RR&D Research Career Scientist Award Application

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Problem. Neurological disease and injury are major causes of disability, reflecting the need for more effective interventions. Additionally, accounting for the aging Veteran population, there is a projected 20% increase in disability for individuals age 85 and older, within the next 10 years. For example, approximately 6,000 VA annual admissions are for stroke, and at least 50% have serious, long term disability. Equally compelling statistics exist for traumatic brain injury (TBI) and other neurological diseases and injury. Research Activities and Overarching Goals. In strong support of the VHA Vision 2020 Strategic Plan and the RR&D mission, Dr. Daly is Director of the VA BRRC, whose mission is as follows: Discover mechanisms of pathology and impairment presenting obstacles to neural function, and generate innovative treatments to potentiate neural plasticity and neural network reorganization that will substantially improve motor, cognitive, and emotion function affected by neurologic disease or injury, sufficient to enhance quality of life and return to society and life role participation. To that end, Dr. Daly’s empowering BRRC leadership has attracted an interdisciplinary critical mass of electrical and biomedical engineers, biomechanists, neurologists, physical and occupational therapists, experimental and clinical neuropsychologists, exercise and neuromuscular physiologists, neuroscientists, and chemical and biophysicists. Significant discoveries have included information regarding the pathologies underlying neural dysfunction and innovative methods for restoring neural control of motor, cognitive, and emotion function for those with TBI, stroke, Parkinson’s disease, spinal cord injury, and multiple sclerosis. Supporting the VHA Mission and goals, and in addition to her BRRC leadership, Dr. Daly directs the Cognitive and Motor Learning Research Program, whose mission is to identify, engage, and restore the neural control that drives recovery of motor function in stroke survivors. Goals of currently ongoing studies are as follows: 1. Identify brain pattern changes that drive motor recovery. 2. Generate novel treatment methods that more accurately target pathology and impairment. 3. Apply motor learning principles that engage brain plasticity mechanisms allowing for productive practice of progressively more normal coordinated gait and upper limb function. 4. Generate and test treatment modules for gait components and upper limb function components. 5. Test gait and upper limb coordination treatment protocols in the clinical environment. Discoveries include the following: development and successful testing of a gait coordination training protocol that is clinically and statistically effective in chronic moderately impaired stroke survivors; successful feasibility pilot testing of a unique two-year care program for gait coordination, mobility, and fitness in stroke survivors; brain activation changes identified that drive upper limb motor recovery; development and successful testing of an upper limb function training protocol that is clinically and statistically effective in chronic moderately/severely impaired stroke survivors; necessary essential content of coordination training protocols includes long-duration, intensive coordination practice of finely incremental progression through a difficulty hierarchy.