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Understanding the Role of Neuroplasticity in Language Rehabilitation | NEWS-Line for Physical Therapists & PT Assistants

Understanding the Role of Neuroplasticity in Language Rehabilitation

Q&A with Dr. Swathi Kiran, Professor, Researcher, Innovator at Sargent College at Boston University

Swathi Kiran is an Associate Professor at Sargent College of Health and Rehabilitation Sciences at Boston University. She also serves as the Director of the Aphasia Research Laboratory, and the Research Director of the Aphasia Resource Center at Boston University. She is a world-renowned expert in rehabilitation after stroke and in understanding neuroplasticity of language recovery. She has over 50 published papers on clinical research and has editorial responsibilities for several key journals in the field including the American Journal of Speech Language Pathology and Journal of Speech Language and Hearing Research. Dr. Kiran is the recipient of numerous grants and awards from the National Institutes of Health and she also serves as a standing member on an NIH grant review panel. She is a fellow of the American Speech and Hearing Association and served on the Research and Scientific Affairs Committee for ASHA. Dr. Kiran received her MA and PhD from Northwestern University. She also is the founder and Chief Scientist of Constant Therapy, a healthcare IT start-up company.

Q: What motivated you to enter into healthcare?
A: I have always been intrigued by the brain. When I was in high school I became interested in how we dream and form memories and was fascinated with the brain since then. I found my way to studying language loss (aphasia) as an undergraduate student and the topic continued to interest me. It is coincidental and fortunate that the work I do helps people who have had strokes. My work has an impact on people’s lives on a daily basis and I am very grateful for that opportunity.

Q: Where do you currently work and what is your major focus?
A: I direct the Aphasia Research Laboratory at Boston University Sargent College of Health & Rehabilitation Sciences. I am also the Research Director at the Aphasia Resource Center. I am fortunate to be at the helm of both these centers. The Aphasia Research Laboratory is aimed at developing cutting-edge treatments for aphasia and understanding the nature of neuroplasticity. The Aphasia Resource Center is aimed at providing patient education, support and treatment for patients in the greater Boston area.

Both these facilities also offer excellent training environments for students wishing to pursue careers in speech-language pathology. These two facilities have the ambitious goal of helping people worldwide with aphasia.

Q: Typically, what are your day-to-day responsibilities?
A: I serve three roles at my facility acting as a teacher, clinician, and researcher. As a professor, I teach students to become successful clinicians and to provide quality care for their patients. As a clinician, I see patients to help them recover their language skills. As a researcher, I am working on cutting edge research in the field of neuroplasticity at a time where there is newfound interest in the brain sparked by the Obama administration’s support for the new BRAIN initiative. My research laboratory is one of the few labs in the world examining neuroplasticity in the brain after rehabilitation.

I am also fortunate that, as a co-founder of Constant Therapy, a mobile rehabilitation software solution based on the iPad, I can see the impact of my work improving a growing patient population’s everyday lives.

Q: Regarding research, what are you working on currently?
A: I am focused on broadening the reach of rehabilitation research on society through technology. With funding from the Coulter Foundation promoting bench to bedside translational research, I have been involved in developing an innovative therapy software platform called Constant Therapy. This platform delivers rehabilitation on mobile devices and records patient performance at a very detailed level automatically. In an initial study with over 50 patients who practiced personalized therapy tasks using this iPad-based software at their homes and at weekly visits to the clinic, we observed remarkable positive treatment outcomes. Importantly, because this software records patient progress automatically, it enables us to isolate and examine treatments that work from those that don’t for specific individuals. This allows the prediction of possible outcomes even before assigning specific therapies to specific individuals. Overall, I expect this work to have an important theoretical, clinical and societal impact to health and rehabilitation.

Q: What are the greatest challenges you face in your work and research?
A: My greatest challenge has been translating the benefits of my brain plasticity research into daily therapies that help patients. I am fortunate that there is much synergy between my roles as a clinician, researcher and my work on the Constant Therapy software solution. I am able to incorporate the insights of my research into Constant Therapy so that it can directly benefit patients using this solution. Likewise, my work with Constant Therapy advances my clinical research as it allows me to collect invaluable research data that I could not obtain anywhere else.

Q: What do you like most about your job? What do you dislike most?
A: I am really fortunate that my work helps people who have had a brain injury or a stroke. This has a positive impact on people’s daily lives and I feel lucky to have a role that is both professionally rewarding and helps people.

I must say that paperwork is the least favorite part of my work! One of the benefits of working on a solution like Constant Therapy is that it helps to eliminate much of the manual and tedious record-keeping associated with our profession. My hope is that automated recording of patient progress will help clinicians obtain a more objective measure of patient progress and gain a deeper understanding of what tasks drive patient progress while giving them more time to focus more on helping patients.

Q: Do you feel that the role of a healthcare professional in your has changed in recent years? If so, how?
A: The benefits of smart and connected health to deliver rehabilitation services have surfaced as an important solution to provide ongoing care to patients. This is apparent, as most patients who require rehabilitation services also need chronic care. Even though speech-language services for communication are particularly suited for remote-rehabilitation due to the emphasis on auditory/visual interaction, the application of connected health for speech-language rehabilitative services is still in its infancy. In general, tele-rehabilitation (provision of rehabilitation services through video-conferencing or over the internet) has been attempted in the past and has been found to be somewhat successful in improving treatment outcomes.

One area that is poised to grow in the next few years is the expansion of tablets, cloud-computing and other technologies to facilitate connected and continuing healthcare services that are patient-centric for individuals needing long-term rehabilitation services. There are several aspects of the ongoing impetus on connected health that apply to rehabilitation of language and cognitive services. I expect that clinicians will need to learn, understand and adopt the emerging technologies and tools that will transform how rehabilitation is delivered in an increasingly patient-centric delivery care system.

Q: What do you feel is of the greatest concern to the profession today?
A: Speech, Language and Hearing Sciences and Disorders, like many other healthcare fields, afford clinicians the rewarding opportunity of helping other people. It also poses unique challenges, since no two individuals are alike; clinicians must use critical thinking skills, scientific knowledge and existing research evidence to make accurate diagnostic and treatment decisions. Once they make these decisions and start a course of therapy, clinicians struggle to demonstrate convincingly that their patients improve. The ability to demonstrate quantitative and qualitative conclusive outcomes is a big concern for the field today.

Another concern is patient access to needed therapy. It is clear that patients show improvements with rehabilitation. However, patients face limitations on the frequency and duration of therapy they can obtain. Most patients attend a therapy session once a week and when this traditional therapy ends patient progress stops. This is a great concern on several levels, as many patients who have survived a brain injury need chronic care to continue on a road to recovery. Additionally, it is difficult to convince payers that individuals need long-term care and, as a result, it is often the patient who suffers.

A third concern is that continuity of patient care is currently fragmented. Once a patient leaves a hospital or clinical facility, it is currently very difficult to transfer the rehabilitation care documentation from one setting to a different setting. Ideally, the patient should have control over their rehabilitation care documentation, so that they are the best advocates for their own care.

Q: What is the most important thing you’ve learned over the course of your career?
A: Like any other mental or physical exercise that improves functional results, continued therapy for patients translates into continued progress. What we do know is that the brain is remarkably plastic and can continue to improve several years after the injury. In the next ten years we need to be able to harness the ability to improve brain function with new technologies.

Q: How has your work as a clinician and as a researcher allowed you to grow professionally?
A: I have been very lucky to serve in multiple roles as a clinician, researcher, and developer of tools to support rehabilitation. In this regard, I have gained a deeper insight into what types of therapies work and don’t work based on each individual’s unique diagnosis and challenges. My research has enabled me to bring insights back into the clinic for practical application and my work to support the development of rehabilitation tools has enabled to me access and analyze data on patient response to therapy tasks that were previously unavailable. This has enabled to grow both as a researcher and clinician in serving my institution’s mission in helping brain injury survivors worldwide.

Q: What developments and trends are you seeing in the industry that will impact the future of language recovery?
A: As I have mentioned above, this is a very exciting time to be in our profession as groundbreaking transformations are taking place. The most important development is that advancements in tools and technologies are removing the limitations associated with traditional rehabilitation methods. This is particularly true for emerging solutions based on mobile platforms as they enable patients to obtain therapy anywhere and anytime.

One of the most important upshots is that these new solutions will allow us to gather large amounts of data across on performance across large patient populations. This rich store of information combined with advanced analytics and data mining tools will give us the ability to predict the outcomes of different courses of therapy for each unique individual’s diagnosis. We will understand, even before applying therapies, what is most likely to work or not work. Armed with this information we can design the best course of therapy for any given patient.

An important result of these developments is a trend of patient empowerment. Patients will no longer be passive consumers. These solutions will shift more power to the patient enabling him or her to assume a more collaborative role with their clinicians to direct the course of their rehabilitation. They will be able to see objective analysis enabling them to measure and understand their progress. They will also gain access to high quality therapy consistently anywhere and anytime for as long as they desire. I believe this will be a game changer and everyone will benefit as a result.

Q: What advice do you have for others thinking of becoming a Speech-Language Pathologist?
A: This is truly an exciting time to be joining our profession as many advances in technology are transforming the way care is delivered. I believe this will make our profession even more rewarding since it will enable clinicians to focus more on patient care while getting objective measures of patient progress. In addition, the new solutions arriving on the scene will enable patients get more care in more flexible ways that increase both the frequency and duration of rehabilitation they receive. This will only enhance the professional rewards clinicians receive and move patient progress forward in ways that were unimaginable only a few years ago.

Therefore, I think it is key that people entering our profession gain a good understanding of the ways advances in technology are transforming the profession and how it can supplement traditional approaches. I would strongly suggest they become familiar with the latest tools that can help them be more effective and productive in providing patient-centric care.

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