Kathleen M. Friel, Ph.D., studies the importance of motor activity in neurorehabilitation. She joined the Burke faculty in February 2013 and is the Director of the Clinical Laboratory for Early Brain Injury Recovery. Her laboratory specializes in non-invasive brain stimulation to study and promote recovery of movement in children and adults with cerebral palsy. She was recently awarded a 5-year grant from the National Institutes of Health to study neural predictors of hand therapy efficacy in children with cerebral palsy.
When did you know you wanted to be a scientist?
In high school. That’s when I realized that science isn’t just memorizing things, it’s trying to understand things.
How did you get started in the field of motor rehabilitation?
I did my Ph.D. work looking at motor training in stroke in animals. Later at Columbia, I worked with Dr. Jack Martin on animal research in cats, trying to understand how the brain is wired and how to rewire the brain after injury. We used a cat model of cerebral palsy and studied motor training to restore brain networks. The cats wouldn’t get food in their home cage, so they had to reach for pieces of steak outside the cage—they were reaching all day and actually gained weight!
Your current work focuses on improving hand function in children with cerebral palsy. How does motor training help with that?
Over the last 30 years, people realized that the brain is plastic, even in adults. Now we know that it changes all the time. Some injuries are more severe than others—but as long as there are some residual motor connections left, we can try to strengthen them.
What we believe is that neurons fire when they’re active and movement seems to activate the networks that have been injured. A lot of the basic science shows that through training, the particular brain areas you use get stronger.
What kind of training does the Early Brain Injury Recovery Program offer?
Together with Dr. Andrew Gordon at Teachers College of Columbia University, we run an intensive hand therapy day camp for three weeks that helps kids with hemiplegia improve hand function through fun games, arts, and crafts. The key is really trying to use their hands in skillful ways, like holding cards, moving dice, or drawing. This means challenging them to do things they can’t do very easily, and making it more difficult week by week.
We use single pulse TMS (transcranial magnetic stimulation) essentially for brain mapping. If you give someone a single pulse TMS over the motor cortex, you’ll see a muscle move. This allows us to get a map of the whole brain showing which brain areas control movement. After therapy, we do TMS again and we see that the brain is bigger and they improve on measures of hand function, like how well they use two hands together.
Are these changes in the brain long-lasting?
We follow-up through 6 months and the changes do last. They have to practice for one hour a day, but hopefully they are using their hands more—like a habit, not homework. Kids with hemiplegia—one side is more impaired than the other—will do everything with the opposite hand, and a lot of kids think it’s good enough. But after therapy, they’ll say, “Oh, I never thought I could use both hands. Now I can.” Their confidence goes up and they use their hands more.
What is the biggest unanswered question in your area of research? There are so many questions! In motor rehab, one question is what kinds of therapy are best for which kids? What are the predictors of efficacy? Different kinds of therapy might be ideal for different kinds of kids based on their impairments and how their brains are wired. If we know that, we can tailor therapy to individual kids.
What is the most rewarding part of your job?
Seeing the kids improve and realizing they can do more. Working with the kids is a lot of fun. They have their own opinions of what’s going on in their brains, how their brains are organized, and it’s cool to see them get interested in the science. One kid participated in our therapy camp when she was 14 years old. Now she is eighteen and is a computer science major at Smith College. She interned in our lab this past summer. The children in the camp responded extremely well to her, as she was able to share her personal perspective with them.