New Research Aims to Predict Residual Motor Learning Capacity After Cerebellar Damage

Damage to a brain structure called the cerebellum causes a movement disorder called Ataxia. Derived from the Greek word for “lack of order,” Ataxia is marked by poor movement coordination. Ataxic movements have a “drunken” appearance, with lateral veering and oscillations. Many neurologic conditions such as stroke, multiple sclerosis, traumatic brain injury, and a host of genetic conditions can cause damage to the cerebellum, and the individuals affected often have disabling Ataxias that impair their balance, walking, arm movements, and speech. According to the U.S. National Ataxia Foundation, 15,000 – 20,000 people are estimated to have autosomal dominant genetic Spinocerebellar Ataxias in the United States, and tens of thousands more are affected by recessive and sporadic genetic ataxias, as well as other conditions that cause cerebellar damage.

There are no medications to treat Ataxia, leaving rehabilitation therapies like physical, occupational, and speech-language therapies as the only option for symptom management. However, rehabilitation outcomes are mixed in this population, with many individuals not benefiting from current intervention techniques. One reason for this may be that, in addition to its role in movement control, the cerebellum is critical to an important mechanism for learning new movement patterns. Many rehabilitation interventions try to train the brain to move the body in different ways to help compensate for neurologic conditions, and often, these techniques leverage the learning mechanism that depends on the cerebellum.

Research by Amanda Therrien, PhD, Director of the Sensorimotor Learning Laboratory at MRRI, has investigated whether a new training technique using binary reinforcement could help people with Ataxia improve their movement control. Using a combination of virtual reality and motion capture technology, binary reinforcement training aims to leverage a brain mechanism for learning new movements that does not depend as heavily on the cerebellum. Prior work from Dr. Therrien, published in the journals Brain and The Cerebellum, established that individuals with Ataxia can use binary reinforcement training to learn to adjust their arm movements and that it can be leveraged to help improve arm movement control. These findings emphasize that binary reinforcement training warrants further research to determine whether it can be applied to improve rehabilitation therapy for Ataxia more broadly.

One question that came out of Dr. Therrien’s previous work is related to the finding that, while most individuals with Ataxia were able to learn with binary reinforcement, a small percentage of study participants did not benefit from the training. The difference in training outcomes across individuals could not be explained by the severity or type of Ataxia, suggesting that the root cause of this variability in outcomes was more complex. Understanding the causes of variability in outcomes across individuals would advance our understanding of which individuals are most likely to benefit from binary reinforcement training, allowing streamlined screening for clinical trials as well as informing future work investigating whether the training technique can be modified to improve outcomes in individuals who respond poorly to the current protocol.

This past year, Dr. Therrien’s research group published a new study in the journal The Cerebellum that tested whether the historically underappreciated role of the cerebellum in movement perception could explain differences in learning across individuals. Movement perception relies heavily on a sense called proprioception (also called kinesthesia), which is how your brain knows where your body is in space when vision is absent. It is thanks to proprioception that you still know where your feet are, even though you may not be looking at them while reading this article. Proprioception is important for binary reinforcement training because the technique reduces visual information about movement outcomes to reduce dependence on cerebellum-dependent learning. Although cerebellar damage doesn’t impair primary proprioception (people with Ataxia have a normal sense of where their body is in space when they are not moving or if they are passively moved by another person or a device), it can interfere with proprioception when moving voluntarily. The degree to which cerebellar damage can interfere with the perception of voluntary movement varies across individuals and, like the response to binary reinforcement training, is not easily explained by Ataxia type or severity.

In Dr. Therrien’s recent study, a group of individuals with Ataxia performed a short binary reinforcement training task that required them to learn a new reaching movement. They then completed an assessment of their movement perception that tested the difference in proprioception between a condition in which they were passively moved by a robotic device and a condition in which they moved voluntarily. Dr. Therrien’s research group analyzed the relationship between the magnitude of learning achieved in the binary reinforcement task and performance in the movement perception assessment. The study team also included other variables in their analysis, such as the severity of participants’ arm movement impairment, their age, and their movement speed in the binary reinforcement task, to determine whether they also played a role in learning. The results showed a strong relationship in which a greater impairment in the perception of voluntary movement relative to the perception of passive movement was associated with a reduced response to binary reinforcement training. Replicating prior findings, none of the other variables tested exhibited relationships with the training outcome.

Overall, the findings suggest that tests of proprioception of voluntary movement may one day serve as a metric to predict which individuals with Ataxia might benefit from binary reinforcement training. This line of research in MRRI’s Sensorimotor Learning Laboratory is answering important questions that are critical for better understanding motor learning in order to develop more effective and more personalized treatments approaches for people with Ataxia.


Clinical Trials at MRRI are Advancing Treatments for Neurological Conditions

Institute Scientists at MRRI, many of whom also hold faculty appointments within the Department of Rehabilitation Medicine at Thomas Jefferson University, are engaged in important clinical trials testing novel treatment approaches to improve outcomes of patients after stroke, spinal cord injury, phantom pain after limb amputation, and other conditions. In celebration of National Clinical Trials Day on May 20th, MRRI is pleased to highlight current clinical trials and acknowledge the important contributions of volunteers who participate in these trials.

Assessing an Animal-Assisted Treatment Program for Adults with Aphasia: The Persons with Aphasia Training Dogs Program

Aphasia is an acquired language impairment characterized by difficulty with word retrieval, and in some cases, difficulty constructing grammatically complete sentences or with auditory comprehension. People living with aphasia report its consequences reach far beyond linguistic, including loss of identity, engagement, and quality of life. This clinical trial, led by MossRehab Aphasia Center Director Sharon M. Antonucci, PhD, CCC-SLP, will determine the feasibility and potential benefits of the Persons with Aphasia Training Dogs (PATD) Program. Founded in the Life Participation Approach to Aphasia, and working from a strength, rather than deficit, perspective, PATD harnesses the pragmatic skill of persons with aphasia, which is critical to working with dogs, and capitalizes on mechanisms of action for animal-assisted treatment, to ameliorate psychosocial consequences of aphasia. The study will determine whether persons with aphasia can implement positive reinforcement techniques to train dogs in basic obedience skills and define participant characteristics associated with positive response to the intervention. This trial is a crucial first step toward the long-term goal to augment the evidence base with well-specified animal-assisted intervention protocols that target the psychosocial consequences of aphasia.

Criterion-learning Based Naming Treatment in Aphasia

Aphasia most commonly occurs following a stroke. The overarching goal of a clinical trial led by Erica Middleton, PhD, is to develop and test early efficacy, efficiency, and the tolerability of a lexical treatment for aphasia in multiple-session regimens that are comprised of retrieval practice, distributed practice, and training dedicated to the elicitation of correct retrievals. The aim of this work is to add to and refine the evidence base for the implementation and optimization of these elements in the treatment of production and comprehension deficits in aphasia, and make important steps towards an ultimate goal of self-administered lexical treatment grounded in retrieval practice principles to supplement traditional speech-language therapy that is appropriate for People with Aphasia from a broad level of severity of lexical processing deficit in naming and/or comprehension. This project cumulatively builds on prior work to develop a theory of learning for lexical processing impairment in aphasia that aims to ultimately explain why and for whom familiar lexical treatments work, and how to maximize the benefits they confer.

Efficacy and Optimization of Speech Entrainment Practice for People with Aphasia

Research has shown that people with chronic aphasia can benefit from treatment, but significant communication challenges often persist after therapy concludes. A clinical trial led by Marja-Liisa Mailend, PhD, aims to test and develop a promising treatment technique, termed speech entrainment, to enhance treatment outcomes for people with aphasia. Speech entrainment refers to speaking in unison with a model speaker by imitating the model in real time. Research has shown that speech entrainment is a ground-breaking technique for prompting connected speech in people with aphasia. The immediate stimulation effect of speech entrainment is well-documented. The present clinical trial will expand on prior findings to determine the direct effect of speech entrainment practice on independent speech production after the entrainment support is removed. The research team will also identify conditions that enhance treatment benefits and examine participant profiles associated with a positive treatment response. Findings from this study will help inform and enhance rehabilitation for individuals with aphasia.

GetUp&Go: A Randomized Controlled Trial of an Intervention to Enhance Physical Activity After TBI

An active lifestyle is known to provide wide-ranging benefits, from lowering the risk of chronic diseases to fostering emotional resilience and mental well-being. For people with moderate to severe traumatic brain injury (TBI), the challenge of meeting recommended activity levels is compounded by mobility limitations, pain, and the loss of social opportunities. The goal of this clinical trial, led by Amanda Rabinowitz, PhD, is to evaluate GetUp&Go, a program to promote increased physical activity in individuals after TBI. GetUp&Go is a remotely delivered program that includes one-on-one sessions with a therapist and a mobile health application (RehaBot). This clinical trial will determine whether the GetUp&Go program increases physical activity and improves mental and physical health in participants, compared to individuals who are put on a waitlist. The study team will also examine whether continued access to RehaBot helps maintain physical activity gains, as well as participant characteristics associated with treatment response. Their findings will inform the development of interventions to facilitate lasting increases in physical activity after TBI.

NIBS Therapy in Subacute Spinal Cord Injury (NIBS-SCI1)

Currently, no approved clinical therapies exist for repair of motor pathways following spinal cord injury (SCI) in humans, leaving permanent disability and devastating personal and socioeconomic cost. Promising findings from pre-clinical studies support that non-invasive brain stimulation (NIBS) may facilitate neural repair following spinal cord injury (SCI). Dylan Edwards, PhD, is leading a clinical trial to begin translating findings from pre-clinical studies to human motor deficits following SCI. This preliminary study will evaluate the effects of a novel non-invasive high-frequency repetitive transcranial magnetic stimulation protocol on arm motor function in people with cervical spinal cord injury. The treatment will involve daily transcranial magnetic stimulation sessions at the inpatient rehabilitation facility. Results from this study will establish the clinical effect size of the intervention, determine the safety and feasibility necessary for a subsequent controlled efficacy trial, and inform preclinical studies for the optimization of dosing.

Transcranial Direct Current Stimulation for Post-stroke Motor Recovery (TRANSPORT 2)

Dr. Edwards is also site principal investigator for a multi-site clinical trial led by Wayne Feng, MD (Duke University). This clinical trial aims to determine if non-invasive brain stimulation at different dosage levels, combined with an efficacy-proven rehabilitation therapy, can improve arm function. The stimulation will be delivered via transcranial direct current stimulation (tDCS), which uses direct currents to stimulate specific parts of the brain affected by stroke. The adjunctive rehabilitation therapy that will be used is called “modified Constraint-Induced Movement Therapy” (mCIMT). During this therapy participants will wear a mitt on the hand of the arm that was not affected by a stroke and will have to use the weaker (more affected) arm. The study will test three different doses of brain stimulation in combination with mCIMT to determine which dose is most effective at improving arm function. Results from this research will help optimize the parameters for non-invasive brain stimulation treatments to enhance motor recovery after stroke.

Virtual Reality Treatment of Phantom Limb Pain

After amputation of an arm or leg, up to 90% of individuals experience a “phantom limb”, a phenomenon characterized by persistent feelings of the missing limb. Many people with a phantom limb experience intense pain in the missing limb that often responds poorly to medications or other interventions. An NIH-funded multi-site clinical trial (NCT05296265) led by Laurel Buxbaum, PsyD, and Branch Coslett, MD (Penn Medicine), is contrasting the efficacy of two virtual reality (VR) treatments for phantom leg pain: an Active VR treatment and a ‘Distractor’ treatment. In the Active VR treatment, participants play a series of novel VR games that provide a realistic rendering of both legs while participants are actively engaged in rewarding VR sports challenges, puzzles, and other immersive activities requiring leg movement. In the Distractor treatment, participants feel passively transported through an immersive VR experience that does not require leg movements. The study is providing important information on how the two types of VR interventions impact pain, psychological health, and quality of life for people with phantom limb pain to inform the optimal clinical treatment of this debilitating condition.


MRRI Scientists Awarded Albert Einstein Society Research Grants

MRRI is pleased to announce the recent receipt of new grants from the Albert Einstein Society to support research studies led by two of the Institute’s postdoctoral fellows.

One of the grant awards will fund a project led by Anna Krason, PhD, with MRRI Institute Scientist Erica Middleton, PhD, as co-investigator. This study will examine the process of conflict adaptation in people with post-stroke aphasia, a language and communication disorder that affects their ability to produce and understand language. While language production deficits have been extensively studied, language comprehension deficits have received limited attention in research and treatment. Moreover, comprehension deficits are multi-determined in that difficulties in comprehension frequently stem from impairments in other modalities, including executive functions. Understanding the underlying mechanisms and factors involved in comprehension deficits is therefore crucial for effective interventions to improve language comprehension.

It has been established that cognitive control, an executive function that enables the detection, revision, and resolution of conflicts between mental representations, plays a pivotal role in language comprehension. Dr. Krason’s study will provide important preliminary knowledge regarding conflict adaptation and whether particular individuals with aphasia could benefit from this potential treatment approach. Specifically, the study will address the question of whether upregulating cognitive control can optimize comprehension in at least some people with aphasia. Drs. Krason and Middleton will also conduct thorough background testing, providing initial observations into linguistic, cognitive control, and neurophysiological traits of individuals who show (or do not show) conflict adaptation. Together, the findings from this study will lay the groundwork for future research to inform patient selection and the development of a new theory-grounded conflict adaptation training for neurorehabilitation of individuals with aphasia after stroke.

As principal investigator of a separate grant award, Simon Thibault, PhD, will work with MRRI Institute Scientist co-investigators Aaron Wong, PhD, and Laurel Buxbaum, PsyD, on a study to clarify the mechanism underlying errors commonly seen in the performance of naturalistic actions (i.e., preparing breakfast and packing a lunchbox) in people with left-hemisphere stroke. Impairments in the ability to perform activities of daily living, such as preparing a meal, have been widely reported after stroke. These impairments are unrelated to underlying motor impairments, such as hemiparesis, as they can be observed when individuals are required to only use their ipsilesional, non-paretic (less-affected) arm.

Although such errors are frequently attributed to an underlying sequencing deficit – i.e., an inability to represent sequential orderings of events – other findings suggest that individuals with left-hemisphere stroke may not be impaired at learning simple finger-tapping sequences. In contrast, individuals with left-hemisphere stroke also frequently exhibit limb apraxia (30-50% of individuals), a disorder characterized by slowed or failed retrieval of single tool-use actions (e.g., stirring with a spoon). To identify the mechanism giving rise to ordering errors in naturalistic actions, the study team will first examine the pattern of impairments across a series of sequencing tasks of increasing complexity. They will then correlate those impairments with performance in naturalistic actions within the same group of individuals with left-hemisphere stroke. This research will address a critical gap in the understanding of impairments in naturalistic actions in individuals following left-hemisphere stroke. It will also bring together two lines of study that have thus far largely been examined separately: naturalistic actions and action sequencing. Ultimately, research in this area will aid in developing rehabilitation techniques that better target the deficits underlying the inability to perform activities of daily living in individuals after stroke, particularly for those who have limb apraxia.


MRRI Participant Spotlight: Jennifer Derry

Research has been a part of Jennifer Derry’s life for many years, even before she was diagnosed with a stroke and aphasia, a condition that impacts a person’s ability to express and understand language.

When Jenn was in college, she participated in research studies in the areas of neuroscience, psychology, and cognition. Later, she worked for a company that did clinical research for mental health conditions, such as depression and bipolar disorder.

Following her stroke, Jenn spent about a month in inpatient rehabilitation at Moss. Afterwards, she was excited to have the opportunity to participate in research at MRRI. “My experience as a participant in MRRI research has been positive. Not only is it stimulating and exciting for me, but it helps to keep me sharp and keep learning,” she said.

Recently, Jenn participated in a study exploring an animal-assisted treatment program for individuals with aphasia called The Persons with Aphasia Training Dogs (PATD) Program. In this study, led by Sharon Antonucci, PhD, CCC-SLP, individuals with aphasia learn and implement positive reinforcement techniques to train dogs in basic obedience skills. The goal is to harness the strengths of individuals with aphasia and the benefits of human-animal interactions to target treatment of some of the psychosocial consequences of aphasia, such as social isolation and loss of self-confidence.

Jenn participated in the program with her dog Lola (pictured above). “We both benefited from it,” Jenn noted. “It helped me practice training with my dog and learn spoken commands. I really loved the study, and I felt proud when I was able to complete it, she continued.”

Beyond her involvement in research studies at MRRI, Jenn has been actively involved in activities at the MossRehab Aphasia Center. She discovered the Virtual Reta’s Games Group during the COVID-19 pandemic. “As horrible as covid was, there was also a bright side for me, because I was brought together with wonderful people and given the opportunity to meet virtually,” she explained.

Each week the Aphasia Center holds Reta’s Games Group meetings where participants engage in card games, board games, and discussions that allow people to practice their communication skills while having fun together. When reflecting on her experiences at these meetings, Jenn said, “I really enjoy the Virtual Reta’s Games Group. Everyone is very welcoming — the host Roberta Brooks, every person with aphasia, and specifically the facilitator Nikki Benson-Watlington who brings her happiness and support to others with her warm-heartedness, consideration, and positivity.”

Through activities at the MossRehab Aphasia Center and research studies at MRRI, Jenn has been able to connect with other individuals with aphasia and continue to make progress towards her communication goals. Jenn is also a co-founder of the Mid-Atlantic Aphasia Conference, an education and advocacy for people living with aphasia in the Tri-State area.  Her advice for others with aphasia speaks volumes about the value of these opportunities. “Do it all!!! Research and activities,” Jenn advised. She went on to explain that “You will be associating with other people who have aphasia. You will have fun and be involved with skilled professionals who are knowledgeable and caring.”

The MossRehab Aphasia Center prides itself on being a warm and welcoming place where people with aphasia and their friends and families can get information and support to help meet their long-term communication and psychosocial needs. The Aphasia Center also provides excellent opportunities for members to get involved in research and treatment programs. MRRI is grateful for the important contributions of research volunteers, and the Institute is honored to be a part of their journey of rehabilitation and recovery.


MRRI Participates in Parkinson’s Disease Outreach in Philadelphia

Researchers and clinicians at MRRI and Jefferson-Moss Magee Rehabilitation participated in a community event this past weekend. The event, “Movement and Memory: Navigating Parkinson’s and memory disorders”, was organized by the Delaware Valley Endeavor for Racial Solidarity in PD (Diversity PD). Diversity PD is a collaborative effort led by the Parkinson Council to provide education and resources for people of color. The purpose of this Saturday’s event was to provide support, education, and resources to individuals from underserved communities who are living with Parkinson’s disease. The event included education from local experts, open sharing sessions, audience Q&A, a performance by a member of the ParkinSINGERS Choir, and time to visit and chat with some local community organizations. The group from MRRI and Jefferson-Moss Magee Rehabilitation, which included Aaron Wong, PhD, Jonathan Wood, PhD, and Michele Aguado, PT, had the opportunity to share and promote the many resources offered here for those living with Parkinson’s disease.

In addition to physical, occupational, and speech therapies at various Jefferson-Moss-Magee Rehabilitation locations, resources here include:

  • A weekly maintenance program designed to help individuals with PD stay active and continue exercising after a bout of therapy is complete.
  • The Klein Family Parkinson’s Rehabilitation Center Clinic, a free multidisciplinary clinic designed to provide recommendations to address goals that might otherwise be challenging to recognize or achieve by one discipline alone, and to create a space where people with Parkinson’s disease and caregivers can ask questions and learn more about what to expect with this disorder
  • A support group for both individuals living with Parkinson’s disease and their caregivers.
  • Information about the research studies currently being conducted as well as opportunities to participant in future research by signing up for the MRRI Research Registry.

Participating in the event is part of an ongoing effort by researchers at MRRI to diversify the individuals who participate in the Institute’s research studies, particularly those living with Parkinson’s disease. This is important because individuals who are included in research studies should represent the community of individuals living with the disease so that research findings are applicable to all individuals with the disease. MRRI scientists were honored and excited to be a part of this event and look forward to future opportunities to share these outstanding clinical and research resources with the community.


Dr. Dylan Edwards Invited to Present TMS Updates at the American Academy of Neurology Annual Meeting

The American Academy of Neurology recently held its 76th Annual Meeting, a hybrid event held in person in Denver, Colorado, with online content available to remote attendees as well. Dylan Edwards, PhD, was among six speakers invited to present in the “Neurology Year in Review” plenary session on April 18th. The speakers discussed the latest developments in a broad range of clinically relevant topics: Car-T cell therapy, gene transfer therapy, migraine management, Long-COVID and the autonomic nervous system, transcranial magnetic stimulation (TMS), and the future of amyotrophic lateral sclerosis (ALS).

In his presentation on TMS, Dr. Edwards highlighted recent technical advances that have resulted in improved electrical field modeling for the targeting of stimulation. He described how TMS can be now used to localize muscle representations on the primary motor cortex in three dimensions for an individual based on their own cortical anatomy.1 This approach is more accurate and personalized compared to prior targeting methods where an estimate of the center of the TMS coil and the electric field would be generated and mapped based on the depth of stimulation in two dimensions. This is a transformative advance, but it requires substantial analysis and computation. which can take several hours or more.

To overcome computational barriers to make the approach more clinically relevant, Dr. Edwards explained how researchers developed a fast, accurate TMS solver that can now determine TMS electrical fields for any coil type in near-real time.2 This represents a substantial breakthrough that could allow clinicians to have an estimate of electric field distribution in a region of interest in a matter of seconds. Other important developments in the field that Dr. Edwards featured were the use of robotic arms for automated precision-targeting (including his own research being conducted at MRRI), as well as emerging technology that shows an alternative approach with static multi-coil arrays.3-4

Dr. Edwards also shared progress in research using repetitive TMS (rTMS) for neuromodulation to facilitate motor recovery after stroke and spinal cord injury. Clinical and translational studies using TMS are showing benefits for recovery of motor function when treatment is started early in post-stroke recovery.5 Future work in this area will continue to pursue individualized targeting and parameter selection based on contemporary theory, potentially selecting targets based on neural networks.

Dr. Edwards finished his presentation by sharing research that he and colleagues have been working on using rTMS to facilitate regeneration and recovery after spinal cord injury. Following promising results in animal models,6 Dr. Edwards is now translating this rTMS protocol in a phase I randomized controlled trial in patients with spinal cord injury.

Substantial headway has been made in TMS research within the past year, and this continues to be a growing field of study with broad potential clinical relevance spanning diagnostic, prognostic, and therapeutic applications. Dr. Edwards’ presentation was well-received by a large audience attending this session. The American Academy of Neurology’s Annual Meeting is the largest international meeting of neurologists and neuroscience professionals in the world, and the selection of TMS as one of the six hot topics to feature in this year’s “Neurology Year in Review” plenary session further attests to the significance of this technology in neurology and beyond.

 

References:

1) Weise, et al., Nature Protocols, 2023

2) Makaroff, et al., Scientific Reports, 2023

3) Navarro de Lara et al., NeuroImage, 2021

4) Daneshszand et al., Brain Stimulation, 2023

5) Vink et al., Stroke, 2023

6) Boato et al., Science Translational Medicine, 2023

Photos courtesy of the American Academy of Neurology


MRRI’s Sensorimotor Learning Laboratory Welcomes a New Research Assistant

Led by Amanda Therrien, PhD, the Sensorimotor Learning Laboratory at MRRI conducts research to improve motor rehabilitation protocols for individuals with neurological disorders by enhancing our understanding of the precise sensory and motor control mechanisms that underlie their behavioral impairments. MRRI is pleased to welcome Alyssa Eyssalenne to the Institute in her new role as a Research Assistant working with Dr. Therrien.

Ms. Eyssalenne graduated from Temple University in 2021 with a B.S. in Neuroscience with a focus in Systems, Behavior, and Plasticity. During her undergraduate career, Ms. Eyssalenne interned at the Children and Adolescent Anxiety Disorder Clinic (CAADC) at Temple Health where she focused on data input and consolidation for clinic patients in behavioral therapy trials. As a student, Ms. Eyssalenne was also an executive member of the student organization for Caribbean awareness and the By Any Means Necessary dance company, from which she hopes to carry over her teamwork/team building and adaptability skills.

Prior to joining the MRRI team, Ms. Eyssalenne was a formulations technician at Charles River Laboratories in Horsham, PA. There, she performed basic to advanced drug formulation techniques for preclinical safety assessment in animal and in-vitro study models for review in reproductive, juvenile, and developmental toxicology. Ms. Eyssalenne became the technical team lead and further developed her regulatory and quality assurance skills as she performed preliminary data quality control, addressed study audits and deviations, and contributed to protocol/standard operating procedure development and review. After more than two years at Charles River Labs, Ms. Eyssalenne is eager to apply and shift her knowledge base to human research/trials as well as be a part of the clinical side of research.

At MRRI, Ms. Eyssalenne will be working with Dr. Therrien on her research in sensorimotor learning, with a focus on proprioception and adaptation learning in the upper limbs. Ms. Eyssalenne’s primary role in lab will be in conducting participant trials using equipment, such as the Kinarm Exoskeleton Robot.


A Beacon of Hope and Healing: Honoring the Enduring Legacy of Nancy Wachtel Shrier with Endowed Directorship

The Shrier Family

From Left to Right: Pete Shrier, Calvin Shrier, Shraddha Shrier, Lee Yonish, Nancy Shrier, Marc Shrier, Lucas Yonish, Zach Yonish, Wesley Yonish, Steve Yonish

In the serene surroundings of Elkins Park, Jefferson Moss-Magee Rehabilitation Hospital stands as more than a medical facility; it is a symbol of hope and healing, profoundly influenced by the compassionate spirit of Nancy Wachtel Shrier. Her connection to this institution was not just philanthropic—it was a vital part of her very being, a manifestation of her unwavering commitment to bettering the lives of others. This tribute, drawn from the rich tapestry of memories shared by her family, including her husband, Marc, and children, Peter Shrier and Lee Yonish, celebrates a woman whose empathy and dedication have indelibly shaped the essence of these institutions.

Marc Shrier’s voice softens with affection as he recalls his wife’s deep involvement with the institution. “Nancy was a whirlwind of activity at Moss, always looking for ways to contribute more meaningfully,” he says. This passion wasn’t solitary; it enveloped Marc, transforming him from a patient to an ardent supporter. Their collaborative efforts, notably their substantial contributions to Moss Rehabilitation Research Institute and the Shrier Family Topics in Rehabilitation Science Lecture Series, are now cornerstones of the institution.

Their children paint a vivid picture of a life exemplified by generosity and empathy. “Our parents cared deeply about a range of causes, but it was always done with so much love,” Lee reflects. Peter adds, “They have giant hearts, and that was evident in everything they did.” For them, Nancy was not just a mother but an exemplar of kindness, her life a lesson in the power of giving.

Nancy’s commitment to Moss Rehabilitation Research Institute and Jefferson Moss-Magee Rehabilitation – Elkins Park was characterized by her visionary approach and tireless dedication. The pinnacle of her contributions was the establishment of the Directorship in her name, a testament to her profound impact on the field of rehabilitation science. Dylan J. Edwards, PhD, the inaugural holder of this directorship, exemplifies the values and vision Nancy cherished, particularly in advancing rehabilitation research.

Her involvement went far beyond financial support; Nancy was a catalyst for innovation and growth. The Shrier Family Topics in Rehabilitation Science Lecture Series, an initiative she spearheaded, has become a tool for disseminating knowledge and fostering collaboration among experts worldwide. This series, along with her other endeavors, has significantly propelled the Institute’s standing in the global rehabilitation community.

Moreover, Nancy’s support was instrumental in developing programs that emphasized the importance of art and sports in rehabilitation. Her enthusiasm for All About Moss Through the Arts and the wheelchair tennis tournament at Penn reflected her belief in the resilience and capabilities of individuals, regardless of their physical challenges.

The legacy of Nancy within the walls of Jefferson Moss-Magee Rehabilitation Hospital – Elkins Park and Moss Rehabilitation Research Institute is both profound and enduring. The establishment of the Directorship in her name stands as a poignant homage to her relentless pursuit of progress in rehabilitation science. This directorship not only honors her memory but also serves as a beacon, guiding future innovations in the field.

Her children reflect on the enduring impact of these tributes. Lee observes, “The Directorship in our mother’s name is more than an honor; it’s a continuation of her life’s work, inspiring others to follow in her footsteps.” Peter adds, “It’s a living testament to her dedication and passion.”

Additionally, the staff and patients of the hospital often speak of Nancy’s influence. Rejoice Jula, the Director of Development, reminisces about Nancy’s readiness to assist in any capacity, underlining her indomitable spirit and dedication to service. These tributes collectively paint a picture of a woman whose life was defined by generosity, innovation, and an unwavering commitment to help others.

Nancy’s story is not just one of personal achievement but a narrative of unwavering compassion and philanthropy. Her profound dedication to Jefferson Moss-Magee Rehabilitation – Elkins Park and Moss Rehabilitation Research Institute has set a benchmark for future rehabilitation philanthropy. Her legacy, echoed in the corridors of these institutions and in the hearts of those she touched, serves as a powerful reminder of the transformative impact one individual can have. Nancy’s memory, defined by purpose and generosity, continues to inspire, and guide us in our efforts to support and uplift those in need.


Catching Up with Former MRRI Postdoc Frank Garcea, PhD

Finding the right mentor at the right time can have a tremendous impact on the trajectory of an early-career scientist. MRRI Institute Scientists are outstanding mentors who are invested in helping train the next generation of researchers in neuroscience and neurorehabilitation. Frank Garcea, PhD, was a postdoctoral fellow at MRRI from September 2017 through August 2020 under the mentorship of Laurel Buxbaum, PsyD, and he has been successful in establishing his independent research program at the University of Rochester Medical Center. In this interview, Dr. Garcea talks more about his experiences at MRRI and his current research.

Can you tell us more about your current position and what you are doing now?

After completing a three-year postdoctoral fellowship at MRRI in 2020, I moved to the University of Rochester Medical Center to begin a postdoctoral research position in the Neurosurgery Department. I then accepted a faculty position in the Neurosurgery and Neuroscience Departments in 2022. In my current position, I spearhead a cognitive neuroscience research lab composed of full-time research assistants, undergraduate students, master’s, MD, and PhD students.

What are your current research interests?

We use a range of neuroimaging and neuropsychological methods to study the structure and function of the human brain/mind. From a basic science perspective, our goal is to advance understanding of the cognitive systems supporting activities of daily life, like object manipulation and language production. Much of our work in this context uses functional MRI, diffusion tractography, and voxel-based lesion-symptom mapping to test hypotheses. One exciting problem we’re working on is to better understand how acquired brain injury to one area within a network can disrupt processing in areas outside the site of injury. This puzzling phenomenon is referred to as diaschisis, and its cognitive and neural bases have been investigated for over a century.

From a translational perspective, our goal is to use neuroimaging to support the planning of neurosurgical procedures here at the University of Rochester Medical Center. For example, if a patient has a brain tumor invading the motor cortex, my lab uses functional and structural MRI to identify where sensory, motor, and cognitive functions are represented in relation to the lesion. With this knowledge, our neurosurgery colleagues can tailor their surgical approach to avoid resecting cortical and subcortical tissues identified in our pre-operative mapping. As patients recover from their brain surgery, they are invited to take part in neuropsychological testing, which allows us to relate pre- and post-operative changes in cognitive function to the location of the lesion, the size of the neurosurgical resection, the type of brain pathology, etc.

What was it like working at MRRI and conducting research in MRRI’s Cognition and Action Lab?

Training at MRRI was a tremendous experience. I benefitted from a structured training plan, the regularly scheduled T32 lectures and workshops, and the opportunity to learn from experts in the cognitive and brain sciences. Working in Dr. Buxbaum’s lab was a fantastic experience on multiple levels. I was familiar with Dr. Buxbaum’s research interests, publications from her lab, and how research was conducted. Because of this, it was easy to embed my postdoctoral training within the broader goals of her lab, to collect neuroimaging and cognitive data, and to apply for extramural grants and publish manuscripts within a short time period.

Are there particular things you learned or skills you developed at MRRI that have helped you in your career?

I came to MRRI right after I finished my PhD. At the time, I understood that running a lab while competing for funding was a huge challenge. Because I had protected training time, I was able to learn how to write grants while also conducting research. I also learned that this is a skill that can take years to hone, so it was important to be patient and learn as much as possible while I had the protected time to do so. The experience was incredibly important for my career development, and I’m very appreciative of the faculty and staff at MRRI who took the time to review my grant proposals and provide critical feedback.

What were the next steps of your career after finishing your postdoctoral fellowship at MRRI?

This is the part of the story where my career development was affected by the COVID-19 pandemic. I finished my postdoctoral fellowship at MRRI in August of 2020. At that time, there were hiring freezes at universities across the country, which made finding another position challenging. I’m from Rochester, NY, and I did my PhD training at the University of Rochester. I moved back home in the spring of 2020 to be closer to family and was lucky to find a postdoctoral position in the Neurosurgery department here at the University of Rochester Medical Center (URMC). I then began writing grants immediately upon starting the position and was fortunate to secure a KL2 career development grant through the Clinical and Translational Science Institute here at URMC. This two-year fellowship provided vital resources to facilitate my career development and transition to a faculty position here at URMC.

Can you describe what it was like for you to launch your own independent research laboratory?

It’s rewarding and demanding all at once. With the KL2 funds, I was able to marshal resources and support to start building my lab. Hiring and training full-time research staff to coordinate day-to-day activities was a challenge because of COVID restrictions. Once I had staff trained and ready to go, my lab expanded in exciting ways. I was able to carve out some time to train undergraduate students and medical students working on projects. I’ve been fortunate to have kind and motivated students work in my lab. Probably the most rewarding aspect of running a lab is watching students develop their scientific skills and independence over time. Though it has been less than two years, I’m enjoying the environment, the culture of my lab, and the scientific content driving our projects forward.

What have been some of the biggest challenges you have had to overcome in your career or research?

Of the many challenges, I’d say the most challenging was recognizing and accepting my limitations. For years I’ve felt comfortable balancing the demands of multiple projects. Though it feels great to publish manuscripts and secure grant funding, this line of work can really wear one down without a proper work-life balance. As I started building my lab, I realized there are probably  5 – 10 tasks on my to-do list every day. I found that when I crossed a task off the list, a new task appeared. It’s overwhelming. I had to learn to say ‘no’ to new projects and to prioritize certain activities while putting other tasks on the back burner. This is incredibly difficult for me. Though I wouldn’t say I’ve ‘figured it out’, I do believe I’ve identified a strategy that allows me to stay productive while also maintaining my mental health.

Do you have a favorite scientific success story from your work?

It’s tough to pick just one! On a personal note, I’m thrilled that I’ve maintained a close relationship with my mentors. Earlier this year, I shared a meal with my postdoc advisor (Dr. Laurel Buxbaum) and my PhD advisor (Brad Mahon, PhD). We had a great time discussing problems we’re working on and challenges in our field. I feel truly blessed that I can call them up on the phone and ask for advice and know they’d be there to support me. I hope to be that person in the lives of the next generation of trainees whom I mentor.

On the scientific side, I’d say one success story that is front of mind is having students in my lab prepare manuscripts for publication. It’s incredible to see a person grow and develop when provided with the right resources and support. This is what success looks like from my point of view.

Knowing what you do now if you could go back in time and give advice to yourself when you were just starting your postdoc, what would you say?

I would tell myself to slow down and be patient. We often view success through the lens of papers published or grants funded. These endeavors can take years to accomplish. Life moves pretty fast, so appreciate the little victories and trust the process. I would also tell myself to go to more concerts! The music scene in Philadelphia is truly special. Though I had a great time seeing some of my favorite bands, I could have branched out and done more. I guess I would tell myself to be more present and enjoy living in Philadelphia while you have the opportunity.

How do you like to spend your free time?

Most of my family and friends live here in Rochester, so I’m lucky that I get to see them often. I’m also fortunate that I have a loving and supportive partner who enjoys traveling. We like to find new restaurants and places to visit in Rochester and in the Finger Lakes area. Upstate NY has a lot to offer in terms of history and culture, so we make a conscious effort to visit attractions close to us and outside of Rochester. In addition, I’m pretty regimented when it comes to working out and running. It helps to clear my head and is a huge stress reliever. I still try to go to concerts as often as I can. Last but not least, I enjoy spending time with my dog Rosie!


Meet the Team: Jaclyn Barcikowski, DO

Jaclyn Barcikowski, DO, is a physiatrist who treats patients in the Drucker Brain Injury Center. Certified in Physical Medicine & Rehabilitation and Brain Injury Medicine, she serves as a Clinical Director of the Stroke Rehab Unit, as well as Associate Program Director of the MossRehab/Einstein Physical Medicine & Rehabilitation Residency Training Program.

“I work as a physiatrist in the Drucker Brain Injury Center in Elkins Park. I came straight to MossRehab after completing my fellowship. Coming here was a huge opportunity for me. MossRehab has a wonderful reputation, particularly for brain injury medicine. My patients include those admitted to the hospital who require a high intensity of medical care due to brain injuries. I also work with outpatients discharged from the hospital. They come to my practice to get care and may receive different outpatient therapies such as physical, occupational, and speech.

I have been excited to work with Dr. Rabinowitz and her team on the Get Up & Go study – a research program to promote physical activity in people living with TBI. I am thrilled to be part of this research. As a marathon runner and avid hiker, I am passionate about the benefits of exercise and experience it personally in my own life. Evidence suggests that encouraging regular exercise not only aids in the rehabilitation process but also brings about a myriad of health benefits. From improved cognitive function and mood enhancement to enhanced cardiovascular health, the positive outcomes are vast. I am enthusiastic about the potential impact this research could have on the well-being of my patients and others living with brain injuries.”

* This article was adapted from an article published in The Moss Traumatic Brain Injury Model System’s Spring 2024 Edition of Brain E-News.