Nancy Chiaravalloti on Improving Memory

In this episode of Kessler Foundation's podcast, we are talking with Dr. Nancy Chiaravalloti. She is the director of the Center for Neuropsychology and Neuroscience Research and the Center for Traumatic Brain Injury Research at Kessler Foundation. She spoke with Rob Gerth, the Foundation's communications director.

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Below is an excerpt from the conversation.

Rob Gerth: If somebody from your group says, "Culture might have something to do with rehabilitation." How does that go from an idea sitting around a table to getting some money to study it?

Nancy Chiaravalloti: That's a great question. Ideas pop out all the time, and we have several different team meetings depending on the topic. So there are several different teams that comprise the big team. So there are a lot of team meetings that occur throughout the week, and there are a lot of ideas that just pop up, sometimes randomly. Usually, the first step is we determine whether or not we have existing data where we can look at a question. So as an example - this happened in the past - we have a memory rehabilitation protocol called the Story Memory Technique that we've been testing for years here. We modified it here. We've been testing it for years. And we have a lot of data showing its efficacy in MS and TBI. We are now collecting data in aging, and we think it's helpful. So what we're doing is looking at the efficacy of that technique. But in order to do that, you see that some people don't benefit. Most people benefit, but there is a small group of people that don't benefit. So that leads to the question as to why. In an MS sample, one of the ideas was that, well, maybe it's processing speed. We know that people with MS have slower processing speed. Maybe processing speed has an impact on whether or not the person with MS can benefit from the memory rehabilitation protocol.

So we went back, and we looked at the memory rehabilitation data, the data on the Story Memory Technique. We had an assessment of processing speed, and we looked at the influence of performance on that measure on their ability to benefit from the rehabilitation protocol. And what we found was that people with impaired processing speed were not showing benefit, and people with intact processing speed showed tremendous benefit. So that led to a whole other study that was submitted to the National MS Society, was funded, and it has now just concluded. We're about to take a look at the data. And that study looked at an intervention for processing speed with processing speed as the primary outcome, but then we're also looking at performance on memory tests as a more distal outcome. So if you improve someone's processing speed, do you improve their memory? So that just came from an idea that was generated, and it developed a whole additional line of research, and now we have a line of research that really looks at processing speed and was taken in a whole other direction by one of our scientists who was previously one of our fellows and came in with fresh ideas and decided to look at the role of eye tracking in processing speed. So it's a whole other line of research in MS.

RG: We've mentioned the Story Technique several times. Just a short definition of what it is so people know what you're talking about.

NC: So the modified Story Memory Technique is a 10-session memory rehabilitation program where people come in and they learn techniques to facilitate new learning and memory. In that program, they learn to use context and imagery to help them learn information across 10 sessions. And what we've shown in both MS and TBI is that it's very effective in improving new learning and memory both in the clinic on our objective neuropsychological test as well as on measures of everyday life. We've also shown imaging data that show the changes that happen at the level of the brain from before to after treatment. And what we've demonstrated is that the manner in which the brain processes and remembers information is different after treatment as compared with before treatment.

RG: The TBI Model System, explain that to us a little bit here at Kessler?

NC: The TBI Model System is a network of rehabilitation centers. It's funded by the National Institute on Disability, Independent Living, and Rehabilitation Research. So we termed it NIDILRR. NIDILRR funds 16 centers across the nation, and they're centers that have been identified as centers of excellence in terms of the clinical care they provide as well as excellence in the research that they conduct. So there are two parts to any one TBI Model System, and that's exceptional clinical care and exceptional research. So our partner, logically, is Kessler Institute for Rehabilitation. So without Kessler Institute for Rehabilitation, there would not be a model system here. The excellent clinical care that they provide is essential to the TBI Model System that we have. Equally as important is the record of exceptional research that we have conducted over the years in traumatic brain injury. So those two factors are combined, and that's how we submit our TBI Model System. The process is a competitive grant process that happens every five years. We have to write a grant that demonstrates both of those characteristics, exceptional clinical care and a strong environment to be able to conduct cutting-edge research. Within the application, we propose research projects and collaborations with other centers.

In the end, after the grant submittal process and review process, there have been 16 centers that are selected. And those centers each conduct their own research, obviously continue with their clinical care, but we also all contribute to a national database of persons who have had traumatic brain injury. We follow those people from the time they're injured through their inpatient rehabilitation, and then we follow up with them one year later, five years later, and then every five years thereafter. And we contribute to this national database to be able to look at the longterm trajectory of patients who have traumatic brain injury. So that database now has over 20,000 cases in it. It's been ongoing since 1987, and there have been different centers involved over the years. And right now, the 16 centers are across the nation. We meet twice a year in Washington DC. We do collaborative work where we work together on certain projects, but we also do independent work. We all have our own projects ongoing that are part of that TBI Model System.

RG: Are there any outcomes that you can point to say here's something that came out of this?

NC: There are several studies. Some of the practices that occur within rehabilitation hospitals are a direct result of the research that was done within the TBI Model System program. In addition, some of our work that we've done specifically here has advanced the work that we're doing in cognitive rehabilitation. So as an example, I mentioned the Story Memory Technique earlier. That was this site's specific project, the project that occurred only at Kessler Foundation, in our 2007 to 2012 model system. So through that project, we demonstrated that the Story Memory Technique was effective in persons with traumatic brain injury. Subsequent to that, we translated it to Spanish. We distributed it, and we continue to distribute it to clinicians across the world. It's translated to Chinese as well now, and we have some other translations in progress. So all of the work in TBI really originated from that-- for the Story Memory Technique really originated from that TBI Model System. But then there are numerous other studies that go on on a daily basis where collaborators from different centers are working together to answer questions related to culture, to aging, to morbidity, mortality, gender issues. There are a lot of different studies that continue to be ongoing that have an impact on clinical care.