MRRI Scientists and Collaborators Receive Chernowitz Medical Research Foundation Award

Carol Parlin Prushan, Vice President and Chief Development Officer, Einstein Healthcare Network; Jack Platt, Vice President and Trustee, The Chernowitz Medical Research Foundation; Dylan Edwards, PhD, Director, MRRI and Principal Investigator; and Shailesh Kantak, PhD, Institute Scientist, MRRI and Co-Principal Investigator.

George and Edith Chernowitz were pioneers in the development of quality control in scientific and industrial applications. Respected and influential service providers and technology leaders in the space program, they combined their analytical interests into developing statistical and engineering analyses of military weapons systems and related aspects of flight-related testing. Their work lives on today in applications used by all branches of the military and NASA.

Together, they created the The Chernowitz Medical Research Foundation as their legacy to enhance human health and well-being by supporting innovative research in the areas of circulatory disorders and mental health. 

The Moss Rehabilitation Research Institute (MRRI) has been awarded funding to further develop treatments for patients who have experienced a stroke. Over $400,000 from The Chernowitz Medical Research Foundation will support this MRRI-led study and conducted in collaboration with the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital, Harvard Medical School, and Massachusetts Institute of Technology.

Led by Principal Investigator, Dylan Edwards, PhD, Director of MRRI and Director of the Human Motor Recovery Laboratory, the study titled “Precision Targeting for Transcranial Magnetic Stimulation (TMS) Treatment in Stroke Patients” will validate advanced computational TMS mapping methods for clinical and research applications including depression, neurosurgery, and stroke.

Co-Principal Investigators include Shailesh Kantak, PhD, Institute Scientist and Director of the Neuroplasticity and Motor Behavior Laboratory at MRRI and Aapo Nummenmaa, PhD, Assistant Professor of Radiology at Harvard Medical School, Assistant in Neuroscience at Massachusetts General Hospital, and Director of the TMS Core at the Martinos Center. Co-Investigators are Sergey N. Makarov, PhD, and Mohammad Daneshzand, PhD.

New Podcast Episode Discusses the Importance of Integrating Research and Clinical Care

Over the years, MossRehab has been consistently recognized as one of the nation’s top ten Best Hospitals for Rehabilitation by US News and World Report. Communication and collaboration between researchers and clinicians allows MossRehab to provide cutting-edge, evidence-based treatment to patients and ensures that scientists at the Moss Rehabilitation Research Institute (MRRI) are pursuing research topics that address critical needs in rehabilitation assessment and treatment.  

MRRI Director and Director of the Human Motor Recovery Laboratory Dylan Edwards, PhD, joins Alberto Esquenazi, MD, to discuss the importance of integrating research with clinical care in the latest episode of the MossRehab Conversations podcast. Dr. Esquenazi is the John Otto Haas Chair of Physical Medicine and Rehabilitation and Chief Medical Officer at MossRehab.  

In this episode, Drs. Edwards and Esquenazi describe the collaborative environment and other factors that drew them to Moss and have kept them here. They also share examples of programs and initiatives that MossRehab and MRRI have developed to foster interactions between scientists and clinicians, and they explain some of the impacts these efforts have on both research and clinical practice.  

You can listen to the full podcast episode or read the transcript on the MossRehab website.  

Dr. Buxbaum Receives Prestigious Freda Newcombe Prize

Moss Rehabilitation Research Institute (MRRI) is honored to announce that Laurel Buxbaum, PsyD, has recently been selected to receive the 2021 Freda Newcombe Prize from the British Neuropsychological Society (BNS). The BNS was formed in 1989 to build relationships between cognitive neuroscience and clinical investigations of patients with neuropsychological impairments. This Prize is named after Freda Newcombe, PhD, a British scientist who played a pivotal role in developing the discipline of cognitive neuropsychology. The Executive Committee of the BNS chooses one distinguished scientist annually to receive The Freda Newcombe Prize for their excellence in research. Dr. Buxbaum is now one of only fifteen scientists to have the distinction of receiving this highly competitive award. Previous recipients include renowned cognitive neuropsychologists Karalyn Patterson, PhD, Glyn Humphreys, PhD, Tim Shallice, PhD, Michael Kopelman, PhD, and Matt Lambon-Ralph, PhD.

Dr. Buxbaum is Associate Director of MRRI and Director of the Cognition and Action Laboratory at MRRI. She will be presenting her prize lecture titled “The way(s) you do the things you do: left hemisphere representation and selection of tool knowledge“ at the BNS Autumn Online meeting on Thursday November 11, 2021

MRRI Contributes to New Research Exploring How to Improve Memory in Traumatic Brain Injury and Depression

Dr. Umesh Venkatesan

Umi Venkatesan, PhD, who directs the Brain Trauma and Behavior Laboratory at Moss Rehabilitation Research Institute (MRRI), is Site Principal Investigator of a new study that will examine learning and memory in individuals living with traumatic brain injury (TBI) and depression. Amanda Rabinowitz, PhD, Director of MRRI’s Brain Injury Neuropsychology Laboratory, will also contribute to this effort. The project represents a collaboration between scientists at Kessler Foundation (lead site; East Hanover, NJ), Montclair State University (Montclair, NJ), the University of Pennsylvania, and MRRI. The work is funded by the National Institute of Neurologic Disorders and Stroke, National Institutes of Health.

Symptoms of depression are commonly experienced by individuals with TBI and can present significant functional challenges beyond cognitive or mobility impairment. However, many research studies on cognition after TBI do not examine depression symptoms, or exclude individuals with depression, rather than understanding the impact of depression on cognitive outcomes. This new study aims to fill that gap by examining how individuals learn and remember information when they are living with either TBI or clinical depression, and also how having both conditions at the same time impacts memory. It will incorporate both paper-and-pencil testing of cognitive abilities as well as advanced, non-invasive neuroimaging (MRI) methods. Using specialized tasks, the research team hopes to study new ways in which we can improve memory performance when people are simultaneously experiencing the effects of TBI and depression. Ultimately, the goal is to find support for new memory treatments that could positively impact patients’ quality of life.

Study planning is well underway, and recruitment at MRRI will begin within the next month. Research participation consists of an MRI scan and computerized testing at the University of Pennsylvania, followed by a research visit at MRRI for further assessment of cognitive abilities and psychological functioning. The study will run through Spring 2026, and findings will provide important insights into the mechanisms underlying memory impairment in TBI. A better understanding of these mechanisms will inform development of future treatments, particularly in individuals living with both TBI and depression. This study is just the latest in MRRI’s long history of productive scientific collaboration and commitment to work that matters to patients, families, and healthcare providers.

The Achievements and Significance of the Moss TBI Model System

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) awards Traumatic Brain Injury (TBI) Model Systems grants to institutions that are national leaders in medical research and patient care. Launched in 1997, the Moss TBI Model System is a world class center of excellence providing state-of-the-art research, innovative treatment, and valuable programs for people with Traumatic Brain Injury. Each TBI Model System contributes to the Traumatic Brain Injury Model Systems National Data and Statistical Center, participates in independent and collaborative research, and provides information and resources to individuals with TBI; their families, caregivers, and friends; health care professionals; and the general public. 

Moss and MRRI are very proud to be recognized as a TBI Model System. This prestigious designation was recently added as an element of the US News and World Report ranking methodology for Best Hospitals for Rehabilitation, and it contributed to Moss’s Top 10 ranking in 2021. In this new data-driven ranking system, rehabilitation facilities receive points for measures of resources related to patient care (structure), clinicians’ decisions and actions toward patients (process), and patient outcomes (outcomes). Facilities receive credit in the structure category if they have one or more model systems designations awarded by NIDILRR (designations are available in the areas of Spinal Cord Injury, Burn, and Traumatic Brain Injury), and the model systems designation accounts for 2% of the overall ranking.

Over the past 24 years, the Moss TBI Model System has followed 1,390 participants and conducted over 4,500 interviews out to 20 years post-injury. Our efforts and collaborations have resulted in 112 peer-reviewed research publications and 16 research grants, as well as the development of novel clinical programs and products. Moss clinicians and researchers look forward to continuing to serve as leaders in the field of rehabilitation for people with traumatic brain injury as they work to advance innovative research projects and deliver exceptional clinical care through the Moss TBI Model System.

Integrating Rehabilitation Research and Clinical Care

MRRI researcher looking at a pamphlet with a research participant.

Clinical/research integration (CRI), like democracy, is a promising ideal that is an ongoing challenge to achieve. It has been part of the vision of Moss Rehabilitation Research Institute (MRRI) since its inception, but what does that vision entail, and what are the key elements required to make some progress toward the vision? “I believe that efforts toward CRI are essential for the success of a translational research enterprise and for a clinical enterprise that seeks to be on the leading edge of practice. We know how hard it is for evidence to make inroads into clinical practice, and it will take efforts on the part of both researchers and clinicians, to bridge this gap,” states MRRI Founding Director and Institute Scientist Emeritus John Whyte, MD, PhD.

CRI is, most importantly, a two-way street – an ongoing process of interaction and dialog among clinicians and researchers. Researchers, by nature, tend to simplify and isolate the problem they study. Clinicians, by nature, must address any problem in the context of the patient’s array of problems and strengths. Consequently, effective translational researchers need a rich understanding of the clinical context of their area of study. This ranges from the very practical (How long will most patients be available in the hospital for study? How busy is their schedule?) to the more scientific (How “important” and how “isolate-able” is this problem in the lives of the patients who have the problem, given the array of other problems they may also face?). On the other hand, researchers can contribute greatly to the clinical environment in both general and specific ways. “I have found that my training often allows me to plan ways of analyzing information for clinical problem solving even outside of my main areas of content knowledge. Just the mere tendency to think in terms of patterns of data and variability in those patterns can strengthen clinical problem solving,” remarks Dr. Whyte. Translational researchers also can synthesize emerging evidence in their area of content expertise and contribute it to discussions of care processes and quality improvement in those areas.

If that two-way vision is convincing, then why is it so challenging to achieve? Dr. Whyte summarizes below some of the barriers that he has encountered.

Attitudes and Leadership

Time and motivation are needed to undertake the communication envisioned by CRI. Ultimately, that means that clinical leaders as well as research leaders need to appreciate the value and support it. Articulating that value is challenging, since most of the assumed benefits are broad and long-term. Although leadership support is necessary, it isn’t sufficient. Front-line clinicians need to have an attitude of questioning their own practice to choose to engage with researchers. Researchers must similarly think they have something to learn from clinicians. Leadership attitudes may be the most useful place to start to build CRI – if not overall leaders, at least “local” leaders who can support small concrete efforts to toward it and who can help advocate for resources. And leaders can help select staff with the needed perspective and groom that perspective among those present.

Time and Money

Even with the most supportive leadership attitudes, it takes time to communicate beyond what’s absolutely necessary for patient care or research progress. But the process of CRI is, to varying extents, an exploratory process. It can be expected to deliver benefits periodically, and to spin off important practical projects, but it cannot be expected to deliver benefits hour-by-hour. One of the biggest challenges is the clinician’s typical productivity requirements and the money required to offset those requirements for “non-productive activity”. Although researchers tend to be more flexible hour-by-hour, if they are largely extramurally funded, they, too, must be quite narrowly focused on their research to succeed, not to mention that it’s not legal to conduct a clinical improvement project on grant-funded time. Ultimately, the process of CRI does require money, and those seeking to advance it would do well to consider philanthropic support, program demonstration grants, and institutional “R&D” investment as sources of funding.

Structures and Processes

The needs of clinicians and researchers for various kinds of infrastructure vary. “Over the years I have seen this in systems ranging from finance to electronic data systems,” Dr. Whyte explains. For CRI, one ultimately needs systems that meet both sets of needs. For example, clinical purchasing systems expect to order large amounts of materials from a stable set of suppliers; research purchasing systems need to provide payments to a variety of vendors, many of which are project-specific or short-term; a payroll system may not flexibly handle an employee whose salary comes partly from research and partly from clinical sources, particularly if that mix changes periodically. In terms of clinical data, researchers benefit from having every variable coded as present/absent or unknown, whereas clinicians prefer to be able to select problems that apply (and may not always exclude those that don’t). Systems for extracting EMR data may be well-suited to producing standard daily or monthly reports and ill-suited to designing and quickly revising one-time complex queries. Both clinical and research perspectives need to be represented when such systems are selected and designed.

Ethics and Communication

Sometimes concern about the ethical boundary between research and clinical care can be an obstacle to CRI. Clinicians should not be pressured to collect patient data for research purposes. But may researchers advocate for the clinical usefulness of data elements that would benefit them and seek their clinical adoption? How much information should a clinician provide to a researcher about a patient’s family situation or behavioral characteristics, to facilitate research recruitment? May clinicians adopt methods such as randomization and blinded treatment conditions in order to validate their clinical conclusions? How familiar should clinicians be with the principles of human subjects research ethics in order to practice in an environment that is rich in CRI? “While I believe that there are risks inherent in CRI of crossing an ethical boundary, and even current human subjects review criteria are rapidly evolving to address ‘learning healthcare systems,’ I don’t believe that building a wall between research and practice is the solution,” says Dr. Whyte. Rather, both sides of the dialog need to understand the possible benefits of CRI as well as the potential risks, and actively discuss the many ethical ambiguities that may be encountered. The challenges associated with CRI as well as the benefits to be achieved will continue to evolve. Small and concrete efforts at CRI (e.g., a joint journal club for clinicians and researchers; a jointly run lunchtime seminar; hiring clinicians as consultants on research grants) can begin to build support for expanding efforts. Designing the process and monitoring its implementation and impact are ongoing processes in a changing landscape. Scientists and clinicians at MRRI and MossRehab are dedicated to working towards better integrating efforts and systems between research and clinical care to continue to advance our understanding of recovery following neurological injury or disease and to provide the best treatments possible for patients with these conditions.

Moss TBI Model System is Part of a New NIH-Funded Multicenter Study

Designation as a Model System highlights Moss’s excellence in treatment and research related to traumatic brain injury (TBI). The Moss TBI Model System has been continuously funded since 1997. Over more than two decades, Moss Rehabilitation Research Institute (MRRI) scientists and MossRehab clinicians have led numerous studies and participated in many research projects in collaboration with investigators from other TBI Model Systems.

MRRI Institute Scientist Amanda Rabinowitz, PhD, will be a Site Principal Investigator for a newly funded 7-year, multicenter research grant awarded to scientists at the ​​Ohio Regional Traumatic Brain Injury Model System at The Ohio State University (OSU). This grant from the National Institutes of Health will be led by Jennifer Bogner, PhD (Professor and Chair in Physical Medicine and Rehabilitation in the Ohio State College of Medicine), and Cynthia Beaulieu, PhD (Ohio State Clinical Neuropsychologist and Associate Professor), and Erinn Hade, PhD (Associate Professor of Population Health at NYU Langone Health), are Co-Principal Investigators on the project.

This “CARE 4 TBI” study will compare the effectiveness of different inpatient rehabilitation approaches for people with moderate-severe TBI in order to optimize functional outcomes and community participation. Moderate-severe TBI results in physical, behavioral, and cognitive impairments that can have devastating effects on functioning in the community. Considering the growing strain on healthcare resources and reductions in inpatient lengths of stay, there is a critical and urgent need to identify the specific rehabilitation approaches that can optimize outcomes for people with TBI.

To address issues related to the complexity of rehabilitation and the heterogeneity of patients with TBI, scientists will conduct a prospective observational study using data from standardized electronic medical records from a total of 15 TBI Model System sites. Results from this study may potentially advance standards of practice in rehabilitation for people with TBI and provide clinicians and healthcare administrators with evidence-based guidance on the most effective practices in TBI rehabilitation.

The Advanced Clinical Therapy Program Incorporates Research Findings to Improve Clinical Care for People with Aphasia

Three individuals looking at a computer screen together.

The MossRehab Aphasia Center Advanced Clinical Therapy (ACT) Program is a unique-to-the-region collaboration among MossRehab Hospital, Moss Rehabilitation Research Institute (MRRI), and the MossRehab Aphasia Center bringing ‘up-to-the-minute’ aphasia rehabilitation research directly into the clinical setting. 

At the time of the inception of the ACT program, treatment was less commonly available for those with chronic aphasia due to the prevailing ‘myth of the plateau’, which suggested that continued improvement was not possible after more than a few months post-stroke. However, a core group of researchers around the world, including scientists at MRRI, were studying new treatments and documenting improvement in people with chronic aphasia. This work was creating a stronger evidence base showing that individuals with aphasia were responsive to treatment even years after their stroke. ACT speech-language pathologist emerita Paula Sobel, MA, CCC-SLP, recently recounted her experience working in the 1990s as a research speech-language pathologist evaluating connected speech samples as part of a project being led by MRRI co-founder Myrna Schwartz, PhD. Although blinded to what was happening during the sessions in the study, it was clear to Ms. Sobel that participants’ language was improving. The treatment those participants received, published under the name Mapping Therapy, has since been cited in more than 200 scientific journal articles, and it continues to be utilized to treat grammatical impairments for those with aphasia.

In addition to Mapping Therapy, MRRI scientists have contributed to the development of the Philadelphia Naming Test, an image-based naming test developed to explore lexical access in people with and without aphasia. This test is used within MossRehab and the ACT program, as well as around the world. In addition, researchers at MRRI worked to develop MossTalk Words and the subsequent MossTalk Words 2. These are evidence-based, computer-assisted treatment programs designed specifically to optimize word comprehension and production in people with aphasia. Once developed, this technology was incorporated into treatment plans to enhance rehabilitation in people with aphasia.

The ACT program was developed to bridge this type of cutting edge research with speech-language pathologists’ clinical expertise for the benefit of individuals with aphasia. Through this program, the MossRehab Aphasia Center became a leader in implementing aphasia rehabilitation approaches based on models of how language is processed in the brain, combined with a functional, person-centered approach to developing direct treatment and home practice programs. Informed by ‘hot-off-the-press’ research findings, speech-language pathologists who understood the methods for taking a theoretically-motivated case-report approach to their practice began to work with individuals with chronic aphasia. 

Today, the speech-language pathologists within the ACT program continue to communicate directly with MRRI researchers, staying apprised of the latest aphasia rehabilitation research for those with chronic aphasia, as well as primary progressive aphasia. Their work incorporates a wide variety of evidence-based assessment and treatment protocols individualized to each patient and grounded in the Life Participation Approach to Aphasia. The Life Participation Approach to Aphasia prioritizes collaborating with each individual to develop and progress toward the goals they have for themselves.

Learn more information about the ACT program and other MossRehab Aphasia Center services.

MRRI and Collaborators Receive NIH Funding to Study a Novel Virtual Reality Treatment for Phantom Leg Pain

Nearly two million people in the United States alone have undergone limb amputation, and up to 85% of individuals experience persistent and debilitating pain in their missing limb after amputation. This phenomenon is known as phantom limb pain. Previous research from the Moss Rehabilitation Research Institute (MRRI) has shown that phantom limb pain can be reduced in people with below the knee amputations by participating in virtual reality (VR) programs that combine active leg movements and visual inputs of a virtual limb.

MRRI Associate Director Laurel Buxbaum, PsyD, and longtime collaborator Branch Coslett, MD, of the University of Pennsylvania are Co-Principal Investigators on a large new multi-site grant recently funded by the National Institutes of Health. Alberto Esquenazi, MD, Chief Medical Officer of MossRehab and Director of the MossRehab Regional Amputee Center will also collaborate. Through this grant, the investigators will conduct a clinical trial to assess the mechanisms and efficacy of a novel VR treatment for phantom leg pain. The treatment consists of a variety of engaging games conducted in the VR world. The project will also assess the neurological changes that accompany the benefits seen following treatment, and will test a low-cost, home-based telerehabilitation treatment that could make this form of therapy more accessible for individuals with leg amputations.

The three sites for this multi-site clinical trial will be MRRI (led by Dr. Buxbaum), the University of Pennsylvania (led by Dr. Coslett), and the University of Washington/Harborview Medical Center (led by Eric Rombokas, PhD, Co-Investigator). The clinical trial will improve our understanding of the neural basis of phantom limb pain and will serve as an important bridge to the development of an accessible clinical treatment for phantom leg pain.

The Sensorimotor Learning Laboratory Brings Expertise in Cerebellar Ataxia to MRRI

Established in 2019, the Sensorimotor Learning Laboratory at Moss Rehabilitation Research Institute (MRRI) is directed by Amanda Therrien, PhD. Dr. Therrien’s research uses a combination of computational and behavioral methods to improve our understanding of the neural mechanisms that underlie movement control and learning. Dr. Therrien uses this knowledge to develop new movement training techniques aimed at improving rehabilitation for individuals who have suffered damage to different brain regions.

The primary focus of Dr. Therrien’s research is studying the effects of damage to a structure in the brain called the cerebellum, which plays a crucial role in the control of movement. When the cerebellum is damaged, the result is impaired movement coordination. Individuals with cerebellar damage have trouble controlling their balance when standing. They also have difficulty speaking, walking, coordinating reaching movements with their arms, and controlling movements of their eyes. The pattern of poorly coordinated movement that results from cerebellar damage is called Ataxia. It represents a disabling movement disorder that affects many people around the world.

Many neurological conditions can damage or disrupt the cerebellum and cause Ataxia – e.g., stroke, Multiple Sclerosis, Cerebral Palsy, and congenital malformations. However, a lot of Dr. Therrien’s work has studied a host of genetic conditions, called Spinocerebellar Ataxias (SCAs) that cause a progressive degeneration of the cerebellum. While SCAs run in families, other genetic conditions that cause cerebellar degeneration can occur without a family history as a result of sporadic genetic mutations.

Dr. Therrien’s research examines whether neural mechanisms that do not depend as heavily on the cerebellum, and are intact in Ataxia, can be leveraged to help individuals with this condition control and learn to adjust their movement. Dr. Therrien’s work also studies impairments in sensory processing that can occur with Ataxia. Impaired sensory processing in Ataxia has received little attention historically, but is likely a major contributor to the movement disorder.

September 25th is International Ataxia Awareness Day, a day where individuals and organizations, such as the National Ataxia Foundation in the United States, unite to increase public awareness and support for Ataxia. MRRI is excited to contribute to this effort! On October 16th, Dr. Therrien will be representing MRRI at this year’s National Ataxia Foundation Walk n’ Roll to Cure Ataxia. While this year’s National event will be held virtually, smaller, local, in-person Walk n’ Roll events will be held across the United States. Dr. Therrien will be participating in and fundraising for the Central PA Walk n’ Roll Event.

Dr. Therrien is not the only MRRI scientist with experience conducting research on Ataxia. Aaron Wong, PhD, Director of the Cognitive Motor Learning Laboratory and Scientific Director of the Klein Family Parkinson’s Rehabilitation Center at MossRehab, has also done important work investigating the role of the cerebellum in eye movement control and movement learning in people 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’s research and the Sensorimotor Learning Laboratory, as well as Dr. Wong’s research and the Cognitive Motor Learning Laboratory on our website.