Don’t Miss The Latest Edition of the MossRehab TBI Model System’s Brain E-News

The MossRehab Traumatic Brain Injury (TBI) Model System team is pleased to provide news and updates in this new edition of Brain E-News. In the Spring 2023 edition of the newsletter, we introduce you to Lauren Krasucki, PT, DPT, MPH, CPH, who has joined the team as a Lab Manager, as well as Emma Stern, who recently started a position as a research assistant. This edition also shares research updates, including an article discussing new studies examining the impacts of the COVID-19 pandemic on people with brain injuries and some of the exciting collaborative projects that MRRI scientists are working on with researchers from other TBI Model System centers.

Click here to read the full Spring 2022 Edition of Brain E-News.

Meet MRRI Scientific Advisory Board Member Dr. Pablo Celnik

Moss Rehabilitation Research Institute is dedicated to conducting rigorous, high-quality science from theory-driven research to clinical treatments in neurorehabilitation. To help ensure the Institute continues to operate at the cutting edge of the field, MRRI maintains a Scientific Advisory Board composed of experts spanning the Institute’s research foci. Pablo Celnik, MD, Director of the Department of Physical Medicine and Rehabilitation and Professor of Physical Medicine and Rehabilitation at Johns Hopkins Medicine, has been part of MRRI’s Scientific Advisory Board since the Board was created. Learn more about Dr. Celnik and his role on the Board in the interview below.

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New Research by Scientists at MRRI and UCL Investigates the Impacts of Gesture on Naming Ability in People with Aphasia

Communication is more than just talking. In a face-to-face conversation, we also use gestures and facial expressions alongside speech to convey information. For example, the concept of waving your hand to greet someone can be expressed by saying the word “waving” or by performing the gesture itself. These concepts stored in long-term memory are thought to be shared across networks of brain areas responsible for speech and gesture. Gestures may also support word-finding: some studies have shown that when people struggle to retrieve words, producing a corresponding gesture also triggers production of the word. Other studies, however, have shown no effect of gesture on word-finding.

For individuals with aphasia, a language disorder that is common after a stroke or brain injury, word-finding difficulties are frequent. Because of this, some types of speech-language therapy encourage individuals with aphasia to rely on gesture to help them retrieve words more easily. However, an alternative approach known as constraint-induced language therapy requires individuals to rely on speech alone and restricts the use of gesture. While some individuals with aphasia benefit from constraint-induced language therapy, others benefit from therapy that allows for the use of gesture. It is unclear why different individuals with aphasia benefit from different types of therapy.

Approximately half of individuals with aphasia following a stroke also suffer from limb apraxia, a disorder which results in the impaired production of gestures and other skilled actions. One possibility is that individuals with limb apraxia will benefit less from the observation and use of gesture during speech-language therapy. To investigate this possibility, researchers from Moss Rehabilitation Research Institute (MRRI) and University College London (UCL) Amy Lebkuecher, PhD, Laurel Buxbaum, PsyD, Isobel Chick, MSc, and Gabriella Vigliocco, PhD, are conducting a study about the effect of gesture on naming ability in individuals with aphasia after stroke. In this experiment, the researchers are using gamified tasks, specifically “Go Fish” and “Heads Up”, to evaluate naming ability in an engaging and naturalistic context. Individuals with aphasia participating in this experiment are asked to complete these gamified tasks in two conditions: one that permits the use of gesture, and one that constrains it. In the condition where use of gesture is permitted, participants also observe the researcher performing gestures that are conceptually related to the objects and actions being named or described. In the condition where the use of gesture is constrained, both participant and researcher are not allowed to use gestures to communicate.

The researchers will compare participants’ performance on the gamified tasks across these conditions to determine whether the ability to name objects and actions improves when individuals with aphasia are allowed to use and observe meaningful, co-speech gestures. Additionally, the researchers will examine whether the benefit of gesture differs for individuals with and without limb apraxia, and explore whether there are other individual differences that affect whether gestures support word retrieval in aphasia. Data collection for this study is currently in progress. This research aims to advance our scientific understanding of the connection between speech and gesture in the brain. From a clinical perspective, the findings of this study may also help identify which individuals with aphasia are likely to benefit from the use of gestures during speech-language therapy, potentially leading to more personalized therapy.

Interview with MRRI Postdoc Dr. Simon Thibault

Moss Rehabilitation Research Institute (MRRI) was pleased to welcome Simon Thibault, PhD, in January of 2022. Since joining the Institute, Dr. Thibault has been working with Institute Scientists Aaron Wong, PhD, and Laurel Buxbaum, PsyD, to further his training and his scientific research. In this interview, Dr. Thibault shares more about his career and his work.

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

I did my studies in France with my undergraduate and postgraduate degrees in Sports and Human Movement Sciences at the University of Nantes. In Nantes, I became interested in research quite early, and I was at that time mentored by Dr. Thibault Deschamps. Afterwards, I did a 5-month postgraduate internship at the University of Queensland in Australia in Dr. Timothy Carroll’s lab which focuses on exercise science and motor control. My early research projects were related to the interaction between cognition and the motor system, or more general motor control projects. After this internship, I started my PhD at the University of Lyon under the supervision of Dr. Claudio Brozzoli and Dr. Alice Roy. During my PhD, I continued investigating interactions between cognition and the motor system, particularly focusing on the interaction between tool-use and language. I started my postdoc at MRRI about one year ago under the supervision of Dr. Aaron Wong and Dr. Laurel Buxbaum, and my current research projects are examining tool-use impairments in patients with neurological conditions such as stroke.

2) What attracted you to science?

I think I find science attractive because you work at the edge of current knowledge, and you can participate in extending this knowledge. I think that is the thing that excites me the most about science. Also, I like the fact that it requires me to learn and master multiple skills for various tasks, such as creating a new project from scratch, setting up a new experiment, analyzing data, and then sharing these results with the community through conferences or journal papers. More specifically, I have been particularly attracted to neuroscience because the brain is an intriguing part of our body, in which the mechanisms for many functions are still unclear. It is definitely exciting to be part of the research community trying to disentangle how this structure works.

3) Why did you choose to work at MRRI?

MRRI has given me the opportunity to pursue my main research interest in tool-use and complex motor behaviors (and how these motor functions interact with the cognitive system) by studying patients with apraxia. Apraxia occurs after a left-hemisphere cerebrovascular accident, and it impacts the actions of daily life, the use of tools, and complex motor behavior without apparent low-level sensorimotor deficits. For me, this is also a real opportunity to learn about the neuropsychological approach from experts in the field.

4) What are some of the research questions you are currently working to address?

Currently, I am working on determining what makes tools difficult to use for patients with apraxia. Dr. Wong, Dr. Buxbaum, and I think the degree to which the hand motion and tool tip motion differ makes these tools difficult to use for these patients. In parallel, I am planning to lead a project to better understand what makes it difficult for stroke patients (with or without apraxia) to perform an action sequence.

5) What have been some of the key findings of your research thus far?

During my PhD, I demonstrated that that tool-use abilities and syntactic abilities in language involved similar parts of the brain, and they reciprocally influence each other at the behavioral level. This finding has been of interest for a large community of scientists but also therapists because it introduces questions regarding whether patient populations with language or motor impairment may recover function by training the non-impaired ability (either language or motor function).

6) Can you tell us more about the impact or potential impact of your research?

Despite several years of research, apraxia is still a poorly understood deficit, and there are a lot of debates about what is really impaired in these patients and what the underlying mechanisms are. I hope my work will help to better clarify the underlying mechanisms, which could result in the development of new rehabilitation strategies to help these patients to cope with the difficulties they experience in their daily lives.

7) What is something that you have learned or hope to learn during your postdoc at MRRI?

Starting my postdoc at MRRI has been exciting and informative on many levels. First, I needed to familiarize myself with this novel environment and a new country. MRRI has a great environment for training and performing neuropsychological research thanks to the MRRI Research Registry. It has been interesting to learn more about how research is funded and conducted in the United States. Also, I was glad to gain experience working with patients. There are many considerations when conducting research with patient populations, and it is very different from working with neurotypical participants. By coming here, I hope to learn new skills, especially in grant-writing, to become a more independent researcher, as well as to gain new skills in neuroimaging analyses of patients’ data.

8) What is one of your favorite MRRI memories?

I would say the inclusion of the first patient in my study was a stressful but an exciting moment. Given some patients may have some language impairments, it is an additional challenge to make sure they can understand me with my (strong) French accent. However, most of them have been able to understand my instructions so far, and there is always a research assistant around that can help me handle more complex situations. I also have to acknowledge that I was particularly well trained by my advisors before this first patient inclusion to avoid these potentials misunderstandings.

9) What are your long-term career goals?

I would like to get a permanent research position in academia. Most likely, I will return to France for my next position, but I am open to any other interesting opportunities that may arise.

10) What do you like to do in your free time?

I am a big fan of sports, especially basketball, so I am happy to live in the U.S. where basketball is popular. I like to go to the 76ers games, and I also try to keep playing basketball at least once each week. In addition, I spend a lot of time with a group of French expats that are now my friends.

Man sitting on a couch looking at the ground

MRRI is contributing to Important Research on Suicidality after TBI

Man sitting on a couch looking at the ground

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

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

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

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

Erica Middleton, PhD, and Malathi Thothathiri, PhD

Collaborative Research at MRRI Will Inform the Development of New Treatments for Aphasia

Erica Middleton, PhD, and Malathi Thothathiri, PhD

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

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

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

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

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

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

New Research Highlights the Impacts of the COVID-19 Pandemic on People with Brain Injury

 

The COVID-19 pandemic disrupted daily life for nearly every individual on the planet, and its effects are still being felt today. Emerging evidence suggests that pandemic-related policies may have been particularly detrimental to individuals with chronic disabilities such as traumatic brain injury (TBI). For example, many individuals with TBI already find it challenging to participate in community activities because of their disability. “Lockdown” policies during the pandemic could have further limited their opportunity to be engaged in their communities.  

Intrigued by this question, MRRI scientists Umesh Venkatesan, PhD, and Amanda Rabinowitz, PhD, worked with a team of investigators from the National TBI Model Systems (TBIMS) to study the effects of the pandemic on societal participation in data from TBIMS enrollees nationwide. Societal participation was self-reported by each participant with TBI over telephone and covered three domains: productive activity (e.g., household chores), social activity (e.g., spending time with friends and family), and community involvement (e.g., dining out). Because of the extensiveness of the TBIMS project, the researchers had access to data from over 7,000 individuals who either reported their participation level in the five years before the pandemic started (before March 2020) or during roughly the first year of the pandemic. The investigators compared participation levels between these two groups of individuals to determine whether there were any changes, and to identify any differences in the demographic or clinical factors that related to participation (e.g., age or disability severity). 

The study findings, recently published in Archives of Physical Medicine and Rehabilitation, show that participation levels among TBIMS enrollees were quite stable in the five years leading up to the pandemic, and these levels remained so during the pandemic in two domains: productive activity and social activity. However, community involvement saw a modest, but significant, decrease among people with TBI during the pandemic. These findings are consistent with pandemic-related lockdowns that limited activity outside the home. People often found ways to do things around the house and to stay socially connected (e.g., virtually), but eating out or going to the movies was off limits for many. Furthermore, the study found no differences between time periods in the demographic or clinical factors that were related to participation. 

It is encouraging that the pandemic does not appear to have greatly disrupted the societal participation of individuals with TBI. Still, researchers are cautious. The observed reduction in community involvement during the pandemic is important, and it is yet to be determined whether this reduction will affect long-term mental health and overall TBI rehabilitation progress. In other words, even if the pandemic placed similar restrictions on everyone, the personal consequences may be especially high for people living with chronic disabilities like TBI. 

The study findings are a starting point for what may be a series of studies examining the pandemic’s effects on the lives of people with TBI. In fact, a companion study with which Drs. Venkatesan and Rabinowitz were also involved, examined mental health symptoms among people with TBI before and during the pandemic. That study arrived at many of the same conclusions as described above. Over time, TBIMS researchers will be able to gather and analyze data from before to during and after the pandemic, and from the same individuals at different points in their recovery, providing a more complete picture of health trajectories throughout the course of this remarkable time in our history. Ultimately, if researchers can characterize how the pandemic’s effects manifest in the individual lives of people with TBI, clinicians will be better able to anticipate, evaluate, and target treatment needs. 

MRRI Welcomes Dr. Lauren Krasucki

Dr. Lauren Krasucki Headshot

Each laboratory at MRRI specializes in innovative research that advances the mission of the Institute. Brain Injury Neuropsychology Laboratory studies the neurobiological and psychosocial factors that influence recovery from traumatic brain injury across the spectrum of injury severity. Amanda Rabinowitz, PhD, MRRI Associate Director and Director of the Brain Injury Neuropsychology Laboratory is pleased to announce that Lauren Krasucki, PT, DPT, MPH, CPH, has accepted the position as Lab Manager in her lab. In this role, Dr. Krasucki will assist with various research projects focused on better understanding and treating traumatic brain injury.

Dr. Krasucki is a two-time graduate of the University of Scranton, earning a Bachelor of Science in Exercise Science in 2015 and a Doctorate of Physical Therapy in 2018, and she recently graduated in December 2022 from Florida International University with a Master’s Degree in Public Health and a Certificate in Epidemiology.

She has clinical experience in many different settings, including long-term care, short-term rehabilitation, and home-based care, and she most recently served as the Professional Education Coordinator at the Parkinson’s Foundation. While at the Parkinson’s Foundation, Dr. Krasucki collaborated with experts in the Parkinson’s space to design several professional education programs, orchestrated the launch of 10 continuing education courses for healthcare professionals, and analyzed quantitative and qualitative data sets.

With a strong interest in neurological disorders and other chronic diseases, Dr. Krasucki is eager to further explore the role of physical activity, psychological processes, and social determinants of health on the incidence and management of these conditions.

MRRI Publishes the 2023 Edition of the MRRI Letters Annual Newsletter

Do you want to learn more about the exciting research that has been going on at Moss Rehabilitation Research Institute (MRRI)? We summarize some of the highlights from the past year in our annual newsletter MRRI Letters. In this edition, you can read messages from MRRI Director Dylan Edwards, PhD, as well as Adelyn Brecher, a Speech-Language Pathologist who has worked at MRRI since shortly after it was founded in 1992. We also shared stories about MRRI’s recent 30th Anniversary celebrations, new postdoctoral fellows who have joined the Institute, our research registry, Senior Staff accomplishments, and updates from each of our four research focus areas.

Read the full newsletter

 

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