The Achievements and Significance of the Moss TBI Model System

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

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

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


Integrating Rehabilitation Research and Clinical Care

MRRI researcher looking at a pamphlet with a research participant.

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

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

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

Attitudes and Leadership

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

Time and Money

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

Structures and Processes

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

Ethics and Communication

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


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

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

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

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

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


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

Three individuals looking at a computer screen together.

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

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

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

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

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

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


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

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

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

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


The Sensorimotor Learning Laboratory Brings Expertise in Cerebellar Ataxia to MRRI

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

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

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

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

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

Dr. Therrien is not the only MRRI scientist with experience conducting research on Ataxia. Aaron Wong, PhD, Director of the Cognitive Motor Learning Laboratory and Scientific Director of the Klein Family Parkinson’s Rehabilitation Center at MossRehab, has also done important work investigating the role of the cerebellum in eye movement control and movement learning in people with Ataxia. To get involved or learn more about Ataxia research at MRRI, you can follow us on Twitter]  and Facebook. You can also learn more about Dr. Therrien’s research and the Sensorimotor Learning Laboratory, as well as Dr. Wong’s research and the Cognitive Motor Learning Laboratory on our website.


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.