rabinowitz, PhD, was recently elected as Secretary of the American Congress of Rehabilitation Medicine’s Brain Injury Interdisciplinary Special Interest Group (ACRM BI-ISIG) Executive Committee.
MRRI is also pleased to celebrate a recent grant award. MRRI Postdoctoral Fellow Marja Liisa Mailend, PhD, is Principal Investigator of a new grant from the Albert Einstein Society in collaboration with MRRI Institute Scientist Erica Middleton, PhD. Through this grant, Drs. Mailend and Middleton will test and improve a promising treatment technique, called speech entrainment, in people with chronic aphasia. Aphasia is a language disorder arising after stroke or other brain injury that affects a person’s ability to communicate. Speech entrainment involves speaking in unison with a model speaker by imitating the model in real time, and this technique has been demonstrated to dramatically improve connected speech output in people with aphasia. This project will expand upon previous research by investigating whether speech entrainment may improve independent speech after practice as well as by investigating conditions that enhance benefits from treatment. The aims of this research project will provide important information that can inform the optimization of a promising clinical treatment technique for aphasia rehabilitation. Furthermore, it will provide key pilot data for a future clinical trial examining the efficacy and long-term benefits of speech entrainment practice within the context of traditional rehabilitation therapy.
Looking ahead, we are dedicated to helping raise public awareness and scientific understanding of aphasia during National Aphasia Month and beyond. MRRI scientists are renowned for their expertise in studying and developing novel therapies to treat aphasia. Keep an eye out throughout this month for more updates and new articles highlighting some of the outstanding aphasia research at MRRI!
At the MossRehab Aphasia Center, every month is Aphasia Awareness Month, but we always plan special events for June. Please join us and help spread the word about aphasia!
