DRAFT: Sargent Case Statement

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REBUILDING LIVES… FROM CELLS TO COMMUNITIES

SUPPORTING SARGENT

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THE CASE FOR SUPPORT OF BU’S COLLEGE OF HEALTH AND REHABILITATION SCIENCES: SARGENT COLLEGE

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THE SARGENT CONTINUUM: OUR WORK AT SARGENT BEGINS WITH PATHBREAKING RESEARCH, TRANSLATES INTO INNOVATIVE PRACTICE, AND RESULTS IN IMPROVED HEALTH FOR ALL.

FROM THE DEAN At Sargent College, we’re intent on changing the healthcare landscape, from the individual to the systems level.

We are Boston University’s College of Rehabilitation & Health Sciences, and we cover all the disciplines our name implies—from physical therapy and athletic training to occupational therapy, nutrition, and speech-language pathology. We study conditions that have been around for millennia—stroke, dyslexia, mental illness, arthritis—to shine new light on their genesis and develop breakthrough treatments based on what we learn. As the parent of one of our grateful patients said, “After his accident, the doctor kept my son alive. Sargent gave him his life.”

With three of the top-ranked programs in the nation, Sargent College is unique: it combines intimate academic experiences with cutting-edge research and the direct translation of that research into technologies and therapies that shape best practices. And we do all of that with unparalleled compassion, commitment, and zest: we call it Sargent Spirit.

We are so proud of the students, faculty, and alumni who contribute the best of Sargent Spirit to everything they do. As you read the following pages, you will experience that Spirit, too, and see how it informs our research, our clinical practice, our teaching, and our interactions with patients worldwide.

We hope you will join us in spreading Sargent Spirit ever wider, to improve healthcare for all.

Christopher A. Moore, PhD Dean and Professor College of Health & Rehabilitation Sciences: Sargent College

A COMMITMENT TO REBUILDING LIVES ONE BY ONE, IN COMMUNITIES AROUND THE WORLD

SARGENT SPIRIT. ALIVE AND WELL IN THE 21ST CENTURY. WHAT IS SARGENT SPIRIT? It is COLLABORATION ACROSS OUR PROFESSIONS—from occupational and physical therapy to athletic training, speech-language pathology, and nutrition—with a single aim: to MAKE ALL PEOPLE’S LIVES BETTER. It is the DRIVE TO DEVELOP TREATMENTS for individuals dealing with challenges—Parkinson’s disease, arthritis, severe mental illness, aphasia, and more—so they can participate in their daily lives at the highest level possible.

It is PURSUING PATHBREAKING RESEARCH that translates into innovative, evidence-based practice—and then disseminating that practice to IMPROVE HEALTHCARE FOR ALL. Graduates of Sargent go on to shape their healthcare disciplines for generations to come. They, like their professors and clinical mentors, BECOME TRAILBLAZERS: researchers unraveling how neurons interact in children with autism, for example, and practitioner-teachers determining how much and what kind of rehabilitation best serves people with arthritis. And they are the innovators who develop diagnostic tools and therapeutic technologies that improve the lives of patients around the world.

We are moving forward from a position of strength: our professional programs are ranked among the nation’s best. But with leadership comes responsibility, and so we must do more. We want to ESTABLISH NEW ENDOWED PROFESSORSHIPS to anchor our teams in neuroscience and other core disciplines. OUR PHD CANDIDATES—who form the engine that drives our research enterprise—are training to become the future leaders in the field of health and rehabilitation sciences. The demand for our doctoral graduates is huge, so we want to INCREASE THEIR NUMBERS SIGNIFICANTLY. And we want to EXPAND OUR INTERNATIONAL SERVICE LEARNING PROGRAM so all undergraduates can participate, regardless of their ability to pay.

This is our opportunity: to STRATEGICALLY INVEST IN PEOPLE AND PROGRAMS. We hope that you will join us as we continue working to erase the boundaries of disability—from cells to communities around the world.

FROM CELLS TO COMMUNITIES

EMPOWERING YOUTH WITH DISABILITIES TODAY, ABOUT 15 PERCENT OF AMERICAN CHILDREN AGES 3–17 HAVE ONE OR MORE DEVELOPMENTAL DISABILITIES. BUT FEW OF THEM HAVE THE OPPORTUNITY TO INFORM THEIR OWN EDUCATION OR CARE.

Jessica Kramer will have none of that. When it comes to developing best practices in occupational therapy rehabilitation, she goes to the source: she partners with teens and young adults who have intellectual and neurodevelopmental disabilities. The aim? To design and implement healthcare interventions and assessments that rely on their insights.

“We learn from their experiences,” says Kramer, who directs Sargent’s Youth and Young Adult Empowerment, Leadership, and Learning Lab. “They, in turn, realize their rights and empower themselves: they’re not just being ‘delivered to’; they have a role in determining what works best for them.”

Kramer’s revolutionary approach marks a significant departure from the traditional focus of pediatric rehab: it concentrates not on the body’s functional capabilities but on how the whole person navigates through life.

Her latest project, PEDI-PRO (Pediatric Evaluation of Disability Inventory-Patient Reported Outcome), gives young people with disabilities a voice in evaluating their own progress as a result of rehab. With PhD student Ariel Schwartz (Sargent’16) and six local youth, she’s adapting an existing assessment tool used by parents and clinicians. The goal: to supplement standard rehab assessment measures with ones that resonate with the young people themselves.

Rather than assessing functional skills as stand-alone tasks—say, using a key to unlock a door or putting on a T-shirt—PEDI-PRO asks users to evaluate the ease or difficulty of the steps involved in a typical activity, for example, going to a restaurant. Steps could include washing your hands before eating (a measure of self-care), waiting your turn to order (self-regulation), and carrying your drink to the table (mobility).

Kramer is working with a software developer to create visuals showing the steps in each PEDI-PRO activity.

Users will then go through the activity on a tablet, reporting to their clinicians whether the task was difficult or easy. The program will calculate a score from their answers that the clinicians will use to inform their intervention planning. Combining clients’ self-reports with the standard assessments will give professionals a much more realistic picture of an individual’s progress, and where rehabilitative efforts should be focused.

For the young people themselves, that’s only the beginning of PEDI-PRO’s value. “The assessment is important because we can explain what things are hard for us, so people know how to help us,” says Mariana Vetoulis-Acevedo, 20, who’s been on the PEDI-PRO youth team for a year. “I also like being involved in making the software because we can try to make it better for youth with special needs.”

“Sargent Spirit to me is the gift that allows me to look at the world with caring and compassion and be reenergized each time I see or read about students carrying on the tradition.”

Sharon Ryan (Sargent’70)

FROM CELLS TO COMMUNITIES

REVEALING THE SOURCE OF BRAIN DISORDERS THE NUMBERS ARE STAGGERING: IN THE US ALONE, 1 IN 59 CHILDREN HAVE AUTISM SPECTRUM DISORDER, AND NEARLY 1 IN 12 ADULTS REPORT HAVING DEPRESSION.

Vasileios Zikopoulos, director of Sargent’s Human Systems Neuroscience Laboratory, is on a mission to help change that. He is mapping the connections between neurons in the brain to understand what goes awry in those pathways in autism, depression, and other neurological disorders.

Recently, in collaboration with Professor Helen Barbas, Zikopoulos revealed, for the first time, the remarkable parallels in the brain architecture of humans and rhesus monkeys as well as in the billions of neuronal connections within that architecture.

“Our findings practically cried out that there’s a principle in the organization of the structure of the brain and its connections between the species,” says Zikopoulos. “We can now use that framework to study specific disruptions in a variety of psychiatric and neurological diseases.”

Understanding those disruptions opens the door to developing treatments that can remedy them.

Zikopoulos spends hours peering at wafer-thin slices of postmortem human brain tissue through high-resolution microscopes to analyze—from the molecular to the structural level—the neurons in those pathways and the nerve fibers that transmit signals from one neuron to others. He is, in essence, charting the brain’s communication networks—conversations between brain regions, with the neurons as the nodes and the nerve fibers as the links.

But such postmortem methods can only go so far.

That’s why, in collaboration with Barbas, he uses fluorescent proteins to trace brain pathways in rhesus monkeys.

Together, the two look for parallels in the human and animal data. Where, they ask, does the architecture of the neurons correlate in the two species? Where does the architecture of the circuitry match?

“We find a lot of parallels,” says Zikopoulos. “That tells us that we can apply a wealth of precise data on pathways in monkeys to hypothesize and make predictions about disruptions that relate to humans.”

One example: a pathway in postmortem brain samples of people with autism showed excessive connections in the same pathway that is involved in focusing attention in monkeys.

“That tells us that these pathways in people with autism must be overactive, making it difficult to shift attention,” says Zikopoulos. Clinical research had identified the behavior, but it took the pair’s work to show what was driving it, paving the way to possible targets for therapies.

“Sargent Spirit is the shared, constructive, meaningful bond that you feel with all alumni who passed through this special place. Together we work endlessly to find innovative solutions to address the health needs of our communities.”

Donna Astion (Sargent’82)

FROM CELLS TO COMMUNITIES

REBUILDING COMMUNICATION ALMOST TWO MILLION AMERICANS LIVE WITH APHASIA, THE DEBILITATING LOSS OR REDUCTION OF COMMUNICATION SKILLS FOLLOWING BRAIN DAMAGE, COMMONLY FROM A STROKE, WITH SOME 180,000 ACQUIRING THE DISORDER EVERY YEAR.

Swathi Kiran, director of BU’s Aphasia Research Laboratory, is at the forefront of aphasia research and rehabilitation—as well as translating that research into breakthrough therapies.

Constant Therapy, the app she developed with tech entrepreneur Veera Anantha, gives patients access to personalized, interactive treatment at home on an iPad or a smartphone, enabling them to recover much more quickly than with standard, once-a-week therapy.

Clinicians benefit too: with remote access, they can track their patients’ activities and progress, measuring compliance and quickly prescribing next steps.

Today Constant Therapy is used by tens of thousands of patients in all 50 US states and 11 countries worldwide, revolutionizing the concept of aphasia rehabilitation.

To determine which exercises would most help people regain their language and cognitiveprocessing skills, Kiran drew from her extensive experience in aphasia rehab, her own and colleagues’ clinical research, and a comprehensive examination of the literature on cognitive therapy. The exercises, which now number more than 100,000, cover 80 task categories, ranging from reading maps to reconnecting everyday items with their names and sounds.

“What matters most to me is making a difference in patients’ lives,” says Kiran, professor of speech, language, and hearing sciences, “that we could take what we have learned in the lab and convert it into accessible therapy for patients everywhere.”

Kiran continues to do that. In ongoing research using functional magnetic resonance imaging (fMRI), her team is proving a longstanding assumption wrong: that in aphasia, the brain reaches a recovery plateau and stops healing. The research participants are at least one year post-stroke—many are 5 to 10 years out—and undergo 4 hours of therapy a week for 12 weeks at Sargent. Scans done before and after the treatment show the brain continuing, as Kiran puts it, to “reorganize itself”—new connections form to make language processing more efficient— regardless of the length of time since the stroke.

“This says that the brain can be plastic at any time in adult life and even after an injury,” says Kiran.

“And that what it needs to be plastic is stimulation— systematic, repeated stimulation. After a stroke, therapy can be that stimulation.”

“Sargent Spirit means cooperation and collaboration, bringing out the best in each other while working for a common goal. It means celebrating the inner drive, pushing ourselves to always do better for our patients.

It means never being satisfied with the status quo, always wanting to learn more and better yourself.”

Kerry Blossfeld (Sargent’99,’01)

FROM CELLS TO COMMUNITIES

RECOVERING MOBILITY AFTER A STROKE EVERY 40 SECONDS, SOMEONE IN THE US HAS A STROKE, LEAVING MORE THAN 795,000 PEOPLE EACH YEAR EXPERIENCING PROBLEMS WITH MOBILITY, INCLUDING CHRONIC WEAKNESS OR PARALYSIS IN THEIR LEGS.

Terry Ellis, director of the BU Center for Neurorehabilitation, has been instrumental in developing a solution for that: a wearable robot, called a “medical exosuit,” that can help people who’ve had a stroke walk faster, farther, and with more stability.

“Walking is a critical element of being able to engage in everyday life,” says Ellis, an assistant professor of physical therapy. “If people can walk more efficiently, with less metabolic cost, they are likely to participate more in the community.”

The exosuit, made of soft, lightweight proprietary materials, wraps around the lower leg. Cables connected to sensors run from inside the user’s shoe to the calf, and from the shoe’s tongue to the shin.

Motors, worn around the waist and regulated by a tiny computer loaded with algorithms, apply forces through the cables to help the user walk.

Ellis, with Louis Awad, also an assistant professor of physical therapy, collaborates with a team of engineers and computer scientists at Harvard’s Wyss Institute for Biologically Inspired Engineering. The Sargent researchers provide the clinical expertise that is fundamental to the project’s success: knowledge of walking’s critical physiological elements—and what goes wrong with those elements in disorders such as stroke and Parkinson’s disease.

Stroke, for example, makes it hard to flex the foot when swinging the leg to take a step forward (dorsiflexion), and to point the toes toward the floor to push off when the leg is behind (plantar flexion).

“We educate the engineers about the specific points in the gait cycle that need to be augmented for people with a particular condition, whether it’s Parkinson’s or stroke or multiple sclerosis,” says Ellis.

Ellis and Awad are now taking the exosuit out of the lab and into the clinic, at the BU Neuromotor Recovery Laboratory, which Awad directs. They’re designing studies to explore how combining the exosuit with physical therapy facilitates rapid recovery.

“Today, physical therapists often must work to help people undo compensatory strategies they develop shortly after they have a stroke,” says Ellis. “What if we introduce the exosuit in the hospital, immediately after the stroke? Then we could work on restoring key aspects of gait, and have the biggest impact.”

“Sargent Spirit is the essence of a Sargent degree. It is about people who want to help others. Sargent Spirit is about helping one another through the science of healthcare.”

Bob Knox, Jr. (CGS’08, Sargent’10, SPH’12)

INVESTING IN OUR FUTURE

SUPPORT FACULTY NEW NAMED PROFESSORSHIPS $4 million each UPGRADED EXISTING PROFESSORSHIPS TO CHAIRED STATUS $2.5 million each CAREER DEVELOPMENT PROFESSORSHIPS, FOR JUNIOR FACULTY $1.25 million each

Our faculty lead by turning ideas into action. Through interdisciplinary research, clinical care, and education, they work to discover the causes and best therapies for some of the most pressing health concerns of our time: Alzheimer’s disease, obesity, mental illness, traumatic brain injury, arthritis, and more.

Support for faculty, then, is a direct investment in advancing our understanding of these disorders, in educating our students—and the public—about them, and in developing evidence-based treatments that enable all people to engage as fully as possible in their everyday lives.

But the health and rehabilitative sciences are very competitive, and hiring and retaining the most talented faculty take significant resources, which we cannot depend on tuition to provide. That means philanthropic support for faculty at all levels is critical. We need to increase the number of junior faculty at Sargent, many of whom have outside-the-box ideas with tremendous therapeutic potential. And we need to establish new endowed professorships to anchor our teams in core disciplines.

Retaining faculty—in the lab, the classroom, and the clinic—helps in recruiting, as those considering joining us will see Sargent as a place to stay, and grow. And a critical mass of scholars on our faculty fosters a long-term culture of excellence, benefiting everyone: students, clients, researchers, teachers.

Please consider supporting these endowed positions to provide our faculty, and Sargent College, with long-term financial stability.

SUPPORT STUDENTS Our graduate programs tracked by U.S. News & World Report all rank in the top 6 percent in their respective fields, including the program in occupational therapy, which takes first place. Our undergraduate programs take an interprofessional approach, giving students a competitive edge in the work world. We want the very best undergraduate and graduate students, from all socioeconomic backgrounds, to be able to choose Sargent.

And we want them to embark on their careers without overwhelming debt.

But earning a degree in any of Sargent’s disciplines is a lengthy and expensive process, and salaries upon graduation are relatively modest.

We maximize scholarships and fellowships, but most of our students still have to borrow. We must do more, not just for our students, but also for the greater good: Sargent students are training to become the future scholars and clinical leaders in the health and rehabilitation sciences.

How do they get there? They learn alongside world-renowned researchers and clinicians. And they engage in extensive hands-on experiences in Sargent’s many specialized centers and labs, as well as in field placements around the world. The demand for our graduates, from both employers and patients, is huge. In response, we must provide more support for those who come into our programs, and we must significantly increase the number of graduate students we can accept.

Helping our students benefits our college, too. While demand for a Sargent education is strong, we must still recruit the most talented students after the admissions cycle is complete. We want Sargent to be our applicants’ first choice, and generous financial aid helps keep us at the top of their lists.

Gifts to support endowed scholarships and fellowships for our students will help us continue to transform their lives, as well as those they serve.

FELLOWSHIP FUND, FOR GRADUATE STUDENTS $1.25 million each (full) $500,000 (partial) CENTURY CHALLENGE SCHOLARSHIP FUND, FOR UNDERGRADUATES $100,000 each (minimum)

SUPPORT INTERNATIONAL SERVICE LEARNING SCHOLARSHIPS FOR ISL EXPERIENCES $25,000 each

Why is support for International Service Learning (ISL) a constant and continuing priority? Because graduates of Sargent College are dedicated to service, at home and abroad, in fields that cut across disciplines, from the health sciences to physical therapy, from speech-language pathology to nutrition and dietetics. Without ISL, we cannot create the next generation of culturally sensitive healthcare workers.

All students at Sargent—undergraduate and graduate alike—are offered the opportunity to participate in our ISL program. Led by faculty and equipped with classroom knowledge and clinical skills, they assist providers, nongovernmental organizations (NGOs), and community health workers in delivering essential healthcare and education to underserved populations around the world.

To date, our students have traveled a combined total of more than two million miles to engage in on-the-ground healthcare efforts in countries such as Guatemala, Thailand, Ghana, Peru, India, and Belize. On one recent trip, students worked with the Mirror Foundation, an NGO in Thailand, to improve the livelihood of ethnic minorities in northern mountainous regions of the country. In another, they teamed up with community leaders in Ghana to conduct health screenings and provide education on hygiene to children in rural villages.

We have made progress, but we still have a long way to go. We need to expand our ISL program so all interested students can participate in it, regardless of their ability to pay. Please join us in helping our students be part of the effort to make the world a healthier place.

JOIN US Addressing all facets of research and practice— from cells to communities—is what distinguishes Sargent faculty and students and, ultimately, our contribution to improving healthcare around the world. Here we have introduced you to four stories that represent the work informing that continuum; there are many, many more.

We welcome your support in helping us grow our renowned faculty and in making a world-class education—in the classroom and the workplace— affordable for our aspiring researchers and clinicians.

They are the ones who will take up the mantle to spread the knowledge, and develop and administer the innovative treatments, that will make all of our lives better.

They are the ambassadors of our Sargent Spirit.

Please join us in our commitment to their training.

TOGETHER, WE CAN REBUILD LIVES.

“Sargent Spirit means a true commitment to improving humankind.”

Carolyn Cohen (Sargent’65)

“Sargent Spirit is a community of friends that lasts a lifetime.”

Betty Arnold (Sargent’45, Wheelock’49)

Boston University College of Health & Rehabilitation Sciences: Sargent College Office of Development and Alumni Relations 635 Commonwealth Avenue Boston, Massachusetts 02215 617-353-4322 saralum@bu.edu bu.edu/sargent