Summary Minutes - December 1, 2025 | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development

National Advisory Board on Medical Rehabilitation Research (NABMRR)
National Center for Medical Rehabilitation Research (NCMRR)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Virtual Meeting

Meeting Attendance

Board Members Present

Sarah Blanton
Steven C. Cramer
Linda Ehrlich-Jones
Angel Hardy Heinz
Steven J. Keteyian

Oluwaferanmi O. Okanlami
Kris Tjaden
Lewis A. Wheaton
Tiffany A. Yu
Kathleen M. Zackowski (Chair)

Ex-Officio Members Present

Alison Cernich, NICHD
Daofen Chen, NINDS
Theresa Cruz, NCMRR
Patricia Dorn, VA
Lyndon Joseph, NIA

Ralph Nitkin, NCMRR
Adam Politis, DPCPSI
Merav Sabri, NIDCD
John C. Shero, DHA

Ex-Officio Members Absent

Jerome L. Fleg, NHLBI
Kristi Hill, NIDILRR

Chuck Washabaugh, NIAMS

December 1, 2025

The VideoCast recording of the December 2025 NABMRR meeting is available online. Use the time stamps (in parentheses) in this report to navigate the recording.

NCMRR Deputy Director and NABMRR Executive Secretary Ralph Nitkin, Ph.D., opened the virtual meeting at 10 a.m. ET.

Welcome, Roll Call, and Approval of Minutes (00:35)

Kathleen M. Zackowski, Ph.D., M.S., OTR, Chair, NABMRR

Board Chair Dr. Zackowski welcomed participants and called the roll. New members have been delayed in onboarding and are expected to be introduced at the May 2026 meeting. The Board voted to approve the minutes of the May 5, 2025, meeting as written. Future meeting dates are as follows:

May 4–5, 2026
December 7–8, 2026
May 3–4, 2027

NICHD Acting Director Report (7:11)

Alison Cernich, Ph.D., Acting Director, NICHD

Dr. Cernich praised NICHD staff returning to work after the government shutdown. She asked for patience with additional changes to come. Dr. Cernich also noted that the position of NICHD Director will remain open until December 12, 2025. Dr. Cernich said she looked forward to continuing to work with NCMRR Director Theresa H. Cruz, Ph.D., alongside the new NICHD Director.

In her report, Dr. Cernich provided updates on the NICHD budget, NIH policies and programs, and successes in rehabilitation research.

NICHD Budget (10:25)

In fiscal year 2025 (FY 2025), NICHD obligated nearly all appropriated funds and provided nearly the same number of awards as in FY 2024, relative to other institutes and centers (ICs). Dr. Cernich thanked the extramural community for working together to make this accomplishment possible.

The government is operating under a continuing resolution (CR) through January 30, 2026, meaning that NICHD will operate at the FY 2025 budget level through this date. To avoid another government shutdown, one of three scenarios must occur: (1) A new FY 2026 bill must be passed, (2) another short-term CR must be passed, or (3) a full-year CR must be passed. The president’s budget, released in May 2025, proposed cutting NIH’s budget by $18 billion, consolidating 27 ICs to eight, and combining NICHD with the National Institute on Deafness and Other Communication Disorders (NIDCD) to form an IC focused on disability. In August 2025, the U.S. Senate Appropriations Committee released its proposed Labor, Health and Human Services, Education, and Related Agencies (LHHS) bill. The Senate proposed no consolidations, an increase of $400 million over the FY 2025 budget for NIH, and an increase of $20 million for NICHD, bringing its operating budget to $1.78 billion. The increase in budget would primarily support the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative. The bill also proposed indirect costs negotiated through similar processes used in past years. The U.S. House Committee on Appropriations’ LHHS bill, released in September 2025, proposed no consolidations, flat budgets for NIH and NICHD, and indirect costs limited to 30% of the award. Dr. Cernich said that she is waiting to see the latest versions of these proposed bills and will provide more updates in the future.

NIH Policy and Program Updates (14:24)

As of October 1, 2025, NIH is no longer posting notices of funding opportunities (NOFOs) on the NIH Guide for Grants and Contracts website. NIH is now posting funding opportunities on Grants.gov. Going forward, the NIH Guide will be used for policy and information notices. Dr. Cernich encouraged attendees to subscribe to Grants.gov and refer to NOT-OD-25-143 for additional information. Replacing Notices of Special Interest (NOSIs), topics related to funding opportunities will now be featured on the Highlighted Topics webpage. Visitors to the webpage will be able to search topics by keywords and filter topics by ICs of interest. They can then apply for funding opportunities through parent announcements, or through broad opportunities featured on Grants.gov. Dr. Cernich noted that highlighted topics will expire after 1 year, but ICs will be able to extend them.

Dr. Cernich also highlighted a new policy outlined in NOT-OD-25-132. In response to reports of manuscripts, grants, and grant reviews generated by artificial intelligence (AI), NIH is only accepting six new renewal, resubmission, or revision applications from individual principal investigators (PIs), program directors (PDs), or multiple PIs for all council rounds in a calendar year, excluding T and R13 conference grant applications. This new policy is meant to support fairness and originality in applications by preventing high volumes of AI-generated applications. The new policy should also encourage applications from younger PIs.

Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) program funding opportunities expired October 1, 2025 (NOT-OD-26-006), and were not renewed because of the government shutdown. Although the House of Representatives has passed reauthorization legislation, a reform bill introduced by the Senate is currently holding up its consideration. Dr. Cernich said that NICHD is tracking updates and will provide more information as it becomes available.

Dr. Cernich also alerted the audience to NOT-OD-26-009, which details new language on termination provisions for NIH awards. Effective October 1, 2025, awards may be terminated if the award no longer advances program goals or agency priorities. The new language will be included in grants in the upcoming year.

A new unified NIH funding strategy is being applied as of the January 2026 council round. ICs will discontinue use of paylines to fund research. Instead, IC directors and extramural staff will consider peer review scores, scientific merit, NIH and IC priorities, investigator career stage, and geographic distribution when determining awards. For all ICs, councils will continue to provide secondary-level peer review, and IC directors will continue to have delegated authority to decide what is funded by their ICs. Dr. Cernich noted that NICHD has already discontinued paylines, in concert with its strategic plan, but flagged this change for meeting attendees that are funded through more payline-driven ICs.

Rehabilitation Research (26:21)

Despite many disruptive changes this year, the NCMRR team held the Rehabilitation Research 2025: Rehabilitation for All meeting. The team also made progress on the NIH Research Plan on Rehabilitation and will be delivering the plan to Congress on time. Publication of new scientific advances also shows a highly engaged research community. Dr. Cernich closed her presentation by expressing her excitement about the field’s continued progress, and she thanked the NCMRR team, the extramural community, and colleagues across NIH and federal partners for all of their work.

Discussion (28:56)

Dr. Cernich reiterated that all policy changes are detailed in the NIH Guide.

Tiffany A. Yu asked what the rationale of removing funding opportunities from the NIH Guide was and whether applicants will have an easier time using Grants.gov. Dr. Cernich said that this policy change is meant to centralize and standardize funding opportunities across HHS, as opposed to improving user experience. NIH will have the opportunity to track how well applicants are adjusting to Grants.gov as time goes on.

Dr. Zackowski asked about the security of NICHD’s funding and future. Dr. Cernich said that NICHD tries to anticipate and model expected changes, while assessing how new policies may intersect and interact with the number of grants NICHD can fund. Although there is more change to come, Dr. Cernich said she felt confident in the risk predictions she and NICHD staff have worked through. Dr. Nitkin said that NICHD also considers how the broader wave of research may shift via changes to federal partners, including the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR); the U.S. Department of Veterans Affairs (VA); and the U.S. Department of Defense (DoD). Dr. Cernich added that the budget team also considers how NICHD will handle another government shutdown in January 2026. She reiterated that there are contingency plans in place for as many scenarios as can be imagined.

Dr. Wheaton asked for clarification on the unified NIH funding strategy. Dr. Cernich explained funding policies at NICHD, with the caveat that these practices may not apply to other ICs enacting this new policy. NICHD determines awards based on review scores and program officer (PO) paylists recommending what should be funded. Early stage investigators are assessed on a curve to improve their funding chances, and renewal applications are assessed based on productivity. All of these factors are discussed with the director of extramural research and go into Dr. Cernich’s final considerations as NICHD Director. Some of these factors will change because of the unified funding strategy, and the effects will be seen sooner in new and competing applications. More changes are likely to emerge with renewals, resubmissions, and international programs.

NCMRR Director’s Report (43:30)

Theresa H. Cruz, Ph.D., Director, NCMRR

In her report, Dr. Cruz shared information on staff, NCMRR activities, science advances, and the NCMRR Research Plan. Dr. Cruz also stated that in spite of many changes in 2025, the dedication to rehabilitation research remains the same through the following: (1) NCMRR’s mission, (2) NCMRR’s fully staffed set of POs, and (3) the extramural community.

Staff Updates (47:42)

June Lee, M.D., Ph.D., and Christopher Hughes, Ph.D., have both transitioned out of NCMRR. Their positions will not be filled in the near future.

Activities and Collaborations (48:22)

Dr. Cruz announced that six new P50 Medical Rehabilitation Research Resource Centers were launched at the end of the previous fiscal year. In partnership with the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), NIDCD, and the National Center for Complementary and Integrative Health (NCCIH), NCMRR established the following centers:

The National Center for Foundational Artificial Intelligence for Rehabilitation
Precision Rehabilitation Across the Lifespan
The Center for Advancing Precision Neural Circuit-Based Rehabilitation
The Data Science and Analytics for Precision Rehabilitation Center
The Disability Community Engaged Medical Rehabilitation Research Center
The Disability Health Promotion Research Center

The K12 national Clinician-Scientist Career Development Program has also gone through both peer and council review. Awards are planned for FY 2026. The awards are part of a national career development program targeting clinician-scientists focused on rehabilitation.

Dr. Cruz reiterated Dr. Cernich’s points on transitioning away from NOFOs and NOSIs to the Highlighted Topics website and parent announcements. These changes in policy will make the NCMRR Research Plan and the NICHD Strategic Plan crucial for communicating interests in funding areas. Dr. Cruz encouraged attendees to work with their trainees and colleagues to use the open parent announcements instead of relying on specific announcements for rehabilitation research. Dr. Cruz also said that there will be reduced specialized review criteria and fewer materials that can be included as part of an application.

As mentioned by Dr. Cernich, the Rehabilitation Research 2025: Rehabilitation for All meeting was held virtually on August 6, 2025. Dr. Cruz estimated that there were 600 attendees that day and said that the VideoCast of the event currently has more than 1,000 views. Dr. Cruz thanked the planning committee, speakers, and contractors who made the event possible.

The Disability Prize Challenge, jointly funded by NIH ICs and NIDILRR colleagues at the Administration for Community Living (ACL), complements other efforts to reduce health disparities experienced by people with disabilities by rewarding community programs working in that space. Applications for Phase 1 have been narrowed down to eight teams that have been working since January 2025. The team will submit their final reports in January 2026. NCMRR hopes to then announce the top three winners with prizes of $75,000 in spring 2026.

NCMRR conducted outreach at the following events:

National Rehabilitation Awareness Week 2025
Workshop in Implementation Science and Health Services (WISH) 2025
American Society of Biomechanics 2025
American Neurological Association 2025
Regenerative Rehabilitation 2025

Dr. Cruz said that the team was unable to make it to the American Congress of Rehabilitation Medicine or Society for Neuroscience annual meetings because of funding issues and the government shutdown. She encouraged attendees to suggest other meetings NCMRR should attend.

Lastly, the Disability Health Research Coordinating Committee, chaired by Adam Politis, M.S., has been working on the Strategic Plan for Disability Health Research. This plan is complementary and references NIH’s Rehabilitation Research Plan. The committee presented the Strategic Plan for Disability Health Research to a Council of Councils working group in August 2025. The plan’s publication has been slightly delayed because of the government shutdown.

Science Advances (1:00:27)

Dr. Cruz shared several science advances. A study funded by NCMRR and NIBIB studied data from 2 million smartphone users and found that moving to a city with greater walkability was related to an increased step count of up to 1,100 steps per day. The study was published in Nature.

Dr. Cruz also highlighted a study in Cell that examined the efficacy of a neural implant used to detect inner speech. The implant was able to perform real-time inner speech detection from a 125,000-word library. Dr. Cruz noted that the study also raises important questions about the privacy of neural data. To that end, users were able to create a passkey to lock their thoughts and then unlock it with 98% accuracy. Dr. Cruz said that she appreciated the consideration for both technological advancement and ethical implications. She additionally noted that the study team included an NCMRR awardee.

Research Plan (1:08:40)

Lastly, Dr. Cruz shared updates on the NIH Research Plan on Rehabilitation. The original timeline involved gathering feedback on the initial themes through a Request for Information (RFI) and finalizing the Research Plan this year, with a goal of publishing the final plan in 2026. In May, the Council voted to approve the following themes:

Basic and Mechanistic Studies
Social Determinants of Health
Rehabilitative and Assistive Technology
Implementation Research
Training, Career Development, and Infrastructure

To obtain additional feedback, Dr. Cruz worked with the Division of Extramural Activities to publish an RFI (NOT-HD-25-029) in late July 2025. An overwhelming majority of the 42 respondents supported the themes. Notable suggestions for additional themes included the following:

Specific areas of rehabilitation that may not be feasible at this time
Biopsychosocial factors
Advancing U.S. Food and Drug Administration (FDA)/health care approval for payable medical devices
Disability data
Individuals who interact with people with disabilities (e.g., family, friends, support professionals)
Stakeholder-driven needs
Reducing ableism
Embedded collaborative infrastructure
Education interventions that enhance rehabilitation goals

This feedback has been incorporated, as appropriate, in the plan’s final draft. NCMRR is now moving the plan through final approvals and publications.

Discussion (1:15:54)

In response to a question posed in the chat, Dr. Cruz explained that NCMRR previously had a newsletter released every 2 weeks. However, because of the loss of NICHD’s communications department and communications contractors, the newsletter is no longer being produced. NCMRR is finding new ways to share information through NIH’s central channels. Dr. Cernich further explained that all communications have moved to the NIH Office of the Director (OD) and the Office of Communications and Public Liaison (OCPL). NICHD and NCMRR are working with OCPL to get information on the general NIH website, given that NICHD’s website is also no longer being updated. Dr. Cernich and Dr. Cruz will provide additional updates to the NICHD Advisory Council and to the Board of Scientific Counselors.

Ms. Yu expressed her interest in hearing from the winners of the Disability Prize Challenge at a future Council meeting.

Ms. Yu also asked whether the responses to the research plan RFI were in line with NCMRR’s broader audience. Dr. Cruz said that most RFIs typically receive 20 to 30 responses.

Dr. Zackowski asked whether NICHD and NIH are focusing on AI innovations and their potential to improve rehabilitation research. Dr. Cruz noted that several P50 centers are dedicated to AI and data sharing. The centers are expected to share their findings in order to move research forward. Dr. Zackowski noted that AI could aid in facilitating greater sample sizes, which could greatly benefit rehabilitation research. Dr. Cruz agreed about these potential benefits but cautioned that training datasets need to be representative in order to produce accurate results. Dr. Nitkin added that AI also has the potential to facilitate personalized rehabilitation. NCMRR is particularly aware of the guardrails that need to be in place for AI while also recognizing its potential.

Dr. Tjaden asked where investigators and their trainees should go to find current, up-to-date information on funding opportunities. Dr. Cruz said that the NIH Guide is updated every week with new policy changes. ICs are still working with Grants.gov to determine how best to inform researchers of useful information. Dr. Cruz encouraged attendees to email NCMRR with questions. Dr. Nitkin added that researchers and their colleagues should double-check funding announcements, make sure they are active, fit the IC, and fit the broader definition of a clinical trial.

Referring to the walkability study, Ms. Yu suggested that future analyses could examine adaptive programs and physical activity programs for people with disabilities. She noted that some walkable cities lack adaptive programs and vice versa.

Cardiac Rehabilitation: Present and Future (1:39:39)

Steven J. Keteyian, Ph.D., Director, Preventive Cardiology Unit, Henry Ford Health

Dr. Keteyian presented several studies demonstrating that patients experience exercise intolerance and related effects on physiological and mental health following a heart attack. These findings led to the development of rehabilitation programs for those with heart disease. Patients who enroll in rehabilitation show improvements that include reduced symptoms, enhanced mood, greater skeletal muscle strength and endurance, decreased risk of all-cause hospitalization, and decreased risk of both all-cause and cardiovascular mortality. But although cardiac rehabilitation offers these clear benefits, prospective participants face numerous barriers that reduce its uptake. Nonparticipation is a significant, multifaceted challenge that includes transportation issues, financial concerns, dependent care responsibilities, work demands, and self-efficacy and motivation to participate in rehabilitation. To improve participation and adherence to cardiac rehabilitation, Dr. Keteyian has explored new paradigms of delivering care.

For example, as part of the improving ATTENDance to cardiac rehabilitation (iATTEND) trial, Dr. Keteyian has used a hybrid model of cardiac rehabilitation at Henry Ford Health. In a study published in The American Journal of Cardiology, Dr. Keteyian found that attendance and completion of the hybrid model was equivalent to traditional cardiac therapy. The hybrid model also showed equivalent improvements to exercise capacity and overall quality of life, suggesting the potential efficacy of nontraditional delivery methods for cardiac rehabilitation.

Dr. Keteyian closed his presentation by reiterating that cardiac rehabilitation has some of the greatest treatment gaps in cardiology, despite its ability to produce improved physiological measures and clinical outcomes. Strategies to address treatment gaps may include the use of nontraditional delivery models, but they require cardiac rehabilitation best practices and more research to verify their efficacy.

Discussion (2:28:23)

Dr. Zackowski noted that there were fewer patients attending cardiac rehabilitation with health care coverage from the Centers for Medicare & Medicaid Services (CMS). She asked what factors may be contributing to that trend. Dr. Keteyian said there are numerous factors affecting those rates of cardiac rehabilitation attendance, including issues with coverage, the financial burdens of copays, and difficulty in getting patients to start rehabilitation after discharge from the hospital.

Dr. Nitkin noted that there was a strong behavioral component to getting patients on board with cardiac rehabilitation, similar to the situation with treatments for other chronic conditions, such as cancer. Dr. Keteyian agreed that changing behavior is a significant challenge to cardiac rehabilitation. He said that in terms of behavior, patients can generally be broken into three subgroups: One group of patients will adhere to any treatment or rehabilitation recommended by their provider. Another group will not comply with a treatment plan, regardless of provider recommendations. The remaining group of patients is the population that can most affect the uptake of cardiac rehabilitation. Addressing behavioral, social, and emotional psychological factors presents additional challenges. Some patients are hesitant to exercise in front of other people, and providers also need to manage patients with high anxiety, anger, or depression. Dr. Keteyian noted that group support is still very important for successful rehabilitation, because social interaction can make it easier to have conversations on the rehabilitation experience. He said that cancer rehabilitation programs are gaining traction in the United States, but these programs face many of the same challenges as cardiac rehabilitation and may also benefit from virtual or hybrid delivery models.

Dr. Zackowski asked what impact cardiac rehabilitation had on comorbidities such as smoking, obesity, and diabetes. Dr. Keteyian said that cardiac rehabilitation generally has a favorable impact on patients who have been smokers, given that smoking cessation efforts are now comingled with these programs. Weight management is also being integrated more into cardiac rehabilitation. With rising use of glucagon-like peptide-1 (GLP-1) medications, this element of rehabilitation is becoming more complex; patients need to understand that these medications are not cure-all solutions. Large health systems can track patient use of such medications, and tracking may be useful for informing intervention. Relatedly, compliance for antihypertensives and other drugs is another major issue addressed during cardiac rehabilitation.

Dr. Dorn asked whether peer-to-peer coaching or counseling is part of cardiac rehabilitation. Dr. Keteyian said that such efforts are largely grassroots now. Henry Ford Health currently has a “health buddies” system, in which a patient further along in cardiac rehabilitation works with a new patient to create social connection and free up staff. These kinds of systems have not spread widely, but Dr. Keteyian said he was interested in expanding them. Dr. Dorn suggested that the health buddy could connect with a new patient before they are discharged from the hospital. Dr. Keteyian said that this was part of the practice at Henry Ford Health decades ago. Currently, a paid staff member acts as a liaison for cardiac therapy and meets with a patient before hospital discharge to schedule the first rehabilitation appointment and provide some patient education.

Dr. Nitkin asked how health care constraints have affected support for cardiac rehabilitation and whether it is an area of rehabilitation that has seen fewer cuts than others. Dr. Keteyian said that cardiac rehabilitation is not a revenue-producing cost center; rather, the goal is largely to financially break even. When health systems are looking to reallocate resources, it is not uncommon for class 1 cardiac rehabilitation to be cut from service offerings and continuum of care. Some hospitals get around these constraints by referring patients to other facilities, but the complexity of navigating referrals then becomes a barrier. At the same time, there are also systems that are fully embracing cardiac rehabilitation as an important avenue of care. Henry Ford Health’s cardiac rehabilitation services have grown, with the support of the institution’s division heads. Other institutions are also showing similar support, with services such as physical therapy and cardiac rehabilitation offered in-house.

Dr. Nitkin expressed interest in the timescale of muscle physiology improvement during cardiac rehabilitation. Dr. Keteyian said there is strong association between rehabilitation and improved aerobic capacity, endurance, and clinical outcomes. Those with better physical fitness have the lowest risk for poor outcomes. Dr. Keteyian noted that his team views having musculoskeletal strength (i.e., through lifting weights or resistance training of some kind) and flexibility training as best practices, and works to incorporate both into the rehabilitation effort.

Election for a New Advisory Board Chair (2:46:40)

Ralph Nitkin, Ph.D., Deputy Director, NCMRR

Dr. Nitkin said that the Board will need to elect a new chair to take over for Dr. Zackowski, who will finish her term after the May 2026 meeting. Nominations were solicited in the months leading up to the meeting and at the meeting itself.

Dr. Cramer submitted his name in nomination for Board chair. Dr. Cramer is a stroke neurologist at the University of California Los Angeles (UCLA). His research focuses on brain restoration and repair after stroke. He expressed his gratitude for NICHD and NCMRR, and his excitement about contributing to the Board. No other nominations were presented to the Board.

The Board voted to approve Dr. Cramer as the next chair after the May 2026 meeting.

Changes in NIH Extramural Policy and Peer Review (2:50:55)

Rebekah Rasooly, Ph.D., Director, NICHD Division of Extramural Activities

Dr. Rasooly provided updates on changes in NIH extramural policies and NIH peer review. She encouraged attendees to reach out with any additional questions.

Fiscal Year 2025 Wrap-Up (2:52:29)

As previously mentioned, NICHD awarded almost all of its budget for FY 2025. From July 8 to the middle of September in 2025, NICHD presented more than 200 awards per week. The institute maximized efficiency of award preparations and had strict criteria for grants that were “forward funding” (i.e., grants that are awarded all the money in a single year). These awards were limited to projects that could sustain receiving all of their award money in a single year and remain productive. Dr. Rasooly thanked her colleagues for their impressive work.

Applications With Foreign Components (2:54:32)

NIH has found that it has been difficult to keep track of foreign subawards, in terms of how much money awardees are receiving and how award money is being spent (see NOT-OD-25-104 and NOT-OD-25-155). Beginning January 25, 2026, new applications with foreign subawards will come as a PF5 application. A NOFO on this change will be published in the coming weeks. Under this new funding structure, applications with foreign components will first be reviewed in their entirety. If an application is funded, foreign components will then be separated out for distinct awards to each foreign entity.

Updates on Peer Review and Revised Peer Review Schedules (2:57:02)

NIH review functionality has moved from individual ICs and is now carried out by the Center for Scientific Review (CSR). This change is unrelated to the government shutdown. Many NICHD scientific review officers and support staff were offered new positions within central NIH and moved to CSR. Although the shift to CSR has been logistically challenging, reviews have largely gone well. Dr. Rasooly expressed her gratitude to her colleagues for their flexibility and hard work.

Because of the government shutdown, NIH is delaying deadlines for receipt of applications. The Loan Repayment Program (LRP) application is due December 4, 2025. All other applications that were due during the shutdown or immediately after can all be submitted through December 8, 2025. Those who submitted applications at the beginning of October have the opportunity to pull and revise their applications until the deadline.

Reviews of applications for FY 2026 were initially scheduled to take place over 577 meetings, using 14,607 reviewers to review 32,692 applications. However, before the shutdown, only 22 meetings had been held. The goal moving forward is to complete a full round of review for all applications in the coming few months, without damaging the quality of review. CSR will try to streamline the review process by pushing deadlines out by several weeks to allow more time to recruit reviewers. CSR will also be relaxing restrictions around reviewer trainings, which are normally needed for accessing applications. Only one third of applications will be discussed in meetings, instead of the typical 50%. The top third of applications will receive a simplified standard summary statement from assigned reviewers. The bottom third will be designated “not competitive and not discussed” and will not be scored. The middle third of applications will now be designated “competitive but not discussed.” These applications will not have a score or resumption of the discussion, but will have individual critiques from assigned reviewers. Summary statements will also be simplified by removing the description of the study and study narrative. Instead, the summary statement will focus on the extent of consensus in committee reviews and list the main score drivers.

New National Advisory Child Health and Human Development (NACHHD) Council meeting dates for FY 2026 include the following:

January 26, 2026: Open Session for the January Council
March 20, 2026: Closed Session for the January Council
July 8, 2026: In-person meeting for the June Council
October 12, 2026: In-person meeting for the October Council

Discussion (3:06:20)

Dr. Dorn asked whether centralization to CSR will change council assignments. Dr. Rasooly said that centralizing review was intended to impose homogeneity across ICs. Once applications go to the ICs, the processes are unchanged.

Dr. Zackowski asked how this information would be shared with the public. Dr. Rasooly said that she will share her presentation slides. She also directed attendees to the Emergency Modifications to NIH Peer Review announcement online. The NIH Extramural Nexus page also has information on grants and funding.

Dr. Nitkin asked how NICHD and other ICs are handling potential budget constraints under a potential CR. Dr. Rasooly said that under a CR, NICHD needs to be conservative in its assessments. However, NICHD will pay all noncompeting continuations until the end of January 2026. NICHD will also pay new awards from the previous council round, prioritizing the most vulnerable. These include awards for career fellowships.

Ms. Yu asked what training reviewers are normally supposed to take and how CSR is ensuring consistency of the caliber of reviews. Dr. Rasooly said that the training addresses implicit bias, and encourages review integrity. Scientific review officers are continuing to encourage reviewers to take these trainings and are tracking who takes them, but the trainings are no longer a requirement for accessing applications. Dr. Zackowski asked whether CSR would evaluate how removing training requirements has affected review. Dr. Rasooly said that she was not sure.

Dr. Tjaden asked for guidance on submitting K or F applications that include mentors from foreign institutions who would not be funded with a subaward. Dr. Rasooly advised noting whether there is significant foreign involvement, regardless of whether or not any funding would be involved. NICHD has had conference grants rescinded because one of the program committee members was from foreign country, but the application did not identify the involvement or justify it as a significant foreign collaboration. Dr. Rasooly strongly advised noting foreign mentorship as significant, with appropriate justification.

Dr. Cruz noted that NCMRR is aligned with NICHD’s competing applications, in that there are approximately 9% fewer competing applications for FY 2026. The process for awarding applications is similar to that used at NICHD. NICHD has also been monitoring reviews for any changes. For example, the institute examined the non-discussed rate and score distribution of applications reviewed over summer 2025. Non-discussed applications were below 50%, as is normal for NICHD. Score distributions were also the same, suggesting the changes have not been detrimental to applicants. Dr. Rasooly said that these data are closely analyzed to ensure early stage investigators are not negatively affected by these changes. Dr. Zackowski expressed an interest in seeing how senior investigators are affected by these changes as well.

Dr. Rasooly closed by saying that NICHD staff were excited to return to work and serve the extramural community after the shutdown. She thanked her colleagues and their communities for their work.

Divided Attention: The Science of Movement Dysfunction and Patient Engagement (3:22:25)

Kathleen M. Zackowski, Ph.D., OTR, Chair, NABMRR

Multiple sclerosis (MS) has a heterogenous presentation of symptoms that, combined with declining function, makes rehabilitation very difficult. Dr. Zackowski’s lab sought to understand how pathology and movement function relate to one another in the context of MS so that treatment and rehabilitation can be targeted and efficacious. Dr. Zackowski conducted several studies imaging white matter fiber tracts and correlating them to clinical measurements of movement impairments. The results, published in Brain, demonstrated correlations between the spinal cord images and sensitivity to sensorimotor impairments. Dr. Zackowski has additionally studied whether neuroimaging could predict how responsive a rehabilitation program may be for patients with MS. In a study published in the Journal of Visualized Experiments, Dr. Zackowski performed magnetic resonance imaging (MRI) and took functional measurements from patients undergoing a 24-week rehabilitation program. She found that progressive resistance training improved strength, walking speed, and quality of life. MRI was also able to predict the changes in strength after the exercise program. These results are not sufficient evidence of personalized rehabilitation, but they suggest the potential for interventions to be individualized to patients based on internal structures.

In her current role at the National MS Society, Dr. Zackowski encouraged attendees to learn about the International Symposium on Gait and Balance in Multiple Sclerosis. The annual 1-day meeting has a different theme each year, with speakers ranging from those with basic mechanistic research backgrounds to those focused on clinical application. The event also features a virtual afternoon lunch with patients with MS.

Dr. Zackowski closed her presentation by sharing the National MS Society’s Community Review of MS Research Committee, which is designed to incorporate the community perspective into research on the disease. The committee ensures that research is aligned with patient needs and priorities, amplifies the voices of those living with and those affected by MS, and complements the scientific peer review with community insight. The 14 committee members include people with MS, care partners, and advocates, and aims for diverse representation across MS types and stages, race, ethnicity, age, gender, geographic location, and socioeconomic status. Committee members review and score research proposals based on plain language descriptions provided by the applicant, and provide feedback on the application’s relevance to their lived experience, the application’s impact on the MS community, and its accessibility and engagement potential. This innovative approach to review informs researchers of the real-world benefits of their work, increases their engagement with MS communities, and enables research to have a greater focus on patient-centered outcomes. A paper published in Research Involvement and Engagementprovides additional details on benefits, lessons learned, and challenges.

Discussion (3:50:43)

Ms. Heinz asked what barriers there are to getting research integrated into treatment plans. As someone with MS, Ms. Heinz noted that her providers have never spoken to her about the potential benefits of rehabilitation. Dr. Zackowski said that funding is a significant barrier. MS is also a difficult condition to study because of the fluctuations in symptoms that come with the progressive damage of the disease. Dr. Zackowski suggested that AI may allow researchers to combine data from multiple clinical sites in a way that allows for larger sample sizes and better, faster detection of subtle changes. Dr. Nitkin added that large datasets will also open up possibilities for other areas of research.

Dr. Tjaden asked how the National MS Society identifies people to serve on the Community Review of MS Research Committee, what challenges the committee has faced, and how frequently members are cycled through. Dr. Zackowski recognized that the committee involves a significant commitment, and members therefore need to be reliable. Many members have been people who were already volunteering with the National MS Society. Society members also promote the committee to the central chapter. Those interested can self-nominate, or an individual in the chapter can nominate potential members. Those candidates are then screened through virtual conversations to assess their fit and interest in the committee. One third of the committee rotates off each year, to ensure a mix of old and new members. Dr. Zackowski noted that it is impossible to encompass all areas of diversity, but the committee tries to include different voices and has even recruited older adolescents.

Dr. Tjaden asked whether there were any themes that came up or surprising lessons learned from the community committee. Dr. Zackowski said that teaching applicants how to write in plain language is a significant challenge. The committee has also pointed out applications with protocols that would be difficult to explain or justify to patients, because of both the complexity and the burden the proposed protocol would place on them. Dr. Nitkin commented that patient populations already have the burden of needing to educate themselves after they get their medical diagnosis. The medical community’s ability to educate patients can also affect how those patients pursue therapy.

Dr. Nitkin asked whether Dr. Zackowski has identified particular areas of importance on the spinal cord. Dr. Zackowski said that pathophysiology does not have a constant trend. Her lab’s goal is to identify pathways that may be more damaged than others and determine whether those pathways are related to whether someone is a good candidate for rehabilitation therapy or other interventions. Dr. Nitkin proposed that additional imaging could offer more insight. Dr. Zackowski agreed and noted that comparison scans could be possible because imaging is done so systematically. The information could be used to guide better rehabilitation or predict particular symptoms or sensory losses. Dr. Nitkin asked whether imaging indicated whether some forms of rehabilitation could potentially be counterintuitive. Dr. Zackowski said that she did not see those indications in her analyses.

Dr. Cruz commented that in her 16 years at NCMRR, the funding landscape for exercise and MS has significantly changed. NCMRR used to receive very few of these applications, but today there are multiple ongoing studies in this area. Dr. Cruz noted that this topic has also been highlighted by assessments of NCMRR’s applications using large language models (LLMs).

Dr. Cramer applauded Dr. Zackowski’s work. He noted that stroke research has also demonstrated that patients with similar phenotypes show stratified responses to the same intervention, but such stratification can be lessened by using biophysical measures to improve prediction.

Dr. Nitkin asked whether subsequent imaging could be used to determine why a certain intervention does or does not work. Dr. Zackowski said that answering this question is the goal of her research; genetics are not typically available to predict therapy response, but imaging may work as a replacement. Dr. Nitkin asked whether imaging supports patient trajectories for recovery. Dr. Zackowski said that imaging can reflect those trajectories, if done early enough. The ultimate goal of Dr. Zackowski’s research is to determine whether exercise and rehabilitation could play a role in remyelination, whether exercise primes the nervous system to be more responsive to medication or primes the nervous system to rebuild on its own. Dr. Zackowski noted that researchers are also exploring brain stimulation for this purpose.

Dr. Nitkin asked whether MS research supports the role of diet and the microbiome in disease prognosis. Dr. Zackowski said that researchers are studying the role of diet on remyelination and cognitive impairment, but there is not enough evidence to suggest a specific “MS diet.” General recommendations include following a healthy diet, similar to the Mediterranean diet, paired with exercise. Dr. Zackowski noted that medications have been able to modify new lesions but are not capable of completely stopping the disease, which has opened the door to studying wellness approaches that could supplement medication.

Dr. Zackowski closed the discussion by encouraging more researchers to get involved in studying MS and to bring their diverse knowledge to a supportive and strong community that is always looking for solutions.

Suggestions for Topics for the Next Meeting (4:16:08)