Q & A with John Whyte, MD, PhD

John Whyte, MD, PhD, MRRI Director

John Whyte, MD, PhD

What is the current focus of your research?

John Whyte: I have a couple of content foci. One is prolonged unconsciousness and the minimally conscious state, from defining patients’ medical needs to developing assessment technology to develop new treatments.

I also have an area of content that’s related to higher functioning traumatic brain injury patients, looking at how their cognitive impairments relate to the nature of their brain damage and what kinds of treatments and supports can help them function better.

Different patients will need different treatments. Just saying, “Oh, the patient forgets things” may not translate immediately into what’s the best treatment for that patient, but if they forget things because of a primary memory problem versus they forget things because they have an organizational problem in terms of how they store things and how they retrieve things in an efficient manner, those might be two different treatments. It’s figuring out ways to sort the patient population such that you end up with groups that will benefit from specific things. It’s kind of the rehab branch of personalized medicine.

Over the course of my years the content of the meta work has also grown. That meta work has to do with, broadly speaking, identifying the specific things that make rehabilitation research challenging and trying to find solutions for those things.

If you look at my publication history, you would see a set of articles and a set of meta articles. There’s the specific things that I’m studying—what’s the best treatment for this and that, and how should we measure something and so on.

For example, in mainstream medicine when we want to assess the efficacy of something, it’s usually the efficacy of a particular chemical molecule or a particular surgical procedure that results in well-defined changes in the anatomy, you know? For example, your stomach is 20 percent as big as it used to be before I shrunk it for you.

In rehabilitation, though, we don’t have any kind of agreed upon nomenclature for the “active ingredients” of treatment. We end up doing a study to see whether six hours of physical therapy is better than three hours of physical therapy. That would be like doing an experiment asking whether more pills are better than fewer pills for curing your pneumonia. We would rather talk about what’s in those pills, but we don’t know how to talk about what’s in that physical therapy.

Implicit in comparing six hours to three hours is saying it must not matter how you spent your time, which is a pretty scary thing to say.

Then because of, let’s say, a challenge in designing a study to find out whether treatment A or treatment B is better, I end up writing about why it’s challenging to compare treatments A and treatment B, and what that tells us about the research design problem.

Just to give you one example, everyone is very fond of the placebo-controlled trial. It’s what we all grow up thinking is the gold standard, but a placebo means something that is fully plausible and completely inert. If I’m doing a training session on how to cope with your memory, what would the training session look like that’s fully plausible and completely inert that I would compare that to?

That’s a big challenge in rehabilitation. It’s easy to make a placebo for a chemical. It’s basically impossible to make a placebo for an experience-based training approach, which is what most of rehab consists of.

Which aspects of your work are you most excited about right now, and why?

JW: I’m excited about everything I do. I do think that I would say about the treatment definition stuff, I’m excited and nervous. It’s an extra-complicated task, and it’s difficult to do it in a way that’s not too complicated. That’ll be exciting if we can pull it off.

What is your most significant success? What are you most proud of?

JW: My most important past success past is a project that Dr. Joseph Giacino and I ran in minimally conscious patients that showed that amantadine can accelerate the recovery of consciousness of those patients. It was really the first successful study to show an impact on recovery from brain injury.

What do you like to do when you’re not working?
JW: Cultural things. I’m a fan of theatre and music and art, and I also like outdoor kinds of things, particularly walking. I’m a downtown person with no car. I like to walk everywhere.

What is there that people might not know about you?

JW: (Laughs) I’ve worked here 25 years so I don’t think there’s anything people don’t know.

Q & A with Tessa Hart, PhD

Tessa Hart, PhD

Tessa Hart, PhD

Tessa Hart, PhD, is director of the Traumatic Brain Injury Clinical Laboratory and principal investigator of the Moss Traumatic Brain Injury Model System at Moss Rehabilitation Research Institute. She joined the MRRI faculty as a full-time researcher in 1999, after spending more than 15 years treating and developing programs for people with acquired brain injury and their families in inpatient, outpatient, and residential settings.

Dr. Hart is also research professor in the Department of Rehabilitation Medicine at Jefferson Medical College and a member of the adjunct professional staff of Einstein Healthcare Network.

What is the current focus of your research?

Tessa Hart: I do research in traumatic brain injury (TBI). I’m especially interested in long-term, severe TBI, and in problems in the psychosocial area. Some of my research has to do with finding out more about the long-term problems that affect people with TBI and their families. But my main interest is in developing and testing new treatments to help people deal with those problems, especially problems of emotional self-regulation.

Which aspects of your work are you most excited about right now, and why?

TH: Right now I’m most excited about my treatment studies because of the feedback that we get from the patients who participate. Some of them have said things like, “It’s changed my life” or “I have my life back now.”

I’m doing one study in which patients with depression or anxiety, or both, develop action plans that will expose them to more rewarding experiences. Then they develop reminders about those action plans that we send in the form of text messages. It’s about remembering to do simple things, little things that give them pleasure. For example, one lady decided she was going to walk to the grocery store instead of driving. She lost some weight through walking more, and she met some of her neighbors for the first time. She reminded herself to pick up baking supplies at the store, and she therefore did more Christmas baking, which made her family happy and gave her a lot of satisfaction.

Some of the plans are designed to overcome avoidance of desired activities. For example, one fellow wanted to work out at the gym but felt self-conscious. One of his messages said something like, “When I’m at the gym, I’ll remember that no one is looking at me.” It worked for him.

What is one of the problems or barriers to success that you’re trying to work past at the moment?

TH: It’s hard to find people to recruit into some studies. It can take a tremendous amount of time and resources to find people to engage in research.

But the perennial barrier is getting funding for research, because it’s so competitive. We go after all kinds of grants, large and small. The small grants help us get preliminary data to support the larger grants.

What do you like to do when you aren’t working?

TH: I love to travel. That’s one of the best perks of the job, that you get to attend meetings around the country and overseas. I like to cook. I’m a jogger—that’s something I really enjoy and I’ve done it my entire life.

What might surprise us about you?

TH: I also love to write, and I wrote two children’s books with my husband, Frank Sergi, about a creature called the Snarth, who I invented when I was 7 years old. The first one got published, but then the publisher went out of business and the second one is still sitting in a drawer. It was fun while it lasted, though!

MRRI Welcomes the World Congress for Neurorehabilitation to Philadelphia!

The 9th World Congress for Neurorehabilitation arrives in Philadelphia this week—May 10-13—and we at Moss Rehabilitation Research Institute extend a hearty welcome to our city. This will mark the first time the Congress will be held in Philadelphia.

You’ll be sure to run into many MRRI and MossRehab staff members at the Congress, both informally and formally. In particular, MRRI and MossRehab will take part in the event as invited speakers and presenters. Continue Reading

Regulating Emotion After Traumatic Brain Injury

Hartimage610In the wake of a traumatic brain injury (TBI), friends and family may find it easy to understand that physical recovery will take time. Fewer people are aware that TBI can take a significant toll on the emotional well-being of the injured person. Yet studies have shown that up to a third of all people with a TBI, whether mild or severe, experience irritability and anger. And patients who wrestled with anger prior to injury may find that a TBI intensifies the problem.

According to Tessa Hart, PhD, director of the MossRehab Traumatic Brain Injury Clinical Research Laboratory and director of the Moss Traumatic Brain Injury Model System, patients with TBI have legitimate reasons to feel angry.

“The brain is the organ that controls emotions,” says Dr. Hart, “and injury to the brain can affect how you express emotions, including anger and irritation. Patients with brain injury also experience drastic changes in their lives, such as the loss of independence, and cognitive problems that interfere with simple things like following a conversation. All of these changes can be very frustrating and can contribute to outbursts of anger. Patients who are angry after a brain injury should know that they are not alone—these are common problems.”

Problems with irritability and anger also can adversely affect those who interact with patients.

“Many people with TBI are at risk for losing their social support networks,” says Dr. Hart, “because people who display anger tend to drive others away. Irritability is also something that can be very difficult for professionals to handle—even those with experience treating brain-injured patients. Compared with other emotional disorders, such as depression and anxiety, anger doesn’t tend to garner much sympathy from others.”

Outside of a few small trials, the management of anger and irritability after brain injury is an area that is only beginning to be explored.

In 2011, Dr. Hart and colleagues from MRRI and Craig Hospital in Englewood, Colorado launched the first multicenter, randomized controlled trial of a psycho-educational treatment for anger following TBI. Funded by an NIH grant, the trial is designed to test and refine a unique protocol that teaches patients how to manage their anger more effectively.

Combining their brain injury expertise with the anger management expertise of collaborator Roland Maiuro, PhD, who directs a domestic violence center in Seattle, Dr. Hart and her colleagues have adapted anger management principles and techniques so that they can be used by patients who have difficulty with reasoning and memory.

“During eight highly structured one-on-one sessions, therapists and patients are guided by a manual that is almost scripted,” says Dr. Hart. “There’s a lot of repetition, which helps to compensate for memory deficits. For example, sessions always begin with a review of the previous session and then end with a recap of the current session. Each session has a particular theme or topic, and topics are organized so that they begin with introductory educational material, and gradually incorporate more sophisticated techniques for self-managing anger.”

The sessions are designed to help patients recognize their feelings and why they have them. Patients learn that anger is a protective emotion that occurs when they feel threatened. They discover that after brain injury, they are more susceptible to feeling belittled, confused, or frightened, and they learn that it’s easy to react to these threats in a knee-jerk way, with anger.

“We teach people to express the underlying emotions instead of reacting in anger. Patients might learn to say ‘I’m confused, can you explain that?’ which works better than a frustrated outburst. We show them how to express themselves in more effective ways to get what they need.”

One patient, who had automatically responded to her mother’s complaints with anger, gradually learned to change their interactions.

“When my mother started complaining to me,” she said, ‘I learned to say: ‘Mom, I really need a time out right now. I know you’re just venting, but can we talk about it later? You can finish venting in about 20 minutes. Right now I’m feeling overwhelmed.’”

The patient’s mother understood and apologized, and communication between the two became more productive.

Recently Dr. Hart and colleagues added a special type of follow-up, a “treatment enactment” phase, to their trial.

“This part of our research is unique,” says Dr. Hart. “The treatment enactment phase allows us to find out how a person has changed his or her everyday behavior in response to this therapy. We hear about the changes in patients’ daily lives, and so far we are getting promising feedback that will help us make the therapy even better.”

At MRRI, Dr. Hart also directs other research involving emotional regulation, including a randomized controlled trial examining the use of the everyday technology of text messaging to help individuals with TBI manage anxiety and depression.

Two New Publications by Myrna Schwartz and Colleagues

Myrna Schwartz, PhD, and colleagues have two new publications.

They provide a detailed look at the organization of spoken language processing in the brain, as revealed by large-scale lesion-symptom mapping in individuals with aphasia.

Both articles may require registration or fee.

Article in the journal Nature.


Article in Neuropsychologia.