Rewiring the Brain to Help Improve Rehabilitation

March 19, 2018
Teresa Jacobson Kimberley, PhD, PT

Imagine a concert pianist coming down for breakfast, pouring a cup of coffee, and going over to the piano bench. She raises her hands to play a familiar piece, but two of her fingers curl involuntarily and she’s unable to perform. Her hands work fine for all other tasks, but more practice or effort at the piano just makes it worse.

It’s called dystonia, a rare condition when a person becomes unable to perform a repetitive motion that they’ve done literally millions of times because their brain has spontaneously disorganized. This goes to the core of the research on which the MGH Institute’s newest faculty researcher, Teresa Jacobson Kimberley, is focusing: How can injured brains be reorganized?

“My research is trying to find ways for the brain to form better connections,” says Dr. Kimberley, a physical therapist whose work has helped to pioneer the use of neuroimaging and non-invasive brain stimulation in the investigation of rehabilitation-related areas, and has had her work funded through the National Institutes of Health, private foundations, and industry partners. “What we want to do is use stimulation as an adjunct to physical rehabilitation by targeting the areas of a brain that need to be enhanced, in essence rewiring them so they work better.”

With dystonia, the goal is to understand exactly which brain areas aren’t connecting properly and then work with the dysfunctional brain pathways to make them work properly—so, for example, the pianist can play music again. Over the next four years, Kimberley will use an NIH grant to investigate how neuroimaging and non-invasive brain stimulation can help people recover from dystonia. “We are only beginning to understand what the best ways are to regain function.”

Other disorders requiring brain “rewiring” are found in people who have had a stroke. In these patients, the brain areas where the stroke hit have been destroyed, so Kimberley looks to identify other existing pathways as a kind of workaround for their brains to adapt new ways of doing everyday tasks. Kimberley has brought her innovative approach of using brain stimulation combined with rehabilitation to the Institute as the director of the school’s new Brain Recovery Lab. Just months after arriving in the fall of 2017, she is launching the first on-campus clinical trial in the Institute’s history.

Clinicians at the IHP and 15 other institutions—including the Mayo Clinic, the Medical University of South Carolina, and Emory University—will combine physical therapy with vagus nerve stimulation (VNS) in an effort to improve patient outcomes after a stroke. This study involves stimulating the vagus nerve with a small electrical pulse from a cuff that’s wrapped around a nerve and powered by a unit implanted in the patient’s chest. The stimulation is paired with rehabilitation. Preliminary studies, of which Kimberley has been a part, have shown the treatment is safe and may help people get better function in their arm and fundamentally improve how they recover from a stroke.

Regardless of which condition is affecting a patient, their brain connections and impairments are unique. The future of medicine, she says, is going to be tailoring rehabilitation and care to each person’s specific needs. “We are only beginning to understand what the best ways to stimulate the brain are to regain function,” Kimberley says. “We hope brain stimulation is going to enhance the impact that rehabilitation has on people with neurologic disorders, leading to dramatically improved recovery.”