Spotlighting Hidden Disabilities
During 2016, our research continued to influence stroke rehabilitation. More health professionals are implementing the tools developed at Kessler Foundation to detect and treat spatial neglect, a hidden disability that complicates recovery after stroke. Even after mild strokes, spatial neglect can be disabling, causing difficulties with activities such as self-care, driving, reading, and navigating one’s surroundings. Individuals with spatial neglect have an increased risk for falls and prolonged hospital stays, and are less likely to return home. Using the Kessler Foundation Neglect Assessment Program (KF-NAP), clinicians are screening patients for spatial neglect. Those diagnosed with this hidden disability receive Kessler Foundation Prism Adaptation Treatment (KF-PAT), a noninvasive, cost-effective behavioral therapy using prism goggles.
VIDEO: Steve Adubato goes on-location to the Kessler Foundation’s Life after Stroke event to speak with Dr. A.M. Barrett, about her research on post-stroke disabilities like spatial neglect - a disability where stroke victims lose the ability to perceive and/or respond to stimuli on one side of the body.
Exploring Reading Difficulties
Another cause of disability after stroke is the inability to read. Despite the implications for this impairment, few studies have focused on the cognitive components of reading. Our researchers, in collaboration with their Rutgers colleagues, are using neuroimaging techniques, neurological examination, and neuropsychological testing to determine the cognitive mechanisms that underlie our ability to read. Led by Olga Boukrina, PhD, the team has correlated specific reading deficits with the location of brain lesions among inpatients with left-sided stroke. This line of research has the potential to improve rehabilitative care after stroke. Based on these findings, new interventions will be developed that will restore the ability to read in stroke survivors and others with acquired reading deficits.
Because recovery from stroke can mean overcoming a range of different deficits, stroke rehabilitation research at Kessler Foundation addresses the spectrum of challenges faced by stroke survivors. Foundation researchers apply broad-based expertise to find new ways to restore cognitive function and mobility, including the use of low-tech solutions such as prism goggles, and high-tech approaches that include robotics and neuroimaging techniques. By closely collaborating with clinicians, advances in research are improving rehabilitative care after stroke, with funding from the National Institutes of Health, the New Jersey Commission on Brain Injury Research, the Wallerstein Foundation, the National Institutes of Neurological Disorders & Stroke, the Mabel H. Flory Collaborative Trust, and Kessler Foundation.
In this report, we highlight Kessler Foundation’s contributions to detecting and treating hidden disabilities, expanding knowledge of reading deficits, improving medication adherence, and testing new interventions during in-patient rehabilitation.
International Reach
The severity of spatial neglect, which can be measured with KF-NAP, could affect rates of home discharge, an important benchmark for stroke rehabilitative care. This finding has attracted interest from facilities in the U.S. and abroad. In 2016, the Select Medical Inpatient Division introduced the directors of their 20 U.S. rehabilitation facilities to the potential benefits of implementing Kessler Foundation’s tools. We also hosted colleagues from Denmark and Sweden interested in collaborating with Kessler Foundation to improve their stroke care. As more professionals incorporate KF-NAP and KF-PAT in their rehabilitation protocols, more stroke survivors will attain optimal recovery and greater independence.
A.M. Barrett, MD
Director of Stroke Rehabilitation Research
Taking medication correctly is critically important to recovery after brain injury and stroke. These tasks are especially challenging for individuals with cognitive deficits, who often are unaware that they are not following instructions for self-administration. This raises the risk for medication errors, and increases the need for assistance at home. Our researchers are working with clinicians at Kessler Institute for Rehabilitation to determine the optimal approach to ensuring that individuals take their medications as prescribed. They are looking at whether timed reminders can boost compliance and comparing two types of controls – automated texts and video calls, with no reminders. Compliance is monitored using computerized pill bottles that track each dose of medication. This information will be correlated with clinical factors, such as whether individuals are re-hospitalized, how they rate their quality of life, and how caregivers view the status of their recovery. By incorporating strategies that support medication adherence into the rehabilitation process, we increase the likelihood that stroke survivors will maximize their independence and successfully return to their communities.
Monitoring Self-administration of Medication
Advancing Science Through Leadership
Dr. Barrett was among the top ten American Academy of Neurology’s (AAN) Transforming Leaders. She was selected from more than 100 mid-career neurologists for her exceptional promise to advance science and patient care.
VIDEO: In this 2016 TEDx Talk, Dr. A.M. Barrett discusses how we move through the world, and identifies new methods for brain injury rehabilitation. To date, the video has received over 32,000 views on YouTube.
Team members Michele Barry, Dr. Neil Jasey, and Jenny Masmela, holding the MEMS Cap’s used to track medication adherence.
Front Row: Charlene Gamaldo, MD, FAASM, FAAN; Daniela Bota, MD; Michael F. Waters, MD, PhD, FAAN; Jennifer Bickel, MD; Barbara C. Jobst, MD, FAAN
Back Row: Susan T. Herman, MD, FAAN; Richard E. Ferguson, MD, MBA, FACP; Anil K. Dhuna, MD, FAASM, FAAN; A.M. Barrett, MD, FAAN; Kirk Roberts, MD
Dr. A.M. Barrett, shares her exciting research with KF-NAP and KF-PAT that is helping patients recover from the debilitating effects of a stroke on One on One with Steve Adubato.
