Directing your attention to where it counts
Dario Cazzoli, June 2020
In stroke patients, successful neurorehabilitation depends on the positive interaction of both brain hemispheres. Similarly, in neuroscience, transformative translational research is based on technical and clinical experts collaborating at eye level. Doctors need to step out of their comfort zone to understand technical functionalities. But this does not mean trusting technology blindly.
As a neuropsychologist, I focus on how to ameliorate cognitive impairments after brain injury, such as neglect. Neglect means that a person is not able anymore to direct attention to one side of reality – typically the left side after a right-hemispheric stroke - a prime example of this being that they would only eat up the left side of a plate or not look left before crossing a road. If we take this very serious condition metaphorically, we could say that sometimes translational researchers also neglect vital aspects when developing new patient treatments: Clinicians that fail to see how much technology experts can contribute to better patient care or engineers who do not bother with medical knowledge.
You can't take good research collaboration between doctors and engineers for granted, of course. When it works, it seems easy enough. But it needs an effort, a conscious re-focusing and paying attention to the other. This is easier in institutions that specifically create an interface for medicine and engineering to develop common research projects. Promoting this on-par dialogue can create a closed loop system, where patient care prompts good research questions and research results feed back seamlessly into patient care.
Starting off the dialogue as a clinician or an engineer needs a bit of humility towards your own role, being open to learn from each other and work towards creating a common ground for understanding. So, it's not about talking in purely clinical or purely technical terms that would not make sense to the other. Clinicians should be more aware of the importance of conducting technically innovative research. Biomedical engineering researchers should realize that clinicians can give them very important input on what is relevant, what aspect needs to be addressed.
Biomedical engineering researchers should realize that clinicians can give them very important input.
To say that this is always coordinated and perfectly functioning is utopic. But it can work. The ARTORG Center for Biomedical Engineering Research in Bern is a good example for this. Here, we are doing things that would not be possible without this close collaboration. So, it is quite something that the same interdisciplinary research group can be led by technical and clinical heads, working in synergy on gerontechnology and rehabilitation. I am aware that this complete integration is quite a luxury, clinical access usually being more difficult.
One way of promoting technology-informed clinical research is to create more positions for clinical scientists. These professionals divide their time between patient care and scientific discovery, partnering up with technical experts. Bern has now started fostering this model within the Graduate School for Health Sciences, providing a structure that encompasses clinical work and research from the start of the PhD training.
One way of promoting technology-informed clinical research is to create more positions for clinical scientists.
But such efforts could be scaled up. There should be more positions for clinical scientists, with institutions supporting doctors or nurses in research. This could be done by providing project seed money and the possibility to reduce clinical duties for a while to conduct experiments and collect preliminary data. Such an approach could motivate colleagues who fancy doing research in addition to patient care but are deterred by the hurdle of acquiring third-party funds. Other ideas are mentoring programs or re-entry incentives for researchers with care duties for children – both men and women.
Classical neuropsychology can work without much technology, for instance asking patients to fulfill a task with a pen on a sheet of paper. But from a neuroscience perspective, adding meaningful technology can open up a whole new dimension for diagnostics and neurorehabilitation, for instance integrating neurophysiological markers and computational approaches, adding techniques to stimulate the brain or creating settings that more closely resemble everyday life, such as monitoring naturalistic behavior with sensors or implementing tailored virtual reality environments.
Modern neuropsychology, as an area of neuroscience, has several points of contact with and an affinity for technology. For instance, we apply MRI or EEG to visualize the brain activity and use magnetic or electric brain stimulation to alleviate specific cognitive symptoms. But we should never blindly trust the results of technological approaches. Having a strong partner who can help to better understand the technical grounds of the results is essential. And the signal reading has to be in line with the clinical behavioral observation of the patient.
Personally, I find the potential of new technologies for diagnostics and rehabilitation in neuropsychology fascinating. The latest findings on the role of the healthy hemisphere in stroke patients have challenged previous conceptions of how the brain reorganizes after injury. It´s exciting to delve into new perspectives, dare to venture into the unknown. Being active both in the clinic and in research needs some discipline, but I find that with time it gets easier, until it becomes hard to imagine ever losing one of the two sides.
Dario Cazzoli is Affiliated Group Head at the ARTORG Gerontechnology and Rehabilitation group, and Research Head Neuropsychology and Clinical Neuropsychologist at the University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital. His clinical work focusses on the diagnostics and rehabilitation of cognitive impairments in patients with acquired brain damage. His main research interests are attention, hemispatial neglect and visual perception.