Making Progress in Research to
“With expanded research capabilities, we discover new treatments to enhance the function, independence, and quality of life of people with disabilities. More than ever before, treatments are reaching patients’ bedsides and are making a real difference. Through our work, individuals are rejoining their communities, being active, and enjoying their lives.”
—John DeLuca, PhD,
Senior Vice President of Research & Training
As John DeLuca, PhD, senior vice president of Research & Training, noted, "Randomized controlled trials like MEMREHAB are essential to demonstrating to third-party payers that cognitive rehabilitation should be a reimbursable intervention. Behavioral intervention should be available for persons with MS who have memory deficits. Without reimbursement, however, few clinicians will use it and few patients will benefit." Its effects are so profound that the protocol for mSMT has already been translated into Spanish and Chinese, and is being used in the US, Argentina, and Mexico.
Progress with Advancing Capabilities
The Foundation’s new capacity for research-dedicated neuroimaging and movement analysis are integral in its acquired funding in cognition and mobility research.
As the Neuroimaging Center at Kessler Foundation opened, researchers now have the ability to take images of the brain and spinal cord before, after, and throughout a studied treatment to assess its effects (read more here).
Renovated, expanded, and equipped with the latest technology, Kessler Foundation’s Human Performance and Engineering Research facility has increased capabilities to study gait abnormalities, assisted walking, and wheelchair propulsion.
Researchers across various area of expertise are collaborating to improve outcomes. “Thanks to our funders, we have the ability to advance research to find new treatments that improve the function and quality of life of individuals with various conditions,” said Dr. DeLuca. “We look forward to combining our expertise in mobility and cognitive research to take the first step towards finding therapies that will delay deficits in thinking, learning and memory while helping people maintain social relationships.” Highlights include:
With grants from the New Jersey Commission on Brain Injury Research (NJCBIR) and the Consortium of MS Centers, Jeannie Lengenfelder, PhD, and Helen Genova, PhD, are using neuroimaging to expand their research of emotional processing, a common disorder in TBI and MS that can hinder rehabilitation, as well as community reintegration and employment.
With a grant from the New Jersey Commission on Spinal Cord Research (NJCSCR), Principal Investigator Dr. Chiaravalloti and co-investigators Trevor Dyson-Hudson, MD, director of SCI Research, and Glenn Wylie, DPhil, associate director of Neuroscience Research and the Neuroimaging Center, are collaborating with the James J. Peters Veterans Affairs Medical Center to examine the impact of aging on cardiovascular, cerebrovascular and cognitive health in individuals with SCI. Findings will be correlated with neuroimaging studies performed at Kessler Foundation. “Using neuroimaging, we can assess whether the changes in how a person feels correlate with changes we see in the brain,” said Dr. Chiaravalloti. “Once we learn more about these factors, we can develop treatments to help them live longer, healthier lives.”
In collaboration with the James J Peters VA Medical Center, Drs. Chiaravalloti and Dyson-Hudson will look at how midodrine—a blood pressure medication—effects cognition and blood pressure regulation in persons with SCI. Hypotension, or low blood pressure, a common finding after SCI, may be a factor in cognitive dysfunction. With funding by the Craig H. Nielsen Foundation, Jill Wecht, EdD, of the VA is principal investigator.
Progress with Cognitive Research
In 2013, Kessler Foundation greatly expanded its capabilities for advanced cognitive, mobility, and stroke research, yielding more national and international collaborations, including Asia, Europe, South America, and Canada. As a result, Kessler Foundation scientists received more than $5 million in external funding for its innovative research from federal agencies, state and private organizations, foundations, and device manufacturers. Foundation researchers strive to improve the outcomes for people with multiple sclerosis (MS), traumatic brain injury (TBI), stroke, spinal cord injury (SCI), and other neurological conditions.
Neuroimaging data contributed to achievements in MS and TBI research. Researchers correlated improvements in memory post-treatment with neuroimaging data, strengthening their results. Highlights include:
The correlation of subjective data—what individuals report—with objective data—what brain scans reveal—documented that cognitive rehabilitation using the modified Story Memory Technique (mSMT) works in individuals with MS who have difficulties with learning and memory. “Since the publication of the MEMREHAB studies, we have received numerous requests from patients and therapists interested in using the mSMT,” reported Nancy Chiaravalloti, PhD, director of Neuropsychology & Neuroscience Research and TBI Research. The effects of this memory retraining continue for six months.
Progress with Neuroimaging
For the first time, researchers found a link between fMRI findings and decline in cognitive function during warmer outdoor temperatures in individuals with MS. Documentation of this fluctuation has implications for individuals and researchers.
In another first, scientists used neuroimaging to study cognitive fatigue, a disabling symptom for many people with MS and TBI, laying the groundwork for developing effective interventions.
In a pilot study, neuroimaging revealed that a regimen of aerobic exercise improved memory and enlarged the hippocampus (the part of the brain responsible for memory activities) in individuals with MS. Future studies will further examine the potential for aerobic exercise.
In 2013, experts in SCI and Human Performance & Engineering research advanced the mobility and overall health of individuals with SCI. Highlights include:
With a NJCSCR grant, Gail Forrest, PT, PhD, assistant director of Human Performance & Engineering Research, is studying the effects of Ekso-assisted walking on muscle and bone. Throughout an ongoing therapy regiment using Ekso—a robotic exoskeletal device, by Ekso Bionics, that enables individuals in wheelchairs to stand and walk—scans of the spinal cord and key muscles and bones will document changes. “Preliminary findings showed the potential for exoskeletal-assisted walking in rehabilitation, as well as for community and home use, and suggest benefits for the heart, lungs, and circulation,” said Dr. Forrest. “Now, for the first time, we can use neuroimaging to observe how the muscles and bones change with use of these devices to determine whether a robotic exoskeleton training program is more effective in improving musculoskeletal outcomes than other interventions,” commented Guang Yue, PhD, director of Human Performance & Engineering Research. Kessler Foundation also studies effects of using the LokomatPro v6 by Hocoma and ReWalk by Argo.
Progress with Mobility Research
Jeanne M. Zanca, PhD, MPT, leads investigators from the Icahn School of Medicine at Mount Sinai, Shepherd Center, and the East Orange Campus of the VA New Jersey Healthcare System to develop an assessment tool that evaluates the ability of individuals with tetraplegia to direct their care. “People with tetraplegia often have loss of movement in their hands and arms, which makes it difficult for them to do things for themselves,” Dr. Zanca explained. “However, if we teach them to direct others to serve as their ‘hands,’ this increases their control over their daily activities and makes it more likely that they can receive the help they need at home and in the community.”
Trevor Dyson-Hudson, MD, is leading Kessler Foundation’s participation in a collaborative study to learn more about the frequency and duration of weight-shifting required to prevent pressure ulcers. This project is the first to gather information during everyday activities while people are sitting in their wheelchair. “This information will enable us to develop better guidelines for weight-shifting and improve pressure ulcer prevention,” explained Dr. Dyson-Hudson.” Shepherd Center in Atlanta, GA, is participating, as well as Georgia Institute of Technology. Stephen Sprigle, PhD, PT, of the Institute is lead investigator.
The Model Systems, funded by the National Institute on Disability & Rehabilitation Research, is a system of coordinated care and research that conducts in-depth collaborative studies that address the recovery and outcomes following an injury. Sharing information is also a top priority. One of eight centers in the nation with dual model systems, Kessler Foundation leads the Northern New Jersey SCI System (NNJSCIS) and the Northern New Jersey TBI System (NNJTBIS). Each produces a newsletter that is distributed to 2,500 patients, caregivers, advocacy organizations, and government agencies.
Updates from 2013 include:
SCI Model System
NNJSCIS, one of 14 TBI model systems in the US, is a collaborative effort of Kessler Foundation, Kessler Institute, and Rutgers, The State University of NJ. Updates from 2013 include:
Eight people with SCI were enrolled in a unique study of a medication by Acorda Therapeutics, Ampyra (dalfampridine). Known to improve walking in people with MS, researchers are studying whether Ampyra and a rigorous regimen of treadmill training improved walking in individuals with SCI.
The Collaboration on Mobility Training (COMIT) study, a multisite project designed to maximize independence among wheelchair users with SCI, launched its first training in November.
SCI Grand Rounds, sponsored by the NNJSCIS, drew large numbers of consumers and professionals in 2013 to hear the latest on robotic exoskeletons and global SCI research activities.
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. Updates from 2013 include:
Progress with National Collaborations
Stroke research at Kessler Foundation helps individuals regain independence after a stroke by finding solutions to treat complications caused by stroke, including spatial neglect, a perceptual problem caused by a disconnect between the brain and the eye, and difficulties in mobility. Highlights include:
Following a successful NIDRR-funded research project, stroke researchers developed the Kessler Foundation Neglect Assessment Process (KF-NAP™), which has been instrumental in clinical care and research. “We found that spatial neglect affects 70 percent of stroke survivors and 28 percent of patients with TBI,” noted Dr. Barrett. In the first multi-center diagnostic training collaboration for spatial neglect—led by Stroke Director A.M. Barrett, MD, Peii Chen, PhD, and Kim Hreha, OTR—the KF-NAP™ led to the identification of hidden functional vision disabilities in 300 stroke survivors that could potentially cause accidents and other adverse events that hinder recovery.
Progress with Stroke Recovery
In 2013, Kessler Foundation joined the New York Columbia-Cornell Stroke Trials Network (NYCCSTN). One of three sites within the Network’s Rehabilitation Sub-Network, the Foundation strengthens NYCCSTN because it is the only rehabilitation site with the capacity for conducting brain-imaging research.
In collaboration with the Kessler Institute for Rehabilitation, the research-clinical team addressed local nurses, therapists, and stroke survivors at Kessler Institute’s Annual Stroke Conference.
Through Kessler Foundation’s ABI (acquired brain injury) Mobility Group, Karen Nolan, PhD, in collaboration with Rutgers-New Jersey Medical School, is collecting gait data in individuals with difficulties in mobility caused by stroke to understand changes in the brain associated with rehabilitation treatments.
To facilitate care, the Stroke team developed an innovative patient-friendly prism adaptation kit, with everything needed to deliver prism training, and began using it at the bedside with therapists at Kessler Institute. Requests for training in KF-NAP™ have come from professionals in North America, Europe, Asia, and Australia.
Under the direction of Dr. DeLuca, Kessler Foundation trains new scientists in rehabilitation research. Fellowships are funded through NIDRR’s Advanced Rehabilitation Research Training Program, the National Institutes of Health, the National MS Society, NJCBIR, Children's Specialized Hospital, and the Foundation’s Mitchell Rosenthal Memorial Fellowship. Ten fellows were funded in 2013. Highlights include:
Progress in Training Future Scientists
Rakesh Pilkar, PhD, was awarded an R03, $153,000 grant by the National Institutes of Health to study the response levels to function electrical stimulation (FES) in paralyzed or weakened extremities in individuals after stroke in hopes of restoring function.
Mehmed Buğrahan Bayram, PhD, is developing a protocol for using electrical stimulation (ES) with mechanical walking interventions, then testing the reliability and sensitivity of ES in preventing loss of bone density. This study was funded by a grant from the NJCSCR to former fellow Megan Damcott, PhD.
Researchers at Kessler Foundation also study how a disability effects employment and strategies to help people stay in, or join, the workforce (click here for more information). In the coming years, the Foundation will expand its robotics research and assess the technology in the stroke population.
Anthony Lequerica, PhD, and Denise Krch, PhD, spoke at The North American Brain Injury Society on the issues of sleep, fatigue, and cultural influences in TBI rehabilitation.
“Brain Injury: The Challenge of Change,” a consumer conference sponsored by NNJTBIS, educated more than 100 consumers, family members, and professionals about maintaining relationships after TBI.
The Journal of Head Trauma Rehabilitation published an important article based on NNJTBIS research [Lequerica, A.H., Chiaravalloti, N.D., et al. The Community Integration Questionnaire: Factor structure across racial/ethnic groups in persons with traumatic brain injury].
“In 2013, our research team taught KF-NAP™ at more than two dozen education sessions in underserved areas, raising awareness of hidden disabilities and training professionals in detection and treatment,” said Mooyeon Oh-Park, assistant director of Stroke Rehabilitation Research. More than 1,000 professionals were reached in this effort funded by NIDRR and the Healthcare Foundation of New Jersey.