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A Fellowship First

Whitney Gray 15DPT and Emory mentors take on StrokeNet

By Dana Goldman

Story Photo

Alum Whitney Gray 15DPT uses noninvasive brain stimulation to activate the side of the brain affected by the stroke and EEG to measure brain responses to stimulation. It’s an effort to understand how the brain functions after stroke to support recovery.

It was the summer after graduation, and Whitney Gray 15DPT was at a crossroads. In between studying for boards, she’d stop in to Assistant Professor Michael Borich’s lab to continue the work she’d started as part of his research group. She wasn’t sure what was next for her professionally.

Gray remembers what happened next. “One day Dr. Borich came in and said, ‘There’s an opportunity to do this fellowship with StrokeNet. Are you interested?’”

No matter that all previous StrokeNet fellows had a PhD or medical degree. Gray applied to the program and was accepted for the 2015-2016 cohort. StrokeNet assigned her two mentors: Michael Borich, DPT, PhD, and another of her former professors, Steve Wolf, PhD, PT, FAPTA, FAHA. With their help, she has spent the past year conducting research likely to have a lasting impact on stroke rehab.

The National Institutes of Health started StrokeNet in 2013 as a national effort to propel research and clinical trials forward in three specific areas: stroke prevention, treatment, and recovery. Twenty-five sites across the United States signed up to participate in StrokeNet, with Emory serving as the coordinating center for all StrokeNet efforts in Georgia. StrokeNet included provisions and funding for one research fellowship at each of the 25 sites.

Steve Wolf, Emory professor of medicine and one of the principal investigators for Georgia StrokeNet, wasn’t surprised to hear colleagues suggest nominating Gray for the fellowship. “She was a stellar student who had interests that go far into the inquiry process of research,” says Wolf. “She was intrigued by a lot of the work that Dr. Borich was doing related to potential measures of neuroplasticity using technologies that haven’t been used that way before. All of that came to the fore and seemed to fit right for the fellowship.”

StrokeNet agreed.

Gray has been interested in neurological aspects of recovery and rehabilitation since her years as an undergraduate studying neuroscience. She chose to come to Emory for physical therapy training because she knew she could participate in research through the Division of Physical Therapy. “Neurorehab is what got me here,” she says.

Her particular focus on stroke recovery came as a result of personal and clinical experiences during her time at Emory. “A lot of my clinical experience was with stroke patients,” Gray says. While balancing classes and research, she learned that a close friend of her family had just suffered a stroke. “Because I had familiarity with strokes and had studied them, I felt the need to understand what happens after a stroke,” Gray says. “What can we do to help recovery and rehabilitation? That’s what drew me specifically 
to stroke.”

At least superficially, Gray’s mentors couldn’t be more different. Professors Steve Wolf and Michael Borich are a generation apart in age. In his spare time, Wolf writes poetry, while Borich is a hard-core bicyclist.

But “our personalities work,” says Borich. As Gray’s official mentors for the StrokeNet fellowship, Borich and Wolf met regularly with Gray throughout the year to discuss research ideas, techniques, and implications. “They discussed and rediscussed when I needed it,” says Gray. “The feedback was always to make my work better. It was a great environment for me as my first foray into serious research.”

That research includes use of electroencephalography (EEG) to capture real-time data about brain function after stroke. “We can see how the brain changes after stroke, and we’re discovering how we can use that information to try and influence brain activity and function,” says Gray.

In one particular study that’s now been completed, Gray used a transcranial magnetic stimulation (TMS) device to deliver magnetic pulses to the part of the brain that controls motor movement. By pairing the TMS intervention with EEG, Gray was able to see in real time how the brain responds at a cellular level to TMS. “We found certain signals that may relate to impaired functioning of a patient’s hand or arm,” says Gray. “It gives us an interesting idea of a potential biomarker of activity in the brain that relates to motor repair.”

In an ongoing study, Gray and colleagues explored TMS to improve and accelerate hand usage after stroke. By stimulating certain parts of the brain and watching the brain’s real-time response, they may be able to enhance neuroplasticity, leading to quicker physical rehabilitation for stroke patients. “Potentially, this could be paired with traditional rehab interventions and speed the rate of functional gains for the patient,” says Gray. Or down the line, researchers could use a similar technique to induce spinal cord neuroplasticity during recovery from a spinal cord injury.

The research topic is unique, says Wolf. “The interest here is the immediacy of time-based processing. The challenge is to interpret what the EEG results mean and what the implications are for the changes that one sees, how those results manifest in the behavior of the patient, and the duration of that effect.”

In addition to their potential therapeutic benefit, both TMS and EEG have the advantage of being noninvasive and relatively inexpensive, Wolf adds.

This past April, Gray spoke at the Minnesota Neuromodulation Consortium and received two awards for her research.

Being the only non-MD, non-PhD physical therapist in the StrokeNet so far helped motivate Gray to prove the worth of her contributions. “Because physical therapy isn’t well represented in StrokeNet, one of my responsibilities is to help people think well of physical therapists in the research community and to open more doors in research for physical therapists in the future,” says Gray.

Gray gives much of the credit for her success to her mentors. “They always encouraged me to ask questions and share my ideas even though I was new to this field and to research in general,” says Gray. “It was the epitome of collaboration. We all came with different skill sets, and we were all willing to share so that we could grow together.”

Now that the fellowship is over, Gray has moved to Oregon with her husband and is looking for work in clinical neurorehabilitation. “Eventually, I think I’d like to find a way to combine clinical practice and research in the neuro setting,” says Gray. With her whole career ahead of her, she looks forward to making that happen.

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