Author: Peter Schnellenberger

Each year on February 11th, The International Day of Women and Girls in Science is celebrated around the world. This day provides an opportunity to honor the achievements of women and girls in science, technology, engineering and mathematics (STEM) fields and to continue important advocacy efforts to advance gender equality and representation in STEM fields. The International Day of Women and Girls in Science was established by a resolution passed by the United Nations General Assembly in 2015. An Assembly is held annually, and a different theme is chosen every year to raise awareness of a particular element of gender equality in science.

For 2024, the main theme is “Women and Girls in Science and Leadership, A New Era for Sustainability”. At Moss Rehabilitation Research Institute (MRRI), we acknowledge and value the significant contributions of women at MRRI and beyond. Within MRRI, women have been instrumental in conducting pioneering research at our Institute and excelling in leadership roles. Women have served and continue to serve in important leadership positions, and women at MRRI have been pivotal in shaping the Institute, its science, and its culture.

Women not only make up the majority of MRRI’s staff, they comprise more than half of the Institute’s scientists, research assistants, post-doctoral trainees, and administrative support staff. At MRRI, women hold prominent roles in senior leadership positions, including the Associate Director (current and past) and Director of the Aphasia Center. This notable representation is rooted in the Institute’s 30-plus year history, with the pioneering presence of MRRI co-founder Myrna Schwartz, who served as the institute’s first Associate Director.

The inclusion of women in science is also evident in our international collaborations, and our current Scientists in Residence are women hailing from University College London and McMaster University in Toronto. Additionally, a Fulbright Fellow from the French National Center for Scientific Research is visiting MRRI currently, further deepening our connections to the international community of women in science.

MRRI would not be the vibrant research institute it is today without the effort, talent, and dedication of each of the remarkable women who have been part of the institute, and we look forward to continuing to help train and support the next generation of female leaders in neuroscience and neurorehabilitation. “The women of MRRI continue to blaze a trail in the United States and abroad. The breadth and influence of their work can be seen through their engagement onsite at the Institute as well as at scientific conferences, within professional societies, and in the scientific literature. Thank you to all of the women of MRRI for your remarkable and ongoing contributions, no doubt you are an inspiration for girls considering a future in science,” remarked MRRI Director, Dylan Edwards, PhD.

As MRRI celebrates Black History Month, the Institute recognizes and honors the extraordinary contributions of individuals who have left an indelible mark on their fields. One such luminary figure is Carl V. Granger, MD, a third-generation African American physician whose groundbreaking work has significantly shaped the landscape of Physical Medicine and Rehabilitation (PM&R).

Dr. Granger’s legacy is perhaps most prominently defined by his visionary role in developing the Functional Independence Measure (FIM) instrument. This instrument, for many years, served as the gold standard for measuring the functioning and functional independence of patients in rehabilitation. Today, it remains a cornerstone in rehabilitation research, a testament to the enduring impact of Dr. Granger’s innovative contributions.

In 1987, Dr. Granger, in collaboration with the State University of New York (SUNY) Buffalo, founded the Uniform Data System for Medical Rehabilitation (UDSMR). This groundbreaking initiative marked a pivotal moment in the history of PM&R, as it introduced a standardized data set for medical rehabilitation. Dr. Granger’s foresight and dedication paved the way for a systematic and uniform approach to measuring rehabilitation outcomes, significantly advancing our understanding of treatment effectiveness.

Beyond his instrumental role in data standardization, his impact on the profession is evident through his presidency of the American Association of Electromyography and Electrodiagnosis in 1968-69, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) from 1975-76, and the International Federation of PM&R from 1978-1980. As President of these esteemed organizations, Dr. Granger played a crucial role in shaping the direction and standards of the field. He was the author or co-author of over 275 scientific articles. In 2010, a comprehensive review of 45,700 articles within rehabilitation journals identified Dr. Granger as a co-author of 10 among the top 100 cited articles, with him serving as the first author in five instances—more than double the count of any other author.

The impact of Dr. Granger’s work extends to his establishment of the world’s largest and most sophisticated rehabilitation outcomes database. This monumental effort, containing over 13 million patient assessments, positioned PM&R at the forefront of tracking outcomes in medicine. Dr. Granger laid the foundation for “evidence-based” care in the field of rehabilitation, a paradigm shift that has shaped contemporary healthcare practices.

On December 29, 2019, in Buffalo, New York, Dr. Carl V. Granger passed away at the age of 91. Born into a family of African American physicians in Brooklyn, he carried on the family legacy with distinction. As we reflect on Dr. Carl V. Granger’s legacy during Black History Month, we celebrate his vital contributions to physiatry and rehabilitation research.

Thank you to Brandon Knight for inspiring the Black History Month blog series.

As we begin this Black History Month at Moss Rehabilitation Research Institute (MRRI), our leadership and staff acknowledge the importance of recognizing the contributions of Black Americans to the work that we do. Here at MRRI, we are dedicated to improving the lives of individuals with neurological disabilities through research. This work cannot be meaningfully conducted without attention to the racial healthcare disparities and history of injustice that impact the experience of the populations we study.

Beyond this month and throughout the year, it is crucial to respect and understand the historical context of this country’s relationship with the Black community. At MRRI, we find ourselves at a unique intersection of research and healthcare, shaped by the historical context of events such as the Tuskegee Syphilis Study and other historical injustices. Many of our research participants come from the same racially and economically diverse communities that have been exploited by medical research in the past. Rebuilding trust, promoting transparency, and prioritizing ethical conduct to address the historical injustices that have contributed to healthcare disparities is critical to the work we do at MRRI.

In reflecting on the composition of research and healthcare professions, it is evident that Black Americans are often underrepresented, and when present, they may occupy fewer positions of influence or comparable roles. The statistics from the Society for Neuroscience’s 2017 report shed light on the stark disparities in the field, revealing that Black PhD recipients constituted only 4% of those awarded a PhD in the 2015-2016 academic year, while White/Caucasian recipients accounted for a significant 72% of the total population. The underrepresentation extends to postdoctoral trainees and faculty, with Black individuals comprising 3% and 1%, respectively (Society for Neuroscience, 2017). Although efforts are being made to increase diversity in these fields, the numbers underscore the need for continued awareness and action.

While acknowledging the atrocities of the past, it is equally vital to recognize the significant contributions Black Americans continue to make in advancing research and healthcare. Actively recognizing our history and the achievements of the Black community, this month and throughout the year, is crucial in dismantling systemic racism and fostering a truly inclusive environment. The advancement of knowledge depends on diversity, and by embracing different perspectives, we strengthen our collective pursuit of scientific and medical breakthroughs.

As MRRI celebrates Black History Month, we honor the past and commit to creating a future where diversity thrives, acknowledging the invaluable contributions of Black individuals in shaping the landscape of research and healthcare.

Thank you to Brandon Knight for contributing to the ideas and data included in this post and inspiring the Black History Month blog series.

References:

Society for Neuroscience. (2017). Diversity in Neuroscience.

After traumatic brain injury (TBI), it is common for individuals to experience difficulties regulating their emotions and behaviors, leading to anger and aggression that may negatively impact their relationships and societal participation. Currently, evidence-based treatments addressing these emotional challenges are lacking. A collaborative study funded by The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) is exploring this topic to better understand why events in everyday life result in feelings of anger and aggression in people with chronic TBI. Led by Flora Hammond, MD, and Dawn Neumann, PhD, at Indiana University, the Reactions Events Appraisals and Context in TBI (REACT) Study spans five Traumatic Brain Injury Model Systems Sites (Indiana University School of Medicine, Moss Rehabilitation Research Institute (MRRI), TIRR Memorial, Spaulding Rehabilitation, and Craig Hospital).

At MRRI, Amanda Rabinowitz, PhD, serves as the site principal investigator for the REACT Study. Dr. Rabinowitz brings to this project extensive experience using mobile technology for assessment and treatment of people with TBI, as well as expertise in ecological momentary assessment (EMA). EMA involves real-time data collection which can be more accurate than relying on recall of past events. Dr. Rabinowitz has completed various studies using EMA and is currently working on a separate ongoing project characterizing the temporal dynamics of chronic post-concussion symptoms.^1-4

In the REACT Study, researchers will sample the thoughts, feelings, and experiences of people with TBI during their daily lives using an accessible mobile application. Participants will report on their experiences of frustrating events, and their emotional and behavioral responses over a two-week period. The study will also examine potential connections between these emotional reactions and factors including the circumstances, patient characteristics, how they assess real-life situations, and their methods of emotional management.

Gaining insight into why people with TBI experience anger and aggression will help scientists and clinicians improve care in a number of ways — by developing better educational approaches for patients and their families, refining screening methods to identify patients at risk, and informing targeted treatments to improve outcomes. “By leveraging valuable collaborations through the TBI Model Systems, this project will bring us closer to developing effective evidence-based interventions to help people with TBI better manage their emotions in real-world situations,” Dr. Rabinowitz remarked.

References

1) Rabinowitz, A. R., & Fisher, A. J. (2020). Person-specific methods for characterizing the course and temporal dynamics of concussion symptomatology: a pilot study. Scientific reports, 10(1), 1-9.

MRRI is pleased to release its Annual Report for fiscal year 2023. This report includes updates from Institute leadership, details about our facilities and collaborative team, and information on MRRI’s activities in the past year. We share details about our scientists’ recent publications, presentations, research funding, and summaries of the research conducted within our Laboratories and Programs.

Read the 2023 Annual Report

After a wonderful holiday season, Moss Rehabilitation Research Institute (MRRI) is pleased to welcome the New Year and all of the forthcoming opportunities and events of 2024. We look forward to continued growth, new collaborations, exciting discoveries, and further disseminating our research that spans the translational continuum in neuroscience and neurorehabilitation.

The past year has seen MRRI rapidly integrating with the Jefferson Enterprise, and we are proud to see how the Institute and our individual Scientists are adapting and leveraging the opportunities offered by this position. We are delighted to celebrate the many accomplishments of our scientists over the past year, and the Institute is already bustling with activity to advance ongoing research and begin new projects this year.

We truly appreciate the support of our donors, scientists, staff, trainees, collaborators, clinical colleagues, and all others who help enable our ground-breaking work towards our mission.

Wishing the entire MRRI community and beyond a happy, safe, and productive New Year.

Sincerely,
Dylan J. Edwards

Nancy Wachtel Shrier Director, Moss Rehabilitation Research Institute
Professor, Rehabilitation Medicine, Thomas Jefferson University

Suicidal thoughts and behaviors are a serious concern after traumatic brain injury (TBI). Research based on the Traumatic Brain Injury Model System National Database – a large database of long-term outcomes after moderate-to-severe TBI including over 1,500 patients recruited from MossRehab – has shown that approximately 3% of individuals report at least one suicide attempt, and over 8% report suicidal thoughts in the first five years after injury. There is an urgent need to identify the risk factors that are associated with these thoughts and behaviors, so clinicians know who needs intervention and how best to intervene.

Amanda Rabinowitz, PhD, is involved in a research project designed to meet this need. Moss Rehabilitation Research Institute (MRRI) is enthusiastic to be one of the sites participating in The Leveraging Nationwide Research Infrastructure to Enrich Brain Health after TBI study, or ENRICH Brain Health for short. This multicenter study, funded by an $8 million Focused Program Award from the Department of Defense to Kristen Dams-O’Connor, PhD, of Mount Sinai, aims to understand and improve long-term cognitive and psychological health after TBI. Moss is participating in one of the five separate projects supported by this award, designed to address a critical gap in understanding risk, resilience, and protective factors associated with cognitive and psychological outcomes among civilians and Veterans with TBI.

This project leverages existing infrastructure of the National Institute of Disability, Independent Living and Rehabilitation Research (NIDILRR)-funded longitudinal civilian and Veteran TBI Model Systems of Care to identify and follow individuals with chronic TBI to investigate factors associated with changes in cognitive function, as well as suicidal thoughts and behaviors over time. Researchers at MRRI will reach out to participants in the TBI Model Systems study who have exhibited changes in their cognitive performance over time to collect new data on potentially-modifiable risk factors and protective factors for cognitive decline. The team will also re-contact Model Systems participants who endorsed high-risk suicidal ideation and/or suicide attempt at a prior study visit to collect data on current suicidality and identify modifiable risk factors and protective factors.

The other projects supported by the award establish a community-based advisory group, broadened recruitment efforts of Veterans with TBI for post-mortem brain donation, histopathological study of post-mortem brain tissue, and brain imaging studies to understand the network-based structural and functional alterations underlying neurobehavioral health deterioration following TBI. Collectively, these projects will contribute to the development of tools for diagnosis and treatment throughout the lives of patients with TBI.

Malathi Thothathiri, PhD, of George Washington University and Erica Middleton, PhD, of Moss Rehabilitation Research Institute

Erica Middleton, PhD, of Moss Rehabilitation Research Institute (MRRI) and Malathi Thothathiri, PhD, of the George Washington University (GWU) have a longstanding history of working together. The two scientists had the good fortune to not only be contemporary postdoctoral fellows under the mentorship of MRRI emeritus Myrna Schwartz, PhD, but they shared an office as well when MRRI was housed at the Einstein facility at Tabor Rd. in Philadelphia. Dr. Middleton reminisced, “I remember getting to know Malathi and all about her family in India during our postdocs. One time, she brought me a fantastic black tea from one of her trips to see her family. She was a great office mate.” Dr. Thothathiri added, “Erica and I had fun talking about all kinds of things from food to philosophy in between work. What was nice was the seamless blending of the personal and professional. I enjoyed meeting Erica’s dog Louie, who in addition to being a great dog was also a great soccer goalie.” Fast forward fourteen years, and Drs. Thothathiri and Middleton are overseeing multiple studies conducted at MRRI, supported by a NIH grant award to GWU and MRRI.

The goal of the research is to test how cognitive control affects sentence comprehension in healthy adults and patients with aphasia. Cognitive control involves regulating your behavior, to meet the specific goals of a given context, including understanding one another in a social interaction. Aphasia is a disorder that affects one’s ability to speak and sometimes understand language, and it is common after a stroke. The research seeks to clarify how cognitive control deficits outside of language comprehension impact the ability of people to interpret sentences. The findings will guide future research on alternative ways to treat language and communication disorders.

In a prior study contrasting two people with aphasia with sentence comprehension impairments, Drs. Thothathiri and Middleton found that each presented with a different reason for their comprehension problems. Multiple measures, including eye tracking and electrophysiological brain recordings, converged to show that one participant had impaired functioning in linguistic cognitive control, whereas the other experienced difficulty because of an overreliance on the meanings of the words at the expense of computing syntax. The identification of distinct underlying problems points to different potential treatment paths for patients who have similar clinical presentations.

Dr. Thothathiri brings to the project her excellent quantitative and methodological skills and expertise in cognitive control, and Dr. Middleton is an internationally recognized expert in designing and conducting studies with people with aphasia from stroke. Drs. Thothathiri and Middleton plan to leverage MRRI’s resources as they prepare a submission for a renewal of the R01 grant award. Dr. Middleton shared, “We’ll be tapping our MRRI colleagues to give feedback on our grant proposal. In this next cycle, we plan to conduct foundational work to begin to translate the findings in the first cycle to address real clinical problems that people with aphasia and their therapists face, including designing different treatment solutions for different individuals. The scientists at MRRI are among the best out there for helping design translational research going from basic scientific findings to clinical application.”

Collaborative projects such as this one allow leading researchers at MRRI and other institutions across the country and around the world to combine their strengths to make meaningful advances in neurorehabilitation.