IN THE INTERIM...
Marjorie Nicholas, PhD, CCC-SLP, FASHA
Interim Dean, SHRS
Welcome to this new year of 2023 from your interim dean of SHRS! I hope you all took some time for rest and reflection this Martin Luther King Day as we await the start of a new spring semester. As you all know, Laura Plummer and I have been sharing the job of interim dean for a few months; and now she is serving as the interim dean of our newest IHP school, the School of Healthcare Leadership (SHL). Laura and I plan to continue to work together to help each other in our new roles and of course in her role as chair of the PT department, I will also be meeting with her regularly, as I will be doing with all the department chairs.
Like you, I was also disappointed that our choice for SHRS dean that we made an offer to in the fall, turned us down after initially accepting the offer. As your interim dean, I will represent your interests and concerns to IHP administration, and I will also advocate for you to the best of my ability. I hope you will feel free to voice any concerns you have with me or with our assistant deans, Mike Boutin and Mary Ellen Ferolito, in the SHRS dean’s office. At the same time, be assured that the search for a new permanent dean of SHRS is ongoing.
Also like you, last week I was saddened to learn of the 20 lay-offs of valued IHP colleagues that the Institute needed to make in order to reduce a significant deficit in our operating budget. We will sorely miss their many contributions that each of them has made to the institute over the years. Although here in SHRS we were fortunate not to have any faculty or staff directly affected by these lay-offs, we are bound to feel the loss of these personnel in other ways. We will also be needing to tighten our belts a bit in our own programmatic operating budgets.
2023 is bound to bring us many new and exciting changes; each new year always does. I am mindful of the fact that in two months in early March, we will mark having lived through three years of the COVID pandemic and a fourth year will commence. By now we have all realized that this truly is the new normal and I hope you feel, like I do, that it is possible to thrive in this environment just as it was earlier. For example, here in the SHRS, we have opened new academic programs (PP-OTD, PP-SLPD) over the past three years; and another new program, an entry level clinical doctorate in Audiology (AuD), is launching in June if all goes well. Our new MGH IHP website will launch later this month- and it is bound to be better than the old one!
In some of our departments we will be recruiting for and hiring new faculty and staff as we say goodbye to people who are retiring or have left for other reasons. As an “old-timer” now at IHP, wearing my 25-year pin on my lanyard, I know that new people bring new ideas and energy that helps us grow and thrive. That is true of new students, too! Some students have just begun their academic programs starting January 17th, and they will attend the PPP (Power, Privilege, and Positionality) event that some of you are assisting with as facilitators. I know you will enjoy the earnest excitement in these new students’ eyes as they get to know IHP and understand our values as an institution.
These past three years have made us all more resilient (I know, we are all sick of that word!) and we have truly learned the importance of stress management and how important having a “growth mindset” is. We have modeled these attributes to our students while we have simultaneously learned from the students as well. I wish you all a semester where you feel you are thriving in the midst of our new and exciting changes.
On a personal note, an exciting new change that will be coming into my life this semester in February is a second grandchild! I am thankful that my son and daughter-in-law live locally so we get to see them and the grandchildren frequently. I am also thankful to work with creative and supportive colleagues and to have an opportunity to teach interested and open-minded students here at IHP. I hope you will also take a moment to think about what you are each thankful for as this new year commences.
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Teresa Kimberley Plays Key Role in New FDA-Approved Tech Offering Stroke Patients New Hope
By Sean Hennessey
Office of Strategic Communications
Every hour, nearly 100 Americans experience a stroke and for most, a long and difficult road to partial recovery will follow. Occupational, physical, and speech-language therapy can help, but a patient’s rehabilitative progress often reaches a plateau.
Now, there’s new hope, and Teresa Kimberley, PhD., researcher and director of the Brain Recovery Lab at the MGH of Health Professions, is playing a key role.
An FDA-approved, drug free approach – a brain stimulation device connected to the vagus nerve, paired with rehabilitation therapy – may improve hand and arm function by 200 – 300% above previous levels. The pairing of therapy with vagus nerve stimulation is helping the brain create or strengthen new neural pathways - like building a bridge to bypass a damaged area.
Dr. Kimberley helped develop the rehabilitation protocol the FDA says is necessary to pair with the groundbreaking technology called the Vivistim® Paired VNS™ System, which employs vagus nerve stimulation (VNS) during rehabilitation therapy to improve upper extremity motor function. Research shows that a stroke survivor will only see significant progress if the rehabilitation and technology are used together.
“This is a watershed moment for rehabilitation science,” said Dr. Kimberley. “This is the first time that brain stimulation combined with rehabilitation therapy for stroke is available for patients beyond a research study. There is a new FDA-approved option that has strong potential to improve hand function. It is very exciting.”
The first step for this new therapy took place in late August when the first patient on the East Coast had the small Vivistim device placed around a nerve in his neck (the vagus nerve) and under the skin of his upper left chest area during an outpatient procedure at Massachusetts General Hospital. The procedure was performed by Ziv Williams, MD, a neurosurgeon at Mass General and Faculty in the Program in Neuroscience at Harvard Medical School, under care being directed by David Lin, MD, a neurologist, Faculty in the Center for Neurotechnology and Neurorecovery, and Director of the Mass General Neurorecovery Clinic.
“When you stimulate the vagus nerve, the brain is firing more than it would on its own,” said Dr. Kimberley. “The VNS enhances neurotransmitter release to help create connections, or pathways, that are critical in getting the brain to perform a specific function, like picking up that pen. The VNS appears to give the brain a way to lay down these pathways permanently. If patients keep using these pathways, while reinforcing with therapy and home practice, these abilities will remain and get stronger.
The therapy that the VNS is enhancing is a rigorous process that puts patients on the cusp of, “I can still do it” without being so frustrated that they want to quit. Kimberley says the key is to find activities that are meaningful to the person and will drive the brain’s neural patterns.
For Dr. Kimberley, years of effort have finally paid off: she researched VNS for a decade through a long-standing scientific consultation relationship with the company developing the technology, brought the trial to MGH, was the principal investigator running the trial, was senior author on the Lancet paper that published the results, and now is working to bring this as a clinical offering to MGB patients.
“I can’t tell you how many hours I have put into this through the years,” said Kimberley. “To see the progress we’ve made, to see a patient who will soon enjoy the benefits of the technology and rehabilitation, makes it all worth it. This is going to change the lives of so many patients, and that’s what research is all about, isn’t it?”
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Making a Difference in Jordan by Collaborating with Community Providers
By Sean Hennessey
Office of Strategic Communications
Classes may be in full swing at the IHP, but for a handful of Doctor of Occupational Therapy Students, a summer experience in Amman, Jordan is very fresh in their minds and the mind of Dr. Rawan AlHeresh, who started “Toward an All-Inclusive Jordan,” an academic-community partnership program under the umbrella of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA’s) that just finished its sixth year.
“Toward an All-Inclusive Jordan” is the only program in Jordan – and perhaps in the UNRWAs portfolio – that operates on a partnership between academia and the community targeting people with disabilities. “There's a lot of rehab programs that do direct one-on-one,” says AlHeresh, an associate professor of occupational therapy who founded the program in 2018. “But ours is focused on community empowerment. We focus on sustainability, so that's what distinguishes our programming.
For the first time since COVID, OTD students were able to travel to the Community-Based Rehabilitation Center in the AlBaqaa Refugee Camp, home to Palestinian refugees displaced by the Israeli occupation. Here, the students trained community-based rehabilitation (CBR) workers – volunteers with minimal training.
This video captures some of the highlights of this summer’s session.
AlHeresh says most global health programs focus on immediate and one on one medical or therapeutic interventions, but because it’s not a long-term sustainable solution, these interventions do more harmful than good to those communities.
“With a lot of programs in Central America and Africa, they treat the child one-on-one where the child gets better for a little bit but then has a bad remission and then the mom isn't able to do anything with them,” AlHeresh said. “We're training the CBR workers who live there. They’re not going anywhere and can make sure there’s continuous care.”
When AlHeresh graduated with her doctorate in rehabilitation sciences, her future was mapped out – she would be a scientist and researcher, win awards, receive grants. and everything that comes with it. Then she received an email from the World Health Organization with an urgent call for help. The video she opened in that email changed her priorities.
It detailed the lack of rehabilitation access in low and middle-income countries – for every one million people, there were less than ten rehabilitation professionals, and for occupational therapists it was barely above two. “It made me ask, ‘What is the significance of what I am doing?’” recalled AlHeresh. “I'm looking at rheumatology statistics that might not ever see the light of day. And yet, there are millions who have never even seen an occupational therapist like myself, and I was uniquely situated in a position where I could do something to fill these gaps of access to rehabilitation worldwide.”
Before she came to the United States in 2011, AlHeresh was trained in community-based rehabilitation in Jordan and tried putting that training to work, in education and awareness. Here’s why: there are no occupational therapists in any public school, and physical therapy doesn’t exist as a profession in most public entities in Jordan.
“You would go in and get a knee replacement and go home without rehab,” she said. “So, if you have a child who has a developmental disability or is in a wheelchair - they don't get into school because they don’t have any type of a facilitation for children with disabilities in any field. It’s a huge phenomenon over there; one program, one person, or one type of intervention isn’t going to solve the issue.”
After spending six years trying to change how the government perceived rehabilitation, she gave up, realizing a top-down approach could not work. So, she tried another tact: “I decided I’d work from the grassroots, and that's why as I started the program, to go to the community and benefit the service recipients directly.”
Through the years, the cost of the student trips to the Gaza and AlBaqaa camp have been funded by the Lucy Burr fund at the IHP and the Durant Fellowship at the Global Health Department at Massachusetts General Hospital, a collaborative coordination for students fortunate to participate in the program.
“We learn a lot about health disparities throughout our courses but it was extremely rewarding to do hands on work in a refugee camp and see disparities first hand,” said Long, the second-year student. “It was a great experience to learn about and understand the perspectives of the people we were working with so we could best help them.”
“It was an amazing experience to immerse myself in a new culture and it opened my eyes to new ways of serving clients in the future,” added Livingston, who will graduate in 2024. “I gained confidence in myself and learned a lot of amazing skills that I plan to use in my future practice. I'm just grateful that I was able to have this experience.”
AlHeresh is already planning for next year’s trip to Jordan – and many more after that. “It's exceptionally rewarding,” said AlHeresh. “This is why I've made it my mission to write, disseminate, and let people know about this model where you really can make an impact with such limited resources. You don't need tons of money to create change. All it needs is building on human power, relationships, and being kind to one another. This can really change people’s lives.”
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New Research Establishes Rate of ALS Speech Decline
By Sean Hennessey
Office of Strategic Communications
It’s an unfortunate reality that some patients with amyotrophic lateral sclerosis (ALS) will lose their ability to speak – the only question is “when.” Now, thanks to research led by Drs. Marziye Eshghi and Jordan Green at the MGH Institute’s Speech and Feeding Disorders Lab, there are now estimates of how fast that occurs considering a patient’s clinical and demographic characteristics.
Dr. Eshghi is the lead author in the paper “Rate of Speech Decline in Individuals with Amyotrophic Lateral Sclerosis,” published in the journal, Scientific Reports; the research provides the first look at the speed ALS progresses.
“Given the importance of speech in everybody's life, one of the first questions that people with ALS have and neurologists and speech pathologists have is: ‘How far away are we until the loss of speech?’” says Eshghi, an Assistant Professor at the Communication Sciences and Disorders Department at the IHP. “We’ve never been able to provide an estimate, but now we have some understanding of that. It’s really about providing appropriate counselling and helping some ALS patients who may need to seek solutions for communication such as the application of augmentative and alternative communication devices.”
The research looked at 166 ALS patients from the United States and Canada and utilized two data points from the same people, making this, according to Eshghi, “the largest longitudinal scale study on this topic ever done.”
Study participants read a list of computer-generated random sentences called a Sentence Intelligibility Test; and subsequently measures of speaking rate (number of words per minute) and intelligibility (the percentage of words that were understandable) were computed from their speech samples.
Researchers have long known that patients with Bulbar-onset ALS will lose their functional speech earlier than those with Spinal-onset ALS, but they had yet to quantify the rate of speech decline. In the paper, the researchers determined that while between 60%-70% of individuals with Bulbar-onset ALS will lose their functional speech in about three years after symptom onset, the majority of individuals with Spinal-onset ALS will retain their functional speech over five years since symptom onset. In addition, the findings of this study revealed that among various demographic and clinical factors (e.g., sex, age at disease onset, and site of onset), the site of onset – the part of the body first affected by ALS - is the main influential factor in the rate of speech decline.
“Our findings provide valuable information about speech decline in ALS,” said Eshghi. “The research is not only helpful for patients and caregivers but also for neurologists and speech language pathologists who are involved in the clinical management of ALS, and who are evaluating the functional changes in patients’ speech performance.”
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New Bill Signed Will Open Doors for First Year Speech-Language Pathologists in Massachusetts
By Kate Chaney
Office of Strategic Communications
For years, Massachusetts carried the dubious distinction of being the only state in the country to consider it fraud for trained and qualified speech language pathologists to bill insurance companies during their first year of practice, known as their clinical fellowship (CF).
That all changed recenty when Governor Baker signed into law House Bill 5094: An Act Providing for Provisional Licensure for Speech-Language Pathologists (SLPs). This will directly impact current CFs and studying speech-language pathologists who, prior to this bill, were unable to bill for their services under Medicare B, Medicaid, and certain insurances, despite the American Speech-Language-Hearing Association considering CFs to be qualified professionals.
Passage of the law is largely the result of advocacy from the Massachusetts Speech-Language Hearing Association (MSHA) and lobbyists Rick Branca and Bill Malloy. Barbara Wilson Arboleda, a 2001 alumna of the MGH Institute of Health Professions' CSD program and a current SLP at Beth Israel Deaconess, Lisa Moran, Assistant Director of External Clinical Education at the MGH Institute of Health Professions, and Jenn Mackey, Director of Clinical Education at the MGH Institute of Health Professions, are members of MSHA and volunteered their time and efforts in helping this bill to pass.
“We couldn’t be happier,” beamed Mackey, “It’s been a long fight. Finally, our CFs don’t have to move out of state to work in settings they are passionate about. We want them to stay here in Massachusetts and fill the many open jobs in our state. We did this for every SLP graduate student in MA, as well as for the integrity of our field.”
Once the remaining logistical political steps are completed, this bill will allow trained and qualified SLPs to bill insurance companies during their first year of practice.
The new law has two immediate impacts:
- Patients needing communications or swallowing care will see an expert quicker because not as many SLPs will need to leave the Commonwealth. Unto this point, newly graduated SLPs were leaving for greener pastures – states where they could be hired easily because they could bill insurance for their services, therefore not requiring their employers to pay their salaries out of pocket.
- Hospitals and schools will have an easier time filling SLP positions left open by the workforce shortage, one exacerbated by SLPs leaving Massachusetts. Organizations will save money because they won’t be paying out-of-pocket to cover a first year SLP’s salary.
That a law like this is even necessary might surprise most; the limitations on first year SLPs certainly stunned those within the SLP field more than a decade ago.
“All of us were ignorant to it,” shared Moran. “Prior to joining the IHP, I worked for a very large organization that had its own compliance and regulation department. When I heard rumblings about this billing issue, I specifically emailed my compliance and regulation department, and it became clear that even they weren’t aware.”
The situation is complex and the prior regulations, archaic.
Enter Moran, who was involved with MSHA at that time. Moran has long been working with the organization, first on the MSHA Executive Council in 2007, and since holding numerous positions including the Co-Chair of Membership, VP of Administration and Planning, President, Past-President and VP of Advocacy, and Government Affairs Committee (GAC) Lead. She joined the IHP in 2015 and brought her advocacy knowledge along with her, teaching the community about the barriers this lack of provisional licensure brought to first year SLP clinicians. Mackey, has been the VP of Advocacy for MSHA for the last two years, and has been working at the IHP for over twenty years.
“I knew it was time for me to stop complaining and act,” Mackey shared. “MSHA had been working so hard for a decade. Our lobbyists, as well as the MGH Office of Government Affairs, were excellent guides in this bill’s advocacy.”
Over the last two years, Mackey continued to work closely with the lobbyists to gather letters of support, testify in legislative committees, and share information about the bill. Simultaneously, she led webinars on advocacy for several speech-language pathology programs in MA to teach students about the Provisional Licensure bill and advocacy in the field.
It was the collaboration among members of the IHP community that lead to such a successful push for change. With Wilson Arboleda as an alumna, and Mackey and Moran as faculty, there was a direct line of student involvement, bringing in more voices to spread the word and more hands on deck. All on a volunteer basis.
The path to getting the bill signed was not smooth and in fact, there were often delays, most of which resulted from a lack of understanding. “There were people who didn't believe us,” Mackey said. “Even now, after all these years, there are people that don’t really understand the issue."
With the new law on the books, the future looks bright for all in the SLP field.
While Mackey, Wilson Arboleda, and Moran have spent twelve years turning hope into reality, their journey with it is far from over. Making the SLP field more equitable while providing better care for all will continue to drive them.
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Research & Awards
Dr. Jane Baldwin, an assistant professor of physical therapy, received the Mary MacDonald Distinguished Service Award from the American Physical Therapy Association of Massachusetts. The award honors past and present members who have significantly helped to advance the profession of physical therapy and who have selflessly provided distinguished service to the organization and to their community.
Dr. Mike Boutin, Assistant Dean for faculty and student success in SHRS, gave two presentations at the National Academic Advisors Association’s 2022 national conference: Coaching Skills for Advising: Using the GROW Model, and Sinking into Grief: Bereavement and Loss in Advising Relationship.
Dr. Kim Erler, an associate professor of occupational therapy, is the sub-PI on a five-year grant from NIDILRR through Spaulding Rehabilitation Network: “Spaulding-Harvard Traumatic Brain Injury Model System.”
Dr. Shweta Gore, an associate professor of physical therapy, is the PI
on a two-year pilot grant from the Learning Health Systems Rehabilitation Research Network (LeaRRn): “Improving patient mobility and service delivery at Boston Medical Center"
Baothy Huynh, OTD ‘19 and a current PhD-RS student, received the Stroke Interdisciplinary Special Interest Group (ISIG) Early Career Poster Award from the American Congress of Rehabilitation Medicine for her poster, “Sensitivity to Change and Responsiveness of the Fugl-Meyer Assessment – Upper Extremity in Individuals with Moderate to Severe Acute Stroke."
Dr. Kathy Lyons, Director of the CaRe Lab, is the site PI on four-year, transfer R01 grant from the University of Alabama at Birmingham
(via Dartmouth-Hitchcock Health) to the IHP: “Implementing
Palliative Care: Learning Collaborative vs. Technical Assistance.”
Dr. Andrea Pittman, Director of the Doctor of Audiology (AuD) program, is the PI on a two-year grant from the William Demant Foundation: “Spatial Listening and Learning in Children with Hearing Loss.”
Dr. Prue Plummer, a professor of physical therapy, was among nine researchers to receive the Best Poster for Stroke-Related Content Award at the Academy of Neurology Physical Therapy Annual Conference for their project, "Functional Ambulation Category in Acute Stroke Predicts Disability in Three Months."
Dr. Diane Smith, a professor of occupational therapy, has been appointed to the Massachusetts Board of Allied Health Professionals where she will work to oversee regulations for practice. She begins her term in January 2023.
The Research Office has launched monthly Speed Mentoring Sessions! These sessions are a great opportunity to speak with department leaders for career advice and research opportunities. Sofia Valilla Rohter, CSD faculty and a recent participant said: "The speed mentoring session reminded me of how energizing and informative it is to connect with colleagues. I learned about analysis resources, strategies to plan my next grant, and even a potential collaboration with a fellow researcher. I am looking forward to the next one already." To find out more or to register for the next sessions, reach out to Riley Keefe.
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SHRS Dean's Office
Marjorie Nicholas, PhD, CCC-SLP, FASHA
mlnicholas@mghihp.edu
Mary Ellen Ferolito
Asst Dean of Operations
mferolito@mghihp.edu
617-724-4841
Emile R "Mike" Boutin, Jr, EdD
Asst Dean for Faculty & Student Success
eboutin@mghihp.edu
617-726-8021
Comments about our newsletter? Article ideas?
Mike Boutin: eboutin@mghihp.edu
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