The Sensorimotor Learning Lab Works to Raise Ataxia Awareness

Amanda Therrien

Ataxia is a disabling neurological condition of impaired movement coordination that can result from damage to a structure in the brain called the cerebellum. Individuals with Ataxia have trouble controlling their balance when standing. They also have difficulty walking, coordinating reaching movements with their arms, speaking, and controlling the movement of their eyes.

MRRI Institute Scientist and Sensorimotor Learning Lab Director, Amanda Therrien, PhD, studies cerebellar Ataxia. Her research uses a combination of behavioral and computational methods to improve our understanding of the neural mechanisms through which the cerebellum contributes to movement control. Dr. Therrien uses this knowledge to develop new movement training techniques aimed at improving rehabilitation for individuals with this disorder.

Cerebellar Ataxia is a component of many neurological disorders – e.g., multiple sclerosis, cerebral palsy, congenital brain malformations, and paraneoplastic conditions triggered by an abnormal immune system response to cancerous tumors. Dr. Therrien’s work focuses on a host of genetic conditions, called Spinocerebellar Ataxias (SCAs), that cause a progressive degeneration of the cerebellum. While SCAs run in families, sporadic gene mutations can cause other genetic conditions that lead to cerebellar degeneration without a family history. The National Ataxia Foundation estimates that, in the United States alone, 15,000 – 20,000 people have SCAs, and that tens of thousands more are affected by recessive and sporadic forms of Ataxia.

Each year, International Ataxia Awareness Day is observed on September 25th. This week, Dr. Therrien and others at MRRI are proud to continue raising public awareness and support for Ataxia. On Saturday October 1st, Dr. Therrien will represent MRRI at the 2022 Central PA Walk n’ Roll to Cure Ataxia. You can donate to the cause here. You are also invited to join us at 10:00 am on Saturday, October 1st at the Lions Pavilion in Kerr Park, Downingtown, PA to participate in the event! Through Walk n’ Roll events across the country, over $3,000,000 has been raised to support the National Ataxia Foundation’s mission to accelerate the development of treatments and improve the lives of people living 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 and the Sensorimotor Learning Laboratory on our website.


Dr. John Whyte Featured in Recent MIT Technology Review Article

Dr. John Whyte

After brain injury, patients may experience disorders of consciousness (DOC) ranging from a decreased awareness of their surroundings to complete unconsciousness in a coma. John Whyte, MD, PhD, has made important contributions to our understanding and treatment of patients with disorders of consciousness through his research at Moss Rehabilitation Research Institute (MRRI). Dr. Whyte is an Institute Scientist Emeritus and the former Director of MRRI, and his research on DOC has helped improve clinical care for patients with DOC. He was featured in a recent article from MIT Technology Review exploring what we know about the capabilities and the limits of minimally conscious brains.

You can read the full article here.


Catching Up with Former MRRI Postdoc Solene Kalenine, PhD, PsyD

Moss Rehabilitation Research Institute (MRRI) is proud to provide outstanding mentorship and an excellent training environment for postdoctoral fellows from the U.S. and around the world. Solene Kalenine, PhD, PsyD, is one former MRRI postdoc who has gone on to a successful independent research career. She trained at MRRI from 2009 to 2011 under the supervision of Laurel Buxbaum, PsyD. Dr. Kalenine shares more about her research and her career in this interview.

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

I am a researcher employed by the CNRS, the French National Center for Scientific Research. I work at SCALab in Lille (France), which is a research institute for Cognitive and Affective Sciences gathering professors from Lille University and researchers from the CNRS.

What are your research interests?

My main research interest concerns the relationships between the perception and representation of objects and actions. How do we perceive objects and how do the motor properties of objects influence the way they are processed and represented? How are our actions represented? Does action experience influence acquisition and retrieval of knowledge about objects (name, category, function)? How can action and semantics benefit from each other, especially when one domain is impaired (such as in apraxia, semantic dementia)? As such, my interests encompass several main research areas of cognition, including visual perception, action, and semantic knowledge.

Can you tell us more about the impacts or potential impacts of your research?

I believe that studying the interconnections between different cognitive functions is really important for rehabilitation and lifespan development. Acquisition/rehabilitation in a particular cognitive domain may be boosted by more developed/preserved cognitive abilities. For example, we have identified that patients with semantic dementia tend to show relatively preserved semantic processing when the semantic knowledge involved is more closely linked to action. We are also investigating how enhancing object motor properties may help children learn new words.

What attracted you to science and the field of cognitive psychology?

In school, I was very attracted to “hard” science on the one hand and humanities on the other hand. For me, cognitive psychology is the perfect combination of both: a very rigorous and scientific approach to studying human mind and behavior.

Why did you choose to work as a postdoctoral fellow at MRRI?

I did my PhD thesis on the development of semantic categories, and I was getting more and more interested in the role of sensorimotor experience in conceptual knowledge. Therefore, I wanted to develop my expertise in the research field of action. Moreover, I had lost contact with my clinical background (I had a PsyD in neuropsychology before my doing my PhD) and hoped to reconcile fundamental and clinical research in my work. The Cognition and Action Laboratory at MRRI was thus the ideal fit for me.

What was it like working in the Cognition and Action Laboratory at MRRI?

People were very nice and welcoming. There were many interactions between us, and the environment was highly stimulating. In particular, I appreciated the regular meetings and seminars where I had the opportunity to learn a lot from expert researchers and clinicians.

Is there something you learned at MRRI that has helped you in your current endeavors?

I learned many things! I think MMRI is a great place to comprehend the whole spectrum of scientific research in cognitive psychology, from theoretical models to clinical rehabilitation. At MRRI, I was encouraged to get an overview first before starting to investigate a new research issue. I also learned to replace the word “problem” with the word “challenge”, and this change in perspective actually makes a major difference in my life!

What is one of your favorite memories from your time working at MRRI?

I really appreciated the scientific exchanges during the different meetings I had the opportunity to attend. I particularly remember amazing clinical seminars during which a neurologist presented the case of a patient, demonstrating their difficulties and preserved abilities and explaining the cognitive processes involved in front a mixed audience composed of clinicians, researchers, and members of the patient’s family.

Can you tell us more about your long-term career plans or goals?

I wish to continue doing research in cognitive psychology for as long as I can! And hopefully, I will be able to return to the U.S. and more particularly to MRRI at some point of my career as a visiting scholar. I am keeping an eye out for grants that could support this kind of travel opportunity. 😉

What are some of your personal interests or hobbies?

I come from the Alps so I definitely like hiking and outdoor activities. I also love traveling and discovering new countries and cultures. In addition, I enjoy reading, live music, and playing the piano when I have time.


MossRehab and MRRI Receive Prestigious TBI Model System Renewal

MossRehab’s Drucker Brain Injury Program and Moss Rehabilitation Research Institute (MRRI) are excited to celebrate the sixth renewal of their world-class Traumatic Brain Injury (TBI) Model System. The continued recognition and support from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) are a tremendous achievement for the researchers and clinicians at Moss who are dedicated to pushing the limits to improve our scientific understanding and clinical treatment of TBI.

Classification as a Model System by NIDILRR requires excellence in treatment and research related to a particular disability. The MossRehab TBI Model System has been continuously funded since 1997, and with this most recent renewal, funding has been secured through 2027. Members of the MossRehab TBI Model System have continued to demonstrate exceptional clinical care, as well as research productivity, innovation, and knowledge dissemination in the field of TBI rehabilitation.

“Moss Rehabilitation Research Institute and MossRehab are delighted by the recent news of renewal of the Traumatic Brain Injury Model Systems of Care. This is a great achievement due to its highly competitive nature. More than three decades of uninterrupted participation in this program have allowed us to help continue to transform TBI care delivery for years to come,” remarked Alberto Esquenazi, MD, Chief Medical Officer of MossRehab. “Now as part of Jefferson, our collaborative team of researchers, clinicians, administrators, and other important stakeholders, including persons living with TBI, will continue to work together to improve the lives of those with brain injury,” he said.

The MossRehab TBI Model System includes patients with moderate to severe TBI, who receive inpatient rehabilitation care at MossRehab and acute care at one of four local Trauma Centers. These patients undergo long-term follow-up and they have various opportunities to participate in research studies led by MRRI researchers and teams within other TBI Model Systems across the nation. Regardless of whether patients elect to participate in research, outstanding clinical care is provided to patients at the Drucker Brain Injury Unit.

The MossRehab TBI Model System is led by Amanda Rabinowitz, PhD, and Tom Watanabe, MD. “Our continued involvement in the TBI Model System allows MossRehab and MRRI to remain at the forefront of research and knowledge translation that will shape the future of TBI care,” Dr. Rabinowitz noted, adding that “the funding and collaborative infrastructure will continue to support important local and multi-site research that would not otherwise be possible.”

Research supported by the TBI Model System funding recently includes longitudinal research in collaboration with other premier centers across the nation, and local research designed to improve TBI treatments and outcomes. For example, in the last cycle, the team examined a hybrid therapist-delivered and mobile health intervention to promote mental health in people living with chronic TBI. In the current cycle, they will evaluate a program using a similar hybrid approach to help people with chronic TBI reduce sedentary behavior and become more physically active. In recent collaborative efforts, the MossRehab TBI Model System has partnered with other TBI Model System facilities to study chronic pain after TBI, the impact on driving outcomes, and the effects of neighborhood characteristics on TBI outcomes.

In addition, consumer-facing activities include an Advisory Council made up of treatment staff, former patients and members of their families, and community members who are helping to improve clinical services, research efforts, and educational/outreach activities. The MossRehab Model System will also hold conferences in collaboration with other rehabilitation facilities and the Brain Injury Association of Pennsylvania for people with brain injury, their families, and professionals in the field. Further, the team looks forward to partnering with the Brain Injury Association of Pennsylvania in this new funding cycle to develop clinical guidelines for providing telehealth to persons with moderate to severe TBI, and expanding their outreach to historically underserved populations.

“The competitive renewal of the TBI Model System of Care is a testament to the leadership of Dr. Rabinowitz at MRRI and Dr. Watanabe at MossRehab,” noted Dylan Edwards, PhD, Director of MRRI. “The success is shared by former TBI Model System directors Dr. Tessa Hart and Dr. John Whyte, as well as an extensive team who have been working together to continue advancing the field to improve the lives of those with brain injury,” he continued.

Through the MossRehab TBI Model System, MRRI scientists and MossRehab clinicians will continue to work together to advance the standard of care for treating TBI and improve the outcomes for patients.


Are personal beliefs about memory ability held by people with traumatic brain injury related to their memory functioning and health satisfaction? A new study suggests yes

Dr. Umesh Venkatesan

“Self-efficacy” is a concept that has been around for a long time in psychological science. Popularized by the famous psychologist Albert Bandura, PhD, the idea is simple: humans form beliefs about how well they can perform tasks successfully. Our performance in real-world tasks is influenced by how confident we are that we can perform those tasks to reach specific goals.

Self-efficacy is applicable to nearly every voluntary human behavior, but it becomes particularly interesting in the context of medical change, where tasks that may not have been much of a problem before the change are now significantly more difficult. For example, self-efficacy for memory ability (or memory self-efficacy) may decline in older adults who experience memory problems, or after a major medical event affecting thinking, like traumatic brain injury (TBI). Self-efficacy theory would also predict that a person’s negative memory beliefs affect their confidence and willingness to engage in everyday tasks that they perceive as memory-demanding. This decreased willingness to engage may, in turn, reduce participation in daily life activities broadly. In other words, poor memory self-efficacy can play a role in a chain of events potentially ending in poorer quality of life.

Umi Venkatesan, PhD, who directs the Brain Trauma and Behavior (BraTBehavior) Laboratory, recently published an article on a study examining memory self-efficacy in a unique group of individuals: adults 50 years of age or older with moderate-severe TBI. Co-authored by MRRI Institute Scientist Amanda Rabinowitz, PhD, and Penn State Professor of Psychology Frank Hillary, PhD, the study asked three main questions: 1) What individual characteristics (e.g., age or injury severity) are related to memory self-efficacy?; 2) How are memory self-efficacy, general psychological distress (e.g., depression and anxiety), and memory test performance related?; and 3) Is memory self-efficacy associated with self-reported ratings of health-related quality of life (e.g., satisfaction with cognitive, social, and physical health functioning)?

In 114 people with moderate-severe TBI, the study found that there is great variability in the level of self-reported memory self-efficacy (i.e., some have very negative memory beliefs, some are in the middle, and some have very positive memory beliefs). This variability was not related to demographic or injury characteristics, but this could have been due to the special nature of the group (middle-aged to older adults). Importantly, results showed that memory self-efficacy was related to general psychological distress, but it was also associated with memory performance even after taking this distress into account. Further, memory self-efficacy was associated with health-related quality of life independent of both psychological distress and memory test performance.

Putting all these results together, the study suggests that memory self-efficacy plays a role in both objective health indicators like memory test performance and in broader, subjective health outcomes like quality of life. While memory self-efficacy is related to general psychological distress, the two are distinct and should be considered separately in treatment.
A bigger picture lesson from the study is that researchers and clinicians should pay attention to what people think about their own functioning, rather than just how they score on clinical tests. This shift in perspective — from provider-determined to patient-driven — is an important step towards personalizing rehabilitation for adults with TBI.


MRRI Researchers Buxbaum and Kantak Receive 5-year NIH Grant Award

Laurel Buxbaum, PsyD, Associate Director of Moss Rehabilitation Research Institute and Research Professor of Rehabilitation Medicine at Thomas Jefferson University, and Shailesh Kantak, PT, PhD, MRRI Research Scientist and Assistant Professor of Physical Therapy at Arcadia University were awarded a $2.5 million grant award from the National Institutes of Health (NIH) to study the cognitive and neuroanatomic factors that influence arm choice after stroke.

As many as 94% of stroke survivors exhibit reduced use of one arm, with adverse consequences for disability, caregiver burden, and quality of life. Approximately 40%-80% of individuals who fail to use the affected arm in daily life possess adequate sensory-motor capacity to do so. The disparity between arm use and capacity (i.e., Use/Capacity Disparity — UCD) occurs across a broad spectrum of sensory-motor severity and is a perplexing and urgent problem in neuro-rehabilitation. Perhaps in part because UCD lies at the interface of sensory-motor processing and cognitive/affective phenomena, very little past research has assessed its underlying mechanisms or neuroanatomic biomarkers. The NIH grant awarded to Drs. Buxbaum and Kantak will test the predictions of three hypotheses of the mechanisms underlying UCD: the sensorimotor, attention, and apathy/motivation accounts.

The researchers will administer a targeted battery of sensorimotor and neuropsychological tests to test the predictions of each of the three hypotheses in a sample of 100 mild to moderate left- and right-hemisphere chronic stroke patients. They will determine the association of these measures, as well as demographic and stroke-related variables, with UCD. They will also use advanced neuroimaging methods with data from resting-state functional magnetic resonance imaging to develop imaging biomarkers associated with UCD. Finally, they will validate a novel virtual reality assessment tool to rapidly and reliably evaluate UCD. In addition to its clinical utility, the virtual reality tool enables built-in assessment of the attention hypothesis by determining whether UCD is influenced by attentional task demands.

By the end of the grant period, the research will determine the demographic, sensorimotor, neuropsychological, and neuroanatomical factors that predict UCD and will validate a clinically-useful VR assessment tool. Given the limited knowledge base in this area, this comprehensive research will pave the way for the development of treatments targeted to underlying mechanisms and enhanced identification of at-risk individuals.


MRRI Welcomes Postdoctoral Fellow Dr. Amy Lebkuecher

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.


MRRI Researcher Receives Rosenthal Award

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.


MRRI Postdoctoral Fellow Haley Dresang Accepts New Faculty Position

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.


Postdoctoral Fellow Dr. Masahiro Yamada Contributes to Research at MRRI

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.