Author: Peter Schnellenberger

Scientists and staff at Moss Rehabilitation Research Institute (MRRI) are pleased to welcome Anna Krason, MSc, to the Institute this month. Ms. Krason is a PhD Candidate in the Department of Experimental Psychology at University College London (UCL). Her dissertation supervisors are MRRI Scientist in Residence and UCL Professor Gabriella Vigliocco, PhD, MRRI Associate Director Laurel Buxbaum, PsyD, and UCL Professor Rosemary Varley, PhD. The focus of her dissertation research has been on multimodal communication and the impact of visual cues on speech comprehension in neurotypical individuals and people with chronic aphasia. These visual cues include the gestures and mouth movements that are integral to face-to-face communication. During her PhD, Ms. Krason was awarded UCL Bogue Fellowship and MRRI Peer Review Committee grant to visit MRRI and investigate the benefit of visual speech information to aphasic comprehension

Ms. Krason received her undergraduate and postgraduate training in French Philology focusing on Linguistics and Translation from the University of Wroclaw in Poland. Afterwards, she continued her studies there, obtaining Speech and Language Therapy qualifications. Next, Ms. Krason earned her MSc degree in Psychology and Language Science from UCL, specializing in Neuroscience and Communication. Drs. Vigliocco and Buxbaum served as her MSc supervisors on a project examining the integration of co-speech gestures in people with aphasia and limb apraxia. Prior to enrolling in her PhD program at UCL, Anna worked as a research assistant on a project investigating a computer-based speech comprehension therapy for individuals with aphasia. This therapy incorporated elements of gamification to increase user engagement.

At MRRI, Ms. Krason will be working on a joint NIH project led by Institute Scientist and Director of the Language and Learning Laboratory, Erica Middleton, PhD, and the Director of Neuroscience of Language Lab at George Washington University, Malathi Thothathiri, PhD. In this project, Ms. Krason will use EEG and eye-tracking methods to investigate the impact of cognitive control deficits on sentence comprehension in individuals with aphasia.

Ms. Krason will also continue her collaboration with the Language and Cognition lab at UCL, as well as with Drs. Buxbaum and Vigliocco on their project examining multimodal communication in aphasia.

With a background in speech and language therapy, Ms. Krason is particularly interested in the interplay between the brain and language. Her long-term research goal is to advance our understanding of cognitive and neural mechanisms underlying language and its impairments.

Healthcare is increasingly turning to big data as a way to build health profiles and predictive models to inform diagnosis and treatment. In the future, it is likely that the types of algorithms that currently predict what movie a person would like to watch or what takeout they would like to order, could be used to select treatments that are personalized to your individual condition and needs.

Critical to achieving this future, however, is the ability to merge scientific information with clinical information derived from well-documented electronic medical records (EMRs). EMRs are replacing traditional paper-based medical records for good reason. These EMR systems can facilitate workflow and improve the quality of patient care and safety. Moreover, the data stored in the EMR may be used to conduct quality improvement initiatives, and it can be analyzed to gain scientific insights to guide models of care. In order to unlock the tremendous promise of these tools, it is important that the EMR is designed in a way that relevant clinical information can be extracted and properly classified.

Extracting data from EMRs for research purposes presents multiple serious challenges, as there is a lack of standardization with regards to the terminology used for diagnosis, clinical findings, and specification of treatments. This latter issue—treatment specification—is of particular concern in the area of rehabilitation. Researchers, including those here at Moss, have noted the lack of detail in descriptions of non-pharmacological behavioral treatments, such as those used in rehabilitative care. “Most rehabilitation treatments are defined in the chart by the discipline of the person providing them, the problem they are addressing, and the time spent on it. Very little is documented about the treatment’s “ingredients” — specific actions taken by the clinician to bring about the desired functional improvements. It’s analogous to an internist documenting that they spent 15 minutes providing large white pills to improve breathing,” notes John Whyte, MD, PhD, who has led and contributed to multiple federally-funded efforts to develop a rehabilitation treatment specification system.

Understanding what treatment factors and processes lead to better outcomes, and for which patient subgroups, would allow the development of more effective rehabilitation strategies. The information required to gain this understanding is very complex and requires capturing detailed information on injury type and severity; the types, timing, and amounts of interventions received; and how these factors affect outcomes across diverse types of patients.

To address this gap, Moss is participating in an effort funded through the National Institutes of Health, National Institute of Neurological Disorders and Stroke that will not only transform our local electronic documentation system, but also harmonize our EMR with 15 other leading rehabilitation hospitals across the country, to enable the largest study to date of the rehabilitation strategies and outcomes for persons living with Traumatic Brain Injury (TBI).

The study, called Comparing Treatment Approaches to Promote Inpatient Rehabilitation Effectiveness for Traumatic Brain Injury (CARE4TBI), is led by Drs. Jennifer Bogner, PhD (contact PI, OSU), Cynthia Beaulieu, PhD (MPI, OSU), and Erinn Hade, PhD (MPI, NYU). This pragmatic observational study will recruit nearly 1,600 participants through 15 TBI Model Systems sites, located across the United States in various health systems and communities. Using the standardized data captured during inpatient stays, the impact of naturally occurring differences in approach to rehabilitation therapy will be evaluated relative to their effectiveness in improving the person’s ability to care for themselves and to function at home, at work/school, and in the community through one-year post-injury.

Amanda Rabinowitz, PhD, is the Site Principal Investigator for the CARE4TBI study at Moss; Mary Ferraro, PhD, OTR/L and Andrew Packel, PT, NCS, are contributing to the multicenter, multidisciplinary team responsible for identifying and designing new data forms and response sets to be added to the standardized EMR; and Dr. Whyte is a Moss member of the study’s Steering and Executive Committees. The aim is to capture data chronicling treatment and recovery during the natural course of a patient’s hospitalization. Dr. Ferraro and Mr. Packel have been working with Moss administrators, clinical frontline staff, and information systems specialists to design EMR changes to capture this important clinical information accurately and efficiently, while ensuring that the changes integrate well into Moss’s current EMR to enhance daily documentation of care.

“It’s of great importance to the whole study team that the EMR changes not only support the research, but also fit within the clinical work-flow. This is why we have included the input of frontline clinicians and clinical leaders in our redesign efforts,” Dr. Rabinowitz states. The study team is hopeful that improvements to the EMR may create efficiencies in documentation and could confer benefits for the delivery of care. As Dr. Ferraro notes, “This process has raised important discussions about how therapists describe interventions and document patient status. With these modifications, there will be a better distinction between clinical assessments and therapeutic treatments, which is an essential step to the examination of care delivery.” And this is only the beginning. Dr. Whyte adds, “This project has led us to develop close working relationships among researchers, clinical leaders, and EMR designers and programmers. We hope this collaboration will lead to additional future projects that exploit the scientific value of a well-designed EMR.”

“We are very enthusiastic about Moss’s involvement in this project, and what it could mean for the future,” noted Dr. Rabinowitz. “We believe that the EMR changes that come from this clinical-research integration will pave the way for continued collaborations — both locally and with other TBI Models System sites — that have the potential to directly inform care.”

Over the years, Moss Rehabilitation Research Institute (MRRI) scientists have provided outstanding mentorship and training to postdoctoral fellows from diverse academic, cultural, and geographic backgrounds. Chia-Lin (Charlene) Lee, PhD, worked at MRRI from 2010 to 2012 in the Cognition and Action Laboratory directed by Laurel Buxbaum, PsyD. In this interview, Charlene discusses her research and her experiences at MRRI.

Question List

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

I am an associate professor at National Taiwan University (NTU). My main appointment is with the Graduate Institute of Linguistics, and I also have joint appointments with the Department of Psychology and Graduate Institute of Brain and Mind Sciences, and I am a member of the NTU Neurobiology and Cognitive Neuroscience Center. My work mainly involves teaching, advising graduate students, and doing research. Other than that, I also help review papers for journals and recently took the associative editor position for Psychophysiology.

 

• What are your research interests?

My research interests lie primarily in the area of language processing. Recent work in our lab focuses on the collaborative nature of the two hemispheres of the brain during language processing. For example, what is the role of the right hemisphere in acquiring syntactic regularities and what support can the right hemisphere provide when the dominant system in the left hemisphere deteriorates with age? We are also interested in understanding the predictive processing in the brain. For example, what kind of linguistic information do we anticipate prior to the actual perception of the inputs? What modulates our abilities to do so? What do predictions formed during language comprehension have in common with predictions formed during perception, actions, or other cognitive tasks?

 

• Can you describe the impacts or potential impacts of your research?

Language is an amazing manifestation of human intelligence. Understanding how a complex system like language is deciphered in the brain brings us closer to the core of the human mind and provides potential help for rehabilitation or intervention. For example, our recent work showed that, although the right hemisphere is usually given little attention in the literature when it comes to syntactic processing, our data suggest that it has some morphosyntactic capacity (processing for both morphological change and syntactic agreement) that is similar to what the left hemisphere has. In addition, the right hemisphere is engaged to a greater degree during syntactic processing in healthy older adults. We also discovered that the right hemisphere can provide important contribution in the initial learning stage of syntactic regularities in healthy young adults.

 

• What first attracted you to science?

I was interested in biology and mathematics as a kid. Growing up I become fascinated by how humans are capable of processing complex symbolic systems like language seemingly effortlessly. Language studies were categorized as humanities in the education system I was in. It was not until my senior year that I realized that what I was interested in could be studied in more scientific ways in linguistics and psychology.

 

• Why did you choose to work as a postdoctoral fellow at MRRI?

I have always been interested in how language interconnects with other sensory-motor systems. At that time, Dr. Buxbaum had a research line that focused on embodied cognition and how different types of actions may differentially constitute meaning representations. I was very drawn to this hypothesis and thought that it was a great opportunity to learn how to systematically examine research questions like this. I was fortunate to have the opportunity to work as a postdoctoral fellow with Dr. Buxbaum at MRRI to learn more on this topic.

 

• What was it like working in the Cognition and Action Laboratory at MRRI?

When I was in the lab, there were also other post-docs and full-time research assistants. Everyone was very friendly and professional. It was a very collegial lab. I still remember the help Dr. Solene Kalenine gave me when I first got to the lab, and those afternoons when people grabbed a cup of coffee and drew new ideas on the whiteboard!

Dr. Buxbaum is a very energetic leader, but she also kept things at a very reasonable pace. She gave us room to sharpen our skills and catch up on the literature that we may not be as familiar with as we wanted to be, and provided the help and resources that we needed. At a project meeting, her suggestions were always insightful and nudged the project in the right direction. J She is also very fun to be with. Her passions for science and music are very inspiring to me.

 

• Is there something you learned at MRRI that has helped you in your current endeavors?

The research training I got from MRRI was very solid and had a great influence on me. Other than that, working at MRRI gave me many opportunities to work with people from various disciplines and to observe how people from different disciplines communicate and collaborate. These kinds of multidisciplinary experiences are very helpful in my current position.

 

• What is one of your favorite memories from your time working at MRRI?

When I think about my time working at MRRI, the first image that pops into my mind is the regular lab meetings we had in the common area. Dr. Buxbaum’s lab had a weekly lab meeting with collaborating labs, including Dr. Dan Mirman’s and Dr. Steven Jax’s labs. Those meetings were always light-hearted and full of friendly comments and discussions. We were very productive, but things were done in a very collegial environment. Maybe that’s why I always remember it as a cozy afternoon scene with autumn sunlight.

I also like that our offices were among the areas where patients regularly came in for therapy sessions or social group activities. This and our clinical seminars that Dr. Kalenine mentioned in her recent interview really helped to flesh out my research experience as they helped me to see how different endeavors can all work together toward a common goal.

 

• Can you tell us more about your long-term career plans or goals?

In my current position, I spend a lot of time working with ‘young students’ (master’s students or undergraduate students). I hope, with time, our young students will become mature and independent scientists. I very much look forward to working with them as peers and colleagues. Then it can be my turn to take a break to refuel my research energy! Eventually, I hope we can build a language science team at National Taiwan University and attract more talented local and international researchers to join us.

 

• What are some of your personal interests or hobbies?

I like watching movies and reading novels. I also like to bring my kids outside to enjoy nature. Taiwan is a mountainous island. There are many easy and moderate hiking trails available, and it is also quite convenient to go to a beach.

Moss Rehabilitation Research Institute (MRRI) is delighted to welcome a new postdoctoral fellow, Yingxue Tian, PhD, to their team of scientists. During the next three years, Dr. Tian will be working under the joint mentorship of Erica Middleton, PhD, in the Language and Learning Lab and Marja-Liisa Mailend, PhD, in the Speech and Language Recovery Lab.

Dr. Tian’s research investigates the cognitive and neural architecture of working memory, specifically the mechanisms dedicated to processing the serial order of verbal and visuospatial information units. To address this topic, she has relied on a wide variety of techniques, including the individual differences approach, the neuropsychological approach, and the network neuroscience approach.

Dr. Tian completed her undergraduate training in Statistics at Beijing Institute of Technology, and she earned her PhD in Cognitive Neuroscience from Rice University. In her dissertation, Dr. Tian investigated the intersection between working memory and spatial processing, identifying the behavioral and network-level neural underpinnings of the reorganization of working memory units in space. She has also investigated the generalization of inhibitory control from executive function to language processing after neuromodulatory (tDCS) training. Dr. Tian has received recognition for her early career research, including the Kenneth R. Laughery Award for Best Master’s Thesis in Psychology, the Pre-Dissertation Research Grant, and the Dissertation Research Improvement Grant from the School of Social Sciences at Rice University.

At MRRI, Dr. Tian will investigate the connection between language, working memory, and long-term memory. Specifically, she will study the relationship between the cognitive-linguistic profiles of people with aphasia and different types of speech errors. She will also investigate the individual differences in response to treatment from different training approaches for word retrieval in aphasia.

Dr. Tian’s long-term research goals are to advance our knowledge of the interplay between language processing and memory and to employ this knowledge for designing effective treatments that can facilitate recovery of disrupted cognitive functions after stroke.

Welcome, Dr. Tian!

Ataxia is a disabling neurological condition of impaired movement coordination that can result from damage to a structure in the brain called the cerebellum. Individuals with Ataxia have trouble controlling their balance when standing. They also have difficulty walking, coordinating reaching movements with their arms, speaking, and controlling the movement of their eyes.

MRRI Institute Scientist and Sensorimotor Learning Lab Director, Amanda Therrien, PhD, studies cerebellar Ataxia. Her research uses a combination of behavioral and computational methods to improve our understanding of the neural mechanisms through which the cerebellum contributes to movement control. Dr. Therrien uses this knowledge to develop new movement training techniques aimed at improving rehabilitation for individuals with this disorder.

Cerebellar Ataxia is a component of many neurological disorders – e.g., multiple sclerosis, cerebral palsy, congenital brain malformations, and paraneoplastic conditions triggered by an abnormal immune system response to cancerous tumors. Dr. Therrien’s work focuses on a host of genetic conditions, called Spinocerebellar Ataxias (SCAs), that cause a progressive degeneration of the cerebellum. While SCAs run in families, sporadic gene mutations can cause other genetic conditions that lead to cerebellar degeneration without a family history. The National Ataxia Foundation estimates that, in the United States alone, 15,000 – 20,000 people have SCAs, and that tens of thousands more are affected by recessive and sporadic forms of Ataxia.

Each year, International Ataxia Awareness Day is observed on September 25^th. This week, Dr. Therrien and others at MRRI are proud to continue raising public awareness and support for Ataxia. On Saturday October 1^st, Dr. Therrien will represent MRRI at the 2022 Central PA Walk n’ Roll to Cure Ataxia. You can donate to the cause here. You are also invited to join us at 10:00 am on Saturday, October 1^st at the Lions Pavilion in Kerr Park, Downingtown, PA to participate in the event! Through Walk n’ Roll events across the country, over $3,000,000 has been raised to support the National Ataxia Foundation’s mission to accelerate the development of treatments and improve the lives of people living with Ataxia.

To get involved or learn more about Ataxia research at MRRI you can follow us on Twitter and Facebook. You can also learn more about Dr. Therrien and the Sensorimotor Learning Laboratory on our website.

After brain injury, patients may experience disorders of consciousness (DOC) ranging from a decreased awareness of their surroundings to complete unconsciousness in a coma. John Whyte, MD, PhD, has made important contributions to our understanding and treatment of patients with disorders of consciousness through his research at Moss Rehabilitation Research Institute (MRRI). Dr. Whyte is an Institute Scientist Emeritus and the former Director of MRRI, and his research on DOC has helped improve clinical care for patients with DOC. He was featured in a recent article from MIT Technology Review exploring what we know about the capabilities and the limits of minimally conscious brains.

You can read the full article here.

Moss Rehabilitation Research Institute (MRRI) is proud to provide outstanding mentorship and an excellent training environment for postdoctoral fellows from the U.S. and around the world. Solene Kalenine, PhD, PsyD, is one former MRRI postdoc who has gone on to a successful independent research career. She trained at MRRI from 2009 to 2011 under the supervision of Laurel Buxbaum, PsyD. Dr. Kalenine shares more about her research and her career in this interview.

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

I am a researcher employed by the CNRS, the French National Center for Scientific Research. I work at SCALab in Lille (France), which is a research institute for Cognitive and Affective Sciences gathering professors from Lille University and researchers from the CNRS.

What are your research interests?

My main research interest concerns the relationships between the perception and representation of objects and actions. How do we perceive objects and how do the motor properties of objects influence the way they are processed and represented? How are our actions represented? Does action experience influence acquisition and retrieval of knowledge about objects (name, category, function)? How can action and semantics benefit from each other, especially when one domain is impaired (such as in apraxia, semantic dementia)? As such, my interests encompass several main research areas of cognition, including visual perception, action, and semantic knowledge.

Can you tell us more about the impacts or potential impacts of your research?

I believe that studying the interconnections between different cognitive functions is really important for rehabilitation and lifespan development. Acquisition/rehabilitation in a particular cognitive domain may be boosted by more developed/preserved cognitive abilities. For example, we have identified that patients with semantic dementia tend to show relatively preserved semantic processing when the semantic knowledge involved is more closely linked to action. We are also investigating how enhancing object motor properties may help children learn new words.

What attracted you to science and the field of cognitive psychology?

In school, I was very attracted to “hard” science on the one hand and humanities on the other hand. For me, cognitive psychology is the perfect combination of both: a very rigorous and scientific approach to studying human mind and behavior.

Why did you choose to work as a postdoctoral fellow at MRRI?

I did my PhD thesis on the development of semantic categories, and I was getting more and more interested in the role of sensorimotor experience in conceptual knowledge. Therefore, I wanted to develop my expertise in the research field of action. Moreover, I had lost contact with my clinical background (I had a PsyD in neuropsychology before my doing my PhD) and hoped to reconcile fundamental and clinical research in my work. The Cognition and Action Laboratory at MRRI was thus the ideal fit for me.

What was it like working in the Cognition and Action Laboratory at MRRI?

People were very nice and welcoming. There were many interactions between us, and the environment was highly stimulating. In particular, I appreciated the regular meetings and seminars where I had the opportunity to learn a lot from expert researchers and clinicians.

Is there something you learned at MRRI that has helped you in your current endeavors?

I learned many things! I think MMRI is a great place to comprehend the whole spectrum of scientific research in cognitive psychology, from theoretical models to clinical rehabilitation. At MRRI, I was encouraged to get an overview first before starting to investigate a new research issue. I also learned to replace the word “problem” with the word “challenge”, and this change in perspective actually makes a major difference in my life!

What is one of your favorite memories from your time working at MRRI?

I really appreciated the scientific exchanges during the different meetings I had the opportunity to attend. I particularly remember amazing clinical seminars during which a neurologist presented the case of a patient, demonstrating their difficulties and preserved abilities and explaining the cognitive processes involved in front a mixed audience composed of clinicians, researchers, and members of the patient’s family.

Can you tell us more about your long-term career plans or goals?

I wish to continue doing research in cognitive psychology for as long as I can! And hopefully, I will be able to return to the U.S. and more particularly to MRRI at some point of my career as a visiting scholar. I am keeping an eye out for grants that could support this kind of travel opportunity. 😉

What are some of your personal interests or hobbies?

I come from the Alps so I definitely like hiking and outdoor activities. I also love traveling and discovering new countries and cultures. In addition, I enjoy reading, live music, and playing the piano when I have time.

MossRehab’s Drucker Brain Injury Program and Moss Rehabilitation Research Institute (MRRI) are excited to celebrate the sixth renewal of their world-class Traumatic Brain Injury (TBI) Model System. The continued recognition and support from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) are a tremendous achievement for the researchers and clinicians at Moss who are dedicated to pushing the limits to improve our scientific understanding and clinical treatment of TBI.

Classification as a Model System by NIDILRR requires excellence in treatment and research related to a particular disability. The MossRehab TBI Model System has been continuously funded since 1997, and with this most recent renewal, funding has been secured through 2027. Members of the MossRehab TBI Model System have continued to demonstrate exceptional clinical care, as well as research productivity, innovation, and knowledge dissemination in the field of TBI rehabilitation.

“Moss Rehabilitation Research Institute and MossRehab are delighted by the recent news of renewal of the Traumatic Brain Injury Model Systems of Care. This is a great achievement due to its highly competitive nature. More than three decades of uninterrupted participation in this program have allowed us to help continue to transform TBI care delivery for years to come,” remarked Alberto Esquenazi, MD, Chief Medical Officer of MossRehab. “Now as part of Jefferson, our collaborative team of researchers, clinicians, administrators, and other important stakeholders, including persons living with TBI, will continue to work together to improve the lives of those with brain injury,” he said.

The MossRehab TBI Model System includes patients with moderate to severe TBI, who receive inpatient rehabilitation care at MossRehab and acute care at one of four local Trauma Centers. These patients undergo long-term follow-up and they have various opportunities to participate in research studies led by MRRI researchers and teams within other TBI Model Systems across the nation. Regardless of whether patients elect to participate in research, outstanding clinical care is provided to patients at the Drucker Brain Injury Unit.

The MossRehab TBI Model System is led by Amanda Rabinowitz, PhD, and Tom Watanabe, MD. “Our continued involvement in the TBI Model System allows MossRehab and MRRI to remain at the forefront of research and knowledge translation that will shape the future of TBI care,” Dr. Rabinowitz noted, adding that “the funding and collaborative infrastructure will continue to support important local and multi-site research that would not otherwise be possible.”

Research supported by the TBI Model System funding recently includes longitudinal research in collaboration with other premier centers across the nation, and local research designed to improve TBI treatments and outcomes. For example, in the last cycle, the team examined a hybrid therapist-delivered and mobile health intervention to promote mental health in people living with chronic TBI. In the current cycle, they will evaluate a program using a similar hybrid approach to help people with chronic TBI reduce sedentary behavior and become more physically active. In recent collaborative efforts, the MossRehab TBI Model System has partnered with other TBI Model System facilities to study chronic pain after TBI, the impact on driving outcomes, and the effects of neighborhood characteristics on TBI outcomes.

In addition, consumer-facing activities include an Advisory Council made up of treatment staff, former patients and members of their families, and community members who are helping to improve clinical services, research efforts, and educational/outreach activities. The MossRehab Model System will also hold conferences in collaboration with other rehabilitation facilities and the Brain Injury Association of Pennsylvania for people with brain injury, their families, and professionals in the field. Further, the team looks forward to partnering with the Brain Injury Association of Pennsylvania in this new funding cycle to develop clinical guidelines for providing telehealth to persons with moderate to severe TBI, and expanding their outreach to historically underserved populations.

“The competitive renewal of the TBI Model System of Care is a testament to the leadership of Dr. Rabinowitz at MRRI and Dr. Watanabe at MossRehab,” noted Dylan Edwards, PhD, Director of MRRI. “The success is shared by former TBI Model System directors Dr. Tessa Hart and Dr. John Whyte, as well as an extensive team who have been working together to continue advancing the field to improve the lives of those with brain injury,” he continued.

Through the MossRehab TBI Model System, MRRI scientists and MossRehab clinicians will continue to work together to advance the standard of care for treating TBI and improve the outcomes for patients.

“Self-efficacy” is a concept that has been around for a long time in psychological science. Popularized by the famous psychologist Albert Bandura, PhD, the idea is simple: humans form beliefs about how well they can perform tasks successfully. Our performance in real-world tasks is influenced by how confident we are that we can perform those tasks to reach specific goals.

Self-efficacy is applicable to nearly every voluntary human behavior, but it becomes particularly interesting in the context of medical change, where tasks that may not have been much of a problem before the change are now significantly more difficult. For example, self-efficacy for memory ability (or memory self-efficacy) may decline in older adults who experience memory problems, or after a major medical event affecting thinking, like traumatic brain injury (TBI). Self-efficacy theory would also predict that a person’s negative memory beliefs affect their confidence and willingness to engage in everyday tasks that they perceive as memory-demanding. This decreased willingness to engage may, in turn, reduce participation in daily life activities broadly. In other words, poor memory self-efficacy can play a role in a chain of events potentially ending in poorer quality of life.

Umi Venkatesan, PhD, who directs the Brain Trauma and Behavior (BraTBehavior) Laboratory, recently published an article on a study examining memory self-efficacy in a unique group of individuals: adults 50 years of age or older with moderate-severe TBI. Co-authored by MRRI Institute Scientist Amanda Rabinowitz, PhD, and Penn State Professor of Psychology Frank Hillary, PhD, the study asked three main questions: 1) What individual characteristics (e.g., age or injury severity) are related to memory self-efficacy?; 2) How are memory self-efficacy, general psychological distress (e.g., depression and anxiety), and memory test performance related?; and 3) Is memory self-efficacy associated with self-reported ratings of health-related quality of life (e.g., satisfaction with cognitive, social, and physical health functioning)?

In 114 people with moderate-severe TBI, the study found that there is great variability in the level of self-reported memory self-efficacy (i.e., some have very negative memory beliefs, some are in the middle, and some have very positive memory beliefs). This variability was not related to demographic or injury characteristics, but this could have been due to the special nature of the group (middle-aged to older adults). Importantly, results showed that memory self-efficacy was related to general psychological distress, but it was also associated with memory performance even after taking this distress into account. Further, memory self-efficacy was associated with health-related quality of life independent of both psychological distress and memory test performance.

Putting all these results together, the study suggests that memory self-efficacy plays a role in both objective health indicators like memory test performance and in broader, subjective health outcomes like quality of life. While memory self-efficacy is related to general psychological distress, the two are distinct and should be considered separately in treatment.
A bigger picture lesson from the study is that researchers and clinicians should pay attention to what people think about their own functioning, rather than just how they score on clinical tests. This shift in perspective — from provider-determined to patient-driven — is an important step towards personalizing rehabilitation for adults with TBI.

Laurel Buxbaum, PsyD, Associate Director of Moss Rehabilitation Research Institute and Research Professor of Rehabilitation Medicine at Thomas Jefferson University, and Shailesh Kantak, PT, PhD, MRRI Research Scientist and Assistant Professor of Physical Therapy at Arcadia University were awarded a $2.5 million grant award from the National Institutes of Health (NIH) to study the cognitive and neuroanatomic factors that influence arm choice after stroke.

As many as 94% of stroke survivors exhibit reduced use of one arm, with adverse consequences for disability, caregiver burden, and quality of life. Approximately 40%-80% of individuals who fail to use the affected arm in daily life possess adequate sensory-motor capacity to do so. The disparity between arm use and capacity (i.e., Use/Capacity Disparity — UCD) occurs across a broad spectrum of sensory-motor severity and is a perplexing and urgent problem in neuro-rehabilitation. Perhaps in part because UCD lies at the interface of sensory-motor processing and cognitive/affective phenomena, very little past research has assessed its underlying mechanisms or neuroanatomic biomarkers. The NIH grant awarded to Drs. Buxbaum and Kantak will test the predictions of three hypotheses of the mechanisms underlying UCD: the sensorimotor, attention, and apathy/motivation accounts.

The researchers will administer a targeted battery of sensorimotor and neuropsychological tests to test the predictions of each of the three hypotheses in a sample of 100 mild to moderate left- and right-hemisphere chronic stroke patients. They will determine the association of these measures, as well as demographic and stroke-related variables, with UCD. They will also use advanced neuroimaging methods with data from resting-state functional magnetic resonance imaging to develop imaging biomarkers associated with UCD. Finally, they will validate a novel virtual reality assessment tool to rapidly and reliably evaluate UCD. In addition to its clinical utility, the virtual reality tool enables built-in assessment of the attention hypothesis by determining whether UCD is influenced by attentional task demands.

By the end of the grant period, the research will determine the demographic, sensorimotor, neuropsychological, and neuroanatomical factors that predict UCD and will validate a clinically-useful VR assessment tool. Given the limited knowledge base in this area, this comprehensive research will pave the way for the development of treatments targeted to underlying mechanisms and enhanced identification of at-risk individuals.