Neurological conditions, including acquired neurologic injuries, have a tremendous adverse impact on daily life and function. The existing landscape of injury characterization, recovery prognostication, and rehabilitation strategy has been outpaced by advances in scientific methodology, technology, and an increasing focus on patient-centered discovery and care. Meaningful information about altered brain and nervous system function deciphered by such advances should therefore drive innovative approaches to tailored diagnostic and therapeutic approaches with new and evolving levels of efficacy. Meticulous scientific approach is especially important for invisible and cognitive disability (e.g., depression, spatial cognitive disorders, language disorders, delirium). Although we are beginning to understand the mechanisms underlying these significant barriers to activity and participation, their gold-standard definitions are still descriptive.
As we noted for Volume I
Rehabilitation Neuroscience: Advancing translational recovery of this Research Topic, translational research spans research development stages, disciplines, settings, and methodologies. Conduct of recovery and rehabilitation translational research is particularly challenging given the diversity and breadth of 1) potential research disciplines, 2) neurobehavioral domains of impairment, 3) outcome measurements, and 4) clinical specialists who ultimately deliver treatments in a variety of settings across the continuum of recovery and rehabilitation. There is a need to unify researchers and clinicians across these elements to enhance general knowledge of the patient experience which will in turn inspire treatment-oriented research.
What we know, and what are open questions:
A pronounced unmet need in recovery and rehabilitation neuroscience is the systematic analysis of brain-behavior relationships after injury, and also before, during, and after treatment. A translational knowledge gap persists; most symptoms identified as rehabilitation targets are not universally linked to specific brain-behavior systems. This is true even for impairments related to well-defined systems (e.g., the functional and structural motor network). In addition, meaningful clinical or functional changes in impairment are not clearly defined with respect to their anatomical, physiological, biochemical, or behavioral mechanisms. Finally, translational recovery and rehabilitation neuroscience should characterize relationships between injury, impairments, and functional performance with the aim of developing individualized treatment paradigms. Such clinical phenotyping can identify treatment targets while facilitating research focus and collaboration. It is extremely important that unawareness of deficit (anosognosia) is specifically accounted for in patient-reported outcomes, or that explicit comparison between patient-reported and objective impairments and outcomes are reconciled in people with brain injury. Lastly, we need to understand the problems of intersectional challenge in recovery for people with cognitive and mobility issues who are also of underrepresented sexual and gender minorities, or underrepresented racial and ethnic groups.
To build and expand on our previous issue
Rehabilitation Neuroscience: Advancing translational recovery, studies submitted to this issue should consider the following elements:
• State the type of neurologic injury and/or the clinical impairment and related neurobehavioral domains that are the focus for the study.
• State candidate brain-behavior systems that will be characterized, used for treatment trial selection, or determine treatment efficacy.
• Present data that supports or clarifies the relationship between an impairment or affected neurobehavioral domain and brain-behavior systems.
• Studies incorporating interprofessional elements, or studies considering harmonization or validation of existing or promising diagnostic or therapeutic efforts are encouraged.
• Suggested neurobehavioral domains include motor, cognitive, language, emotional, visual, and other systems, or subsystems. Studies concerning different etiologies of neurological deficits, and studies focused on the behavior of healthy subjects, are welcome so long as they serve the primary goal of advancing a theoretical and translational framework.