Compassion drives brain injury research

The effects of brain injuries, especially traumatic brain injuries, are often devastating.

They can lead to serious health issues like disorders of consciousness (DOC) that range from comas and persistent vegetative states to states in which patients are minimally conscious. Yet, for all the destruction they wreak, brain injuries have no documented treatments and no gold standard of assessment.

But if Ghazala Saleem, assistant professor of rehabilitation science, has any say in the matter, that situation will change. She focuses on two specific areas related to brain injury: sequela — abnormalities — following a brain injury or concussion in children, and brain injury related to intimate partner violence.

Saleem’s work spans the spectrum of acquired brain injury — injuries that occur after birth due to accidents, stroke and other causes. But her interest in DOC emerged after experiences during a postdoctoral fellowship, when she observed an occupational therapist working with a two-year-old patient who had been in a coma but was now in an unresponsive vegetative state.

“The way the therapist was communicating with the family, addressing the family’s worries about their toddler, and his dedication to his work fascinated me,” she says. Inspired, Saleem began doing research on DOC in children.

Ultimately, she recognized a shortage of evidence-based treatments and assessments for pediatric and adult patients with acquired brain injuries. Those lacks, she felt, led to issues in diagnosing and offering prognoses for patients. She found, for instance, very limited data that differentiated a vegetative state (person is awake but showing no signs of awareness) from a minimally conscious state (some awareness, inconsistent responses to commands and passage through the stages of sleep).

“Estimates are that 40% of DOCs are misclassified,” Saleem explains. “If you do not diagnose conditions correctly, survival decisions become difficult.” Over time, she expanded her interest in DOC by exploring possibilities around using a basic type of brain stimulation to treat DOCs.

Saleem joined the School of Public Health and Health Professions’ faculty about a year ago and was just about to set up her Brain Function and Recovery Lab when the COVID-19 pandemic put a halt to the work. Once the lab is running, Saleem will continue research into brain injury rehabilitation that she began while a post-doctoral fellow at Johns Hopkins University School of Medicine. The focus is on children’s post-concussion issues that might not show symptoms but that can often lead to further brain injuries. Saleem looks specifically at children’s ability to stand and sit upright without any support — called postural control — and other issues, like how they control their way of walking.

The questions she strives to answer are important factors in how well children recover from concussion: “What kind of deficits are [children] having even after recovery? Is their brain recovering at the same time that they have physical recovery? Does postural control make them more prone to further injury? They’re at higher risk of sustaining another musculoskeletal injury after the concussion, so we’re trying to find answers about what happens when they go back into high-risk activities, for instance.

“Traumatic brain injury is so devastating to families and children,” Saleem notes. “The number of children with disorders of consciousness is small, but the suffering and impairment is so severe.”

Saleem’s interest in women who suffer brain injury from intimate partner violence is similarly informed by compassion and the fact that brain injury and its signs and symptoms are very individualized. After she arrived in Buffalo, she connected with the Family Justice Center of Erie County, which offers free services for domestic violence victims and their children, and became a medical adviser to the organization’s board.

“There’s still not any definitive research on intimate partner violence and brain injury,” she says. The Family Justice Center “welcomed me and were very interested in finding solutions, especially since female survivors are experiencing symptoms and getting dismissed by primary care doctors.”

Saleem next hopes to determine objective ways to diagnose brain injury in survivors through biomarkers like exercise intolerance.

“This will be a breakthrough,” she says. “We want to do a longitudinal study of this population, which will be the first step to helping individualize treatment. Other populations experience the same devastation with brain injury, but it’s so much more difficult when children or women experience brain injury through intimate partner violence. Sometimes these populations suffer in silence. This is what motivates me.”

Attention is growing for Saleem’s work:

• A paper on which she was first author, “Sleep Symptoms Predict School Attendance after Pediatric Concussion,” was accepted without revision by the journal Clinical Pediatrics. The study is the first to examine the impact of post-concussion symptoms on school attendance in children and adolescents who had specialty care after their concussion. It shows the importance of managing sleep issues after a concussion to smooth the path to a CDC recommended early return to school.
• Another paper Saleem co-authored with a team from the United Arab Emirates University Department of Neurology, “Brain Data in Pediatric Disorders of Consciousness: Special Considerations,” was recently accepted in The Journal of Clinical Neurophysiology.
• The journal Neuromodulation; Technology at the Neural Interface accepted her paper “Transcranial Direct Current Stimulation Feasibility Challenges in Youth with Severe Brain Injury: A Case Report,” which she will present at the North American Neuromodulation Society Conference.
• A poster Saleem co-authored with one of her doctoral students reviewing the use of brain stimulation as a possible intervention during occupational therapy received the Early Career Scientist Award at the American Occupational Therapy Association Conference’s Early Career Scientist Theater.
• An editorial on the harmful brain injury-related consequences in Pakistani female survivors of intimate partner violence during COVID-19 lockdown was recently accepted in The Journal of Pakistani Medical Association. Saleem was a senior author.
• Through UB’s Clinical and Translational Science Institute, Saleem is participating in Building Up Research, a yearlong nationwide study at academic institutions that aims to jump-start the careers of underrepresented junior investigators through mentoring and training on key career-development skills.