This week, Moss Rehabilitation Research Institute (MRRI) welcomes postdoctoral researcher Amy Lebkuecher, PhD. Dr. Lebkuecher will be furthering her scientific training under the joint mentorship of Laurel Buxbaum, PsyD, Associate Director of MRRI, as well as H. Branch Coslett, MD, Professor of Neurology at the Perelman School of Medicine at The University of Pennsylvania.

Dr. Lebkuecher completed her undergraduate training in psychology at East Stroudsburg University. She then enrolled in a graduate program at Lehigh University where she was awarded a Masters of Science degree in psychology. Afterwards, Dr. Lebkuecher worked as a study coordinator at Kessler Foundation. In this position, she contributed to research on cognitive rehabilitation in individuals with multiple sclerosis and traumatic brain injury. Dr. Lebkuecher was recently awarded her PhD in Psychology and Language Science from The Pennsylvania State University.

Her graduate research investigated commonalities between language (linguistic) and nonlinguistic domains of cognition, particularly motor planning. A focus of her recent work has examined parallels in planning biases and error patterns across motor planning and language. In another line of research, she has investigated the connection between language and other nonlinguistic domains of cognition, such as learning and attention, in individuals with and without a history of language disorder. Findings from her dissertation research demonstrate that individuals with a history of language disorder do not attend to regularities in the environment in the same manner as individuals without a history of disorder. This difference could contribute to the variable language outcomes observed across these populations. Dr. Lebkuecher has received multiple awards for her early career research, including the Research and Graduate Studies Office Dissertation Award and the Donald A. Trumbo Research Award, both from The Pennsylvania State University.

At MRRI, Dr. Lebkuecher will continue to investigate the connection between language and motor domains by evaluating motor and language abilities in patients with aphasia or apraxia resulting from left-hemisphere stroke. Aphasia is an acquired language disorder that affects a person’s ability to express and understand language. Apraxia is a movement disorder where individuals have difficulty performing skilled movements. Dr. Lebkuecher also looks forward to continuing her research on analogous error patterns across motor planning and language domains. In this work, she will examine electroencephalography (EEG) signals to determine whether they reflect error detection in individuals with aphasia or apraxia caused by left-hemisphere stroke, as well as in neurotypical individuals.

In the long term, Dr. Lebkuecher hopes to develop a research program that will elucidate the connection between language, motor planning, and other non-linguistic domains of cognition to improve our basic understanding of human cognition, as well as to inform rehabilitation treatments for individuals with various motor and cognitive deficits.

Mitchell Rosenthal, PhD, was an early pioneer in the field of traumatic brain injury (TBI) widely recognized for his contributions to the advancement of clinical exploration and therapeutic practice. He was influential in the founding of the National Head Injury Foundation (now the Brain Injury Association of America), the creation of the Journal of Head Trauma Rehabilitation, and the development of the national TBI Model System (TBIMS) National Database (NDB). After he passed away in 2007, in recognition of his invaluable contributions to the TBIMS and the NDB, the TBIMS established the Rosenthal Award in 2008 to keep Dr. Rosenthal’s memory alive and to inspire new generations of investigators. Each year, a committee reviews all papers that were published in the prior calendar year and rates them on 3 criteria: importance, technical quality, and writing quality. The top ranked paper is named the Rosenthal awardee for that year.

The 2022 recipient of the Rosenthal award is MRRI Institute Scientist Amanda Rabinowitz, PhD. She was recognized for her publication in the Journal of Neurotrauma entitled, “Aging with Traumatic Brain Injury: Deleterious Effects of Injury Chronicity Are Most Pronounced in Later Life.” In this paper, Dr. Rabinowitz and her collaborators attempted to disentangle potentially distinct effects of age and brain injury chronicity (the amount of time that has passed since injury) on TBI outcomes. There is evidence that both advancing age, and processes initiated by neurotrauma that unfold over time may contribute to brain health, which in turn impacts functional status, disability, and an individual’s ability to participate in society. In a large sample including 3,986 individuals who had sustained a moderate to severe TBI, followed either 2- or 10-years post-injury, Dr. Rabinowitz and colleagues found that both older age and greater injury chronicity were related to greater poorer outcomes. Furthermore, the adverse effects of chronicity were most pronounced among individuals who were 75 years old or older. Dr. Rabinowitz is very honored to receive this award alongside fellow MRRI Institute Scientist Umesh Venkatesan, PhD, and MossRehab clinician Thomas Watanabe, MD, as well as colleagues at Icahn School of Medicine at Mount Sinai, TIRR Memorial Hermann, Spaulding Rehabilitation Hospital, JFK University Medical Center, Indiana University, and University of Alabama who were co-authors on the paper.  “It has been rewarding to work on this project with such talented collaborators, and it means a lot to me to have our work recognized with this award. We look forward to continuing to advance our understanding of traumatic brain injury and the factors that impact TBI outcomes,” remarks Dr. Rabinowitz.

Haley Dresang, PhD, began her postdoctoral fellowship at Moss Rehabilitation Research Institute (MRRI) in August of 2020. Since then, she has worked under the guidance of her mentors Laurel Buxbaum, PsyD, and Roy Hamilton, MD, MS, to further develop her research investigating the neural networks related to semantic knowledge of actions and events in language processing, as well as to examine the neuroplasticity and reorganization of these networks in individuals with stroke and neurodegenerative conditions.

We are excited to congratulate Dr. Dresang as she prepares to begin her next position as an Assistant Professor in the Department of Communication Sciences and Disorders at the University of Wisconsin-Madison. Dr. Dresang will launch her independent research lab there and teach about the neural mechanisms of speech and language disorders.

Before beginning her postdoctoral fellowship at MRRI, Dr. Dresang received her PhD in Communication Science and Disorders with a neuroscience concentration from the University of Pittsburgh and her bachelor’s degree in Communication Sciences and Disorders, as well as Spanish Language and Hispanic Studies, from the University of Wisconsin-Madison. Dr. Dresang grew up in Wisconsin, and she is looking forward to returning to Madison as a faculty member at her alma mater.

The goals of Dr. Dresang’s new research lab are to advance our understanding of the brain and how treatments can facilitate language recovery and successful communication strategies in individuals with neurogenic communication disorders. MRRI is pleased to have the opportunity to train and learn from talented postdoctoral fellows like Dr. Dresang who will go on to make important contributions to the field of neurorehabilitation.

Masahiro (Masa) Yamada, PhD, joined Moss Rehabilitation Research Institute (MRRI) as a postdoctoral fellow in December 2021, and he has been contributing to the exceptional stroke research team at MRRI. Dr. Yamada is working under the mentorship of Shailesh Kantak, PT, PhD, who is an Institute Scientist and Director of the Neuroplasticity and Motor Behavior Laboratory.

Dr. Yamada was awarded his BS from California State University, Northridge, majoring in Kinesiology. He received his MS in Exercise Science and Motor Learning from Southern Illinois University, Carbondale. His early research focused on the effect of directing one’s attention to different aspects of movements (i.e., attentional focus) on performance and injury prevention. Dr. Yamada was awarded his PhD in Kinesiology and Applied Neuromechanics from the University of North Carolina at Greensboro in 2020. His dissertation research examined the effect of attentional focus on perception, motor control variability, and skill acquisition. Dr. Yamada joins MRRI after serving as a lecturer and postdoctoral fellow at the University of North Carolina at Greensboro.

His prior research has shown that attending to bodily movements disrupts performance, but the effects may be mediated by practice. In his previous postdoctoral fellowship, the research team has shown that motor dysfunctions from a concussion can be detected by quick, objective, portable, and cost-effective biomechanical analyses using a smartphone.

Through his postdoctoral fellowship at MRRI, Dr. Yamada hopes to integrate his experience in biomechanics and kinesiology with neuroscience focused on motor skill acquisition and rehabilitation by working with relevant researchers at MRRI.

The long-term goal of Dr. Yamada’s research is to develop an effective instructional strategy for practitioners (e.g., physical therapists, occupational therapists) that maximizes motor skill learning/re-learning in patients with movement impairments or disorders.

Primary progressive aphasia (PPA) is a cluster of neurodegenerative disorders characterized by insidious loss of speech and language, which over time severely impairs the ability to articulate, remember words, understand others, and in some cases even comprehend the use for common objects, like a spoon or a key. There are several variants of PPA, which are associated either with Frontotemporal Degeneration, the most common form of dementia for people under the age of 60 (theaftd.org), or, in some cases, Alzheimer’s Disease pathology. While knowledge of PPA has begun to increase in the healthcare community, it can still take more than three years for families to receive an accurate diagnosis, delaying access to treatment. Due to the young-onset of PPA, difficulty accessing resources is further exacerbated by the fact that many caregivers are still working full time to support families that may include young children.

To assist in bridging this critical gap in services within the greater Philadelphia community and beyond, the MossRehab Aphasia Center developed a program called the Strategy Training and Education Program for People Living with Primary Progressive Aphasia (STEP-LPPA). This pilot program, funded by the Albert Einstein Society, provides communication, psychosocial, and educational support to individuals with PPA and their primary care/communication partners. Participants receive individualized training and information regarding support services in a service-delivery model designed to maximize building friendships and a community for long-term support. Direct programming occurred over the course of approximately one month in the late spring of 2022, with follow-up support sessions planned through November 2022.  Participants with a diagnosis of PPA and their communication partners provided feedback throughout the course of the month-long program and will continue to have the opportunity to share their thoughts and advice.

People with PPA

“I think this is what we have to have. When we started, it [PPA] was weird, now it is not.”

“I have taken so much. I didn’t know what it [PPA] was, but now … It is very comforting.”

Communication Partners

“I feel like I’ve become a better caregiver”

“There are things I have never said to anyone else that I have said in this group.”

“We’re so grateful to each of the pilot participants for their dedication to the program and their willingness to provide us with such informative feedback. It was a true pleasure getting to know each of them.” says Sharon M. Antonucci, PhD, CCC-SLP, Director of the MossRehab Aphasia Center.

This article was adapted from an article originally published in the 2022 MRRI Letters annual newsletter.

MossRehab Aphasia Center Director Sharon M. Antonucci, PhD, CCC-SLP, was recently invited by the National Aphasia Association to present as part of their “Ask the Expert” webinar series. This series uses an interactive format to connect people with aphasia with experts in a variety of aphasia-related clinical and research fields. In her presentation, Dr. Antonucci discussed animal-assisted therapy, historical evidence supporting this form of therapy, and her current research on aphasia rehabilitation using animal-assisted therapy.

You can watch the full webinar on the National Aphasia Association’s YouTube Channel.

A person’s ability to properly coordinate their movements as they go through their daily life relies on a part of the brain called the cerebellum. Cerebellar ataxia is a movement disorder that results when the cerebellum is damaged. People with cerebellar ataxia have difficulty controlling their balance, and their walking can have a “drunken” appearance. Damage to the cerebellum also impairs the control of reaching movements, eye movements, and speech.

There are a host of genetic conditions that can cause a progressive degeneration of the cerebellum, and these conditions affect many people around the world. In the United States alone, it is estimated that between 15-20,000 people have autosomal dominant spinocerebellar ataxias, and tens of thousands more are affected by autosomal recessive and sporadic ataxias.

Currently, there are no medications that are effective in treating the broad movement incoordination associated with cerebellar ataxia. This leaves physical and occupational therapy as the main options for managing the condition. However, current therapy interventions often show limited success.

Rehabilitation for cerebellar ataxia is challenging because cerebellar damage impairs an important mechanism for learning to alter movement patterns, called adaptation. For the past few years, Amanda Therrien, PhD, Director of the Sensorimotor Learning Laboratory at Moss Rehabilitation Research Institute (MRRI), has been studying whether people with cerebellar degeneration can leverage a different mechanism, called reinforcement learning, to change their movement. This work has shown that reinforcement learning is less dependent on cerebellar integrity than adaptation and that people with cerebellar degeneration can use reinforcement learning to change their movement patterns.

Despite showing promise for most people with cerebellar degeneration, Dr. Therrien’s research has revealed some variability in the responses to reinforcement learning interventions. That is, some people with cerebellar ataxia learn more with this training than others. The ability to predict which people are likely to benefit most from reinforcement learning is a critical step in translating this kind of training to interventions that could be useful in clinical settings.

Reinforcement learning depends on excitatory plasticity in a region of the brain called the primary motor cortex. The cerebellum is highly connected with the primary motor cortex, and cerebellar damage can alter primary motor cortex activity in a way that may hinder the plasticity needed to leverage reinforcement learning. Dr. Therrien recently received a grant from the National Center for Neuromodulation for Rehabilitation to use non-invasive brain stimulation to study changes in primary motor cortex activity in people with degenerative cerebellar ataxia. MRRI Institute Scientist Shailesh Kantak, PT, PhD, is a co-investigator on the grant, and MRRI Director Dylan Edwards, PhD, will serve as a consultant on the project. The project will determine whether these changes can predict responsiveness to a reinforcement learning intervention.

Mobile health (mHealth) has tremendous potential to change the nature of health care worldwide, and different mHealth approaches are being explored for a wide variety of health conditions. Amanda Rabinowitz, PhD, is Director of the Brain Injury Neuropsychology Laboratory at Moss Rehabilitation Research Institute (MRRI), and her work has been examining how mHealth technology can be used to improve outcomes for people following traumatic brain injury (TBI). Dr. Rabinowitz served as a guest editor for the latest issue of The Journal of Head Trauma Rehabilitation, a leading peer-reviewed journal focused on the clinical management and rehabilitation of people with TBI. The Journal of Head Trauma Rehabilitation is the official academic journal of the Brain Injury Association of America.

As guest editor of this issue, Dr. Rabinowitz and Shannon Juengst, PhD, of UT Southwestern Medical Center worked to assemble a collection of articles from top scientists examining important areas of research related to the use of mHealth for TBI rehabilitation. Dr. Rabinowitz is lead author on one of the featured articles in this issue, and she is a co-author on another article. In the first article, Dr. Rabinowitz and colleagues describe their work developing and testing a chatbot (called RehaBot) that can communicate with users with TBI to provide reminders, encouragement, and supportive feedback. RehaBot is being designed to augment face-to-face therapy to reduce depression and increase participation in people with moderate-to-severe TBI.

In the second article, Dr. Rabinowitz and colleagues investigated the feasibility of remote collection of data on neurobehavioral symptoms and heart rate variability via a commercially available wearable device. Their work suggests this method of data collection is feasible, and heart rate variability has potential to be used as a physiological biomarker or neurobehavioral symptoms.

Through opportunities such as serving as guest editors for academic journals, MRRI scientists are continuing to lead and guide research in their respective fields with the ultimate goal of advancing neurorehabilitation treatments to improve the lives of patients.