Research Programs

Our innovative, patient-centered approach focuses on the development and implementation of neurorehabilitation research focused on preserving independence and improving quality of life for stroke survivors.

Please look through some of our current research programs described below.

 

 

Identifying Subtle Cognitive and Language Impairments in Acute Stroke

In collaboration with acute care providers, we have developed a quality improvement initiative to enhance screening for cognitive and language impairments during the acute hospitalization. Often, these impairments can be subtle and not apparent to the patient or the provider on a simple bedside evaluation. Changes in memory, attention and processing speed are common cognitive domains affected by stroke, and these changes may surface when a stroke survivor leaves the hospital and attempts to go back to their normal activities. In this QI initiative, led by Leslie Vnenchak, MA, CCC-SLP. with her team of speech and language pathology graduate students, we conduct more detailed testing, including the (Saint Louis University Mental Status and the Quick Aphasia Battery. We provide patient education and resources, both local and national, for improving cognitive and language function after stroke. We have been continuing this initiative at HUP and recently started screenings for outpatients with history of stroke receiving care at the Perelman Center for Advanced Medicine (PCAM). We are planning to expand to Presbyterian and Pennsylvania Hospital. Pictured below is former Clinical Research Coordinator and current Penn medical student presenting findings from this initiative at the 2025 International Stroke Conference. 

Medical student Taylor Phillips was selected to present her findings from this initiative for a podium presentation at the International Stroke Conference in Los Angeles, February 2025.

 

 

TRAINS: Transcranial Direct Current Stimulation (tDCS) and Rehabilitation to Ameliorate Impairments in Neurocognition after Stroke

This randomized controlled trial aims to leverage non-invasive brain stimulation (Transcranial Direct Current Stimulation (tDCS)) to improve cognitive function after stroke. TDCS is a form of neuromodulation which can non-invasively target specific brain regions to augment function. In this double-blinded, randomized controlled trial, we are stimulating the left dorsolateral prefrontal cortex, which is important for memory, attention and executive function and is also a hub for numerous cognitive networks in the brain. We are enrolling a total of 70 individuals who have experienced acute ischemic stroke within 6 weeks with subsequent cognitive impairment and are hospitalized at Penn Medicine Rittenhouse Acute Rehabilitation Hospital. We will compare the effect of 5 sessions of tDCS versus sham, paired with cognitive therapy, to improve cognitive performance. This research is supported by the American Heart Association Career Development Award and Penn CTSA KL2/K12 Mentored Career Development Award program. 

Diagram showing steps from cognitive training and brain stimulation to improved cognitive function: stimulation → neuron depolarization → synaptogenesis → long-term potentiation → network connectivity → improved function.
This figure demonstrates the proposed mechanism of action for transcranial direct current stimulation (tDCS) and cognitive therapy to promote neuroplasticity and result in improved cognitive function. 

 

 

Transcranial Magnetic Stimulation (TMS) biomarkers of neuroplasticity in Small Vessel Disease (SVD)

This image shows the conceptual framework for the STMS-SVD study. Multiple factors contribute to cognitive phenotypes in small vessel disease. Neuroplasticity, the brain's innate ability to reorganize and re-network in the setting of injury, may explain resilience and conversely vulnerability to cognitive decline.  
This image shows the conceptual framework for the STMS-SVD study. Multiple factors contribute to cognitive phenotypes in small vessel disease. Neuroplasticity, the brain's innate ability to reorganize and re-network in the setting of injury, may explain resilience and conversely vulnerability to cognitive decline.

 

 

 

 

 

 

 

 

 

 

 

 

Small vessel disease (SVD) is a common age-related vascular condition, occurring in the majority of adults over the age of 60. SVD can manifest as cognitive impairment and dementia but it can also be entirely asymptomatic. The severity of SVD, namely the volume of SVD seen on neuroimaging, does not fully explain variability in cognitive phenotypes nor vulnerability to cognitive decline and dementia. Neuroplasticity, the brain's intrinsic ability to re-organize and re-network in the face of injury, may play an important role in cognitive function among individuals with age-related and neurodegenerative cognitive changes over and above structural anatomy and functional connectivity.  To address this critical knowledge gap, this proposal will investigate the role of neuroplasticity in vulnerability to cognitive impairment in SVD using both genetic and neurophysiologic approaches. In this observational study in collaboration with the Penn Memory Center, we investigate the role of neuroplasticity in differentiating cognitive phenotypes in SVD. We are working with Dr. Corey MacMillan's BIND Laboratory to develop a polygenic risk score (PRS) for neuroplasticity. PRS can aggregate a cumulative sum of genetic risk variants related to disease-specific traits. We are also collecting neurophysiologic measures of neuroplasticity through TMS. This work will improve our understanding of the role of neuroplasticity in both resilience and susceptibility to cognitive impairment and dementia after brain injury. 

 

Remotely Administered tDCS to Improve Cognitive Function in Veterans with mTBI and PTSD

We will be launching a double blinded, randomized controlled trial of tDCS in Veterans with mild traumatic brain injury and post-traumatic stress disorder. A significant proportion of Veterans live in rural areas, making access to care and to research challenging. Participants will undergo tDCS to the left dorsolateral prefrontal cortex, a hub for cognitive function and network connections in the brain, while performing a cognitive training task for 20 minutes daily over the course of 10 days. Pre and post intervention cognitive testing will be performed to measure the change in cognitive performance between groups. By conducting a clinical trial with a remotely administered intervention, we will be able to test the real-world effectiveness of this treatment that is directly applicable to Veterans. As a part of this project, we will also be conducting detailed interviews with Veterans about their perspectives on non-invasive brain stimulation. 

Timeline of study procedures: pre-enrollment (recruitment, screening), enrollment visit with tDCS training, pre-intervention testing, 10 remote neurorehabilitation sessions, and two post-intervention tests.
Overview of the study procedures. Veterans who are eligible and consent for participation will undergo tolerability testing to ensure that they are comfortable using the transcranial direct current stimulation (tDCS) device. They will then undergo pre-intervention cognitive testing. Once that is complete, Veterans will complete 10 session of remotely administered tDCS along with cognitive training. After completion of the 10th session and 2 months later, they will undergo post-intervention cognitive testing.