“Our research team had a record-breaking year.
Through our work, new treatments that maximize
function and independence are benefiting the
individuals who need them. Now more than ever,
people with disabilities are recovering, and
rejoining their communities and the workforce.”
— John DeLuca, PhD, Senior Vice President of Research and Training
Translating Research to Change Lives
An effective method for improving memory, the modified Story Memory Technique (mSMT) protocol was made available online to professionals who care for people with MS. “For optimal care, it is crucial for clinicians who care for this population to become familiar with this protocol for cognitive rehabilitation,” said Nancy Chiaravalloti, PhD, who developed the protocol with funding from the National MS Society and the National Institutes of Health. This 10-session program, available in English and Spanish, uses context and imagery to aid new learning and memory in individuals with MS. Neuroimaging showed that positive effects of mSMT were still apparent six months after the program was administered. The mSMT is used in Mexico, Argentina, as well as the US. Results of mSMT testing in traumatic brain injury (TBI) will be published in 2015.
Translating Discoveries into Patient Care
Research discoveries at Kessler Foundation translated into improved care for people with disabilities caused by multiple sclerosis (MS), stroke, and spinal cord injury (SCI).
Advances were implemented in the detection and treatment of spatial neglect, a common hidden disability that hinders recovery after stroke. Funded by a grant from the Healthcare Foundation of New Jersey, researchers tested the feasibility of incorporating screening and treatment for spatial neglect into acute care. The study—the first of its kind—was conducted in the high-risk population at Newark Beth Israel Hospital. Therapists were trained to screen inpatients with the Kessler Foundation Neglect Assessment Process (KF-NAP™) and treat with the Kessler Foundation Prism Adaptation Therapy (KF-PAT™), using a specially developed prism therapy kit. They found 135 patients with right brain stroke, and administered the KF-NAP to 78. Of the 15 patients identified with spatial neglect, 8 underwent KF-PAT during their stay. “Our findings show that stroke survivors will benefit from early screening and prompt intervention,” said A.M. Barrett, MD, director of Stroke Rehabilitation Research. Training in the KF-NAP and KF-PAT will be widely available starting in 2015, via an online course.
Advances in exoskeletal research translated to the clinical use of two devices—Ekso and ReWalk—in rehabilitation. Gail Forrest, PT, PhD, led the team studying exo-assisted walking in individuals with spinal cord injury, and the potential for minimizing secondary complications like pressure ulcers, chronic pain, and loss of bone density and muscle strength. “At least 40 people have participated in our studies,” said Dr. Forrest. “Nine participants have walked 100 hours in a robotic exoskeleton, each taking a total of 80,000 to 150,000 steps.” Dr. Forrest is assistant director of Human Performance & Engineering Research, which is led by director Guang Yue, PhD.
Dr. Chiaravalloti, director of Neuropsychology & Neuroscience and TBI Research, administers the mSMT.
Kim Hreha, OTR, of Kessler Institute,
Dr. Barrett, and Peii Chen, PhD, Foundation research scientist
40 Particpants
900 Hours
150,000 Steps
Developing New Treatments through Neuroimaging
In 2014, 300 scans were performed at the Rocco Ortenzio Neuroimaging Center for 18 clinical studies aimed at developing new ways to aid recovery from disabling illness and injuries. The Center’s unique neuroimaging capabilities increased our knowledge of factors that contribute to disability, such as cognitive fatigue, spatial neglect, and disorders of emotional processing, executive function, and processing speed. Scientists measured the effectiveness of interventions, such as cognitive training, exo-assisted walking, and exercise. Dr. Forrest applied neuroimaging of the spinal cord to her research on the impact of exo-assisted walking on bone and muscle. “Neuroimaging of the spinal cord is a new area,” noted Brian Yao, PhD, the physicist who manages the Center.
“Kessler Foundation is one of the few facilities with such capability.”
Veterans from across the nation participated in a neuroimaging study of cognitive fatigue associated with Gulf War Illness. Glenn Wylie, DPhil, associate director, leads this collaborative effort of the Foundation and the VA New Jersey Health Care System. “Preliminary findings showed brain activity patterns comparable to those seen in people with cognitive fatigue associated with MS or TBI,” said Dr. Wylie. “This suggests a common ‘fatigue network’ in the brain, a finding that may help us develop effective treatments for this disabling condition.”
Collaborative research is conducted at the Center under the leadership of John DeLuca, PhD, director.
Improving Cognition through Research
Under the leadership of John DeLuca, PhD, and Nancy Chiaravalloti, PhD, researchers made advances to improve thinking, learning, and memory for individuals with MS, TBI, and other neurological conditions.
Lauren Strober, PhD, of Kessler Foundation, collaborated with the Cleveland Clinic on a long-term follow-up study of the course of cognition in MS—important information for researchers in this field. Over 18 years, significant declines were found in information processing speed, auditory attention, memory, episodic learning, and visual construction.
MS researchers, including Joshua Sandry, PhD, a post-doctoral fellow, investigated working memory, which is essential for complex cognitive tasks. Researchers found that during working memory tasks, brain activation patterns differ in people with MS and that working memory contributes to cognitive reserve in this population. In another long-term study led by James Sumowski, PhD, researchers found that intellectual enrichment and brain reserve, or brain volume, protected against cognitive decline in MS at 4 1/2-year follow-up.
In other studies, task length was found to be the major factor associated with cognitive fatigue, and self-generated learning significantly improved learning and memory in MS. In the area of sleep research, scientists completed a pilot study of the efficacy of Rozerem, (ramelteon). According to Anthony Lequerica, PhD, results supported efficacy for sleep disturbances post-TBI that hinder rehabilitation and recovery.
The Foundation formed a new collaboration in 2014, bringing expertise in rehabilitation research to the Children’s Specialized Hospital Research Center. Dr. Chiaravalloti and post-doctoral fellow Julia Coyne, PhD, received initial grant funding of $250,000 to study memory in children and adolescents with TBI. Four research scientists, supported by three fellows, are spearheading projects in neuropsychology, bioengineering, biomechanics, and education aimed at improving outcomes in children with brain injury, SCI, cerebral palsy, and autism.
New Beginnings in Rehabilitation Research
Kessler Foundation, a leader in training rehabilitation researchers, hosted 14 postdoctoral fellows in 2014. Dr. DeLuca heads the fellowship program, which attracts young professionals from here and abroad. In 2014, new partners joined in supporting our fellowship training, including The Hearst Foundations and Children’s Specialized Research Foundation.
Improving Mobility through Research
Led by directors Trevor Dyson-Hudson, MD, and Guang Yue, PhD, Kessler Foundation expanded its work to improve mobility and health of people with disabilities.
Scientists reported results of their exoskeletal research in SCI, which is overseen by Dr. Forrest in the Foundation’s Gait Lab. At the 2014 World Congress of Biomechanics, Kessler Foundation reported that individuals with incomplete and complete SCI actively increased muscle activation, step swing time, stride length, and hip extension after walking in Ekso. In addition, the Foundation acquired a second Ekso GT for a stroke research study being conducted with inpatients at Kessler Institute by Karen Nolan, PhD, and Mooyeon Oh-Park, MD. Kessler Foundation expanded its exoskeletal research, joining a new multi- center study of the effects of Indego, a new exoskeleton from Parker-Hannifin, in individuals with SCI.
Translating Knowledge to Improve Outcomes – the Model Systems
Kessler Foundation is one of eight centers in the US with dual model systems in SCI and TBI. Federally funded by the National Institute on Disability, Independent Living & Rehabilitation Research (NIDILRR), Model Systems are networks of coordinated care and research that conduct in-depth collaborative studies aimed at improving rehabilitation and fostering community participation and employment.
“Through the model system, we share our research findings for the benefit of the people with SCI living in our community,” said Dr. Dyson-Hudson, co-director of the Northern New Jersey Spinal Cord Injury System (NNJSCIS). “In 2014, 120 consumers attended our successful conference, “Rising to the Challenge: Creating Employment and Maximizing Success. We distributed 5,000 copies of Connections, our consumer newsletter, engaged with the community through our SCIRehabResearch page on Facebook, and welcomed hundreds to our informative series of SCI Grand Rounds.” NNJSCIS, one of 14 SCI model systems in the US, is a collaborative effort of Kessler Foundation, Kessler Institute, and Rutgers, The State University of New Jersey. Dr. Dyson-Hudson co-directs the NNJSCIS with Steven Kirshblum, MD, medical director of Kessler Institute for Rehabilitation.
The Northern New Jersey Traumatic Brain Injury System (NNJTBIS) ended 2014 with a milestone—the enrollment of its 500th research participant. “I want to thank all of the wonderful individuals with TBI who contributed their time to help find new ways to improve life after brain injury,” said Dr. Chiaravalloti, project director of the NNJTBIS. “We connected with thousands of consumers, caregivers, and collaborators through our newsletter, TBI News & Views, and our TBI Research page on Facebook.” NNJTBIS, one of 16 TBI model systems in the US, is a collaborative effort of Kessler Foundation, Kessler Institute, University Hospital, St. Joseph’s Regional Medical Center, Morristown Memorial Hospital, and Hackensack University Medical Center.
Researchers
developed comics as a way to communicate health information to individuals with TBI living in the community.
