Hope through Rehabilitation & Research
Existing strategies to enhance motor function following brain and spinal cord injury are suboptimal, leaving patients with considerable disability. A greater understanding of motor recovery, refinement of existing strategies, and development of new methods is warranted. Our laboratory uses established and developing technologies to understand control of human voluntary movement, and functional recovery following neurological damage. Available evidence suggests that motor training can improve function, greater than spontaneous recovery alone. As well, the mechanisms underlying brain plasticity can be specifically targeted, using noninvasive brain stimulation and pharmacologic intervention. We are presently conducting a trial of controlled physical rehabilitation (robotics) combined with noninvasive brain stimulation of motor areas, to augment motor recovery following stroke and spinal cord injury. The robotic movement devices represent the most sophisticated interactive rehabilitation systems available, and are additionally appealing for their ability to quantify various aspects of movement. Transcranial Magnetic Stimulation (TMS) is an accepted tool to probe changes in the brain that might occur with training. Both TMS (applied repetitively, rTMS) and Transcranial Direct Current Stimulation (tDCS), are promising neuromodulation methods that can independently lead to transient improvements in motor behavior. We are investigating if rTMS or tDCS might enhance the practice-dependent plasticity resulting from behavioral training, and thus promote long-lasting improvements in function.
Learn more about our current clinical studies.
My main research interests focus on understanding and promoting neuroplasticity following brain lesion, and in particular, using controlled physical rehabilitation (robotics) combined with noninvasive brain stimulation of motor areas. I have a broad background and experience in clinical and basic neuroscience, as well as physical rehabilitation.
I have accumulated over 15 years of experience with the application of Transcranial Magnetic Brain Stimulation and more recently Transcranial Direct Current Stimulation (tDCS), and I possess a sound understanding of motor training and skill acquisition. This work commenced in 1994 with research involving healthy, skilled individuals, mapping cortical representations of muscles of the skilled preferred arm compared with the non-preferred arm. This was followed by investigations of how afferent information from moving limbs interacts with descending motor information. A number of studies were conducted to investigate aspects of movement kinematics and corticospinal excitability in healthy subjects. The purpose of these studies was to understand how proprioceptive information shapes movement output, and to provide an understanding of what might be occurring during passive movement therapies that form part of physical neurorehabilitation. These studies conducted over a three- year period examined limb movement speed, range and phase. In addition, how information from moving limbs affects different body parts was assessed, and the question of whether this projected to stationary but functionally related areas was investigated. This was further examined in a longitudinal case study in chronic stroke. In parallel to these studies I have conducted separate work focusing on enhancing motor function in patients with myositis using exercise therapies, with the development of novel strategies to provide suitable muscle overload without additional muscle degeneration. These included interventions designed to improve aerobic capacity. I have provided quantitative balance assessment for patients with orthostatic tremor, as well as Parkinson’s disease pre and post deep brain stimulation. I have been involved in the development of a novel rTMS technique known as iTMS (I-wave TMS) that leads to a progressive rise in corticospinal excitability, while using a lower dosage and intensity than conventional excitatory rTMS techniques. This work led to the application of iTMS in chronic stroke patients where it was shown to improve function in upper limb tasks. A larger study is presently under way. We have commenced work assessing basic physiological interactions of triple-pulse TMS delivered at I-wave intervals of 1.5ms. This appears to enhance excitatory networks and may prove to be a promising technique for neuromodulation.
My principal interest is in motor rehabilitation following neurological injury (stroke, spinal cord injury, and traumatic brain injury), and the majority of work has been in stroke. In 2007 I orchestrated a collaborative effort between MIT (robotic rehabilitation lab, engineering), the Burke Medical Rehabilitation Institute, neurorecovery and robotics section, and the Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, to investigate the novel combination of robotic movement therapy and brain stimulation. This led to a successful study, which has been presented internationally and published. These findings received wide interest and a full research proposal was subsequently funded by the NIH, with Dr. Edwards as the Principal Investigator, to examine these effects in a larger cohort, and to establish clinical significance. From 2005 and 2006 I established a funded Stroke / rTMS study between the major teaching hospitals in Western Australia. I have supervised and trained therapists/research assistants, and have completed the associated administration (e.g. IRB process). I have previously visited and presented at a number of reputable scientific laboratories in the field of human motor control and rehabilitation including University College London (Queen Square), Karolinska Institute Stockholm, and Monash University Melbourne. I have been interviewed by local and international media pertaining to my work and leading to printed publication (community and international newspapers).
I have successfully supervised 10 research, higher degree students in the field of motor rehabilitation, proprioception, and magnetic brain stimulation. Two of these students have received formal accolades for this work, including Australian government awards for science and innovation, and the work has been presented internationally. I have approximately 12 years experience lecturing at tertiary level in the areas of human motor rehabilitation, motor control and skill acquisition, and clinical neuroscience. This includes over 1,000 hours lecturing to more than 3,000 students at undergraduate and post-graduate levels. I have been recruited as a consultant for practical and theoretical aspects of human motor function testing in Malaysia and Singapore. I have lectured to students on topics of motor control and learning in relation to motor rehabilitation at three separate Universities in Western Australia, and various countries across the world in on-line format. I currently teach three times per year in a Harvard Medical School course, which I also co-direct. Students in this course are local, national and international (including Australia) and are typically medical doctors or Ph.D. graduates. I have the privilege to assist with the research training of some of the leading Physical Medicine Specialists in the United States, through my clinical laboratory at the Burke Medical Research Institute and Adjacent Hospital.
My clinical experience in motor rehabilitation has involved working with traumatic brain injury, stroke, Parkinson’s disease, inclusion body myositis, polymyositis, spinal cord injury, multiple sclerosis, chronic pain, peripheral neuropathy, developmental coordination disorder and cerebral palsy. I have also worked with orthopaedic outpatients for retraining of correct movement patterns. This work was conducted in three separate locations as a part-time clinical load over five years, including an inpatient stroke rehabilitation ward, an outpatient movement disorders hospital clinic, and a private outpatient clinic. In addition, I have advised graduate students and clinicians on movement control issues for their patients, and I have conducted many hours of pro-bono work relating to physical rehabilitation or community education. I currently supervise clinical research in a facility that admits over 500 patients per year, as well as interstate and international operations. My clinical research expertise has been recognized through invitations to review and comment on some of the largest recent Neurorehabilitation Mulitcenter Clinical Trials in the United States, via the American Physical Medicine and Rehabilitation Society, and the American Society for Neurorehabilitation,
In summary, my collective experiences have lead me to pursue research using established and developing technologies to understand control of human voluntary movement, and functional recovery following neurological damage. Existing strategies to enhance motor function following stroke are suboptimal, leaving patients with considerable disability. A greater understanding of motor recovery, refinement of existing strategies, and development of new methods is warranted. The robotic movement devices represent the most sophisticated interactive rehabilitation systems available, and are additionally appealing for their ability to quantify various aspects of movement. TMS is an accepted tool to probe changes that might occur with training, however the promising neuromodulation method is to use TMS or tDCS to prime the brain for the activity-dependent plasticity induced by training.
Citations via Google Scholar
Cortes, M., Black-Schaffer, R. M. and Edwards, D. J. (2012). Transcranial Magnetic Stimulation as an Investigative Tool for Motor Dysfunction and Recovery in Stroke: An Overview for Neurorehabilitation Clinicians. Neuromodulation: Technology at the Neural Interface.
L Conesa, U Costa, E Morales, DJ Edwards, M Cortes, D Leon, M Bernabeu, J Medina (2012). An observational report of intensive robotic and manual gait training in sub-acute stroke. JNeuroengRehabil. 9(1): 13.
J Benito-Penalva, DJ Edwards, E Opisso, M Cortes, R Lopez-Blazquez, N Murillo, U Costa, JM Tormos, J Vidal-Samsό, J Valls-Solé (2011). Gait Training in Human Spinal Cord Injury Using Electromechanical Systems: Effect of Device Type and Patient Characteristics. Arch Phys Med Rehabil. 93(3): 404-412.
V Giacobbe, BT Volpe, GW Thickbroom, F Fregni, A Pascual-Leone, HI Krebs, DJ Edwards (2011). Reversal of TMS-induced motor twitch by training is associated with a reduction in excitability of the antagonist muscle. J NeuroengRehabil. 8(1): 46.
AR Brunoni, MA Nitsche, N Bolognini, M Bikson, T Wagner, L Merabet, DJ Edwards, A Valero-Cabre, A Rotenberg, A Pascual-Leone, R Ferrucci, A Priori, P Boggio, F Fregni (2011). Clinical research with transcranial direct current stimulation (tDCS): Challenges and future directions. Brain stimulation. In Press.
M Cortes, GW Thickbroom, A Pascual-Leone, J Valls-Sole, DJ Edwards (2010). P20-19 Spinal associative stimulation (SAS): a non-invasive stimulation paradigm to modulate spinal excitability. Clinical Neurophysiology 121: S224-S224.
DJ Edwards, L Dipietro, A Demirtas-Tatlidede, GW Thickbroom, FL Mastaglia, HI Krebs, A Pascual-Leone (2010). P20-18 Movement-generated afference paired with TMS: an associative stimulation paradigm.Clinical Neurophysiology 121: S223-S224.
Edwards DJ, On the understanding and development of modern physical neurorehabilitation methods: robotics and non-invasive brain stimulation. J Neuroeng Rehabil, 2009. 6: p. 3. (Invited Editorial)
M Cortes, GW Thickbroom, J Valls-Sole, A Pascual-Leone, DJ Edwards (2011). Spinal associative stimulation: A non-invasive stimulation paradigm to modulate spinal excitability. Clinical Neurophysiology. 122(11): 2254-2259.
Naïf U, Bashir S, et al. (2011). Transcranial brain stimulation: clinical applications and future directions. Neurosurg Clin N Am 22(2): 233-51.
Oberman L, Edwards DJ, et al. (2011). Safety of theta burst transcranial magnetic stimulation: a systematic review of the literature. J Clin Neurophysiol.
Edwards DJ, Dipietro L, Demirtas-Tatlidede A, Thickbroom GW, Mastaglia FL, Krebs HI, and Pascual-Leone A (2010). Movement-generated afference paired with tms: an associative stimulation paradigm. Clinical Neurophysiology 121, S223.
Cortes M, Thickbroom GW, Pascual-Leone A, Valls-Sole J, and Edwards DJ (2010). Spinal Associative Stimulation (SAS): A non-invasive stimulation paradigm to modulate spinal excitability. Clinical Neurophysiology 121, S224.
Kumru H, Murillo N, Vidal Samso J, Valls-Sole J, Edwards DJ, Pelayo R, Valero-Cabre A, Tormos JM, and Pascual-Leone A (2010). Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury. Neurorehabil Neural Repair.
Chye L, Nosaka K, Murray L, Edwards DJ and Thickbroom G (2010). Corticomotor excitability of wrist flexor and extensor muscles during active and passive movement. Hum Mov Sci 29, 494-501.
Bashir S, Edwards DJ and Pascual-Leon A. Neuronavigation increases the physiologic and behavioral effects of low-frequency rtms of primary motor cortex in healthy subjects. Brain Topogr, 2010
Volpe BT, Huerta PT, Zipse JL, Rykman A, Edwards DJ, Dipietro L, Hogan N, and Krebs HI (2009). Robotic devices as therapeutic and diagnostic tools for stroke recovery. Arch Neurol 66, 1086-1090.
Johnson LG, Collier KE, Edwards DJ, Philippe DL, Eastwood PR, Walters SE, Thickbroom GW and Mastagli FL (2009). Improvement in Aerobic Capacity after an Exercise Program in Sporadic Inclusion Body Myositis. J Clin Neuromuscul Dis 10, 178-184.
Edwards DJ, Krebs HI, Rykman A, Zipse J, Thickbroom GW, Mastaglia FL, Pascual-Leone A and Volpe BT (2009). Raised corticomotor excitability of m1 forearm area following anodal tdcs is sustained during robotic wrist therapy in chronic stroke. Restor Neurol Neurosci 27, 199-207.
Boggio PS, Amancio EJ, Correa CF, Cecilio S, Valasek C, Bajwa Z, Freedman SD, Pascual-Leone A, Edwards DJ and Fregni F. (2009). Transcranial DC stimulation coupled with tens for the treatment of chronic pain: a preliminary study. Clin J Pain 25, 691-695.
Edwards DJ and Fregni F. Modulating the healthy and affected motor cortex with repetitive transcranial magnetic stimulation in stroke: development of new strategies for neurorehabilitation. NeuroRehabilitation, 2008. 23(1): p. 3-14. (Invited Review)
Chapman D, Needham KJ, Allison GT, Lay B, and Edwards DJ (2008). Effects of experience in a dynamic environment on postural control. Br J Sports Med 42, 16-21.
Edwards DJ, Krebs HI, Rykman-Berland A, Zipse J, Thickbroom GW, Pascual-Leone A, and Volpe B. (2008). Priming human motor cortex with anodal tdcs for robotic wrist therapy in chronic hemiplegia. Neurorehabilitation and Neural Repair 22, 637.
Edwards DJ, Mastaglia FL, Byrnes ML, Fregni F, Pascual-Leone A, and Thickbroom GW (2007). Supraspinal inputs reduce corticomotor excitability during passive movement: evidence from a pure sensory stroke. Restor Neurol Neurosci 25, 527-533.
Millar LC, Edwards DJ, Blacke DJ, Mastaglia FL, and Thickbroom, GW (2007). Can magnetic brain stimulation help improve motor performance after stroke? Internal Medicine Journal 37, A113.
Edwards DJ, Krebs, HI, Rykman-Berland, A, Zipse, J, Thickbroom, GW, Mastaglia FL, Pascual-Leone, A, and Volpe, B. (2007). Raised corticomotor excitability after transcranial direct current stimulation is sustained during robotic wrist therapy in chronic stroke. Internal Medicine Journal 37, A115.
Johnson, LG, Edwards DJ, Thickbroom, GW, and Mastaglia FL (2006). A pilot study on the effects of a patient-specific, home-based, functional exercise program on patients with inclusion body myositis (IBM). Neuromuscular Disorders 16, S1-S208.
Thickbroom GW, Byrnes ML, Edwards DJ and Mastaglia FL (2006). Repetitive paired-pulse tms at i-wave periodicity markedly increases corticospinal excitability: a new technique for modulating synaptic plasticity. Clin Neurophysiol 117, 61-66.
Rodrigues JP, Edwards DJ, Walters SE, Byrnes ML, Thickbroom GW, Stell R and Mastaglia FL (2006). Blinded placebo crossover study of gabapentin in primary orthostatic tremor. Mov Disord 21, 900-905.
Edwards DJ, Mastaglia FL, Byrnes ML, and Thickbroom GW (2006). Does a TMS induced increase in cortical excitability trigger adaptive mechanisms? a repeat bout iTMS study. Neurorehabilitation and Neural Repair 20, 95.
Rodrigues JP, Edwards DJ, Walters SE, Byrnes ML, Thickbroom G Stell R and Mastaglia FL (2005). Gabapentin can improve postural stability and quality of life in primary orthostatic tremor. Mov Disord 20, 865-870.
Rodrigues JP, Edwards DJ, Walters SE, Thickbroom GW, Stell, R, and Mastaglia FL (2005). Differential effects of globus pallidus stimulation and levodopa on postural stability in Parkinson’s disease. Clinical Neurophysiology. 116.
Rodrigues JP, Edwards DJ, Walters S, Thickbroom GW, Stell R, and Mastaglia FL (2005). Static and dynamic postural stability in orthostatic tremor. Clinical Neurophysiology. 166.
Rodrigues JP, Edwards DJ, Walters S, Thickbroom GW, Stell R, and Mastaglia FL (2005). State-dependent effects of Parkinson’s disease on static and dynamic postural stability. Proceedings of the Australian Neuroscience Society Annual Meeting. 16.
Edwards DJ, Rodrigues, JP, Stell, R, Walters, S, Thickbroom, GW, and Mastaglia FL (2005). The effect of lower limb tremor on postural stability. Proceedings of the Australian Neuroscience Society Annual Meeting. 16.
Edwards DJ, Mastaglia FL, and Thickbroom GW (2004). Short-latency intracortical inhibition during passive movement. Clinical Neurophysiology 115, 991, P-995.
Edwards DJ, Thickbroom GW, Byrnes ML, Ghosh S, and Mastaglia FL (2004). Temporal aspects of passive movement-related corticomotor inhibition. Hum Mov Sci 23, 379-387.
Edwards DJ, Mastaglia FL, and Thickbroom GW (2003). Corticomotor excitability during cyclic passive movement: effect of movement rate and phase. Proceedings of the Australian Neuroscience Society Annual Meeting. 14.
Edwards DJ, Thickbroom GW, Byrnes ML, Ghosh S, and Mastaglia FL (2002). Reduced excitability of the corticomotor pathway to the hand with cyclic passive movement of the index finger. Proceedings of the Australian Neuroscience Society Annual Meeting 13.
Edwards DJ, Thickbroom GW, Byrnes ML, Ghosh S, and Mastaglia FL (2002). Reduced corticomotor excitability with cyclic passive movement: a study using transcranial magnetic stimulation. Hum Mov Sci 21, 533-540.
Edwards DJ, Sacco P, Thompson ML, Thickbroom GW, and Mastaglia FL (1996). Corticomotor representation of elite badminton players. Proceedings of the American College of Sports Medicine 50th Annual Meeting Medicine, Science, Sports and Exercise.
Edwards D, Sacco P, Pearce AJ, Thickbroom GW, Thompson ML and Mastaglia FL (1996). Differences in the corticomotor projection to dominant and non-dominant wrist flexor muscles in elite badminton players. Proceedings of the Australian Neuroscience Society Annual Meeting. 7.
Alvaro Pascual-Leone,M.D., Ph.D.; Felipe Fregni, M.D., Ph.D., M.P.H.; & Alex Rottenberg, M.D., Ph.D., Berenson-Allen Center for Non-Invasive Brain Stimulation, Harvard Medical School
Mar Cortes, M.D., Burke Medical Research Institute
Bruce Volpe, Burke Medical Research Institute
Chema Tormos & Raul Pelayo, The Guttmann Neurological Rehabilitation Institute, Barcelona
Gary Thickbroom, Ph.D., & Frank Mastaglia, M.D., The Centre for Neuromuscular and Neurological Disorders, The University of Western Australia
Hermano Krebs, Ph.D., & Laura Dipietro, Ph.D., Massachusetts Institute of Technology
PI: Dylan J Edwards, (Co-PI: A. Pascual-Leone, BT Volpe, HI Krebs) Agency: National Institutes of Health. Type: R01: HD069776-01A1 Amount: $1,000,000, Period: 2011-2016. Title: Transcranial Direct Current Stimulation and Robotic Training in Chronic Stroke.
PI: Gary W Thickbroom, (Co-PI: Dr. Dylan J. Edwards, Professor Frank L. Mastaglia) Agency: The WesternAustralian Institute for Medical Research & The Road Safety Council. Type: Neurotrauma ResearchProgram Grant Period: 2011-2012 Title: Cortical plasticity after spinal cord injury – measurement andmodulation.
Principal Investigator (PI): Dylan J. Edwards (Co-PI: A Pascual-Leone, BT Volpe, HI Krebs) Agency: National Institutes of Health, Government of the United States. Type: R21. Amount: $530,000 Period: 2009-2010 Title: Transcranial Direct Current Stimulation and Motor Training in Chronic Stroke
PI: Gary W Thickbroom, (Co-PI: Dr Dylan J. Edwards, Professor Frank L. Mastaglia) Agency: The Western Australian Institute for Medical Research & The Road Safety Council 2007 Type: Neurotrauma Research Program Grant Period: 2007-2010 Title: Using brain stimulation to help recovery after SCI and stroke.
PI: Gary W Thickbroom, (Co-PI: Dr Dylan J. Edwards, Professor Frank L. Mastaglia). Agency: The Western Australian Institute for Medical Research & The Road Safety Council Type: Neurotrauma Research Program Grant Period: 2005 Title: Can interventional brain stimulation improve motor performance after stroke?
May 18, 2013: Guest on WOR Radio's Health Talk with Dr. Ronal Hoffman. Listen to the segment.
April 1, 2013: Introduction to transcranial Direct Current Stimulation (tDCS) and High Definition transcranial Direct Current Stimulation (HD-tDCS), a one-day intensive workshop on the fundamentals of the theoretical and practical aspects of transcranial Direct Current Stimulation (tDCS) and High-Definition transcranial Direct Current Stimulation (HD-tDCS).
March 20, 2013: Brain therapy, Lyme breakthroughs fueled by federal stimulus, The Journal News. Watch the accompanying video
Oct. 30, 2012: Electric brain stimulation gains ground, San Francisco Chronicle.
Sept. 13, 2012: Burke Rehabilitation Center open house to show off cutting-edge work, The Journal News.
Dylan J. Edwards (middle), Ph.D., PT, examines and stimulates a patient's brain with Michael Reding (right), M.D., director of Burke Rehab Hospital's Stroke Rehabilitation Program, using the Nexstim navigated TMS (transcranial magnetic stimulation) system.
Avrielle Rykman (right), MA, OTR/L, clinical robotics research coordinator, prepares a patient for robotics therapy.
Avrielle Rykman (middle) and Dr. Dylan J. Edwards (right) observe a patient working with the wrist robot.