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.


Developing a Novel Clinical Program for People with Primary Progressive Aphasia

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

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

People with PPA

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

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

Communication Partners

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

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

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

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


Dr. Sharon Antonucci Featured by the National Aphasia Association

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

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


The Sensorimotor Learning Lab Receives New Grant to Study Primary Motor Cortex Changes in People with Degenerative Cerebellar Ataxia

 

A lab assistant tests hold an electromagnetic to a patients head.

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

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

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

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

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

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