MUSC named national coordinating center for rehabilitation research

July 06, 2020
People crowd into a room to listen as a man talks while behind him another man sits in a chair with a brain stimulation contraption strapped to his head
MUSC biomedical engineer Jayce Doose speaks to a small group during a conference hosted at MUSC in 2019. Photos by Anne Herford

About one in five Americans has a disability of some sort, whether because of accident, war, congenital issues or aging, according to the National Institutes of Health. 

The Medical University of South Carolina has been a leader in supporting research to help individuals to rehabilitate their bodies and participate more fully in life for the past five years. This will continue as the National Center of Neuromodulation for Rehabilitation (NC NM4R), housed within the College of Health Professions (CHP) at MUSC, has received a five-year renewal from the National Institutes of Health (NIH). It is one of only two rehabilitation research centers to be renewed in this grant cycle.

In addition, the NC NM4R will take on a new leadership role as it has been named the national coordinating center for a group of six such centers, the Medical Rehabilitation Research Resource Network, each with its own particular focus on rehabilitation research. The coordinating center is what can truly make the whole greater than the sum of its parts, said NC NM4R program director Steve Kautz, Ph.D., an endowed professor whose research focuses on stroke recovery. 

“We're now working hand in glove with the NIH to help set the agenda to improve rehabilitation research across the country,” he said.

As the national coordinating center, MUSC will be able to develop conferences and initiatives to meet the emerging needs and interests of the rehabilitation research community, Kautz said.

The NC NM4R, which includes faculty from the College of Medicine as well as CHP, focuses on research into neuromodulation, using noninvasive techniques like transcutaneous auricular vagus nerve stimulation (taVNS), transcranial magnetic stimulation (TMS) and operant conditioning to train the brain and spinal cord in new ways of moving or thinking. Multiple clinical trials are using these techniques on a variety of physical and mental conditions, and TMS is already FDA approved for treatment-resistant depression.

But the key to MUSC’s successful renewal is its focus not just on MUSC researchers but on training researchers across the country, Kautz said.

“We try to nurture people at different levels of their involvement in rehab research to take them to the cutting edge and make it more likely they can get funded to do things that are going to have impact,” said Richard Segal, PT, Ph.D., chairman of the CHP Department of Health Professions.

He made note of one graduate student who came to a workshop at MUSC and learned techniques for operant conditioning of spinal reflexes, took that information back to the lab where his advisor gathered preliminary data and then successfully applied for a grant from the NC NM4R. With those results, the advisor was able to secure an NIH grant. That the researcher is at the University of Texas at Austin, rather than MUSC, isn’t a drawback in Segal’s eyes but a win.

“That’s perfect,” he said. “That’s our job, to reach out.”

people sit at long tables in a classroom listening to a speaker  
Paul Sajda, Ph.D., of Columbia University speaks during a 2019 conference at MUSC.

The NC NM4R has trained people from more than 30 states, Segal and Kautz said. Traditionally, those trainings are in the form of in-person workshops, but the pandemic has forced them to get creative and go online. In doing so, they’ve discovered how many more people they can reach. One recent workshop was slated to have 40 in-person attendees. When it was moved online, 200 people registered, Segal said. At times, there were as many as 150 people logged into Zoom sessions. Segal and Kautz are enthusiastic about continuing virtual trainings even when in-person sessions are feasible again because they offer a way for scientists from universities with smaller travel budgets to receive training.

“The training we do is for researchers who want to change the structure and function of the nervous system to help people recover after an injury or disease. We do most of it without being invasive, so we’re helping people with things we believe, ultimately, could end up in practice,” Segal said.

The currency of the nervous system is electricity, Kautz explained. Thus, stimulating certain nerves or areas of the brain promises to deliver results in a more targeted fashion with fewer side effects than drugs. 

“The gold standard for what we hope to achieve is what Dr. Mark George already achieved with respect to depression. He came up with a TMS protocol that is now saving the lives of people with depression for whom drug therapy isn’t working,” Kautz said.

“We try to nurture people at different levels of their involvement in rehab research to take them to the cutting edge."

Richard Segal, PT, Ph.D.

George is a key member of the neuromodulation center and serves its scientific director.

“I’ve told him if I could develop one treatment in my career that had that kind of impact, I would be a happy scientist when I retire,” Kautz added.

Brain stimulation can be used on conditions as varied as Parkinson’s disease, epilepsy or anxiety. MUSC researchers have been using taVNS to help premature babies learn how to drink from a bottle, a skill that is difficult for a significant portion of premature infants.

Kautz’s work is in stroke recovery. For years, it was assumed that stroke patients would achieve most of their recovery in the first few months post-stroke; after that, there was nothing further that could be done. “Thousands of people did not receive the rehabilitation they needed because of that thought. Neuromodulation is one of those ways in which we can both treat acute injuries and those that are longstanding,” he said.

MUSC’s strength is in its collaboration between the brain stimulation experts in the College of Medicine Department of Psychiatry and Behavioral Sciences and the rehabilitation experts in the College of Health Professions, Kautz said. He also serves as the program director of the Center for Biomedical Research Excellence (COBRE) in Stroke Recovery, which includes a brain stimulation component. He believes the success of MUSC’s initial application for the NC NM4R was due to the COBRE having already trained a half-dozen junior investigators who started with expertise in either brain stimulation or rehabilitation and showed them how to combine the two fields in research.

“We took national what we were doing locally,” he said. “It worked so well that now we get to serve the rehabilitation research community for five more years.”