Author: Peter Schnellenberger

Research has been a part of Jennifer Derry’s life for many years, even before she was diagnosed with a stroke and aphasia, a condition that impacts a person’s ability to express and understand language.

When Jenn was in college, she participated in research studies in the areas of neuroscience, psychology, and cognition. Later, she worked for a company that did clinical research for mental health conditions, such as depression and bipolar disorder.

Following her stroke, Jenn spent about a month in inpatient rehabilitation at Moss. Afterwards, she was excited to have the opportunity to participate in research at MRRI. “My experience as a participant in MRRI research has been positive. Not only is it stimulating and exciting for me, but it helps to keep me sharp and keep learning,” she said.

Recently, Jenn participated in a study exploring an animal-assisted treatment program for individuals with aphasia called The Persons with Aphasia Training Dogs (PATD) Program. In this study, led by Sharon Antonucci, PhD, CCC-SLP, individuals with aphasia learn and implement positive reinforcement techniques to train dogs in basic obedience skills. The goal is to harness the strengths of individuals with aphasia and the benefits of human-animal interactions to target treatment of some of the psychosocial consequences of aphasia, such as social isolation and loss of self-confidence.

Jenn participated in the program with her dog Lola (pictured above). “We both benefited from it,” Jenn noted. “It helped me practice training with my dog and learn spoken commands. I really loved the study, and I felt proud when I was able to complete it, she continued.”

Beyond her involvement in research studies at MRRI, Jenn has been actively involved in activities at the MossRehab Aphasia Center. She discovered the Virtual Reta’s Games Group during the COVID-19 pandemic. “As horrible as covid was, there was also a bright side for me, because I was brought together with wonderful people and given the opportunity to meet virtually,” she explained.

Each week the Aphasia Center holds Reta’s Games Group meetings where participants engage in card games, board games, and discussions that allow people to practice their communication skills while having fun together. When reflecting on her experiences at these meetings, Jenn said, “I really enjoy the Virtual Reta’s Games Group. Everyone is very welcoming — the host Roberta Brooks, every person with aphasia, and specifically the facilitator Nikki Benson-Watlington who brings her happiness and support to others with her warm-heartedness, consideration, and positivity.”

Through activities at the MossRehab Aphasia Center and research studies at MRRI, Jenn has been able to connect with other individuals with aphasia and continue to make progress towards her communication goals. Jenn is also a co-founder of the Mid-Atlantic Aphasia Conference, an education and advocacy for people living with aphasia in the Tri-State area.  Her advice for others with aphasia speaks volumes about the value of these opportunities. “Do it all!!! Research and activities,” Jenn advised. She went on to explain that “You will be associating with other people who have aphasia. You will have fun and be involved with skilled professionals who are knowledgeable and caring.”

The MossRehab Aphasia Center prides itself on being a warm and welcoming place where people with aphasia and their friends and families can get information and support to help meet their long-term communication and psychosocial needs. The Aphasia Center also provides excellent opportunities for members to get involved in research and treatment programs. MRRI is grateful for the important contributions of research volunteers, and the Institute is honored to be a part of their journey of rehabilitation and recovery.

Researchers and clinicians at MRRI and Jefferson-Moss Magee Rehabilitation participated in a community event this past weekend. The event, “Movement and Memory: Navigating Parkinson’s and memory disorders”, was organized by the Delaware Valley Endeavor for Racial Solidarity in PD (Diversity PD). Diversity PD is a collaborative effort led by the Parkinson Council to provide education and resources for people of color. The purpose of this Saturday’s event was to provide support, education, and resources to individuals from underserved communities who are living with Parkinson’s disease. The event included education from local experts, open sharing sessions, audience Q&A, a performance by a member of the ParkinSINGERS Choir, and time to visit and chat with some local community organizations. The group from MRRI and Jefferson-Moss Magee Rehabilitation, which included Aaron Wong, PhD, Jonathan Wood, PhD, and Michele Aguado, PT, had the opportunity to share and promote the many resources offered here for those living with Parkinson’s disease.

In addition to physical, occupational, and speech therapies at various Jefferson-Moss-Magee Rehabilitation locations, resources here include:

• A weekly maintenance program designed to help individuals with PD stay active and continue exercising after a bout of therapy is complete.
• The Klein Family Parkinson’s Rehabilitation Center Clinic, a free multidisciplinary clinic designed to provide recommendations to address goals that might otherwise be challenging to recognize or achieve by one discipline alone, and to create a space where people with Parkinson’s disease and caregivers can ask questions and learn more about what to expect with this disorder
• A support group for both individuals living with Parkinson’s disease and their caregivers.
• Information about the research studies currently being conducted as well as opportunities to participant in future research by signing up for the MRRI Research Registry.

Participating in the event is part of an ongoing effort by researchers at MRRI to diversify the individuals who participate in the Institute’s research studies, particularly those living with Parkinson’s disease. This is important because individuals who are included in research studies should represent the community of individuals living with the disease so that research findings are applicable to all individuals with the disease. MRRI scientists were honored and excited to be a part of this event and look forward to future opportunities to share these outstanding clinical and research resources with the community.

The American Academy of Neurology recently held its 76th Annual Meeting, a hybrid event held in person in Denver, Colorado, with online content available to remote attendees as well. Dylan Edwards, PhD, was among six speakers invited to present in the “Neurology Year in Review” plenary session on April 18th. The speakers discussed the latest developments in a broad range of clinically relevant topics: Car-T cell therapy, gene transfer therapy, migraine management, Long-COVID and the autonomic nervous system, transcranial magnetic stimulation (TMS), and the future of amyotrophic lateral sclerosis (ALS).

In his presentation on TMS, Dr. Edwards highlighted recent technical advances that have resulted in improved electrical field modeling for the targeting of stimulation. He described how TMS can be now used to localize muscle representations on the primary motor cortex in three dimensions for an individual based on their own cortical anatomy.¹ This approach is more accurate and personalized compared to prior targeting methods where an estimate of the center of the TMS coil and the electric field would be generated and mapped based on the depth of stimulation in two dimensions. This is a transformative advance, but it requires substantial analysis and computation. which can take several hours or more.

To overcome computational barriers to make the approach more clinically relevant, Dr. Edwards explained how researchers developed a fast, accurate TMS solver that can now determine TMS electrical fields for any coil type in near-real time.² This represents a substantial breakthrough that could allow clinicians to have an estimate of electric field distribution in a region of interest in a matter of seconds. Other important developments in the field that Dr. Edwards featured were the use of robotic arms for automated precision-targeting (including his own research being conducted at MRRI), as well as emerging technology that shows an alternative approach with static multi-coil arrays.^3-4

Dr. Edwards also shared progress in research using repetitive TMS (rTMS) for neuromodulation to facilitate motor recovery after stroke and spinal cord injury. Clinical and translational studies using TMS are showing benefits for recovery of motor function when treatment is started early in post-stroke recovery.⁵ Future work in this area will continue to pursue individualized targeting and parameter selection based on contemporary theory, potentially selecting targets based on neural networks.

Dr. Edwards finished his presentation by sharing research that he and colleagues have been working on using rTMS to facilitate regeneration and recovery after spinal cord injury. Following promising results in animal models,⁶ Dr. Edwards is now translating this rTMS protocol in a phase I randomized controlled trial in patients with spinal cord injury.

Substantial headway has been made in TMS research within the past year, and this continues to be a growing field of study with broad potential clinical relevance spanning diagnostic, prognostic, and therapeutic applications. Dr. Edwards’ presentation was well-received by a large audience attending this session. The American Academy of Neurology’s Annual Meeting is the largest international meeting of neurologists and neuroscience professionals in the world, and the selection of TMS as one of the six hot topics to feature in this year’s “Neurology Year in Review” plenary session further attests to the significance of this technology in neurology and beyond.

 

References:

1) Weise, et al., Nature Protocols, 2023

2) Makaroff, et al., Scientific Reports, 2023

3) Navarro de Lara et al., NeuroImage, 2021

4) Daneshszand et al., Brain Stimulation, 2023

5) Vink et al., Stroke, 2023

6) Boato et al., Science Translational Medicine, 2023

Photos courtesy of the American Academy of Neurology

Led by Amanda Therrien, PhD, the Sensorimotor Learning Laboratory at MRRI conducts research to improve motor rehabilitation protocols for individuals with neurological disorders by enhancing our understanding of the precise sensory and motor control mechanisms that underlie their behavioral impairments. MRRI is pleased to welcome Alyssa Eyssalenne to the Institute in her new role as a Research Assistant working with Dr. Therrien.

Ms. Eyssalenne graduated from Temple University in 2021 with a B.S. in Neuroscience with a focus in Systems, Behavior, and Plasticity. During her undergraduate career, Ms. Eyssalenne interned at the Children and Adolescent Anxiety Disorder Clinic (CAADC) at Temple Health where she focused on data input and consolidation for clinic patients in behavioral therapy trials. As a student, Ms. Eyssalenne was also an executive member of the student organization for Caribbean awareness and the By Any Means Necessary dance company, from which she hopes to carry over her teamwork/team building and adaptability skills.

Prior to joining the MRRI team, Ms. Eyssalenne was a formulations technician at Charles River Laboratories in Horsham, PA. There, she performed basic to advanced drug formulation techniques for preclinical safety assessment in animal and in-vitro study models for review in reproductive, juvenile, and developmental toxicology. Ms. Eyssalenne became the technical team lead and further developed her regulatory and quality assurance skills as she performed preliminary data quality control, addressed study audits and deviations, and contributed to protocol/standard operating procedure development and review. After more than two years at Charles River Labs, Ms. Eyssalenne is eager to apply and shift her knowledge base to human research/trials as well as be a part of the clinical side of research.

At MRRI, Ms. Eyssalenne will be working with Dr. Therrien on her research in sensorimotor learning, with a focus on proprioception and adaptation learning in the upper limbs. Ms. Eyssalenne’s primary role in lab will be in conducting participant trials using equipment, such as the Kinarm Exoskeleton Robot.

In the serene surroundings of Elkins Park, Jefferson Moss-Magee Rehabilitation Hospital stands as more than a medical facility; it is a symbol of hope and healing, profoundly influenced by the compassionate spirit of Nancy Wachtel Shrier. Her connection to this institution was not just philanthropic—it was a vital part of her very being, a manifestation of her unwavering commitment to bettering the lives of others. This tribute, drawn from the rich tapestry of memories shared by her family, including her husband, Marc, and children, Peter Shrier and Lee Yonish, celebrates a woman whose empathy and dedication have indelibly shaped the essence of these institutions.

Marc Shrier’s voice softens with affection as he recalls his wife’s deep involvement with the institution. “Nancy was a whirlwind of activity at Moss, always looking for ways to contribute more meaningfully,” he says. This passion wasn’t solitary; it enveloped Marc, transforming him from a patient to an ardent supporter. Their collaborative efforts, notably their substantial contributions to Moss Rehabilitation Research Institute and the Shrier Family Topics in Rehabilitation Science Lecture Series, are now cornerstones of the institution.

Their children paint a vivid picture of a life exemplified by generosity and empathy. “Our parents cared deeply about a range of causes, but it was always done with so much love,” Lee reflects. Peter adds, “They have giant hearts, and that was evident in everything they did.” For them, Nancy was not just a mother but an exemplar of kindness, her life a lesson in the power of giving.

Nancy’s commitment to Moss Rehabilitation Research Institute and Jefferson Moss-Magee Rehabilitation – Elkins Park was characterized by her visionary approach and tireless dedication. The pinnacle of her contributions was the establishment of the Directorship in her name, a testament to her profound impact on the field of rehabilitation science. Dylan J. Edwards, PhD, the inaugural holder of this directorship, exemplifies the values and vision Nancy cherished, particularly in advancing rehabilitation research.

Her involvement went far beyond financial support; Nancy was a catalyst for innovation and growth. The Shrier Family Topics in Rehabilitation Science Lecture Series, an initiative she spearheaded, has become a tool for disseminating knowledge and fostering collaboration among experts worldwide. This series, along with her other endeavors, has significantly propelled the Institute’s standing in the global rehabilitation community.

Moreover, Nancy’s support was instrumental in developing programs that emphasized the importance of art and sports in rehabilitation. Her enthusiasm for All About Moss Through the Arts and the wheelchair tennis tournament at Penn reflected her belief in the resilience and capabilities of individuals, regardless of their physical challenges.

The legacy of Nancy within the walls of Jefferson Moss-Magee Rehabilitation Hospital – Elkins Park and Moss Rehabilitation Research Institute is both profound and enduring. The establishment of the Directorship in her name stands as a poignant homage to her relentless pursuit of progress in rehabilitation science. This directorship not only honors her memory but also serves as a beacon, guiding future innovations in the field.

Her children reflect on the enduring impact of these tributes. Lee observes, “The Directorship in our mother’s name is more than an honor; it’s a continuation of her life’s work, inspiring others to follow in her footsteps.” Peter adds, “It’s a living testament to her dedication and passion.”

Additionally, the staff and patients of the hospital often speak of Nancy’s influence. Rejoice Jula, the Director of Development, reminisces about Nancy’s readiness to assist in any capacity, underlining her indomitable spirit and dedication to service. These tributes collectively paint a picture of a woman whose life was defined by generosity, innovation, and an unwavering commitment to help others.

Nancy’s story is not just one of personal achievement but a narrative of unwavering compassion and philanthropy. Her profound dedication to Jefferson Moss-Magee Rehabilitation – Elkins Park and Moss Rehabilitation Research Institute has set a benchmark for future rehabilitation philanthropy. Her legacy, echoed in the corridors of these institutions and in the hearts of those she touched, serves as a powerful reminder of the transformative impact one individual can have. Nancy’s memory, defined by purpose and generosity, continues to inspire, and guide us in our efforts to support and uplift those in need.

Finding the right mentor at the right time can have a tremendous impact on the trajectory of an early-career scientist. MRRI Institute Scientists are outstanding mentors who are invested in helping train the next generation of researchers in neuroscience and neurorehabilitation. Frank Garcea, PhD, was a postdoctoral fellow at MRRI from September 2017 through August 2020 under the mentorship of Laurel Buxbaum, PsyD, and he has been successful in establishing his independent research program at the University of Rochester Medical Center. In this interview, Dr. Garcea talks more about his experiences at MRRI and his current research.

Can you tell us more about your current position and what you are doing now?

After completing a three-year postdoctoral fellowship at MRRI in 2020, I moved to the University of Rochester Medical Center to begin a postdoctoral research position in the Neurosurgery Department. I then accepted a faculty position in the Neurosurgery and Neuroscience Departments in 2022. In my current position, I spearhead a cognitive neuroscience research lab composed of full-time research assistants, undergraduate students, master’s, MD, and PhD students.

What are your current research interests?

We use a range of neuroimaging and neuropsychological methods to study the structure and function of the human brain/mind. From a basic science perspective, our goal is to advance understanding of the cognitive systems supporting activities of daily life, like object manipulation and language production. Much of our work in this context uses functional MRI, diffusion tractography, and voxel-based lesion-symptom mapping to test hypotheses. One exciting problem we’re working on is to better understand how acquired brain injury to one area within a network can disrupt processing in areas outside the site of injury. This puzzling phenomenon is referred to as diaschisis, and its cognitive and neural bases have been investigated for over a century.

From a translational perspective, our goal is to use neuroimaging to support the planning of neurosurgical procedures here at the University of Rochester Medical Center. For example, if a patient has a brain tumor invading the motor cortex, my lab uses functional and structural MRI to identify where sensory, motor, and cognitive functions are represented in relation to the lesion. With this knowledge, our neurosurgery colleagues can tailor their surgical approach to avoid resecting cortical and subcortical tissues identified in our pre-operative mapping. As patients recover from their brain surgery, they are invited to take part in neuropsychological testing, which allows us to relate pre- and post-operative changes in cognitive function to the location of the lesion, the size of the neurosurgical resection, the type of brain pathology, etc.

What was it like working at MRRI and conducting research in MRRI’s Cognition and Action Lab?

Training at MRRI was a tremendous experience. I benefitted from a structured training plan, the regularly scheduled T32 lectures and workshops, and the opportunity to learn from experts in the cognitive and brain sciences. Working in Dr. Buxbaum’s lab was a fantastic experience on multiple levels. I was familiar with Dr. Buxbaum’s research interests, publications from her lab, and how research was conducted. Because of this, it was easy to embed my postdoctoral training within the broader goals of her lab, to collect neuroimaging and cognitive data, and to apply for extramural grants and publish manuscripts within a short time period.

Are there particular things you learned or skills you developed at MRRI that have helped you in your career?

I came to MRRI right after I finished my PhD. At the time, I understood that running a lab while competing for funding was a huge challenge. Because I had protected training time, I was able to learn how to write grants while also conducting research. I also learned that this is a skill that can take years to hone, so it was important to be patient and learn as much as possible while I had the protected time to do so. The experience was incredibly important for my career development, and I’m very appreciative of the faculty and staff at MRRI who took the time to review my grant proposals and provide critical feedback.

What were the next steps of your career after finishing your postdoctoral fellowship at MRRI?

This is the part of the story where my career development was affected by the COVID-19 pandemic. I finished my postdoctoral fellowship at MRRI in August of 2020. At that time, there were hiring freezes at universities across the country, which made finding another position challenging. I’m from Rochester, NY, and I did my PhD training at the University of Rochester. I moved back home in the spring of 2020 to be closer to family and was lucky to find a postdoctoral position in the Neurosurgery department here at the University of Rochester Medical Center (URMC). I then began writing grants immediately upon starting the position and was fortunate to secure a KL2 career development grant through the Clinical and Translational Science Institute here at URMC. This two-year fellowship provided vital resources to facilitate my career development and transition to a faculty position here at URMC.

Can you describe what it was like for you to launch your own independent research laboratory?

It’s rewarding and demanding all at once. With the KL2 funds, I was able to marshal resources and support to start building my lab. Hiring and training full-time research staff to coordinate day-to-day activities was a challenge because of COVID restrictions. Once I had staff trained and ready to go, my lab expanded in exciting ways. I was able to carve out some time to train undergraduate students and medical students working on projects. I’ve been fortunate to have kind and motivated students work in my lab. Probably the most rewarding aspect of running a lab is watching students develop their scientific skills and independence over time. Though it has been less than two years, I’m enjoying the environment, the culture of my lab, and the scientific content driving our projects forward.

What have been some of the biggest challenges you have had to overcome in your career or research?

Of the many challenges, I’d say the most challenging was recognizing and accepting my limitations. For years I’ve felt comfortable balancing the demands of multiple projects. Though it feels great to publish manuscripts and secure grant funding, this line of work can really wear one down without a proper work-life balance. As I started building my lab, I realized there are probably  5 – 10 tasks on my to-do list every day. I found that when I crossed a task off the list, a new task appeared. It’s overwhelming. I had to learn to say ‘no’ to new projects and to prioritize certain activities while putting other tasks on the back burner. This is incredibly difficult for me. Though I wouldn’t say I’ve ‘figured it out’, I do believe I’ve identified a strategy that allows me to stay productive while also maintaining my mental health.

Do you have a favorite scientific success story from your work?

It’s tough to pick just one! On a personal note, I’m thrilled that I’ve maintained a close relationship with my mentors. Earlier this year, I shared a meal with my postdoc advisor (Dr. Laurel Buxbaum) and my PhD advisor (Brad Mahon, PhD). We had a great time discussing problems we’re working on and challenges in our field. I feel truly blessed that I can call them up on the phone and ask for advice and know they’d be there to support me. I hope to be that person in the lives of the next generation of trainees whom I mentor.

On the scientific side, I’d say one success story that is front of mind is having students in my lab prepare manuscripts for publication. It’s incredible to see a person grow and develop when provided with the right resources and support. This is what success looks like from my point of view.

Knowing what you do now if you could go back in time and give advice to yourself when you were just starting your postdoc, what would you say?

I would tell myself to slow down and be patient. We often view success through the lens of papers published or grants funded. These endeavors can take years to accomplish. Life moves pretty fast, so appreciate the little victories and trust the process. I would also tell myself to go to more concerts! The music scene in Philadelphia is truly special. Though I had a great time seeing some of my favorite bands, I could have branched out and done more. I guess I would tell myself to be more present and enjoy living in Philadelphia while you have the opportunity.

How do you like to spend your free time?

Most of my family and friends live here in Rochester, so I’m lucky that I get to see them often. I’m also fortunate that I have a loving and supportive partner who enjoys traveling. We like to find new restaurants and places to visit in Rochester and in the Finger Lakes area. Upstate NY has a lot to offer in terms of history and culture, so we make a conscious effort to visit attractions close to us and outside of Rochester. In addition, I’m pretty regimented when it comes to working out and running. It helps to clear my head and is a huge stress reliever. I still try to go to concerts as often as I can. Last but not least, I enjoy spending time with my dog Rosie!

Jaclyn Barcikowski, DO, is a physiatrist who treats patients in the Drucker Brain Injury Center. Certified in Physical Medicine & Rehabilitation and Brain Injury Medicine, she serves as a Clinical Director of the Stroke Rehab Unit, as well as Associate Program Director of the MossRehab/Einstein Physical Medicine & Rehabilitation Residency Training Program.

“I work as a physiatrist in the Drucker Brain Injury Center in Elkins Park. I came straight to MossRehab after completing my fellowship. Coming here was a huge opportunity for me. MossRehab has a wonderful reputation, particularly for brain injury medicine. My patients include those admitted to the hospital who require a high intensity of medical care due to brain injuries. I also work with outpatients discharged from the hospital. They come to my practice to get care and may receive different outpatient therapies such as physical, occupational, and speech.

I have been excited to work with Dr. Rabinowitz and her team on the Get Up & Go study – a research program to promote physical activity in people living with TBI. I am thrilled to be part of this research. As a marathon runner and avid hiker, I am passionate about the benefits of exercise and experience it personally in my own life. Evidence suggests that encouraging regular exercise not only aids in the rehabilitation process but also brings about a myriad of health benefits. From improved cognitive function and mood enhancement to enhanced cardiovascular health, the positive outcomes are vast. I am enthusiastic about the potential impact this research could have on the well-being of my patients and others living with brain injuries.”

* This article was adapted from an article published in The Moss Traumatic Brain Injury Model System’s Spring 2024 Edition of Brain E-News.

Physical activity stands as a cornerstone for holistic health, playing a pivotal role in disease prevention, emotional well-being, and physical vitality. Engaging in regular physical activity isn’t merely a lifestyle choice; it’s a powerful prescription for a healthier, more fulfilling life. Scientific evidence consistently highlights the myriad benefits of an active lifestyle, from lowering the risk of chronic diseases such as heart disease, diabetes, and certain cancers to fostering emotional resilience and mental well-being. Unfortunately, nearly 80% of Americans, fall short of recommended physical activity guidelines, leading to a surge in public health initiatives, campaigns, and smartphone applications aimed at increasing activity levels.

For those with living with moderate to severe traumatic brain injury (TBI), the challenge of meeting recommended activity levels is compounded by mobility limitations, pain, and the loss of social opportunities. The unique barriers faced by those living with the effects of TBI, from safety concerns to emotional hurdles, make the need for tailored interventions all the more critical.

Dr. Rabinowitz recently initiated a new study funded by the National Institute of Disability Independent Living and Rehabilitation Research, examining a novel program developed in her Brain Injury Neuropsychology Laboratory designed to boost physical activity among individuals living with TBI. This 10-week program, called GetUp&Go, was designed with input from persons with lived experience of TBI, and includes one-on-one meetings with a therapist by video conference and phone, as well as a supportive smartphone application to offer real-time reminders and encouragement. Dr. Rabinowitz stated, “We hope the results of this research will lead to improvements in treatment that, not only promote physical activity, but also to redefine possibilities for those navigating life after TBI.”

Recruitment for participation in this clinical trial began at the beginning of this year and will continue until reaching the target enrollment of 70 participants (expected in early 2027).

* This article was adapted from an article published in The Moss Traumatic Brain Injury Model System’s Spring 2024 Edition of Brain E-News.

Brain injury is a chronic condition. However, many people think about a brain injury as a single, isolated event from which a person fully recovers. This incorrect perception is something that Monica Vaccaro, M.S., is determined to change. Ms. Vaccaro is a Research Associate at MRRI as well as the Director of Programs at the Brain Injury Association of Pennsylvania, a non-profit organization dedicated to preventing brain injuries and fostering an inclusive community of education, advocacy, support, and research to maximize quality of life for people with brain injuries and their families.

At MRRI, Ms. Vaccaro works in the Brain Injury Neuropsychology Laboratory directed by Amanda Rabinowitz, PhD. In this role, Ms. Vaccaro assists with clinical trials of potential treatments for brain injury rehabilitation, co-chairs the Advisory Council, represents the Moss TBI Model System on the Pennsylvania Department of Health Brain Injury Advisory Board, helps with planning an annual consumer conference, and coordinates focus groups with individuals with brain injury and their caregivers.

“The persons with lived experience with brain injury (the survivors and their family members), their stories, their experiences — that’s what drives me. Because in my role, I get to directly interact with people with lived experience all the time, and they really inspire me. It’s a group of people who are brave, navigating a difficult world, and doing so many wonderful things,” Ms. Vaccaro explained.

Ms. Vaccaro’s Path To a Career in Brain Injury

Her career began in education, and Ms. Vaccaro spent about ten years as a teacher for children in preschool through fifth grade with significant learning disabilities. During her time as a teacher, Ms. Vaccaro became fascinated by the kinds of errors she saw her students making, and she wanted to learn more about the brain and how disabilities could impact learning. She decided to go back to school to study the brain and neuropsychology.

As a student, Ms. Vaccaro had an opportunity to work at Einstein Healthcare Network and Moss in the early 1990s through a pre-doctoral clerkship program. This experience allowed her to conduct inpatient neuropsychological evaluations, and it was a major turning point in her career. Working with patients was powerful and eye-opening. After her internship, Ms. Vaccaro accepted a position in the inpatient unit of the hospital, and she worked there for years before transitioning to directing an outpatient program, and then moving into research at MRRI.

After more than three decades of working with people with brain injuries, Ms. Vaccaro has important insights into the needs of the brain injury community that remain unaddressed. These include greater awareness of brain injury as a chronic condition, funding for brain injury research and resources,

Raising Awareness About Brain Injury

While Ms. Vaccaro and many others are committed to increasing awareness of brain injury year-round, brain injury awareness and advocacy efforts are particularly concentrated during the month of March as The Brain Injury Association of America leads nationwide efforts in observing Brain Injury Awareness Month. A key goal of these efforts is to change the public perception of brain injury from thinking about it as one transient event to understanding that it is a chronic condition. After experiencing a brain injury, individuals can show substantial improvements in the acute phase, but many may take longer to recover or may have life-long impairments.

It is critical for the public, as well as legislators and other policymakers to realize that many people with brain injury require ongoing treatment and services for a long time. Currently, traumatic brain injury is not recognized as a chronic condition by either the Centers for Disease Control (CDC) or Centers for Medicare & Medicaid Services (CMS), and this has a detrimental impact on the availability and affordability of long-term care for people with brain injury, as well as funding to support brain injury research and resources.

Advocating for More Funding for Brain Injury Research, Resources, and Clinical Care

Recently, Ms. Vaccaro joined others from the Brain Injury Association of America and the brain injury community in participating in a rally on Capitol Hill for Brain Injury Awareness day on March 5, 2024. One of their goals was to encourage legislators to reauthorize the Traumatic Brain Injury (TBI) Act which was signed into law in 1996. The most recent TBI Program Reauthorization Act in 2018 ensures funding of the Program through 2024. Brain injury advocates are hoping to include language in a new reauthorization act that would add brain injury to the CDC and CMS’s list of chronic conditions.

The TBI Act also provides funding to states to support brain injury resources and initiatives. In Pennsylvania, the Department of Health has received funding to develop infrastructure that is crucial for serving the needs of people with brain injuries and their families. For example, the Pennsylvania Department of Health has contracted with the Brain Injury Association of Pennsylvania to provide education and training about brain injury to professionals in the community who will come into contact with individuals with brain injury in their everyday work, including counselors, nurses, general practitioners, first responders, law enforcement, and others. The Brain Injury Association of Pennsylvania also operates the Brain Injury Resource Line, which is a venue for people from the community to call in with questions and learn about resources. Another key program in Pennsylvania supported by funding from the TBI Act is the NeuroResource Facilitation Program for Brain Injury Services which helps people with brain injury and their families identify and navigate brain injury resources, services, and supports.

In addition, during her visit to Capitol Hill, Ms. Vaccaro shared important work being done by the TBI Model Systems nationwide, including at the Moss TBI Model System, and requested additional funding to support these critical efforts to advance brain injury research and clinical care. Further research, including research being done at MRRI, is critical for understanding which interventions are effective and ensuring that people with brain injury can access effective interventions that are developed.

Thinking about other areas of need, Ms. Vaccaro highlighted the importance of providing services to marginalized populations, including individuals with brain injury in the justice system, those with mental health conditions, and people who are homeless or have housing insecurity. She would also like to see funds budgeted at the state level for services such as conferences, information lines, support groups, or other necessary resources.

Ms. Vaccaro is part of a coalition of stakeholders working with policymakers in Pennsylvania to try to get funding to support clinical care beyond acute inpatient rehabilitation. Currently, there is limited funding to support outpatient rehabilitation and post-acute care, so many individuals with brain injury are not getting the care they need. To address this care gap, the coalition has proposed a plan for commercial insurance providers to pay for post-acute rehabilitation services for brain injury. “This, again, emphasizes that brain injury is a chronic condition. It isn’t over after a person leaves the acute care setting,” Ms. Vaccaro stated.

As part of The Brain Injury Association of America’s Brain Injury Awareness Month Campaign, they are asking people with brain injury to share their story to help reinforce the chronic nature of brain injury. “Brain injury is a lifelong journey for many people,” Ms. Vaccaro reflected. Visit The Brain Injury Association of America’s website to learn more about the Brain Injury Awareness Month Campaign and read some of these stories.

MRRI is pleased to announce that Kelly Horel, M.S., SLP, has recently accepted a position at MRRI. Ms. Horel graduated from Rutgers University with a B.A. in Linguistics and minors in Psychology and Cognitive Science. While at Rutgers, she worked as a Research Assistant in a Phonetics Laboratory. After graduation, she began working at MRRI under Erica Middleton, PhD, and Myrna Schwartz, PhD, in the Language and Aphasia Lab. Ms. Horel worked as a Research Assistant at MRRI from 2011-2013.

She was inspired to go to graduate school to become a Speech Language Pathologist (SLP) after working with Adelyn Brecher, SLP, and with the people with aphasia who would come in to participate in research studies. Ms. Horel graduated from Boston University in 2015 with an M.S. in Speech-Language Pathology. From there, she worked clinically in a variety of settings including sub-acute rehabilitation, home health, and in local schools. After taking some time off for the births of her children, Ms. Horel began working part-time at the Adler Aphasia Center (Maywood, NJ) as an aphasia group facilitator. This position renewed her passion for working with people with aphasia. Remembering her experiences at MRRI, Ms. Horel explained, “When I saw that MRRI was looking for a research SLP, I knew I had to reach out!”

She is excited to be starting her position as a Research Associate – Speech Language Pathologist in the Language and Learning Laboratory under Dr. Middleton and the Speech and Language Recovery Laboratory under Marja-Liisa Mailend, PhD. In this role, she will be administering language and cognition tests and transcribing and coding data, among other tasks. In thinking about her new role, she noted “I am eager to contribute to research that will support clinicians in helping people with aphasia in their recovery process.”