MRRI Scientist Studies Mobile Healthcare

Two researchers working on a study

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

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

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

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

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

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

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

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

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

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


Dr. Laurel Buxbaum on People Behind the Science

Dr. Buxbaum's headshot

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

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

Listen to the interview on peoplebehindthescience.com.


MRRI Phantom Limb Pain Study Featured in Philadelphia Magazine

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

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

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

Read the article on Phillymag.com.


Promoting Mental Health After TBI

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

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

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

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

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


Sleep Apnea After TBI

Sleep apnea is a disorder that involves brief periods of not breathing when the individual enters deeper sleep stages. When breathing stops, the individual becomes short of oxygen and partially wakes up again, which causes them to resume breathing. However, these respiratory events disrupt deep sleep throughout the night, and this can cause daytime drowsiness, cognitive impairment, auto and work-related accidents, and increased blood pressure and risk of stroke and heart attack.

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Dr. John Whyte Receives Gold Key Award From ACRM

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

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

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Dr. Buxbaum Writes Invited Blog for Psychonomics Society

Laurel J. Buxbaum, PsyD, recently wrote an invited blog for the Psychonomic Society. Her piece, entitled “#time4action: Using eyegaze to understand object-related action and goal knowledge” discusses some of the latest research on how visual attention and eyegaze are guided or distracted by objects that share similar purposes and manipulations.

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

Read the article on Psychonomic.org


MRRI Launches Annual Newsletter

The Moss Rehabilitation Research Institute recently published the inaugural issue of its annual newsletter, MRRI Letters. Highlighting the Institute’s accomplishments and successes from the past year, the newsletter tells the story of 2018 at MRRI.

This first issue includes a message from the Institute’s incoming Director, Dylan Edwards, PhD; a reflection from the former Director, John Whyte, MD, PhD; as well as feature stories on some of MRRI’s focus areas during the past year. Stories included features about grants awarded for research in stroke recovery, “naming impairment” in aphasia, and Traumatic Brain Injury treatments, just to name a few.

Read the newsletter

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