image: Kiran Karunakaran, PhD (left), and Vikram Shenoy Handiru, PhD, receive $3.4 million from Congressionally Directed Medical Research Programs for their pioneering work studies aimed at improving gait, balance, and overall quality of life for individuals affected by TBI.
Credit: Kessler Foundation
East Hanover, NJ – December 9, 2024 – Kessler Foundation research scientists Kiran Karunakaran, PhD, and Vikram Shenoy Handiru, PhD, were recognized for their pioneering work in enhancing rehabilitation strategies for individuals with traumatic brain injury (TBI) with $3.4 million in grant awards from the Congressionally Directed Medical Research Programs (Department of Defense). They are research scientists in the Foundation’s Center for Mobility and Rehabilitation Engineering Research. The grants will support two groundbreaking studies aimed at improving gait, balance, and overall quality of life for individuals affected by TBI.
Dr. Karunakaran, principal investigator for the project titled “Personalized Cognitive Integrated Motor Training Using Virtual Reality to Improve Gait and Balance,” has been awarded $2,727,158 for a four-year study. TBI impairs both cognitive and sensorimotor functions with debilitating after-effects on gait and balance, persisting even during the chronic stages of recovery. Deficits in these motor and cognitive functions result in decreased overall quality of life and activities of daily living.
“Evidence suggests that cognitive function capacity is vital to physical function, and cognitive effort contributes to motor recovery,” explained Dr. Karunakaran. “Our study aims to strengthen the inseparable link between cognitive and sensorimotor control using virtual reality to deliver the novel cognitive integrated sensorimotor training. This intervention will result in improved and efficient recruitment of cognitive and sensorimotor brain regions during gait and balance and will likely result in improved and efficient gait and balance function and in reduced falls,” she added.
Ambulation involves a number of tasks while walking and balancing in the real world, complete with obstacles. “These tasks include being able to perform healthy gait cycles, while paying attention to the environment, assimilating and processing the information, reacting effectively to produce efficient movement, avoiding any obstacles, and preventing a fall,” said Dr. Karunakaran. The study will use cognitive integrated sensorimotor training with virtual reality to improve functional ambulation.
The study will enroll 135 participants with TBI who will be randomly assigned to one of three training groups: 1) personalized cognitive integrated sensorimotor virtual reality or augmented reality training, 2) traditional dual-task training, and 3) standard of care. Each group will receive 12, one-hour training sessions for four weeks. Participants will complete three data collection sessions: baseline, post-training, and follow-up after one month post-training. This study will comprehensively and quantitatively evaluate the changes in biomechanics, neurophysiology, cognition, and examine their relation to functional gait & balance and community participation. “The mobile neuroimaging technique functional near-infrared spectroscopy will be used to understand the cortical activity changes while performing a dynamic task (such as walking) to help us understand the relationship between functional, biomechanical, and training-induced cortical changes,” said Dr. Karunakaran.
Improve Postural Control in TBI
Dr. Shenoy Handiru received $718,090 for his project, “Neurobalance: Neuromodulation Enhanced Use of Robotic Balance Training to Improve Postural Control in TBI.” This research combines robotic balance training with non-invasive brain stimulation techniques to enhance neuroplasticity and motor recovery in individuals with TBI-related balance impairments.
Traumatic brain injury (TBI) often leads to impaired balance and postural control, increasing the risk of falls, reducing mobility, and impacting daily life. “To address this issue, we propose a novel approach combining a robotic balance platform called hunova (developed by Movendo Technology, Genova, Italy) with a non-invasive brain stimulation technique called high-definition transcranial direct current stimulation (HD-tDCS). The scientific premise for this approach is that the HD-tDCS, a targeted brain stimulation protocol, will help strengthen the top-down, brain-to-muscle signals by priming the motor cortex, while the robotic platform will provide targeted balance training and enhance the sensory feedback from the lower-limb muscles to the brain.,” said Dr. Shenoy Handiru.
Dr. Shenoy Handiru’s three-year study plans to enroll 45 individuals with TBI-related balance issues who will be randomly assigned to one of three groups: (1) robotic balance training with active HD-tDCS, (2) robotic balance training with sham HD-tDCS, or (3) standard rehabilitation. “The intervention will consist of 12 sessions over four weeks. We will assess balance, gait, and neurophysiological responses [using Electroencephalography (EEG), Electromyography (EMG), and transcranial magnetic stimulation (TMS)]) at baseline, immediately after four-week intervention, and at a two-month follow-up,” explained Dr. Shenoy Handiru. “This comprehensive evaluation will help us determine the effectiveness of the combined treatment and inform the development of personalized rehabilitation protocols,” he concluded.
Both studies represent significant advancements in TBI rehabilitation, offering hope for improved outcomes and quality of life for those affected by this debilitating condition.
Funding: This work is supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense in the amount of $2,727,158, under Award No. HT9425-24-1-0911 and $718,090 under Award No. HT9425-24-1-0696. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Assistant Secretary of Defense for Health Affairs.
About Congressionally Directed Medical Research Programs (CDMRP)
The CDMRP fills research gaps by funding high impact, high risk and high gain projects. While individual programs are unique in their focus, all programs managed by the CDMRP share the goal of advancing research and solutions towards cures or improvements in patient care or breakthrough technologies and resources for clinical benefit. The CDMRP strives to transform health care for service members and the American public through innovative and impactful research. Visit https://cdmrp.health.mil/tbiphrp/ for more information on CDMRP.
About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research. Our scientists seek to improve cognition, mobility, and long-term outcomes, including employment, for adults and children with neurological and developmental disabilities of the brain and spinal cord including traumatic brain injury, spinal cord injury, stroke, multiple sclerosis, and autism. Kessler Foundation also leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. Visit www.KesslerFoundation.org for more information.
Press Contact at Kessler Foundation:
Deborah Hauss, DHauss@kesslerfoundation.org
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