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What is the best way to rehabilitate a person with traumatic brain injury (TBI)?

"Right now, the protocols being used for TBI rehabilitation are the same as those used for stroke and degenerative diseases,” says Dorothy Kozlowski, associate professor, Department of Biological Sciences. “But a brain with a traumatic injury is a different story.”

When one part of the brain is damaged, other parts try to compensate — the brain ‘rewires’ itself or finds a way to work around the damaged area. This ‘neural plasticity’ is strong after a stroke. But Kozlowski has found that the opposite is true of brains suffering traumatic injury: their plasticity is decreased or at least not increased. This suggests that TBI might require different rehabilitation strategies.

With funding from the Department of Defense, Kozlowski has spent the last two years defining what those strategies might be by testing the efficacy of three commonly used rehabilitation techniques — reaching, exercise, and constraints — in rats with controlled, induced TBI. To teach the animals fine motor skills, the research team trained them to reach for, pick up, and eat small banana pellets. For exercise, they ran in a wheel. Constraints — whose success with post-stroke patients is well-documented — forced the rats to use their damaged paws by binding the healthy ones.

By varying protocols and measuring the results, Kozlowski addressed treatment-critical questions: Which rehabilitation strategies work, in what combinations? What’s the optimal order and timing of the strategies? How much, how soon? How might rehabilitation be combined with drug therapy to yield better results? The data suggests that TBI requires a combination of all three rehabilitation techniques. “This research is breaking new ground,” she says.

Testing was complex and time-consuming, including 10 treatment groups, each following different rehabilitation protocols, all compared with each other and to a control group. Eight students (six undergrads and two grads) worked on the project; Steven Lance (’11) and Aleksandr Pevtsov (’11) presented posters at the 2011 meeting of the Chicago Society for Neuroscience. Among 31 undergraduate competitors — from University of Chicago, Loyola, University of Illinois Chicago, Northwestern, and other schools — Lance placed first and Pevtsov placed third.

“One of my jobs was to videotape the effects of various protocols on the rats,” says Lance. “We had massive amounts of data — 90 rats in each of 10 days of filming. It was apparent that the animals getting all three therapies were the ones trending toward pre-injury performance levels. Then, when we assessed the size and condition of the brain, we also found that the coordinated treatment resulted in a reduction of the amount of cell death. In this project, I’ve learned what it’s like to do science in the real world; I doubt I would have got this opportunity at another university.”

Among his activities in the lab, Pevtsov tested the protocols and analyzed data. “At the meeting, I presented the rehabilitation regime most effective in decreasing motor deficits following TBI. Participating in the event has given me confidence in explaining ideas and presenting work, while the project itself has made me committed to biological research and a future career in science.”

“This is long-term research,” says Kozlowski. “It will take years to publish our results, but I’ve already been invited to a number of institutions to discuss the findings. A recent article in USA Today said insurance companies don’t want to pay for TBI rehabilitation because there’s not enough evidence to show that it works. But we’ve clearly demonstrated: rehab can be effective with the right strategies and protocols. US soldiers are coming home from foreign wars with traumatic brain injury. How can they be helped? Our work might make a real difference.”