MRRI Launches Brain Trauma and Behavior Laboratory

After traumatic brain injury, patients often complain about memory problems that interfere with their activities. Current laboratory tests are good at detecting significant memory impairment, but they often fall short of capturing the more subtle, everyday difficulties that people report experiencing.

In this video, Umesh “Umi” Venkatesan, PhD, Director of the Brain Trauma and Behavior Laboratory (BraTBehavior) at MRRI, discusses some of his latest research into better detecting and predicting memory loss.

MRRI Publishes 2020 Edition of Annual Newsletter

The MRRI team gathered for a group photo.

The Moss Rehabilitation Research Institute recently published the 2020 edition of its annual newsletter, MRRI Letters. Highlighting the Institute’s accomplishments and successes from the past year, the newsletter tells the story of 2019 at MRRI.

This issue includes a message from the Institute’s Director, Dylan Edwards, PhD; a letter from a research participant; an introduction to institute scientist, Amanda Therrien, PhD; as well as feature stories on some of MRRI’s focus areas during the past year. Stories include articles about grants awarded for research in phantom limb pain, “conversation cafes” being held by the MossRehab Aphasia Center, and the development of new mobile rehabilitation tools, just to name a few.

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MRRI Researchers are Dedicated to Better Understanding and Treating Brain Injury

A group shot of the MRRI TBI research team

Scientists at MRRI work with individuals with brain injury year round, and we are committed to helping raise awareness of brain injury during Brain Injury Awareness Month. For over 30 years, the Brain Injury Association of America and organizations across the country have engaged in public awareness campaigns each March to educate the general public about brain injury, empower people with brain injury and their caregivers, and highlight support available to people living with brain injury.

This month, MRRI is excited to highlight the work of its exceptional researchers in the area of traumatic brain injury (TBI). The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) provides funding support for institutions recognized as national leaders in clinical research and patient care through its TBI Model Systems grant program. A Model System is a center of excellence that performs at the highest level in research and treatment of a particular condition.

The Moss Traumatic Brain Injury Model System led by MRRI Institute Scientists Amanda Rabinowitz, Ph.D., and John Whyte, M.D., Ph.D. is currently one of only 16 TBI Model Systems in the United States. MRRI is honored to collaborate with outstanding clinicians at MossRehab’s Drucker Brain Injury Center to continue conducting cutting-edge research on brain injury and providing world class patient care for people with brain injury.

Moss has been continually funded as a TBI Model System Center since 1997. Over more than 20 years, MRRI Scientists and MossRehab clinicians have led and contributed to state-of-the-art research studies,  shared their findings with the public, and provided comprehensive clinical care to help guide patients from injury through re-entry into community living. To complement their efforts within the TBI Model System, MRRI’s TBI research program also receives funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, the Pennsylvania Department of Health, and the Defense Advanced Research Projects Agency.

In addition to Drs. Rabinowitz and Whyte, the TBI research group includes Institute Scientist Umi Venkatesan, Ph.D.; Scientist Emerita Tessa Hart, Ph.D.; Clinical Director of the Drucker Brain Injury Center Thomas Watanabe, M.D.; Scientist in residence Lyn Turkstra, Ph.D.; as well as an excellent team of research assistants and clinician partners.

TBI research done at Moss spans the full range of injury severity and chronicity, from concussion to disorders of consciousness, and from the first hours and days after injury to chronic long-term effects decades later. MRRI’s prior work includes clinical trials of medications and behavioral treatments targeting recovery of cognitive and emotional function, evaluation of the effects of duration and intensity of rehabilitation on outcomes, and development of new assessment measures, such as the Moss Attention Rating Scale (MARS) and a specialized tool to measure pain in people with severe TBI.

Some of MRRI’s ongoing research includes examining the potential benefits of combining Behavioral Activation therapy with mobile health technology to reduce depression and anxiety after TBI, refining the understanding of memory impairment after brain injury, and evaluating genetic factors related cognitive and neuroimaging markers of brain health in those aging with TBI.

Brain injuries can happen to anyone, and the research conducted by scientists at MRRI provides important knowledge to continue advancing and improving clinical care for people with traumatic brain injury.

MRRI Scientist Studies Mobile Healthcare

Two researchers working on a study

More and more people use mobile technology to help with everyday tasks like keeping track of appointments and planning their morning commute. It seems like there’s an app for everything from ordering coffee to finding romance, but could mobile technology be the future of healthcare?

Mobile healthcare, or mHealth, is receiving growing attention as a tool for managing chronic health conditions. mHealth refers to the delivery of healthcare services via mobile devices, such as cell phones, tablets, and wearable devices like smart watches. Recent years have seen a proliferation of mHealth products to facilitate self-management of a variety of chronic health conditions. However, despite tremendous growth in the general market, few products are available that address the needs and concerns of users with disabilities.

Amanda Rabinowitz, PhD, Director of the Brain Injury Neuropsychology Laboratory at MRRI is working to address this gap as part of a recently funded Rehabilitation Engineering Research Center (RERC). Led by Mike Jones, PhD, FACRM, of the Shepherd Center in Atlanta, Georgia and Frank Deruyter, MA, PhD, of Duke University Medical Center, this multi-million dollar program, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), aims to improve the effectiveness of services authorized under the Rehabilitation Act by conducting advanced engineering research and development of innovative technologies.

Drs. Jones and Deruyter are leading a team of researchers and technology developers from MRRI, Shepherd Center, Duke University, University of California Irvine, and private industry (pictured below) to improve information and communication technology (ICT) access for mobile rehabilitation. Dr. Rabinowitz explains, “we’re calling this new area of healthcare technology ‘mobile rehabilitation,’ or ‘mRehab,’ to distinguish it from the broader world of mHealth, which has yet to adequately meet the needs and concerns of people living with traumatic brain injury (TBI), stroke, and other disabling conditions.”

Member of the RERC research team gather in front of a staircase.

“Digital technology is expanding the world of possibilities for rehabilitation,” said Dr. Rabinowitz. “Most health insurance plans are limited in how much outpatient rehabilitation they will support. So, maybe you get 10 sessions with a therapist before your benefit runs out.” This is a problem, because a growing body of research now shows that rehabilitative treatments work best when patients have opportunities to practice exercises repeatedly every day. “Practice makes perfect, and more is better. Frequent repetition is what leads to neural plasticity and enduring behavior change,” explains Dr. Rabinowitz.

But too often, financial and transportation barriers interfere with getting the optimal amount of practice in the clinic. To fill in this gap, home-based activities are an important component of care. That’s where mRehab comes in. Mobile technology provides a variety of tools that can improve engagement and effectiveness of home-based rehabilitation, including app-based therapy, sensor-based activity tracking, gamified exercises, and advanced monitoring that allows therapists to adjust treatments between outpatient visits.

A shift to this type of a model has the potential to transform and extend the rehabilitation care patients receive in clinic. “In the current model, we send patients home with written instructions. Then the therapist may have to wait a whole week to find out that their patient stopped the home-based program because she lost the instruction sheet or encountered another challenge,” Dr. Rabinowitz says. “Imagine sending that patient home with the confidence that she has guided instructions available on her smartphone, or better yet, instrumented exercise equipment that can actually measure and monitor what she’s doing at home and adjust exercises as she goes.” Such a model would provide more support to patients in working towards their rehab goals between clinic visits.

As part of the RERC, Dr. Rabinowitz is leading a development project with data scientist and software developer Dr. George Collier focused on treating depression and anxiety in persons with TBI. “Coping with mental health issues, like depression and anxiety, is among the most important concerns identified by people living with TBI and their families,” Dr. Rabinowitz explains. But despite this clear need, most patients never get treated. This is partly due to poor screening and identification, but it also reflects a lack of evidence-based guidelines for treatment of depression in this population.

Researchers at MRRI, led by Scientist Emerita, Dr. Tessa Hart, have a long track-record of developing and evaluating behavioral interventions for treating emotional dysfunction in persons with TBI. Dr. Rabinowitz says, “We plan to draw on our prior research to develop an mRehab tool for improving emotional health and well-being after TBI.” Dr. Rabinowitz’s project represents one of several research, development and training projects supported by this program. Learn more at the mRehab RERC website.

Dr. Laurel Buxbaum on People Behind the Science

Dr. Buxbaum's headshot

Laurel J. Buxbaum, PsyD, was recently featured as a guest on the People Behind the Science podcast. In her interview with host Marie McNeely, PhD, Buxbaum discussed not only her professional and academic interests, but also gives listeners a peek into her personal life.

Dr. Buxbaum is associate director of Moss Rehabilitation Research Institute and director of MRRI’s Cognition and Action Laboratory, which focuses on studying the behavioral and brain bases of skilled action and object use in healthy and stroke participants.

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MRRI Phantom Limb Pain Study Featured in Philadelphia Magazine

Woman with prosthetic leg sitting in chair while wearing a VR headset.

Laurel J. Buxbaum, PsyD, recently spoke with Philadelphia Magazine about a pilot study she is conducting that investigates whether or not virtual realty headsets can help rewire the brains of patients with lower limb amputations to alleviate phantom limb pain.

Dr. Buxbaum is associate director of Moss Rehabilitation Research Institute and director of MRRI’s Cognition and Action Laboratory, which focuses on studying the behavioral and brain bases of skilled action and object use in healthy and stroke participants.

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Promoting Mental Health After TBI

Coping with mental health issues, like depression and anxiety, is among the most important concerns identified by people living with TBI and their families. A recent study completed at the Moss Traumatic Brain Injury Model System (TMBIS), led by Dr. Tessa Hart, evaluated a treatment for depression and/or anxiety in individuals with moderate to severe TBI using the “gold standard” method for evaluating treatments—a randomized controlled trial.

The treatment in this study is based on Behavioral Activation (BA)—an intervention that focuses on increasing involvement in rewarding and pleasurable activities. Participants in the program were randomly assigned to receive either 1) a single session of BA, followed by 8 weeks of daily text messages to remind them of their individualized goals for taking part in more rewarding activities, or 2) a single session focused on the importance of motivation followed by 8 weeks of motivational text messages.

Participants in both groups showed mild improvement in their mood at the end of the program. Those in the BA condition reported more exposure to environmental reward and greater productivity. Although the benefits of both treatments were modest, the results of this study suggest that BA was effective at increasing participation in rewarding activities, and the delivery of frequent text messages was a feasible and acceptable way of supporting treatment.

The findings from this study have been published in the journal Neuropsychological Rehabilitation.

This article was originally published in The MossRehab Traumatic Brain Injury Model System’s Fall 2019 Edition of Brain E-News.

Dr. John Whyte Receives Gold Key Award From ACRM

Dr. Whyte (center) accepts The Gold Key award at 2019 ACRM Annual Conference.

On November 8, 2019, Dr. John Whyte, MD. PhD, FACRM, founding director and Institute Scientist Emeritus for the MRRI, received the Gold Key lifetime achievement award from the American Congress of Rehabilitation Medicine (ACRM). The Gold Key, awarded by the ACRM Awards Committe and Board of Governors, is the ACRM’s highest honor.

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