Transcription:
Updates in Neurorehabilitation

Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. And joining me today is Dr. Eric Larson. He's the Director in Psychology and Brain Injury at Northwestern Medicine's Marianjoy Rehabilitation Hospital, and he's here to offer updates in neurorehabilitation.

Dr. Larson, it's a pleasure to have you join us again. As patients with neurological deficits and conditions face a significant disruption to so many facets of their lives and clinicians are left with so many treatment dimensions to consider that rehabilitation is never really simple, can you tell us some of the challenges to staying current with, choose and use the best options for neurorehabilitation? And we know this is the key to optimizing patient outcomes. Tell us a little bit about neurorehabilitation.

Dr Eric Larson: Well, I think one of the things that's been most interesting since I've come to Marianjoy is recognizing that there needs to be kind of a broad understanding of how patients get better. Of course, we're really focused on physical recovery and helping people regain mobility. The thing that happens when people have different kinds of neurological illnesses or injuries is that it affects thinking abilities as well. So a neurorehabilitation facility needs to address not only the issues of mobility, but also how a person's able to participate in other roles that they have. They need to be able to return to work, to be able to think through the different things that they focus. And then, even beyond that, it starts to affect their behavior, how they get along with people and their families, how they get along with people at work. They have to kind of redefine a quality of life.

There's a really interesting body of literature that looks at how people predict or anticipate the kinds of challenges they're going to face if certain bad things happen to them. And generally, we're pretty bad at it. We can't anticipate what things are going to be like and the kinds of things we think we could never get over. In fact, we do get over, but it requires someone with some experience, someone who's actually it's not their first rodeo. They've been through this before. They've treated dozens, if not hundreds, of people with the conditions that we face after an injury or an illness, and they know how to maximize that recovery. Not only to help us start to see new things that we didn't know about, new ways that we can regain independence and find quality of life, but also help us learn new things that we didn't even know were an issue. Help us find the kinds of activities and relationships that give our lives meaning that are the core of regaining function and achieving a good outcome. That kind of broad interdisciplinary approach that includes not only medical interventions and skilled therapy, but also incorporates some complementary disciplines, like spiritual care, like psychology, therapeutic recreation, music therapy, all these different additional interventions that we offer here at Marianjoy, that kind of broad approach maximizes that good outcome that we're shooting for here.

Melanie Cole (Host): Thank you so much for that comprehensive answer, Dr. Larson. And we're hearing this term neuroplasticity. Can you explain it a little bit for us and how the principles of neuroplasticity can help us to understand what's really happening during neurorehabilitation with all of those various avenues you were just discussing?

Dr Eric Larson: Whenever people bring up the definition of neuroplasticity, I always feel like I should give them just a quick and dirty answer, which is it's just the capacity of the brain to change. There's a slightly longer answer, that it's the property of the central nervous system to reorganize, which allows a certain degree of recovery, even in cases of permanent structural damage. But here's the thing that I think, the really long answer, that I think is even more interesting is that a long time ago, the original neurologists who are looking at psychophysiology, they had proposed this idea of equal potentiality, that if you have an injury or an illness that affects a particular region of the brain, any part can step in and assume the role of another part. As things moved on and as additional research was done, we found out that isn't true. That in fact some structures of the brain do have specialized functions, and there was this whole science that most clinicians are familiar with, where we looked at people with lesions in different parts of the brain, and then we looked at the kinds of functions they lost.

The thing that has been happening more recently is that through the advent of functional imaging, we're starting to see not only what the functions of these different regions of the brain are, but how the brain changes during recovery. We're starting to see when people are regaining abilities, that certain structures in the brain either come back or that other structures in the brain that didn't used to be involved, they are recruited. You will find that certain structures of the brain, their abilities are unmasked. They can get better at something even though it's not it's specialization.

And the reason why this is kind of interesting to me is, a long time ago when I was doing my dissertation research, I was focusing on the functions of the corpus callosum, this bridge that connects the two hemisphere of the brain. Way back in grad school, they came up with this theory, that one process that contributes to specialization in cerebral function is suppression of ineffective processing. So the most competent regions make the least competent regions redundant.

What I never thought about back in grad school many years ago was the possibility that when most competent regions get sidelined, the other parts can get back in the game. And there's been a lot of cool work over the past 30 years since I did my lab work where they've actually used imaging to identify not only specialization in a healthy brain, but reorganization in recovering brains. And that's what I think Marianjoy does a really good job. It takes into consideration those principles of neuroplasticity when they're planning the rehabilitation therapies.

Melanie Cole (Host): That's fascinating and it's very similar to collateral circulation, as I'm understanding you describe this, that other avenues take up the slack in a way. So tell us what diagnoses benefit from neuroplasticity? In what medical conditions does recovery rely on it? And how does Marianjoy tap into the guiding principles you're discussing here today?

Dr Eric Larson: The brain injury program where I do most of my work, specializes in people who've had traumatic injury. They had achieved, you know, a certain degree of independence in their lives that's suddenly lost, and then they regain it, oftentimes making pretty remarkable recovery. The same pattern of adaptive function followed by a sudden loss, followed by a slow recovery is seen in people with stroke. But the other thing is that there's some chronic illnesses that will sometimes have flare ups and they can benefit from rehabilitation too. Multiple sclerosis has episodes where people will have a certain, exacerbation of their symptoms. And then if they have a therapist who's working with them, they can regain their independence. There's some other non-traumatic injuries, different kinds of infections of the central nervous system, inflammatory disorders. They also benefit from skilled rehabilitation.

One of the other things that Marianjoy's been doing a lot lately is we've been collaborating with neurosurgeons in the area who have patients who have undergone resection of a brain tumor. They come to us, they start to regain some of the functions that were lost because of their illness and due to the effects of their surgery. And they can oftentimes regain a lot of that independence and make a strong comeback.

Melanie Cole (Host): This is so interesting, Dr. Larson. And it's not only innovation in terms of new technology and devices, but innovation as a philosophical shift from providers working in silos to really working together and taking advantage of virtual reality, artificial intelligence, clinical research to disseminate data and research quickly. How have you seen this manifest itself at Northwestern Medicine's Marianjoy Rehabilitation Hospitals Tellabs Center for Neurorehabilitation and Neuroplasticity? Tell us about the importance of this multidisciplinary team.

Dr Eric Larson: Well, I guess one of the things that's really important to take into consideration when we're looking at all the stuff that's out there, and there's a lot that's out there. The thing that we have do is it's not like we're at a loss for finding options, what we really are confronted with is an ability to choose what are the most effective ones. Like you said, we have all these different disciplines who are willing to pitch in and help these patients. But what a lot of facilities don't have is a capacity to identify which are the ones that are most effective.

And I think the thing that a place that specializes in neurorehabilitation, the thing that they're best at, the thing they bring to the table, the value added they have that other places don't have is that they are aware of the science that was used to develop these different technologies. They have a method for identifying what works and what doesn't. There are certain techniques that have been shown by scientists to be effective at encouraging a return of functions.

Marianjoy has a special center called the Tellabs Lab Center for Neurorehabilitation and Neuroplasticity that uses those technologies. But the thing that I'm a little bit concerned about is that there are some facilities that when they bring technologies into the treatment plan, they may use them to replace the human element of rehabilitation. And that's unfortunate. And in fact, the research suggests that it doesn't work, that places that have a largely mechanized and computer-driven approach to rehabilitation do not achieve the outcomes that human therapists can achieve in partnership with using these tools. So at the Tellabs Center, there's therapists who will examine the patient. They'll find the technologies that best meet their need. Then, they work close with the patient to supervise the use of the technologies. They really optimize the care and, as a result, our patients don't actually have to work harder, they just work smarter.

Melanie Cole (Host): What a great point you made. And before we wrap up, what would you like other providers to know about neuroplasticity and neurorehabilitation and what you're doing there at Northwestern Medicine's Marianjoy Rehabilitation Hospital's Tellabs Center for Neurorehabilitation and Neuroplasticity?

Dr Eric Larson: I guess the first thing that patients and their families need to hear most is that there's hope. In fact, because of the properties of the brain, it does have a capacity to reorganize and it can make improvements even in situations where you might not be able to see that. Like I was saying earlier, that your ability to anticipate potential outcomes is not great. We're not fortune tellers. If you've never been through this before, if you hook up with the right team, who actually has done this stuff and is familiar with treatment options that are out there, you're going to be able to find some ways to make improvements that you didn't even know existed. You didn't even know that technology existed to make these things happen. You're going to be able to achieve things that you couldn't really anticipate before the onset of your illness or injury.

Melanie Cole (Host): Thank you so much, Dr. Larson, for joining us today. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/rehab to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians.

Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.