Rehabilitation Research and Development Service

West Haven, CT, United States

Rehabilitation Research and Development Service

West Haven, CT, United States

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News Article | December 9, 2016
Site: www.eurekalert.org

Massachusetts General Hospital (MGH) researchers have developed what appears to be a significant improvement in the technology behind brain implants used to activate neural circuits responsible for vision, hearing or movement. The investigators, who are also affiliated with the Boston VA Healthcare System, describe their development of tiny magnetic coils capable of selectively activating target neurons in the Dec. 9 issue of Science Advances. "Neural stimulation systems based on electrodes are currently being used to restore senses such as vision and hearing; to treat neurological disorders such as Parkinson's disease, and for brain-computer interfaces that can give paralyzed patients the ability to communicate or move objects," explains lead author Seung Woo Lee, PhD, of the MGH Department of Neurosurgery. "But electrode-based neural stimulation devices, especially those that target the cortex, have several significant limitations. The environment within the brain can erode a metal electrode over time, and the brain's natural foreign-body response can lead to scarring, which can impede passage of electrical fields." The use of magnetic rather than electrical fields to stimulate neurons presents several advantages, including the ability to penetrate scar tissue. Since the magnetic signal can pass through biocompatible insulating material, direct contact between neural tissue and the metal coil is eliminated, further reducing the potential for damage to the coil. But it had been believed that magnetic coils strong enough to activate neurons would be too large to be implanted within the brain's cortex. The device developed by Lee and senior author Shelley Fried, PhD, of MGH Neurosurgery -- in collaboration with scientists at the Palo Alto Research Center - takes advantage of the fact that the passage of electric current through a bent wire will induce a magnetic field. The novel coil they designed, while similar to the size of electrodes used for brain stimulation, was able to generate magnetic fields in excess of the thresholds required to activate neurons. Testing these microcoils in brain tissue samples from mice revealed not only that they were capable of activating neurons but also that they did so more selectively than would be possible with metal electrodes. Electric fields most effectively activate neurons when they are oriented along the length of nerve cells, but most implantable electrodes generate fields that spread uniformly in all directions. In contrast, magnetic fields extend in specific directions, allowing selective targeting of neurons with the same orientation while simultaneously avoiding the activation of other neurons. The ability to avoid activation of passing nerve fibers prevents the spread of activation that typically occurs with electrodes, which can lead, for example, to the blurring of a visual image generated in response to stimulation of the visual cortex. The MGH team proceeded to show that these microcoils could safely be implanted into the brains of anesthetized mice. Stimulation of coils inserted into the portion of the motor cortex that controls the animals' whiskers resulted in whisker motion, with the direction depending on the frequency of the signal. Stimulating coils placed in the whisker sensory cortex caused whisker retraction. These experiments proved that implanted coils can be used to drive responses associated with the targeted neurons. "Our next steps will be to continue improving coil design to reduce power and enhance selectivity, to confirm that the enhanced effectiveness of these coils will persist over time, and to determine whether stimulation of the visual cortex does elicit a visual signal," says Fried, who is an associate professor of Neurosurgery at Harvard Medical School. "More stable long-term performance of these microcoils and the high-resolution signals produced by ever greater selectivity in neuron activation would significantly improve currently available neural prostheses and open up many new applications." Florian Fallegger and Bernard Casse of the Palo Alto Research Center are co-authors of the Science Advances report. The study was supported by Veterans Administration-Rehabilitation Research and Development Service grant 1I01 RX001663, National Eye Institute grant R01-EY023651, National Institute for Neurological Disease and Stroke grant U01-NS099700, and the Rappaport Foundation. The MGH has filed a patent application for the technology described in this paper. Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2016 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."


Barnett S.D.,James A Haley Veterans Hospital | Heinemann A.W.,Northwestern University | Libin A.,Georgetown University | Houts A.C.,University of Memphis | And 4 more authors.
Journal of Rehabilitation Research and Development | Year: 2012

Rehabilitation research presents unique and challenging problems to investigators during both the design and analysis periods. Statistical issues regarding sample size requirements for an adequately powered study may be in direct conflict with realistic recruitment and subject retention goals. Issues of underpowered studies, sample size requirements, and recruitment goals plague rehabilitation research. Randomized clinical trials (RCTs) are typically narrow in scope and thus lack generalizability to everyday, yet specific, clinical problems; they are also costly and time-consuming and require large numbers of participants for randomization to have optimal, desired effects. Further, the RCT design may not be applicable to assistive technologies and environmental modifications-vital components of disability and rehabilitation research-nor is it appropriate in situations in which theoretical models of change are lacking or premature. Single-case designs are better suited for studies in which understanding and changing patient behavior and functional status are primary goals and the targeted sample sizes are less than 30 and frequently less than 10. Theoretical, methodological, and clinical reasons for using experimental and quasi-experimental single-case designs are presented. Recommendations for designing and conducting single-case studies that contribute to the evidence base are also discussed.


Maas A.I.,University of Antwerp | Harrison-Felix C.L.,Craig Hospital | Menon D.,University of Cambridge | Adelson P.D.,Phoenix Childrens Neuroscience Institute | And 13 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2010

Comparing results across studies in traumatic brain injury (TBI) has been difficult because of the variability in data coding, definitions, and collection procedures. The global aim of the Working Group on Demographics and Clinical Assessment was to develop recommendations on the coding of clinical and demographic variables for TBI studies applicable across the broad spectrum of TBI, and to classify these as core, supplemental, or emerging. The process was consensus driven, with input from experts over a broad range of disciplines. Special consideration was given to military and pediatric TBI. Categorizing clinical elements as core versus supplemental proved difficult, given the great variation in types of studies and their interests. The data elements are contained in modules, which are grouped together in categories. Three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail in the advanced version. In every case, the more detailed coding can be collapsed into the basic version. Templates were produced to summarize coding formats, motivation of choices, and recommendations for procedures. Work is ongoing to include more international participation and to provide an electronic data entry format with pull-down menus and automated data checks. This proposed standardization will facilitate comparison of research findings across studies and encourage high-quality meta-analysis of individual patient data. © 2010 American Congress of Rehabilitation Medicine.


Kim S.-P.,Korea University | Simeral J.D.,Rehabilitation Research and Development Service | Simeral J.D.,Brown University | Hochberg L.R.,Rehabilitation Research and Development Service | And 7 more authors.
IEEE Transactions on Neural Systems and Rehabilitation Engineering | Year: 2011

We present a point-and-click intracortical neural interface system (NIS) that enables humans with tetraplegia to volitionally move a 2-D computer cursor in any desired direction on a computer screen, hold it still, and click on the area of interest. This direct braincomputer interface extracts both discrete (click) and continuous (cursor velocity) signals from a single small population of neurons in human motor cortex. A key component of this system is a multi-state probabilistic decoding algorithm that simultaneously decodes neural spiking activity of a small population of neurons and outputs either a click signal or the velocity of the cursor. The algorithm combines a linear classifier, which determines whether the user is intending to click or move the cursor, with a Kalman filter that translates the neural population activity into cursor velocity. We present a paradigm for training the multi-state decoding algorithm using neural activity observed during imagined actions. Two human participants with tetraplegia (paralysis of the four limbs) performed a closed-loop radial target acquisition task using the point-and-click NIS over multiple sessions. We quantified point-and-click performance using various humancomputer interaction measurements for pointing devices. We found that participants could control the cursor motion and click on specified targets with a small error rate (< 3% in one participant). This study suggests that signals from a small ensemble of motor cortical neurons (∼40) can be used for natural point-and-click 2-D cursor control of a personal computer. © 2011 IEEE.


PHOENIX, AZ, November 07, 2016 /24-7PressRelease/ -- The unique, online event is titled, "A Salute to Veterans and Service Members." Timed with Veteran's Day, the one-hour program offers life-changing information regarding many brave men and women whose service to our country created their hidden disability. Tinnitus is the most common service-connected disability among Veterans. While levels of severity vary, it is an audiological and neurological condition often resulting from noise encountered during service, such as gunfire, explosives, machinery, aircraft, and more. 60 percent of Veterans returning from Iraq and Afghanistan come home with tinnitus and hearing loss due to noise exposure during service. "We're calling it A Salute to Veterans and Service Members, but really it's so much more," said Melanie West, Board Chair of the American Tinnitus Association, and acting Executive Director. "We're teaming with the Department of Veterans Affairs and Department of Defense in highlighting their programs. It fits the mission of ATA's webinar series to provide help and hope through sharing valuable information including the latest research, a multitude of solutions for treatment and management of tinnitus, hyperacusis (sensitivity to certain sounds), and hearing loss." A pair of America's leading tinnitus experts will share the webinar online stage as presenters: • LaGuinn Sherlock, Au.D., is a research audiologist with the Army Public Health Center, stationed at Walter Reed National Military Medical Center (WRNMMC). With over 25 years of experience, she is also an adjunct faculty member in the Department of Hearing and Speech Sciences at the University of Maryland. Dr. Sherlock also serves on the American Tinnitus Association Board of Directors. • Based at the Veterans Affairs National Center for Rehabilitative Auditory Research in Portland, Oregon, James Henry, Ph.D. has been a pioneer in tinnitus research for 22 years. He also has tinnitus himself. Dr. Henry is the 2016 Paul B. Magnuson Award winner, the highest honor any medical investigator can achieve from the VA's Rehabilitation Research and Development Service. As a sign of gratitude and respect, ATA waived the standard $25 fee for Veterans, and Service Members who want to attend its popular webinar series. "Despite being a non-profit organization ourselves, we chose to put finances aside for those who protect our freedom," said Scott Mitchell, American Tinnitus Association Co-Chair. "This is a special opportunity to bring together our ATA members, our Veterans and Service Members with two of the nation's leading researchers and healthcare professionals regarding tinnitus." People interested in registering for ATA's Salute to Veterans and Service Members, should go to http://ata.org. Space is limited. About the American Tinnitus Association Since 1971, the American Tinnitus Association has been a global leader and the nation's foremost and trusted organization committed to finding a multitude of cures for tinnitus and hyperacusis. ATA is the only patient-based membership association which directly funds tinnitus research. Since 1980, it has allocated over $6 million to advance tinnitus research. As a registered 501(c)(3) non-profit association, ATA is driven to support the 45 million Americans struggling with tinnitus. It is governed by a Board of Directors, and advised by a Scientific Advisory Committee, each composed of leading patient advocates and stakeholders in the tinnitus and hearing health fields.


Corrigan J.D.,Ohio State University | Selassie A.W.,Medical University of South Carolina | Orman J.A.,Rehabilitation Research and Development Service
Journal of Head Trauma Rehabilitation | Year: 2010

Objective: To describe the most recent estimates of the incidence and prevalence of traumatic brain injury (TBI) and review current issues related to measurement and use of these data. Design: State of the science literature for the United States and abroad was analyzed and issues were identified for (1) incidence of TBI, (2) prevalence of lifetime history of TBI, and (3) incidence and prevalence of disability associated with TBI. Results: The most recent estimates indicate that each year 235 000 Americans are hospitalized for nonfatal TBI, 1.1 million are treated in emergency departments, and 50 000 die. The northern Finland birth cohort found that 3.8% of the population had experienced at least 1 hospitalization due to TBI by 35 years of age. The Christchurch New Zealand birth cohort found that by 25 years of age 31.6% of the population had experienced at least 1 TBI, requiring medical attention (hospitalization, emergency department, or physician office). An estimated 43.3% of Americans have residual disability 1 year after injury. The most recent estimate of the prevalence of US civilian residents living with disability following hospitalization with TBI is 3.2 million. Conclusion: Estimates of the incidence and prevalence of TBI are based on varying sources of data, methods of calculation, and assumptions. Informed users should be cognizant of the limitations of these estimates when determining their applicability. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Bell M.D.,Yale University | Vissicchio N.A.,Rehabilitation Research and Development Service | Weinstein A.J.,Yale University
Journal of Dual Diagnosis | Year: 2016

Objective: This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older veterans with alcohol use disorders. Methods: Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early-phase recovery (N = 31), were randomized to receive a three-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at three-and six-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure. Results: Participants were primarily male (97%) and in their mid-50s (M = 55.16, SD = 5.16) and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at three-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at three-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p <.005, Cohen's d = 1.3) and verbal memory (HVLT Total T-score, p <.01, Cohen's d = 1.1). Condition effects were sustained at six-month follow-up. At baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of verbal IQ. At three-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p <.01, number needed to treat = 3.0) compared with the work therapy alone condition and a trend toward significance for verbal learning deficits, which was not sustained at six-month follow-up. Conclusions: This National Institute on Drug Abuse-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is registered on ClinicalTrials.gov (NCT 01410110). © 2016 Taylor & Francis Group, LLC.


Bell M.D.,Yale University | Vissicchio N.A.,Rehabilitation Research and Development Service | Weinstein A.J.,Yale University
Drug and Alcohol Dependence | Year: 2016

Background: This study examined visual and verbal learning in the early phase of recovery for 48 Veterans with alcohol use (AUD) and substance use disorders (SUD, primarily cocaine and opiate abusers). Previous studies have demonstrated visual and verbal learning deficits in AUD, however little is known about the differences between AUD and SUD on these domains. Since the DSM-5 specifically identifies problems with learning in AUD and not in SUD, and problems with visual and verbal learning have been more prevalent in the literature for AUD than SUD, we predicted that people with AUD would be more impaired on measures of visual and verbal learning than people with SUD. Methods: Participants were enrolled in a comprehensive rehabilitation program and were assessed within the first 5 weeks of abstinence. Verbal learning was measured using the Hopkins Verbal Learning Test (HVLT) and visual learning was assessed using the Brief Visuospatial Memory Test (BVMT). Results: Results indicated significantly greater decline in verbal learning on the HVLT across the three learning trials for AUD participants but not for SUD participants (F= 4.653, df = 48, p= 0.036). Visual learning was less impaired than verbal learning across learning trials for both diagnostic groups (F= 0.197, df = 48, p= 0.674); there was no significant difference between groups on visual learning (F= 0.401, df = 14, p= 0.538). Discussion: Older Veterans in the early phase of recovery from AUD may have difficulty learning new verbal information. Deficits in verbal learning may reduce the effectiveness of verbally-based interventions such as psycho-education. © 2015.


PubMed | Rehabilitation Research and Development Service and Yale University
Type: Journal Article | Journal: Journal of dual diagnosis | Year: 2016

This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older veterans with alcohol use disorders.Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early-phase recovery (N = 31), were randomized to receive a three-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at three- and six-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure.Participants were primarily male (97%) and in their mid-50s (M = 55.16, SD = 5.16) and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at three-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41hours of cognitive training, and both conditions had more than 230hours of productive activity. HVLT results at three-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p < .005, Cohens d = 1.3) and verbal memory (HVLT Total T-score, p < .01, Cohens d = 1.1). Condition effects were sustained at six-month follow-up. At baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of verbal IQ. At three-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p < .01, number needed to treat = 3.0) compared with the work therapy alone condition and a trend toward significance for verbal learning deficits, which was not sustained at six-month follow-up.This National Institute on Drug Abuse-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is registered on ClinicalTrials.gov (NCT 01410110).


PubMed | Rehabilitation Research and Development Service and Yale University
Type: | Journal: Drug and alcohol dependence | Year: 2016

This study examined visual and verbal learning in the early phase of recovery for 48 Veterans with alcohol use (AUD) and substance use disorders (SUD, primarily cocaine and opiate abusers). Previous studies have demonstrated visual and verbal learning deficits in AUD, however little is known about the differences between AUD and SUD on these domains. Since the DSM-5 specifically identifies problems with learning in AUD and not in SUD, and problems with visual and verbal learning have been more prevalent in the literature for AUD than SUD, we predicted that people with AUD would be more impaired on measures of visual and verbal learning than people with SUD.Participants were enrolled in a comprehensive rehabilitation program and were assessed within the first 5 weeks of abstinence. Verbal learning was measured using the Hopkins Verbal Learning Test (HVLT) and visual learning was assessed using the Brief Visuospatial Memory Test (BVMT).Results indicated significantly greater decline in verbal learning on the HVLT across the three learning trials for AUD participants but not for SUD participants (F=4.653, df=48, p=0.036). Visual learning was less impaired than verbal learning across learning trials for both diagnostic groups (F=0.197, df=48, p=0.674); there was no significant difference between groups on visual learning (F=0.401, df=14, p=0.538).Older Veterans in the early phase of recovery from AUD may have difficulty learning new verbal information. Deficits in verbal learning may reduce the effectiveness of verbally-based interventions such as psycho-education.

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