Month: August 2024

MRRI recently welcomed Alexander De Angelis to the Institute as a Research Assistant working in the Cognition and Action Laboratory, directed by Laurel Buxbaum, PsyD. Alex graduated from The College of New Jersey (TCNJ) in 2022 with a B.A. in Psychology, specializing in Biopsychology. As an undergraduate student, Alex gained research experience working as an assistant in two different laboratories at TCNJ.

In the Social Psychology Laboratory, led by Dr. Jarret Crawford, Alex studied mental health conditions that could potentially be inherited genetically based on social circumstances experienced by one’s ancestors. The COVID-19 pandemic impacted participant recruitment and other in-person activities within the lab, but Alex had an opportunity to learn more about this research area by reviewing the scientific literature. His literature review focused on previous studies on the potential for mental health conditions, such as depression, to be passed down genetically in a population of people who were descendants of survivors of Stalinist purges in Russia and Ukraine. The findings were mixed, such that in some cases, evidence supported the possibility of genetically inherited depressive symptoms, but there was also evidence suggesting that descendants may have a greater appreciation for life and a better overall quality of life.

While in the Event-Related Potential (ERP) Laboratory, directed by Dr. Andrew Leynes, Alex contributed to a research project investigating the identification of previously encountered information or “recognition memory”. His role included participant recruitment, informed consent, and data collection. Data collection involved recording electroencephalogram (EEG) data from participants and extracting the ERPs, or electrical signals generated in the brain in response to stimuli. Participants were asked to view a series of words and respond whether the words had been presented previously or not. Before a word was shown, participants were primed with brief exposure to a word that matched (match primes), was similar in meaning to (semantic primes), or was similar in structure/spelling to (orthographically similar primes) the target word. They reported that match primes showed the largest effect for accurately recognizing previously viewed words, and participants’ confidence ratings were also the highest. Accuracy and confidence were lower for orthographically similar primes and lowest for semantic primes. The study provided important information on the effects of priming on fluency during an episodic recognition task, and this may impact the design of future studies in the field.

In his final year at TCNJ, Alex conducted an independent research project under the guidance of Dr. Margaret Ruddy. For this project, he performed an in-depth literature review on the efficacy of Psilocybin and ketamine for alleviating treatment-resistant mental health conditions. Through this literature review, Alex learned about theoretical biochemical mechanisms of action of these drugs and how they could potentially benefit patients who had been classified as having treatment-resistant depression and/or anxiety. Additional research is needed to determine the optimal dose, course of treatment, and potential combination of therapies to maximize benefits for patients.

During his time at TCNJ, Alex also served as a teaching assistant for the General Chemistry II and Organic Chemistry II courses, and he worked part time at Princeton Nassau Pediatrics as a medical assistant. After graduating, Alex began working full time as a medical assistant and phlebotomist. In this role, his responsibilities included recording patient vitals, collecting patient blood samples and sending them for testing, and peer training.

At MRRI, Alex will be working with Dr. Buxbaum and Shailesh Kantak, PT, PhD, on research exploring arm nonuse in patients with fronto-parietal stroke, as well as a separate research project further evaluating an experimental treatment for phantom limb pain using virtual reality. In these projects, Alex will assist with participant recruitment and collecting data on motor, language, and cognitive function. Through this research, he hopes to learn more about the neuroanatomy and mechanisms underlying arm nonuse in stroke and phantom limb pain in people with limb loss, and how therapies can be modified to best treat these patients in the future.

Treatment theory, in which active ingredients influence a functional target through a proposed mechanism of action, forms the foundation for the RTSS.

The Rehabilitation Treatment Specification System (RTSS) has been under development for more than 15 years to address one of the most fundamental obstacles to progress in rehabilitation research: the “black box” problem related to our treatments. Whereas drugs are named and categorized in terms of their active ingredients, the vast majority of rehabilitation treatments involve systematic exposure to various kinds of experiences, delivered through interactions with a clinician. The active ingredients of such treatments are not self-evident, so we resort to naming them according to the facility (“3 weeks of inpatient rehabilitation”), discipline (“3 hours/week of physical therapy”), or the problem addressed (“a course of cognitive rehabilitation”). This makes it difficult to replicate research on effective treatments, to know whether two treatments differ in important ways, or to implement successful treatments in the clinic.

Principal investigators of the funded projects that led to the development of the RTSS (Marcel Dijkers, NIDIlRR; John Whyte, PCOR), were recognized with personalized “black boxes” signifying the problem that the RTSS aims to “unpack”.

The RTSS provides a standardized framework for describing all rehabilitation interventions with respect to their known or hypothesized active ingredients, based on an explicit treatment theory. This ensures that the label for the treatment is matched to the active ingredients that it contains, and that dissemination of the treatment will mean dissemination of those ingredients. It also means that clinical trials are much more than empirical comparisons of two treatments. They are tests of an underlying treatment theory, and their results help advance rehabilitation science.

Since the publication of the Manual for Rehabilitation Treatment Specification in 2019 and the organization of the Rehabilitation Treatment Specification Networking Group (RTS-NG) at the American Congress of Rehabilitation (ACRM), the manual has been downloaded by over 1,400 individuals worldwide and been the subject of numerous publications in diverse areas of rehabilitation. Nevertheless, individuals seeking to use the RTSS to guide research design, education, or clinical practice have found some of the implementation tasks to be challenging, despite recognizing the value of the underlying concepts. While the concepts embodied by the RTSS are useful to individual researchers and clinicians once they are understood, other benefits of the RTSS can only be realized with broader implementation so that it becomes a shared communication system. For example, the ability to aggregate research and conduct meaningful meta-analyses requires that the contributing studies report their results in RTSS-compatible ways.

A number of recent activities by members of the RTS-NG have helped explore ways to improve specific practices in rehabilitation, by implementing RTSS-based concepts. Jeanne Zanca, MPT, PhD, at Kessler Rehabilitation Institute, received an engagement contract from the Patient-Centered Outcomes Research Institute (PCORI) to understand barriers and facilitators to researchers’ application of RTSS-related concepts in research reporting, and the barriers and facilitators to clinician’s’ application of published research evidence. These stakeholder discussions provided insight into the targeted education and support materials that would help researchers apply RTSS principles to design and report their research. However, clinicians felt that treatments that were clearly reported along these lines would be feasible to implement by clinicians without requiring their intensive exposure to the RTSS directly.

In April, Moss Rehabilitation Research Institute (MRRI) sponsored and hosted a “RTSS Superusers Summit” to bring together researchers, educators, and clinicians from North America and Europe who have had the most experience in concrete projects involving the RTSS. The invited workshop was attended by 44 individuals from a range of rehabilitation disciplines. The workshop aimed to address two broad goals: to help these “early adopters” address challenges that they faced in their own RTSS-related work; and for RTSS developers to get feedback on the types of centralized infrastructure and support that might be needed to advance further implementation efforts. Questions and challenges faced by participants were surveyed in advance and shaped the contents of the meeting agenda. Cross-cutting questions related to the level of granularity that is optimal for treatment specification and the process needed for arriving at consensus labels for targets and ingredients were central discussion topics. As a result of the workshop, a number of new task forces were formed or reorganized within the RTS-NG, and plans were developed to apply for an ambitious infrastructure grant to support further implementation efforts.

Participants at the SuperUsers Summit engage in discussion.

This last goal was successfully met with the submission of an application for a P50 rehabilitation research infrastructure grant from the National Institutes of Health, led by Jarrad Van Stan, PhD, CCC-SLP, at Harvard as principal investigator. The proposal includes a Resource Core at MRRI, led by John Whyte, MD, PhD, and a Community Engagement and Outreach Core, at the Massachusetts General Hospital Institute for Health Professions, led by Kathleen Lyons, ScD, OTR/L. Should this grant be funded, it would support research on the impact of RTSS consultation on the quality of published research reporting, and on a generalizable method for arriving at standard menus of targets and ingredients in specific treatment domains. Moreover, the grant would provide resources to expand the pool of RTSS experts who can consult to researchers, educators, and clinicians about their implementation efforts. Regardless of the outcome of this specific grant application, the collaborative network of investigators will undoubtedly continue to move forward with implementation efforts.

This fall, at the annual meeting of the ACRM (10/31/24 – 11/3/24, Dallas) the RTS-NG will again offer a full schedule of symposia related to the RTSS. This will include a focus on its use by specific disciplines, its use for specific purposes, such as research design or clinical reasoning, as well as a symposium devoted to summarizing the work of the Superusers Summit, itself. Dr. Whyte will be among the presenters in two ACRM symposia on November 3^rd. The first will discuss how the RTSS can be used to improve the experimental design and reporting for intervention studies, and the second will cover real-life challenges to using the RTSS. Reflecting on recent RTSS-related activities, Dr. Whyte remarked, “Widespread implementation of the RTSS has the potential to transform the field of rehabilitation to improve research and ensure patients receive the best possible care. It has been exciting to see the advances we have made over the years, and scientists at MRRI look forward to continuing to be involved in future developments.”

MRRI is happy to announce that Tejaswini Sudhakar has joined the Institute’s team as a Research Assistant in the Human Motor Recovery Lab led by Dylan Edwards, PhD. Tejaswini’s extensive educational background and real-world expertise are a wonderful fit with the lab’s goal of developing neuromodulation and rehabilitation technology.

Tejaswini graduated from The City College of New York (CUNY) with a bachelor’s degree in biomedical engineering. She immersed herself in research and real-world applications throughout her academic career, showcasing her expertise in biomedical engineering, neurology, and a range of scientific data collection methods. Her research internships and coursework gave her practical knowledge with relevant experimental techniques.

Tejaswini co-founded AutoTENS, a firm that specialized in creating automated transcutaneous electrical nerve stimulation (TENS) devices for the treatment of persistent lower back pain, before joining MRRI. Her capacity to think creatively and effectively within strict regulatory constraints was demonstrated by her leadership, which was crucial in obtaining funds and guaranteeing FDA compliance. Her internships at Pfizer and Cresilon also gave her vital knowledge of process engineering, quality control, biotech manufacturing, and regulatory standards.

Tejaswini has made contributions to research in a variety of fields, including biomedical engineering and nanoscience. Her work at the CUNY Advanced Science Research Center and CCNY was noteworthy since it resulted in publications in respected journals like Soft Matter and Nature Communications. Her passion for expanding scientific knowledge and methods is seen in her meticulous approach to experimental design and data analysis.

As a Research Assistant at MRRI, Tejaswini will play a pivotal role in supporting funded studies involving non-invasive brain stimulation assessments, the development of the Spinal Cord Injury registry database, and intensive gaming/robotics-based training programs. Her responsibilities will encompass participant recruitment, data collection and analysis, literature reviews, and manuscript preparation—all critical components for advancing our understanding of motor recovery in populations with spinal cord injury and stroke.

Tejaswini’s exceptional academic background, entrepreneurial spirit, and passion for research make her a valuable addition to the MRRI team. The Institute looks forward to leveraging her skills and insights to drive forward MRRI’s mission of enhancing motor rehabilitation through cutting-edge technology and scientific inquiry.