Putting the Pieces Together

1. Putting the Pieces Together Nancy D. Chiaravalloti, Ph.D. Director of Neuroscience and Neuropsychology Director of Traumatic Brain Injury Research Kessler Foundation Associate Professor of Physical Medicine and Rehabilitation Rutgers, New Jersey Medical School

2. What have we learned? • Dr. Wylie • Types of neuroimaging (fMRI, MRI, DTI) • Many technologies available to us • Dr. Lengenfelder • Emotional processing following TBI • Can be a challenge • Neuroimaging is helping us understand the deficit and treatment • Dr. Genova • Cognitive Rehab post-TBI • Applying neuroimaging to understand efficacy patterns

3. What have we learned? • Dr. Wylie • Types of neuroimaging (fMRI, MRI, DTI) • Many technologies available to us • Dr. Lengenfelder • Emotional processing following TBI • Can be a challenge • Neuroimaging is helping us understand the deficit and treatment • Dr. Genova • Cognitive Rehab post-TBI • Applying neuroimaging to understand efficacy patterns

4. What have we learned? • Dr. Wylie • Types of neuroimaging (fMRI, MRI, DTI) • Many technologies available to us • Dr. Lengenfelder • Emotional processing following TBI • Can be a challenge • Neuroimaging is helping us understand the deficit and treatment • Dr. Genova • Cognitive Rehab post-TBI • Applying neuroimaging to understand efficacy patterns

5. Changes after Emotional Processing Intervention • Increased activation post-treatment • frontal regions • parietal regions • Also saw improvements on measure of facial affect

6. What have we learned? • Dr. Wylie • Types of neuroimaging (fMRI, MRI, DTI) • Dr. Lengenfelder • Emotional processing following TBI • Can be a challenge • Neuroimaging is helping us understand the deficit and treatment • Dr. Genova • Cognitive Rehabilitation Post-TBI • Applying neuroimaging to understand efficacy patterns

7. Changes after Memory Retraining (fMRI) More activity in hippocampus, occipital, frontal and parietal regions

8. Changes after a PS Intervention • Increased activity throughout the brain • Also saw an improvement in PS performance and daily activities

9. Increased Communication after treatment Increased communication between the memory center and regions in the frontal lobes

10. What is neuroimaging telling us to date? • Telling us about the brain • Telling us about the treatment

11. 1. Telling us about the brain • How the brain functionsafter treatment • Increased activity after treatments • Engaging more brain areas in the task • Exercising the brain • Increased communication between brain regions after treatment • Associated with better functioning

12. 2. Telling us about the treatment • What is theimpact of the treatment on the brain? • What brain changes are associated with better functioning?

13. What else can we learn from neuroimaging? • Anatomical imaging • Relationship between lesion location and treatment efficacy • 2 cases in which there is no benefit from treatment

14. What else can we learn from neuroimaging? • Example 1 • MRI with a lesion in the occipital lobe • Are the cognitive deficits associated with the occipital lobe injury preventing the treatment from working?

15. What else can we learn from neuroimaging? • Example 2 • DTI shows poor white matter connections • Is poor communication between brain areas preventing the treatment from working?

16. Emotional Processing in TBI Using DTI, persons with fewer correct responses also had lower measure of white matter integrity in inferior longitudinal fasciculus (ILF).

17. What else can we learn from neuroimaging? • Functional imaging • What aspects of the treatment are working? • Example: Memory Retraining • We expect 2 things after treatment • Increased activity in frontal regions • Teaching organization of material • Increased activity in spatial regions • Teaching visualization of material • If one does not occur, both aspects of treatment may not be working

18. What else can we learn from neuroimaging? • Increased activity in spatial regions • Increased activity in frontal regions • Increased activity in spatial regions • Do NOT see increased activity in frontal regions Illness 1 Illness 2

19. What else can we learn from neuroimaging? • Role of individual differences • What are those individual differences related to brain structure and function?

20. What else can we learn from neuroimaging? • Functional imaging • What other treatment might yield the same result? • Example • We see improved function with increased activation in a specific region • What other treatments have been shown to increase activation in that brain area? • E.g. Medication in Multiple Sclerosis

21. What else can we learn from neuroimaging? • Functional imaging • How can we maximize our treatment effect? • Example • We see improved function with increased activation in a specific region • Can we given a higher dose of the treatment to increase activity even more? • More sessions?

22. Future Continued Applications of Neuroimaging Application Information Yielded How is the brain responding What is cause the improvement in function? Does the location and extent of the injury play a role in treatment efficacy? • Before and after cognitive rehab • Before and after physical rehab • Before and after other treatments • Emotional processing

23. Future Continued Applications of Neuroimaging Why is rehabilitation working?

24. Funding Sources • Kessler Foundation NIDRR Grants H133A120030 H133A070037 H133G090078 Thank You!

25. Our Research Participants • You are essential to the work we do! Thank You! • See our research table to get involved!