Rehabilitation Research – the Continuum
Restoring Function, Preparing for Work, &
Overcoming Barriers to Employment –
the Pathway to Independence for People with Disabilities
The findings of our 2015 Employment Survey confirm the work we do at Kessler Foundation. Our research spans the spectrum of recovery — restoring function so people can access education and training, and finding ways to help people return to work after disabling illness or injury.”
— John DeLuca, PhD
Senior Vice President of Research and Training
During 2015, the Foundation was awarded nearly $9 million dollars, including substantial federal and state funding for our Human Performance & Engineering Research, led by director Guang Yue, PhD. A multi-million-dollar federal grant funded an important new collaboration with the New Jersey Institute of Technology (NJIT): the Rehabilitation Engineering Research Center (RERC) on Wearable Robots. With this five-year grant, a joint team of Foundation researchers and NJIT bioengineers is developing the next generation of wearable robotic devices, and applying
available robotic technology to improve mobility for people with spinal cord injury (SCI), Duchenne Muscular Dystrophy, and stroke. “Robotic exoskeletons have fundamentally altered the way we approach rehabilitation,” said Dr. Yue. “As a result of these new RERC studies, we will see broader use of robotic exoskeletons in rehabilitation and the community.”
Restoring Mobility through Technology
Research discoveries at Kessler Foundation translated into improved care for people with disabilities caused by multiple sclerosis (MS), stroke, and spinal cord injury (SCI).
The RERC draws on the talents of Foundation experts in Human Performance & Engineering Research, TBI Research, SCI Research, Stroke Rehabilitation Research, and the Rocco Ortenzio Neuroimaging Center at Kessler Foundation. In the SCI population, Gail Forrest, PT, PhD, associate director of Human Performance and Engineering Research, is combining exoskeletal-assisted walking with external functional electrical stimulation (FES) of the spinal cord and evaluating the impact on muscle firing, balance, and independent walking. “Our interest goes beyond assessing the effects on walking,” emphasized Dr. Forrest. “Based on the novel work of our bioengineer Rakesh Pilkar, PhD, on the direct implications of electrical stimulation on paralyzed muscle, we're now able to measure the total effects of this combined therapy on the body. That will tell us what this really means for the person with SCI.”
By performing functional neuroimaging of the spinal cord before and after therapy, scientists will look deeper into how this combination therapy affects the connections between the brain and injured spinal cord. The Foundation is one of only a few research centers with the capability for imaging the spinal cord as well as the brain, according to Glenn Wylie, DPhil, associate director of the Ortenzio Neuroimaging Center. “This study will help advance our knowledge of spinal cord imaging, as well as the mechanisms of neural recovery after injury,” noted Dr. Wylie.
Dr. Guang Yue,
Director, Human Performance & Engineering Research
Bioengineer Rakesh Pilkar, PhD
Other studies led by Dr. Forrest are adding to our knowledge of the role of standing and walking interventions in minimizing secondary medical complications after SCI. In 2015, a 4-year grant from the U.S. Department of Defense funded a collaborative study of the biological processes that influence recovery. Individuals with acute SCI are being enrolled at Kessler Foundation, Northwell Health (formerly North Shore-LIJ), and the University of Louisville, and will be monitored for their immune responses during recovery and rehabilitation. “Identifying biomarkers will help us determine optimal interventions after SCI, and better predict long-term outcomes,” Dr. Forrest explained.
Gail Forrest, PhD,
Associate Director, Human Performance & Engineering Research
In the stroke population, Karen Nolan, PhD, senior research scientist in Human Performance & Engineering Research, continues to study the use of the Ekso GT, a wearable robot, in inpatients with one-sided weakness or paralysis. “Use of a wearable robot early in rehabilitation not only helps restore function to the paralyzed limb, it promotes a healthy and efficient gait,” explained Dr. Nolan. “Our ultimate goal is to minimize disability and optimize quality of life after stroke,” she said. “Maintaining a quality gait makes a big difference in a person’s ability to participate in the community, continue their education, and find and maintain employment.”
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Advances in research at the Foundation are reaching U.S. and international stroke rehabilitation professionals. Through outreach by the Kessler team, therapists are being trained to administer the KF-NAP (Kessler Foundation Neglect Assessment Process) and KF-PAT (Kessler Foundation Prism Adaptation Training), according to A.M. Barrett, MD, director of Stroke Rehabilitation Research. “In 2015, we trained therapists in Missouri, Ohio, and New Jersey to diagnose and treat spatial neglect. We also published an important neuroimaging study on reading impairment, a serious disability that has received little attention. These findings are an important step toward planning individualized treatments to address this major obstacle to recovery after stroke.”
Researchers are also investigating the impact of stroke on the ability to read, a serious disability that has received little attention. Using neuroimaging, they've identified relationships between reading impairment and the location of stroke lesions. These findings are an important step toward planning individualized treatments to address this major obstacle to recovery after stroke.
Regaining Function after Stroke
“All the individual specialties are pulling together to improve recovery in different populations with a variety of disabling conditions,” Dr. Yue observed, “and this is reflected in our remarkable gains in external funding over the past two years.”
Preparing Children for Productive Lives
In 2015, five grants totaling $3 million were awarded to the Foundation by the New Jersey Commission on Brain Injury Research (NJCBIR) for studies that improve mobility, cognition, and psychosocial adjustment after traumatic brain injury (TBI). “All of the studies share common themes,” noted Dr. DeLuca. “The discoveries can easily be translated into patient care and create lasting changes in quality of life.”
The largest of these grants funds research into balance dysfunction after TBI. “This funding extends our work on this under-recognized cause of disability,” noted Dr. Yue, referring to the ongoing Department of Defense study of veterans with TBI, led by Dr. Nolan and Denise Krch, PhD. Another NJBIR grant enables Dr. Nolan to extend her expertise in wearable robots to a new population – children and adolescents with impaired mobility.
The three remaining grants support studies in adolescents with cognitive and physical disabilities and behavioral difficulties, in partnership with Children’s Specialized Hospital. Following TBI, difficulties in cognitive, emotional, social, and behavioral functioning can persist for years. “Impairments in perceiving emotions from facial expressions may act as a barrier for successful social functioning.” said Helen Genova, PhD, senior research scientist. “Compared to research in adults, there are fewer studies evaluating emotional processing deficits in the pediatric population,” she observed. “We anticipate that identifying and treating these deficits will improve their quality of life.”
Helen Genova, PhD, Senior Research Scientist
Cherylynn Marino, PhD
Mindfulness-based cognitive therapy, which has been researched extensively in adults with sadness, anxiety, and excessive anger, is another tool being studied in this population. “This treatment combines cognitive therapy with the newer coping strategies of mindfulness meditation,” explained Cherylynn Marino, PhD. “We feel
it holds great promise for treating youth with emotional and behavioral problems following brain injury.”
Scientists are also testing different learning strategies in these children, to determine ways to improve academic performance. “This NJCBIR funding is an important step toward identifying and addressing deficits in emotional processing, learning, and psychosocial adjustment in children living with brain injury,” said Nancy Chiaravalloti, PhD, director of Neuropsychology, Neuroscience & TBI Research. “By discovering ways to improve their academic and interpersonal skills, they’ll be better equipped to contribute at home, in their communities, and eventually, in the workplace – that’s the key to achieving real independence.”
Custom marker holder
created with 3D printer
Kessler’s joint research with Children’s Specialized Hospital addresses urgent needs in pediatric mobility rehabilitation with new technology. In addition to robotics, 3D printing allows researchers to create custom components for testing in children. “We’re the first to study manual wheelchair propulsion in this population,” said Peter Barrance, PhD, “and we’re also testing a feedback system with a visual display to help children develop a more efficient gait pattern during treadmill walking.”
A grant from the New Jersey Commission on Spinal Cord Research recognized the growing importance of neuroimaging techniques in SCI research. Zhiguo (Tony) Jiang, PhD, in Human Performance & Engineering Research, will study the recovery of the injured spinal cord using diffusion tensor imaging, an advanced, non-invasive form of MRI technology available to researchers at the Ortenzio Neuroimaging Center. "Documenting how the spinal cord recovers will help us determine the best course of treatment and improve our predictions of functional recovery,” said Dr. DeLuca, the director of the Ortenzio Neuroimaging Center. “As a result, individuals with SCI will be better able to plan for their futures.”
Improving Long-term Outcomes
“Spinal cord injury has effects that are long-lasting and far-reaching,” noted Trevor Dyson-Hudson, MD, director of Spinal Cord Injury & Outcomes Assessment Research, “and the spectrum of our research reflects that.” In addition to developing ways to restore function, researchers are comparing the long-term outcomes for veterans with service-related and nonservice-related injuries, the impact of early intervention to maintain employment, and how factors such as race, ethnicity, and the community where they live affects the health of people with disabilities. “In New Jersey, we found that environments which benefit the healthy population may not benefit people with limited mobility, such as individuals with SCI, “said Amanda Botticello, PhD, MPH, senior research scientist in Outcomes & Assessment Research. “By understanding the relationship between disability and the environment, we can address the needs of individuals at risk for poorer outcomes.”
Zhiguo (Tony) Jiang, PhD,
Research Scientist
“Deficits in learning and memory are common in the TBI population,” said Dr. Chiaravalloti, project director of the NNJTBIS, “and the impact can be severe. Through the NNJTBIS, we‘re looking at new strategies to help individuals regain the cognitive skills they need to function at home, in school and at work. We’ve also studied how differences in culture and language affect the success of TBI rehabilitation, an important consideration given the diversity of the TBI population.” More than 120 people attended “Taking Care of Yourself after Brain Injury”, the TBI consumer conference hosted by the NNJTBIS. Presenters addressed grief and loss, nutritional support, meditation, and self-advocacy; the panel discussion focused on volunteering as a way to transition into employment. For the first time, those unable to attend were able to listen to podcasts via social media. “We also publish a popular newsletter, TBI News & Views, which features the practical perspectives of individuals, caregivers, and professionals,” added Dr. Chiaravalloti. NNJTBIS is a collaboration of Kessler Foundation, Kessler Institute for Rehabilitation, and local hospitals.
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“Because wheelchair use is integral to the lives of many, we’re studying how wheelchair skills training can help people maintain their participation in the community,” said Dr. Dyson-Hudson, co-director of the NNJSCIS. “Connecting with consumers to educate and inform is an important task for the NNJSCIS,” said Jeanne Zanca, PhD, MPT, assistant director of SCI Research. “In addition to our consumer newsletter, Connections, we hosted eight SCI Grand Rounds - bringing experts in care, technology, and lifestyle issues to our SCI community. And to reach a wider audience, we made podcasts of each presentation available via our social media channels.” NNJSCIS is a collaboration of Kessler Foundation, Kessler Institute for Rehabilitation, and University Hospital in Newark.
Through the Northern New Jersey Spinal Cord System (NNJSCIS) and the Northern New Jersey TBI System (NNJTBIS), the Foundation collaborates with SCI Model System (SCIMS) centers and TBI Model System (TBIMS) centers across the U.S. on research aimed at helping individuals live productive lives after catastrophic injuries. These federally funded Model Systems provide a coordinated national system of acute and rehabilitative care that incorporates innovative research aimed at maximizing functional recovery, and participation in the community and the workplace.
Overcoming Obstacles to Employment
Cognitive problems are often under-recognized as obstacles to community participation and employment. Important advances in memory research in TBI were published in 2015, underscoring the Foundation’s practical approach to developing strategies that help people perform everyday activities. “We conducted a randomized clinical trial of the modified Story Memory Technique© (mSMT), a cognitive intervention to improve learning and memory,” said Dr. Chiaravalloti, “and found improvements among adults with moderate to severe TBI. This study is the first Class I evidence for the efficacy of mSMT in this TBI population, and supports efforts to gain reimbursement for cognitive rehabilitation.”
Unemployment is a major problem among working-age people diagnosed with MS, which has negative consequences for their physical and mental health, as well their standard of living. Lauren Strober, PhD, senior research scientist, studies why some people leave their jobs, and how others manage to stay in the workforce. “Fatigue and cognitive difficulties are often cited by individuals who leave the workforce,” said Dr. Strober, “but symptoms alone do not account for the large drop in employment. Through our research, we have identified other factors that influence these decisions, such as coping skills and perceptions of the benefits of employment. Finding ways to identify persons at risk for leaving work will lead to interventions that will help them stay.”
Cognitive research also attracted media attention in 2015. Two consumer videos featuring Helen Genova, PhD, and Jeannie Lengenfelder, PhD, were produced for EveryDayHealth.com by medical journalist Dr. Sanjay Gupta. The topics were cognitive fatigue and emotional processing deficits, disabling conditions that occur after TBI and with MS. “The inability to perceive the emotions of others can lead to inappropriate responses,” said Dr. Chiaravalloti, “adversely affecting relationships with family members, co-workers, and others. In 2015, we received three new grants for this important line of research, including funding for an International Progressive MS Alliance study with the University of Bordeaux.”
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Funded by a MS Collaborative Network grant from the National MS Society, the Foundation is the only MS Center of Excellence in the U.S. devoted solely to rehabilitation research. Research studies target under addressed areas, including the benefits of exercise, how cognitive and motor skills interact to affect performance, the mechanisms of physical and cognitive fatigue, and new interventions for these debilitating symptoms. “At Kessler Foundation, we are uniquely equipped to accelerate progress in this field,” said Dr. DeLuca.
Dr. Nancy Chiaravalloti, Director, Neuropsychology,
Neuroscience and Traumatic Brain Injury Research
Dr. Lauren Strober
Senior Research Scientist
Dr. John DeLuca
Senior Vice President for Research
View consumer videos:
People With MS May Have Trouble Recognizing Emotions
http://www.everydayhealth.com/news/people-with-ms-may-have-trouble-recognizing-emotions/
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MS Can Cause ‘Emotional Blindness
http://www.everydayhealth.com/sanjay-gupta/multiple-sclerosis/ms-can-cause-emotional-blindness/
Providing Pathways to Careers
The need for effective rehabilitation continues to grow, underscoring the increasing demand for trained scientists. “At Kessler Foundation, we help ensure the future of rehabilitation research through our postdoctoral training program, which prepares young scientists who are striving to discover new ways to improve the lives of people with disabilities,” said Dr. DeLuca. In 2015, we extended our leadership in educating rehabilitation researchers, with the addition of five postdoctoral fellows and 16 research assistants. Of the six Switzer Research Fellowship Awards funded by the National Institute on Disability Independent Living and Rehabilitation Research in 2015, two went to Foundation scientists and former research fellows at Kessler Foundation – Silvana Costa, PhD and Ekaterina Dobryakova, PhD. “This really speaks to the quality of our training program,” said Dr. DeLuca.