A Behind-the-Scenes Look at the Sensorimotor Learning Laboratory

The nervous system is critical for integrating sensory information with motor commands to control our movements in everyday life and to allow us to learn new movements. Brain injury or disease can impair an individual’s ability to perform movements and make it more difficult to learn new movements. In particular, damage to the cerebellum can cause a condition called ataxia which is characterized by poor coordination of movements.   

In this video, Amanda Therrien, PhD, Director of the Sensorimotor Learning Laboratory shares more about her research. Her work is dedicated to understanding the mechanisms that underlie movement problems in cerebellar ataxia in order to improve and develop new rehabilitation interventions for this population.  

Learn more about research in the Sensorimotor Learning Laboratory.

Facilitating Informed Consent for People with Aphasia and Cognitive Impairment: Breaking through Communication Barriers in the Language and Learning Lab

A man and woman looking at tablet on table.

Scientists and staff at Moss Rehabilitation Research Institute (MRRI) have vast experience in working with patients with stroke and other nervous system injuries that can impact decision-making capability. What follows are tips and advice on facilitating appropriate communication based on that experience.

The ethical principle of respect for people as described in the Belmont Report is twofold. It cautions researchers to treat all individuals as autonomous agents throughout the consent process, and it also mandates protections for people with diminished autonomy.  Adequately assessing a potential participant’s decision-making capability is crucial for this requirement.

What is Decision-Making Capability, and how does it differ from the legal definition of Competence?

The phrase “decision-making capability” refers to an individual’s ability to make a meaningful, informed decision about a certain task at a point in time. The researcher can assess it with careful consideration during the consent process. Competence is a legal term determined by a court. It can either be a global declaration about a person, or it can be limited to specific domains, such as financial matters, personal care, etc. Decision-making capability regarding research participation must include a person’s ability to:

  1. Understand the nature of the research procedures, the potential risks and benefits, and the fact that research is voluntary.
  2. Reason and make a personal judgment about the research in light of their personal priorities, values, and any available alternatives.
  3. Express choice by communicating their choice (verbally or nonverbally) in a consistent fashion.
  4. Remember key elements involving the research project for the duration of the consent session.

Preparing to begin the informed consent process, researchers are bound ethically to remember:

  • All adults are presumed competent to consent to participation unless there is documented evidence of “decisional impairment.”
  • Cognitive impairment may (but does not necessarily) impair decision-making.
  • Not all individuals with cognitive impairment have decisional impairment!

The challenge for language researchers is how to tap into an individual’s thought process when they have a diagnosis of aphasia. Aphasia is a language disorder that can impact someone’s ability to understand when listening or reading, and it can inhibit their ability to express their intent fully through speech or in writing to varying degrees. Individuals with aphasia can become prisoners of their native language and may be incorrectly assumed to be incapable of making a decision by virtue of lack of access to language. Researchers should build a ramp to facilitate communication to ultimately determine if it can be determined if a person with aphasia has the capability to make an informed decision.

To determine decisional capability, MRRI scientists recommend the following:

  1. First, allow ample time for the consent process. Some participants may need more than one session. Be prepared to continue the “process” over several sessions if necessary. The participant should never feel rushed. 
  2. Encourage the participant to bring a family member or trusted friend with them; not to make the decision for them, but to act as a second pair of ears or a source of comfort. 
  3. Use outside enhancements to the printed consent form to facilitate understanding of concepts. While it may not be possible to modify all parts of a consent form to accommodate a 5th grade reading level for better health literacy, effort should be dedicated to parsing longer sentences into chunks, rephrasing vocabulary as necessary, and adding pictures to illustrate a task.
  4. Acknowledge the participant’s capability nonverbally through welcoming posture and eye contact; and frequently verbalize support (e.g. “I know you know it”) to dispel fears they may have about trying to communicate.
  5. Researchers should acknowledge frustrations and attribute breakdowns to their own limitations as a listener. For example, “Gee, I’m having a lot of trouble today, but I’m going to do my best to understand what you have to say.”
  6. Openly explain the need to speak to someone else if critical information is needed. A researcher might say, “I think we need to bring your wife in so I can make sure I understand whether you can have the MRI.”
  7. Throughout the consent process, ask predetermined questions to elicit responses to specific concepts that need to be communicated, but always pay close attention to the participant’s nonverbal reactions at other junctures to see if there is need for additional intervening questions. Ask the comprehension questions that pertain to a specific topic soon after that topic is discussed to aid understanding.

This is a comprehensive questionnaire used by the Middleton Language and Learning lab, in which people with aphasia undergo language assessments.

8. Use the techniques of Supported Conversation for Adults with Aphasia (SCATM) to frame the interaction with the participant during these consent questions:

Reveal Competence:

  • Is the researcher’s message getting IN?
  • Judge how much support is needed and overcome the barrier by adding meaning in layers.

Nonverbal support:

a. First, add gesture. These are meaningful, slightly exaggerated movements used to emphasize or clarify. For example, a researcher could hold up 10 fingers to emphasize 10 visits.
b. Supplement with writing. Make sure to have clear and visible appropriate “key” words.
c. Picture Resources or drawings: These should be used when necessary (ask yourself if something simpler would suffice). However, they may be helpful for explaining tasks that a participant would be asked to do in a research study. For instance, a scientist could explain how one task in a study will involve a participant saying the names of objects in pictures. They could then demonstrate by pointing at a picture and saying the name (e.g. “It’s a cab”.)

Verbal support:

a. Start with short simple sentences.
b. Use redundancy.
c. Be prepared to repeat, rephrase, expand, and recap to verify understanding.              
Participant: “one day?”                                                                               
Researcher: “yes, you start with one day. Then 9 more days (while pointing on a calendar). You could come here a total of 10 days. Was that your question?”

  • Look for the person’s response to communicative cues. Researchers can assess whether a participant is interacting in dynamic and meaningful ways, or if instead there is a lack of expression or constant nodding yes.
  • Is the participant’s message getting OUT?

Determine if the person has a nonverbal way to answer questions.

a. Gesture: pointing, thumbs up/down

b. Evaluate whether the person has a way to control the conversation flow.

Encourage writing (make sure there is paper and pen) and/or provide written key words for pointing with use of yes/no and fixed choice questions.

d. Actively suggest that the participant give you a clue.

  • Acknowledge competence throughout interactions.

a. Verify each chunk of information to ensure that the conversation is on track from the perspective of the person with communication challenges.  Researchers should always check to make sure they understood what the potential participant intended to say.

b.   Summarize slowly, reflect, and expand: “So let’s see if I’ve got this right” This can help to catch inconsistent yes/no responses and hone in on misconceptions. It gives both the researcher and the participant a chance to catch an inaccurate assumption.

Communication may not always be successful the first time. If a potential participant doesn’t understand something, a researcher should be prepared to rephrase what they said. If a researcher doesn’t understand a potential participant’s response, they should ask again to make sure.

While this post focuses primarily on how to proceed with the consent process in order to determine a person’s decisional capability, the principles of Supported conversation for Adults with Aphasia (SCATM) can and should be used from the very first interaction in recruitment either via phone or in person throughout the length of the study—

well beyond obtaining consent. Confirming that your participant understands all directions and has a way to answer your study questions adequately helps to ensure valid data collection.

Belmont report (1979) – Issued by the National Commission for the Protection Of Human Subjects of Biomedical and Behavioral Research https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Kagan, A., Black, S.E., Duchan, F.J., Simmons-Mackie, N. & Square, P.  (2001). Supported Conversation for Adults with Aphasia (SCA™), Aphasia Institute, www.aphasia.ca

MRRI Receives Donor Gift to Support Concussion Research

Born and raised in Kikinda, Yugoslavia, Dragica Pesci came to the United States in 2000.

She has always valued education, and Dragica earned the highest diploma that can be awarded in Yugoslavia. She studied English and other languages prior to coming to the States. With her language and computer skills, she found a job with ease and dedicated herself to her work. Outside of work, she enjoyed exploring nature, engaging in a variety of sports and exercise, reading, knitting, learning languages, traveling, and spending time with family and friends. She felt like she was truly living the American Dream.

Unfortunately, her life changed dramatically in November of 2016. The accident occurred on a busy freeway during rush hour. Suddenly Dragica’s car was struck from behind by another vehicle, and she sustained a severe concussion. When it happened, Dragica was in shock, and she didn’t really understand at that point how serious her injuries were. After a few minutes, she became aware of her surroundings and began to feel pain in her head. Dragica went home that night, but her condition was worse the next day. Beyond the headaches and fatigue, she also experienced severe vision problems. Her primary care physician diagnosed her with concussion, but she was not referred to a specialist for further evaluation.

When Dragica heard she had a concussion, she was under the impression that she would likely fully recover with a little rest, time, and patience. About a month later, she was taken to the emergency room. Following discharge from the hospital, Dragica began physical therapy, and the care team continued to emphasize that she just needed to give herself more time to recover. The physical therapy sessions ended after six months, and Dragica began to feel much worse again. She struggled to complete basic household tasks like cooking, cleaning, and laundry. Further, as a person who was previously very active, it was frustrating for Dragica to discover that she couldn’t perform basic yoga poses and didn’t have the endurance to go on walks outside. She also wasn’t able to travel to visit her family in Europe, and her vision problems made it difficult to read for long periods of time.

Many patients with invisible injuries like concussion experience negative emotional symptoms, including depression and anxiety, and not being able to engage in her favorite leisure activities was taking an emotional toll on Dragica. With her health deteriorating, Dragica was losing hope of returning to the person she used to be and the life she used to have. At this point, she realized that she needed a care team with expertise in her condition. A few friends recommended that she call MossRehab, and she was so glad that she did.

It is unfortunately common for traumatic brain injury, such as the concussion Dragica experienced, to go unreported or be undertreated. As a result, many patients do not receive the acute care and longer term rehabilitation services they need. After nearly a year following her injury, Dragica had her first appointment at MossRehab. She said she’s “lucky she found Moss”. She explained that “Moss is the best professional care I experienced,” and she went on to describe how her clinical care team treated her as a whole person, rather than just focusing on her physical brain injury. Dragica’s treatment involved physical therapy, speech therapy, vision therapy, and counseling aimed at maximizing her recovery and improving her quality of life.

MossRehab physician Thomas Watanabe, MD, has been instrumental in helping Dragica work through the emotional, mental, and physical aspects of her recovery. “I can say he’s my hero. He saved my life,” Dragica said of Dr. Watanabe. She has enjoyed working with a variety of clinicians, researchers, and staff members at MossRehab over the years. “They’ve become like my family,” Dragica stated. Through her clinical care, she has developed trust in the team at MossRehab and a deep appreciation of their efforts to help her through what she described as the biggest challenge of her life.

For people like Dragica who have experienced a traumatic brain injury, the road to recovery can take months to years. She has continued to benefit from rehabilitation services at MossRehab over the past five years, as well as innovative programs that have helped bring joy to her life. In particular, MossRehab offers horticultural therapy for patients through their “Shoots and Roots” program at the Alice and Herbert Sachs Therapeutic Conservatory. The Conservatory provides opportunities for patients to work with clinicians in a real-world environment to meet their rehabilitation goals, and it also serves as a plant-filled space where patients and visitors can relax and clear their minds.

Participating in the “Shoots and Roots” program and later volunteering at the Conservatory helped Dragica develop a deep passion for gardening and arranging flowers. It was this passion and the plants she has been cultivating in her garden that have helped her endure the recent stresses of the COVID-19 pandemic. Seeing how doctors, nurses, and other frontline workers put their lives on the line to take care of others and save lives during the pandemic really motivated Dragica to find a way that she could give back and show her appreciation for the high quality clinical care she received at MossRehab.

In light of her lifelong love of science and her own experiences with concussion, Dragica decided to make a generous contribution in support of concussion research at Moss Rehabilitation Research Institute (MRRI). Her donation will support a pilot research study that will provide insights into the symptoms that people experience following brain injury. Amanda Rabinowitz, PhD, MRRI Institute Scientist and Director of the Brain Injury Neuropsychology Laboratory is leading this research study. She explains that they have developed an application that will allow users to record their concussion symptoms in real time using their smartphones. These symptoms may range from fatigue to difficulty with memory, and we will be asking participants to record their symptoms at 5 different times throughout the day for 20 days.

“This will give us important insights into the onset, presence, and duration of different symptoms that people may experience after brain injury so that we can work to develop new treatment approaches to ensure comprehensive and personalized treatment is delivered in a timely manner to address the needs of this population,” explained Dr. Rabinowitz.

Helping others is a driving force for Dragica, and she has made it a goal for herself to help MossRehab clinicians and MRRI researchers better understand and treat people with concussion. “I lived through that, so I know how difficult it is, and it is very personal,” she said. Dragica encourages others coping with brain injury to focus on the things they can do, and “never, never give up”. Dragica and other generous donors have provided Moss scientists and clinicians with important resources to advance our understanding of the brain and to further optimize rehabilitation after brain injury.

Learn more about how you can support cutting edge research at MRRI.

Brain Injury Neuropsychology Laboratory Welcomes New Research Assistant

The Brain Injury Neuropsychology Laboratory, directed by Amanda Rabinowitz, PhD, is pleased to welcome Alissa Kerr into her new role as a research assistant. Prior to accepting this position at Moss Rehabilitation Research Institute (MRRI), Alissa attended Fordham University where she majored in Integrative Neuroscience, with a concentration in Cognitive Neuroscience.

During her time as an undergraduate student, Alissa served as a research assistant in the Fordham University Memory and Aging Laboratory, and she conducted independent research on the relationship between experience with music training and short-term memory capacity for melodies. Her research provided evidence that people who had received at least one year of music lessons could remember significantly longer melodies than people who had no experience with music lessons. However, overall working memory scores were not significantly different between the two groups. Beyond her research experience, Alissa also served as a teaching assistant for biology and physiology lab courses. At MRRI, Alissa is looking forward to contributing to three ongoing research projects which focus on different aspects of recovery following traumatic brain injury (TBI). These include investigations of how use of mobile technology can assist therapy, the impacts of physical activity on recovery, and detection of blood biomarkers relevant for recovery.

Meet MRRI Postdoctoral Fellow Haley Dresang

Haley standing next to an MRI image of a brain.

Haley Dresang, PhD, joined Moss Rehabilitation Research Institute (MRRI) as a Postdoctoral Fellow in August of 2020. Since then she has been working with MRRI Associate Director Laurel Buxbaum, PsyD, and Roy H. Hamilton, MD, MS, Associate Professor at The University of Pennsylvania on a project investigating the use of gestures and brain stimulation to enhance language in people after stroke. In this interview, she shares more about her career, her research interests, and how she spends her time outside of the lab.

1) Can you tell us more about your academic background and training?

I began in academia studying neurobiology and Spanish as a pre-medical student at the University of Wisconsin-Madison. I volunteered in a cellular neuroscience lab for a year, but I was eager to have more direct work with patients. Then I joined the lab of Lyn Turkstra, PhD, where I had the opportunity to research cognitive and communication impairments in patients living with traumatic brain injury. For me, this was the perfect coalescence of neuroscience, linguistics (I have always loved languages.), and patient care.

I went on to earn my PhD in communication science and disorders at the University of Pittsburgh with a concentration in neuroscience from the Center for the Neural Basis of Cognition at Carnegie Mellon University. During my doctoral studies, my work centered on aphasia, which is a communication disorder following brain damage such as stroke or neurodegenerative disease. My mentor, Mike Dickey, PhD, provided me opportunities to work across multiple institutions and departments, including cognitive psychology (Tessa Warren, PhD), the VA Pittsburgh Medical Center (Will Hula, PhD), and neurosurgery at the University of Pittsburgh Medical Center (UPMC; Frank Yeh, MD, PhD). My research has developed from this multidisciplinary training, with a specific focus on elucidating how undamaged brain systems can be leveraged to improve function following neurological injury.

2) What attracted you to the field of neurorehabilitation?

I have had chronic migraines since age 12, and this condition has involved a long journey of auras, medication resistance, side effects, and neurology visits. Through this experience, I became fascinated by how little is known about the human brain. I also learned about the challenges and stigmas associated with neurological conditions, which are often considered “invisible illnesses.” Working in the field of neurorehabilitation enables me to feed my curiosity about the brain and to help others, while working toward improving disparities in medicine.

3) Why did you decide to work at MRRI?

The NIH-funded T32 postdoctoral fellowship provides a terrific training program, including seminars and workshops specifically designed for early-career researchers in translational neuroscience and neurorehabilitation. The shared environment between the University of Pennsylvania (Penn, where I hold my primary position) and MRRI offers me a unique opportunity where I can work across multiple disciplines with neuroscientists, neurologists, cognitive scientists, speech-language pathologists, and motor scientists. I admire the patient-centered work done at MRRI, and I look forward to joining the impressive group of scholars who have completed this T32 program.

4) What are some of the things you hope to learn or skills you hope to develop as a postdoc?

One of my goals is to work with patients with a variety of neurological disorders that affect cognition and communication. Over the past year, I have had the opportunity to research conditions including post-stroke aphasia, limb apraxia, primary progressive aphasia, Alzheimer’s disease, and Parkinson’s disease. Another goal I have is to develop expertise in neuroplasticity. I am learning different forms of non-invasive brain stimulation (NIBS) and the specific ways in which they can alter brain activity in service of rehabilitation. I have also gained experience in analyzing NIBS data along with neurophysiological and genetic biomarkers of neuroplasticity to improve our understanding of language recovery following strokes. (A preprint of that research is available here.) The goal I am working toward next is writing a grant proposal that will facilitate my transition to becoming an independent investigator.

5) Can you tell us more about a research project you are currently working on?

I am involved in many research projects through Penn, MRRI, and various collaborations. One new project I am leading will integrate multimodal gesture cues with non-invasive brain stimulation to investigate how activating undamaged semantic brain networks can help stroke patients with aphasia find and produce words more effectively. Read more about this project here.

6) What are the potential impacts your work may have in terms of future research and patient care?

My work makes contributions toward understanding how the human brain recovers from injury to support language, memory, and action. This research can inform prognostics for functional recovery and facilitate the development of precision medicine approaches in rehabilitation by improving predictions of which patients will respond best to different types of treatment.

My work also provides evidence for how patients may adapt to rely more heavily on relatively undamaged cognitive systems to improve both language and movement. This can guide development of neurorehabilitation strategies that target ancillary cognitive systems, like semantic memory (one’s general knowledge about the world). Finally, my work also includes development of novel assessment measures, which provide new tools for researchers and clinicians to help detect the presence and impacts of specific impairments across many patient populations.

7) Can you describe some of the challenges you have faced in your research or your career?

I know I’m not alone in saying that COVID-19 presented numerous challenges for me, both personally and professionally. I completed my PhD, moved to a new city, started my postdoc, and became a primary caregiver during the pandemic. Despite these challenges, I received great support from my colleagues, and I managed to make meaningful progress on a number of research projects this past year.

8) What have been some of your most memorable experiences in your first year at MRRI?

I have really grown from meeting new people through MRRI. There is an inspiring community of postdoc fellows, who have helped me navigate the pandemic, provided me with project feedback, and enhanced my professional development. I have also met many scientists and clinicians through virtual meetings and events. It is wonderful to learn different perspectives from such a diverse set of experts. Moving forward, I am particularly excited to work on a new project with an international group of female clinician-scientists led by Drs. Laurel Buxbaum and Gabriella Vigliocco, PhD, who is a Scientist in Residence at MRRI.

9) What are your long-term career goals?

My overarching career goal is to advance scientific understanding of brain-behavior relationships and to translate this information to improve clinical medicine and rehabilitation. To achieve this goal, I aim to be a researcher or professor in an environment with strong connections between medical, academic, and scientific research teams. I believe that multidisciplinary collaborations are essential to advancing translational neuroscience and neurorehabilitation, and I relish opportunities to learn new and diverse perspectives.

10) How do you like to spend your time when you’re not working?

I have been out exploring Philadelphia a lot! I love taking long walks to explore the many parks, markets, museums, coffee shops, and restaurants around the city. I try to do something active and/or creative every day. Some of my hobbies include painting, photography, playing piano, reading, song writing, yoga, and trying new ways to work out – kickbox Tabata, barre, and Latin dancing are some of my current favorites. Finally, I am very excited to start traveling when it is safe again!

MRRI Scientist in Residence Gabriella Vigliocco Featured in a New Podcast Interview

As a Scientist in Residence, Gabriella Vigliocco, PhD, has collaborated with scientists at Moss Rehabilitation Research Institute (MRRI) on a variety of research projects focused on language and cognition. Dr. Vigliocco was recently invited to discuss her research, her career, and her life in an episode of the People Behind the Science podcast.

During the interview Dr. Vigliocco spoke with podcast host Marie McNeely, PhD, about an exciting ongoing study in which she is characterizing language development and language comprehension in face-to-face social interactions. We also learned more about her scientific journey, starting in a small village in rural Italy where she grew up. Dr. Vigliocco also shared her passion for cooking, reading science fiction and fantasy books, and other interests outside of science.

Dr. Vigliocco is currently Professor of Psychology and Language Sciences in the Department of Experimental Psychology at University College London where she directs the Cognition and Language Laboratory.

You can listen to the full interview and learn more about Dr. Vigliocco on the People Behind the Science website.

MRRI Receives NIH Grant to Study Apraxia and Potential Pathways to Target in Rehabilitation

The athletic prowess seen in sporting events like the Olympics and the musical skills demonstrated at concerts highlight the amazing variety and complexity of skillful behaviors that humans are capable of producing. These and many other actions performed throughout daily life rely on at least two critical abilities. The first is the ability to quickly learn new behaviors through imitation. For example, when learning to dance, people often watch an instructor demonstrate a move and then attempt to copy it. Humans have a remarkable ability to imitate others, even without ever having seen a particular movement before. With this ability, people don’t have to spend a long time trying different actions to figure out how to successfully accomplish a task. The second critical ability is the use of tools such as hammers and saws, sporting equipment, musical instruments, and so forth. Tools increase the number of ways that individuals can influence their environments, helping them accomplish a much wider range of things than might otherwise be possible. However, tools are only helpful to people if they have the ability to properly manipulate the tools to achieve their desired effects.

Although on the surface imitation and tool use seem like two very different abilities, they are surprisingly related to each other. Their relationship is highlighted by the observation that losing the ability to imitate and to use tools are the two hallmark impairments of a neurological disorder known as limb apraxia. Limb apraxia can be observed in many common neurological disorders such as Parkinson’s disease, Alzheimer’s disease, and Autism Spectrum Disorder, although it is most commonly studied in individuals who have had a stroke on the left side of their brain. In fact, apraxia can be detected in roughly 50% of people who have a left-hemisphere stroke (about 200,000 people each year in the United States). Apraxia is unusual because although it affects the ability to move, it cannot be explained by the typical underlying movement problems, like muscle weakness or paralysis, that are commonly observed after a stroke – particularly as apraxic impairments can be detected on the less affected side of the body. Despite that, the presence of apraxia is one of the best indicators of poor recovery and caregiver reliance after experiencing a stroke. Unfortunately, understanding exactly what the problem is, and why imitation and tool use are the two abilities specifically affected, remains a puzzle despite over 100 years of investigation into this disorder.

Eight years ago, Dr. Aaron Wong, Dr. Laurel Buxbaum, and Dr. John Krakauer realized that a new approach would greatly benefit our understanding of apraxia. Although apraxia is a disorder that resides somewhere along the spectrum between high-level cognition and low-level control of movement, it had until that point rarely been studied by neuroscientists with a primary background in investigating the control of movement. This unfortunately had resulted in theories about apraxia that were somewhat disconnected from current views about the way in which the brain actually plans and controls movements. By combining the expertise of individuals who study apraxia with those who study the neuroscience of movement, it would be possible to develop a more comprehensive and contemporary understanding of apraxia.

This approach has culminated in the recent receipt of a five year, $2.2 million grant from the National Institutes of Health (NIH) to conduct a series of studies testing a novel theory about what might have gone awry in individuals with apraxia. This grant is being led by Dr. Wong, Director of the Cognitive-Motor Learning Laboratory at Moss Rehabilitation Research Institute (MRRI). MRRI Associate Director Dr. Buxbaum, and long-time collaborators Dr. Krakauer at Johns Hopkins University and Dr. Branch Coslett at the University of Pennsylvania, will contribute to the project as co-investigators. The novel theory proposed by these investigators posits that part of the difficulty in nailing down the specific problem caused by this disorder is because individuals may actually plan imitation and tool-use movements in two distinct ways. First, people can specify how to move various parts of their body relative to each other. For example, tennis coaches sometimes tell their players to focus on where their elbow is positioned relative to their hand during a tennis serve. Alternatively, people can plan the desired motion of their hand as it moves through space, without also worrying about the motion of the rest of the arm. For example, a tennis player might instead focus on producing a smooth arcing motion of the racket as it moves to hit the ball. Dr. Wong’s recent work has not only shown that people are able to use these two distinct strategies when preparing a movement, but also that impairments when imitating bodies or motion paths are associated with strokes to different parts of the brain.

Dr. Wong’s team will test their new theory using a variety of tools including carefully measuring the behavior of individuals with left-hemisphere strokes, as well as examining the specific locations in the brain that may be responsible for these impairments using state-of-the-art lesion-symptom mapping techniques as well as transcranial magnetic stimulation. Experiments to test this theory for imitation are currently underway, and Dr. Wong is looking forward to expanding this work to study tool-use abilities in early 2022. If borne out, this research will lay the groundwork for developing new rehabilitation approaches that could train people to leverage the movement strategy that is less affected by the stroke (that is, by focusing on whole-arm positions versus hand paths) in order to overcome imitation and tool-use impairments. This NIH-funded study illustrates MRRI scientists’ expertise in developing innovative theory-driven research projects with the long-term goal of improving clinical treatments in neurorehabilitation.

MossRehab Aphasia Center Featured in WHYY in Segment on Language

Recently, public radio station WHYY broadcast a segment taking a deep look at different aspects of language. They interviewed experts to shed light on the process of language learning and what happens when a person’s ability to communicate is disrupted.

Aphasia is an acquired language impairment that commonly affects people after stroke. People with aphasia may have challenges in remembering and expressing words. More than two million Americans are affected by aphasia, and the MossRehab Aphasia Center is a world class center dedicated to meeting the long-term communication and psychosocial needs of people with aphasia.

In this radio segment, expert clinicians and scientists including MossRehab’s Karen R. Cohen, MSPA, CCC-SLP, and Sharon Antonucci, PhD, CCC-SLP, share their expertise.

You can listen to the full story on WHYY’s website.

A History of Pioneering Research and Clinical Care for People with Aphasia

Since opening its doors in 1996 as the third aphasia center in North America, MossRehab Aphasia Center has been a leader in aphasia rehabilitation. In recognition of National Aphasia Awareness Month, we are pleased to highlight the exceptional contributions of the Center.

The MossRehab Aphasia Center has been a pioneer in developing and implementing programs to address the long term communication and psychosocial needs of those living with aphasia (Fink & Schwarz, 2000). An early adopter of the Life Participation Approach to Aphasia (Chapey et al., 2001), the work of the Center has always been guided by several foundational principles:

  • Recovery from aphasia involves a life-long process of re-education, adaptation, and support.
  • Under the right conditions, people with aphasia can continue to recover even years after the onset of aphasia.
  • Participating in social, recreational, and educational activities reduces isolation and helps people with aphasia and their families make psychosocial adjustments.
  • Individuals with aphasia and their families can play an important role in increasing public awareness of aphasia.

Through the collaboration of founding directors, Myrna Schwartz, PhD (research director), and Ruth Fink, MA, CCC-SLP (clinical director), the Center has always been a place in which the convergence of scholarly and clinical innovation is the norm, a trajectory that continues today.

Through the integration of the Aphasia Activities Center, the Advanced Clinical Therapy Program, and ongoing aphasia rehabilitation research, the Center supports the continuum of communication needs of people with aphasia and their families. Access to cutting edge treatment has been brought into the homes and communities of those with aphasia, through early adoption of technology and through ‘outside the box’ approaches to targeting the psychosocial consequences of aphasia.  

Aphasia Activities Center

Social interaction facilitates rehabilitation. The Activities Center provides a variety of opportunities for engagement and conversation, activities that are therapeutic and life-enhancing. Group activities including Constance Sheerr-Kittner Conversation Cafés, Talking Book Club, and Reta’s Games Groups provide not only for practicing communication, but perhaps even more critically, for building friendships. Computer lab, technology workshops, and online resources such as the Aphasia Center Blog and library of video resources expand the reach of the Center beyond the space and provide additional ways for members to reach out into their communities.

The Advanced Clinical Therapy (ACT) Program

ACT is a specialized outpatient program bringing up-to-the-minute aphasia rehabilitation research into a clinical setting. Clinicians use this cutting edge research and computer technology to design a program for each individual that emphasizes effective home practice routines using computers whenever possible.

Aphasia Rehabilitation Research: Innovative Treatments

Scientific and clinical collaborations at the MossRehab Aphasia Center have facilitated the development of novel treatments, informed by cognitive neuropsychology and psycholinguistics, as well as by a person-centered approach to rehabilitation.

  • MossTalk Words 2® is an evidence-based computer-assisted treatment program developed to strengthen understanding and production of single words for individuals with aphasia.
  • Mapping Therapy (Schwartz et al., 1994) is a treatment for agrammatism that targets the ability to link grammatical constituents (subject, object) with thematic roles (agent, theme) to facilitate  comprehension and production of language at the sentence level.
  • The Persons with Aphasia Training Dogs (PATD) Program is a treatment designed to target the psychosocial consequences of aphasia by training participants in positive reinforcement dog training techniques that harness new skill learning and the advantages of human-animal interactions.

The Center has always maintained a commitment not only to developing the highest quality programs, but also to providing community leadership.

  • Aphasia rehabilitation research evidence has been disseminated to scientific and consumer communities through more than 40 peer-reviewed publications and presentations based on work at the Center.
  • As a founding member center of Aphasia Access and a member of the Aphasia Resource Collaboration Hub, the Center participates in local, national, and international education and advocacy efforts with healthcare professionals and community advocates around the world.

The clinicians, scientists, community advocates, donors, and most importantly, the members of the MossRehab Aphasia Center have contributed substantially for 25 years to research and rehabilitation.  We look forward to continuing this innovation and person-centered service with the goal of supporting individuals and families in living well with aphasia.

Interview with MRRI Postdoctoral Fellow Abhijeet Patra

Abhijeet Patra, PhD, joined Moss Rehabilitation Research Institute (MRRI) as a postdoctoral fellow at the end of 2018. During his time at MRRI, he has conducted exceptional research in the Language and Learning Laboratory. As Dr. Patra prepares to wrap up his postdoctoral training and begin his new position at Manchester Metropolitan University, we were pleased to have an opportunity to speak with him about his career and his experiences at MRRI.

1. How did you first get interested in science and rehabilitation research?

I remember that when I was in high school, I went to visit a relative who was undergoing treatment in a rehabilitation hospital. After completing high school, I explored different career options, but I was not really sure which direction to go. However, I think my experience that day in the hospital made me lean more towards a career in rehabilitation. Especially, after seeing the dedication of the clinicians working in that rehabilitation hospital, I wanted to have a career where I could help people after injury and improve their quality of life. After completing a clinical undergraduate degree in speech-language therapy and audiology, I decided to pursue a master’s degree in cognitive science. During my master’s degree, I gained further knowledge about the relationship between brain and behavior and how brain injury or stroke can impact that relationship. Once I completed my master’s degree, I decided to pursue a PhD to further continue my research in the rehabilitation field. I received my PhD from the University of Reading, UK in 2018, and I am glad that my PhD research work involved patients from the same region (Kolkata, India) where I started my career as a clinician.      

2. Why did you choose to come to MRRI for a postdoctoral fellowship?

Throughout my academic career, I have read multiple impactful research articles written by MRRI scientists and that’s why MRRI was always on the top of my list. After completing my PhD, I was looking for research opportunities which would be more translational, and I came across the work of Erica Middleton, PhD (my current postdoctoral mentor). I started reading her papers and was fascinated by her simple yet powerful approach to rehabilitation. One day, I decided to write an email to Dr. Middleton. I discussed my research interests and my background with her, and that’s how it all started.

3. What has it been like working at MRRI?

I believe that my decision to come to MRRI has been one of the best decisions in my life. From day one, I have continued learning new and valuable things. All the scientists, research assistants, and staff at MRRI are wonderful, and they are always there to help. There is a very supportive and vibrant work culture at MRRI, and I feel that my postdoctoral mentors, lab members, and all the MRRI people are like my family.

4. What are some of the key questions you are focusing on in your research?

My postdoctoral work has focused mainly on three key areas: 1) how to improve naming impairments in people with aphasia using psychological learning principles, 2) understanding the changes in brain waves when an individual with aphasia produces common naming errors (e.g., saying cat instead of dog) and how that understanding may lead to better understanding of such impairment, and 3) understanding the relationship between sentence comprehension and cognitive control (e.g., inhibiting prepotent responses, working memory) in healthy adults and people with aphasia.

5. What have been some of the findings of your work?

In one of our studies, we found that people with aphasia make more naming errors when we asked them to name common everyday objects which belong to the same semantic category (e.g., dog, cat, elephant) versus objects from multiple semantic categories (e.g., dog, table, orange). However, one day later, that performance was reversed such that greater effort during training provided greater learning opportunities and led to better performance in future. During COVID-19 last year, we ran a web-based study on healthy young adults where participants read sentences word-by-word and also performed various cognitive control tasks. Our results provide evidence to support that cognitive control modulates sentence processing in healthy adults. We are currently writing the report to submit to a journal, and we also have plans to replicate these findings. These are only a few of the findings from my work, and I am looking forward to analyzing the results of a variety of other studies in the pipeline.

6. In terms of your research, what is the next step or something new you are excited to begin working on?

I am currently in the process of designing two electroencephalogram (EEG) experiments that I wanted to start last year but could not do due to COVID-19. I am looking forward to finally being able to get these studies going. In one of the experiments, I will look at the changes in brain activity during word production in people with aphasia. In the second, I will be examining the changes in brain activity during sentence processing in people with aphasia.

7. Thinking about the big picture, can you describe some of the impacts or potential impacts of your research?

During my PhD, I examined the characteristics of language breakdown in Bengali-English bilinguals with aphasia. Despite Bengali being the sixth most spoken language in the world, there were very few studies in the aphasia literature at that time when I started my PhD. I feel that through my PhD work I was able to contribute to broadening the sparse literature in this area. I have done some exciting research as a postdoc at MRRI, and I am still working on several projects. I think the output of my postdoctoral research will help the rehabilitation community better understand the relationship between cognitive control and language processing in aphasia and how to improve language impairments in those population.   

8. What experiences or skills from your fellowship at MRRI do you think will be most important as you transition into your first faculty position?

I have learned many skills during my fellowship at MRRI that I feel will be important in my future job position. However, I would say following are the top four in my list: 1) experience in writing grant proposals, 2) communicating research ideas and results to people outside my field, 3) how to manage a lab, and 4) how to successfully manage my time and work on multiple projects at the same time.

9. Can you share one of your favorite memories from your time at MRRI?

I think it will be my first lab/postdoctoral get together at my mentor Dr. Middleton’s place. I had a really good time with everyone there, but I would like to mention one particular experience from that day. For most of my life, I was afraid of dogs and would avoid them if I could. However, I was surprised to discover that I really liked Dr. Middleton’s dog when I had a chance to spend time with the dog at her house. After this enjoyable encounter, I have decided to get a dog for myself someday.

10. Outside of research, what are some of your favorite pastimes or interests?

I am a fan of cricket, a very popular sport in India that is not as well-known in the U.S. I enjoy watching cricket games as well as playing tournaments. I also love cooking and experimenting with different cuisines.