Summary Minutes – May 5, 2025

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

Ex-Officio Members Present

Ex-Officio Members Absent

May 5, 2025

The VideoCast recording of the May 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 hybrid meeting at 10 a.m. ET.

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

Barbara Bregman, Ph.D., PT, Chair, NABMRR

Board Chair Dr. Bregman welcomed participants and called the roll. The Board voted to approve the minutes of the December 2–3, 2024, meeting as written. Future meeting dates are:

• December 1–2, 2025
• May 4–5, 2026
• December 7–8, 2026

NICHD Acting Director Report (14:32)

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

In her report, Dr. Cernich shared updates from HHS and NIH leadership, research and program highlights from NICHD, and staff updates.

HHS/NIH Leadership Updates (17:26)

Robert F. Kennedy Jr., J.D., LL.M., assumed office as the 26th HHS Secretary on February 13, 2025. At the same time, the new administration released an executive order that established the Make America Healthy Again (MAHA) Commission, which is focused on childhood chronic disease. Diseases of focus include mental health conditions, obesity, and diabetes. The commission will also be working to improve nutrition and access to healthy foods. A Make Our Children Healthy Again Strategy document from the MAHA Commission is to be released within the first 180 days of the administration.

Jay Bhattacharya, M.D., Ph.D., M.A., has also assumed office as the new NIH Director, while Matt Memoli, M.D., M.S., has transitioned from Acting NIH Director to NIH Principal Deputy Director.

New acting directors across NIH institutes and centers (ICs) include:

• Courtney Akin, Ph.D., at the National Institute of Nursing Research (NINR)
• Andrea Beckel Mitchener, Ph.D., at the National Institute of Mental Health (NIMH)
• Alison Cernich, Ph.D., at NICHD
• Carolyn Hutter, Ph.D., at the National Human Genome Research Institute (NHGRI)
• Jeff Taubenberger, M.D., Ph.D., at the National Institute of Allergy and Infectious Diseases (NIAID)
• Monica Webb Hooper, Ph.D., at the National Institute of Minority Health and Health Disparities (NIMHD)

NICHD is tracking additional forthcoming changes and will continue providing updates throughout the year.

In an upcoming town hall, Dr. Bhattacharya will discuss the following leadership priorities:

• Population health
• Reproducibility and rigor
• Innovation and collaboration
• Research safety and transparency
• Academic freedom

NICHD Research Highlights (21:26)

Dr. Cernich invited attendees to visit NICHD’s website for the 2024 Selected Research Advances Showcase, which highlights institute research across NICHD’s portfolio and mission areas.

Dr. Cernich also presented several recent studies from NICHD. For example, NICHD has been tasked with learning more about the impact of long-term medications on the macronutrient content of human milk. A study in January 2025 examined 3,974 samples from participants on long-term medications and untreated healthy and matched controls. Medications studied included serotonin reuptake inhibitors (SSRIs), corticosteroids, and anti-inflammatory drugs. The study found that human milk samples from participants who take certain SSRIs and corticosteroids had lower levels of protein and fats, but carbohydrates were not affected.

The NICHD Neonatal Research Network has also evaluated whether extending caffeine treatment to resolve apnea during prematurity reduces the length of hospitalizations. The study included data from 29 hospitals and looked at the differences between caffeine treatment for 6 days versus 10 days. The study concluded that although extended treatment was effective at resolving apnea, there is no effect on hospital stay or time to reach full maturity.

Dr. Cernich also shared a study from February 2025 that examined whether steroids given a short time before a preterm birth improved infant survival. The study showed that infants experienced a 1% increase in survival for every hour that passed between steroid administration and birth. The study also suggested that a dose of steroids administered to parents at risk of preterm birth could benefit infants as young as 22–27 weeks of age.

NICHD has also been advancing studies related to younger children’s use of digital media and technology, through institute-sponsored research and the Adolescent Brain Cognitive Development (ABCD) Study®. A recent study of approximately 11,000 children ages 9–10 and 13–14 collected self-reports, from children and parents alike, of time associated with television, video games, social media, texting, and YouTube. The researchers found that time associated with all technologies and media except YouTube increased over time and that usage differed by National Advisory Board on Medical Rehabilitation Research | May 5, 2025 4 sex. Children spent less time with digital technology if their parents were married and had higher income or higher education levels. Finally, parents’ estimates of their children’s technology use were lower than those the children provided.

NICHD Program Highlights (28:34)

Dr. Cernich next shared updates from NICHD research programs. In collaboration with the National Institute of Biomedical Imaging and Bioengineering (NIBIB), NICHD has been using the Rapid Acceleration of Diagnostics (RADx®) platform to spur commercialization of technology through cash prizes and competitions. Initiated during the previous administration, NICHD has issued challenges with a focus on women’s health.

One challenge focuses on endometriosis, a condition that requires surgical diagnostic procedures and takes an average of 10 years to diagnose. The Advancing Cures and Therapies and ending ENDOmetriosis diagnostic delays (ACT ENDO) Challenge seeks to shorten the diagnostic time and reduce the invasiveness of diagnostic procedures. The challenge leverages an innovation funnel previously used for coronavirus disease (COVID-19) to examine applications in three phases. Technology prototypes were submitted in Phase 1. Eight Phase 1 winners were identified and invited to present their technology in a “Shark Tank”–style demonstration for Phase 2. Four Phase 2 winners were recently identified and given a $100,000 prize. Those four are now entering Phase 3, during which their technologies will be further developed on an accelerated schedule. The grand prize winners will be selected in March 2026. Dr. Cernich noted that the Phase 2 winners came from 3CPM Company, Inc.; Endometrics LTD; the Feinstein Institutes for Medical Research, Northwell Health; and Washington University in St. Louis. Diagnostic approaches include imaging, gastrointestinal motility, and menstrual effluent DNA, RNA, and biomarkers.

Another initiative under development prioritizes therapeutic research needs for pregnant, postpartum, and lactating women. In line with recommendations from the Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC), NICHD is working to increase the quantity, quality, and timelines of research on the safety and efficacy of therapeutic products used by pregnant, postpartum, and lactating women. The institute held an initial stakeholder meeting in July 2024 to begin identifying research gaps and areas of prioritization; it will be planning additional meetings in 2025 to further build on the developing framework.

NICHD also has a research framework on developmental disabilities. One study in this framework is the INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE (INCLUDE) Project—a partnership with the National Institute on Aging (NIA), the National Cancer Institute (NCI), and the National Heart, Lung, and Blood Institute (NHLBI). These ICs have joined this effort because of observed higher risk of Alzheimer’s disease and cardiovascular conditions, and lower risk of solid tumor development in people with Down syndrome. The project features three components:

• Basic Science: Targeting high-risk, high-reward basic science studies in areas relevant to Down syndrome
• Cohort Development: Building a large cohort of individuals with Down syndrome across the lifespan to perform deep phenotyping and study co-occurring conditions
• Clinical Trials: Including people with Down syndrome in existing and future clinical trials to better understand the safety and efficacy of medications in this population

The program has supported $90 million of research since 2024, including $20 million in Down Syndrome Cohort Development Program awards to improve the understanding of heterogeneity and the natural history of Down syndrome. The awards support research that examines how demographic, social, experiential, and environmental factors affect outcomes. Recruitment is aimed for the latter half of 2025. Another goal is to expand study sites over the next 5 to 10 years.

NICHD has also relaunched DS-Connect®: The Down Syndrome Registry—a secure, confidential online survey tool that collects basic information about people with Down syndrome. Participants can fill out surveys used for research. DS-Connect® has 5,962 people registered globally as of April 2025 and has promoted research enrollment for more than 100 projects. The relaunched website features improved user-friendliness and works across devices. NICHD will continue to enhance the registry’s features so that they work for the Down syndrome community and its needs.

Dr. Cernich shared a new research opportunity: Leveraging Network Infrastructure to Conduct Innovative Research for Women, Children, Pregnant and Lactating Women, and Persons with Disabilities (UG3/UH3 - Clinical Trial Optional). The opportunity is meant to support laboratory research, clinical trials, and studies relevant to infants, children, women (including pregnant and lactating women), and people with disabilities; examine the impact of disabilities, diseases, and defects on the lives of individuals; and provide a platform for extramural investigator-initiated innovative research in existing NICHD infrastructure. Application budgets are limited to direct costs of $6,250,000 for the entire project period. The number of awards is contingent on NIH appropriations and the submission of enough meritorious applications.

Lastly, NICHD has the Data and Specimen Hub (DASH), a centralized resource that allows researchers to share and access de-identified data from NICHD-funded studies. The hub has data from more than 230 studies on more than 60 topics. Importantly, the hub will be unavailable beginning May 5, 2025, because of a months-long transition that will migrate data to another long-running NIH data repository platform. The move will provide additional functionality and data security.

NIHCD Staff Updates (40:34)

Dr. Cernich closed her presentation by announcing the appointment of Brett Miller, Ph.D., as Acting Chief of the Child Development and Behavior Branch. Dr. Miller received his Ph.D. in cognitive psychology from the University of Massachusetts Amherst and completed his postdoctoral training at Haskins Laboratories. He was previously Program Director of the Literacy and Related Learning Disabilities Program. As Acting Chief, Dr. Miller supports programs and training to increase knowledge relevant to typical and atypical development of reading and written language.

Discussion (41:40)

Dr. Bregman asked what Dr. Cernich sees as some of the greatest opportunities at NICHD. Dr. Cernich said that NICHD has been trying to open its processes and make its resources more available to researchers whose work furthers the institute’s mission. These efforts create opportunities to leverage large-scale infrastructure to answer questions about early interventions for preterm infants. NICHD is also part of NIH-wide initiatives that include improving consent processes and clinical trials for people with disabilities. Additionally, Dr. Cernich has an intramural research program and works with the Rehabilitation Medicine Department. The department is now collaborating with the NIH All of Us Research Program to integrate information about assistive technologies.

Lewis A. Wheaton, Ph.D., asked for information on NIH-wide initiatives that enable collaborative opportunities to develop new neurologic devices. Dr. Cernich cited the Brain Research Through Advancing Innovative Neurotechnologies® (BRAIN) Initiative, the NIH Blueprint for Neuroscience Research, and the Helping to End Addiction Long-term® Initiative (or NIH HEAL Initiative®), whose executive leadership committee Dr. Cernich serves on. Rehabilitation science is also being advanced through the NIH Back Pain Consortium (BACPAC). Finally, the HEAL KIDS (Knowledge, Innovation and Discovery Studies) Pain Program is designed to support clinical trials that address acute pediatric pain so that children are at lower risk of future long-term opioid use. All of these large-scale initiatives enable NIH-wide opportunities to advance rehabilitation science and better integrate people with disabilities into biomedical research.

Kathleen M. Zackowski, Ph.D., M.S., OTR, asked for information on the application process for NICHD grants. Dr. Cernich said that NIH is moving toward a centralized review process. The NIH Center for Scientific Review (CSR) originally reviewed applications for parent announcements and shared announcements, while ICs largely reviewed their own applications and contracts. In the centralized process now underway, all applications are to be reviewed by CSR. Some NICHD staff members are being transferred to CSR to facilitate this transition. Dr. Cernich said that there may be delays to reviews for this year’s October council, but NICHD’s funding may not be as hampered because the institute usually receives fewer applications affected by this transition. NIH is working to get back on schedule by fiscal year (FY) 2026. NICHD is also looking to fund within its regular discretionary zones, so is assessing its budget and pay plans for the year. Dr. Cernich noted that the institute is under a continuing resolution and also received its annual funding later than scheduled, resulting in some awards being issued later than normal. Dr. Cernich also noted that the FY 2026 budget is still being decided. The president released his proposed budget, which is now going to Congress for approval.

Michelle J. Johnson, Ph.D., asked how health disparity work has been affected by executive orders that have removed diversity, equity, and inclusion (DEI) initiatives and goals. She also asked for advice on how to address health disparities in research applications. Dr. Cernich said that NICHD is reviewing existing Notices of Funding Opportunities (NOFOs) and republishing them to guide the extramural community. Dr. Bhattacharya will also be releasing a policy statement with additional guidance. The answers to this issue are still evolving, but Dr. Cernich National Advisory Board on Medical Rehabilitation Research | May 5, 2025 7 said that she expects to have more information in the coming months. She also encouraged meeting attendees to refer to the NIH Grants and Funding Information Status website, which provides regularly updated information on current policies and funding.

Karl Cooper, J.D., asked for updates on ableism research grants. Dr. Cernich said that those grants are still open and active.

Dr. Johnson asked whether the simplified review criteria have been implemented at NIH. Dr. Cernich said that the process has been implemented, but forms may still need to be updated. NCMRR Director Theresa H. Cruz, Ph.D., said that forms do not need to be updated for the new review process, but there has been a delay in implementation for fellowships. Research grants reviewed under the simplified process were due February 5, 2025, so there is no feedback on the process at this time.

NCMRR Director’s Report (58:12)

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

Activities and Collaborations (59:41)

Based on Advisory Board feedback, NCMRR published the Request for Funding Announcement (RFA) for the National Clinical Scientist Career Development Program (K12). Applications were due March 19. Dr. Cruz thanked Dr. Nitkin for his leadership in moving the RFA forward. The award is open to any clinician scientists involved in rehabilitation medicine, as well as physical and occupational therapists. Dr. Cruz noted that these applications have been transferred from NICHD to CSR for review. There is currently no review date in place, but Dr. Cruz said that she was confident the reviews could be finished with minimal delay.

Another significant NOFO is the Medical Rehabilitation Research Resource Centers (MR3) Program (P50). Applications were reviewed April 7–8, 2025. NCMRR is now working on pay plans. The funding opportunity is a partnership of National Institute of Biomedical Imaging and Bioengineering (NIBIB), the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Complementary and Integrative Health (NCCIH). Awards will be issued through the NIH Medical Rehabilitation Coordinating Committee, with input from other ICs.

Dr. Cruz acknowledged the centers that will be leaving the MR3 Network and thanked them for educating people in the field, providing leadership and training opportunities, and strengthening rehabilitation research. At the MR3 Network’s fifth annual Scientific Retreat, on April 3, 2025, the centers gave their farewells and shared the outcomes they achieved, which featured junior pilot awardees. Dr. Cruz said that although these centers will no longer be part of MR3, they still have resources they can share. To that end, she encouraged meeting attendees to keep in touch with them.

The Community Champions for Disability Health Challenge is a collaborative effort among NIDCD, the National Eye Institute (NEI), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the Office of the Director (OD), and the Administration for Community Living (ACL) within the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The challenge has been launched in two phases. Phase 1 launched on August 29, 2024, and closed on November 1, 2024. The eight winners are now competing in Phase 2. Winners of that phase will be announced on January 16, 2026. A total of $485,000 will be awarded over the two phases. The Phase 1 winners cover topics that provide support for a range of disabilities, and resources include: preventive care, dental care, support for nurses and nurses with disabilities, peer-support groups for aphasia, physical activity, access to rehabilitation, and access to assistive technology.

The Rehabilitation Research 2025 Conference has been postponed until further notice, but Dr. Cruz is hopeful that it will be rescheduled before the end of FY 2025. NCMRR needs to adjust the conference’s agenda and format, but Dr. Cruz expressed her gratitude to the Board members and internal planning committees who had helped plan the original event. NCMRR will work to keep the event as intact as possible, but the conference will likely need to be virtual instead of in person. NCMRR will provide an update once the new date is set.

In addition to the staff updates presented by Dr. Cernich, Dr. Cruz announced that Nicole Kleinstreuer, Ph.D., has been appointed Director of the Division of Program Coordination, Planning, and Strategic Initiatives, or DPCPSI (Adam Politis, M.S., represented DPCPSI at this Board meeting). NCMRR and DPCPSI are now working together to develop a strategic plan for the Disability Health Research Coordinating Committee. In mid-December 2024, the committee was able to issue a Request for Information (RFI); it closed on March 12, 2025, and is currently under review.

NCMRR outreach has not been as extensive as in previous years, but the Center was able to participate in a Training in Grantsmanship for Rehabilitation Research (TIGRR) event, which connected NCMRR staff and junior investigators to discuss federal funding opportunities. NCMRR also hosted the Early Career Research R03 webinar, in which program analysts shared common mistakes and pitfalls in applications. The webinar has been posted for the community. Lastly, NCMRR participated in a virtual “lunch and learn” on rehabilitation research for congressional staffers. Dr. Cruz said that these opportunities enable NCMRR to showcase its value and the excellent work of its researchers.

Dr. Cruz congratulated Brooke Ann Slavens, Ph.D., an NCMRR-funded researcher who received the Presidential Early Career Award for Scientists and Engineers (PECASE). Dr. Slavens is a professor at the University of Wisconsin-Milwaukee and won for her R01, Prediction of Shoulder Injury for Disease Prevention in Children and Adults with Spinal Cord Injury Using Advanced Biomechanical Modeling and Diagnostic Imaging.

Publication Analysis (1:14:03)

NCMRR recently conducted a publication analysis to quantify the impact of its research. The analysis used the NIH Office of Portfolio Analysis iCite citation ratio—a metric score that National Advisory Board on Medical Rehabilitation Research | May 5, 2025 9 normalizes an article’s influence over time by the field of research and how long the publication has been available. The analysis looked at publications from 2019 to 2025 associated with NCMRR grant numbers. There were 4,766 publications in total, 4,343 of which were available in the iCite system. The distribution was slightly skewed by a few highly influential publications. Analysts manually checked the top 50 publications to confirm them as part of the NCMRR portfolio. Citation ratios had a mean score of 1.84, and the weighted Relative Citation Ratio (RCR) was 6,822.36. Dr. Cruz noted that mean ratio scores higher than 1 and RCRs higher than the set of publications are considered good.

Science Advances (1:16:48)

Dr. Cruz shared several science advances. First, the NIH Blueprint for Neuroscience Research features a toolbox with more than 50 assessments to study cognition, sensation, and emotion. However, the toolbox is designed for those ages 3 to 85. NICHD’s Child Development and Behavior Branch has therefore launched the NIH Baby Toolbox, in collaboration with the NIH Blueprint for Neuroscience Research. The toolbox is available in English and Spanish as a mobile app and is designed for use with infants ages 1 to 42 months.

ONWARD Medical has also received approval from the U.S. Food and Drug Administration (FDA) for a noninvasive spinal cord stimulator called ARCEX. The approval comes after an industrysupported trial with 60 patients across 14 sites in the United States, United Kingdom, Canada, and the Netherlands. Electrodes were placed on the surface of the skin above the level of injury. The device did not use epidural stimulation, implants, or functional electrical stimulation to the muscle. Instead, the spinal cord was primed to activate at the volitional intent of the user. The target goal was to have at least 50% of patients show improvement from the baseline, which included rehabilitation alone. Patients who used the device with rehabilitation showed drastic increases in motor and sensory functions; they also reported fewer muscle spasms and better sleep. The study, published in Nature Medicine , is an excellent example of the U.S. ecosystem supporting biomedical research: The trial would not have been possible without decades of basic research supported by NIH and the National Science Foundation (NSF), early feasibility studies, and work from FDA to approve the device. All of these elements are part of an ecosystem that works together for the health, function, and well-being of Americans.

Research Plan (1:23:42)

Lastly, Dr. Cruz shared updates and asked for input on the NCMRR Research Plan. The original timeline involved gathering feedback on the initial themes through an RFI and finalizing the Research Plan this year, with a goal of publishing the final plan in 2026. However, NCMRR was not able to publish the RFI and obtain feedback. Dr. Cruz asked the Board whether publication should be pushed back to allow more time to gather feedback from the field or if the current themes should be approved as:

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

Board members recommended moving forward with the current themes and course-correcting as needed to ensure forward movement. Stalling could result in delays achieving strategic priorities, and moving forward is critical given the rapid convergence of technology and science.

Dr. Bregman called for a motion to approve the 2026 Research Plan. The motion was approved.

Dr. Cruz thanked the Board members for their input. NCMRR will still work on releasing the RFI but will now move forward with the Research Plan while waiting for public input.

Discussion (1:32:00)

Tiffany A. Yu asked how Board members could highlight the importance of NCMRR’s work. Dr. Cruz encouraged Board members and other private citizens to contact their representatives and highlight how NCMRR-supported research has supported the American people.

Jose Luis Contreras-Vidal, Ph.D., M.S., praised the noninvasive spinal cord study and expressed excitement about noninvasive technologies.

Dr. Zackowski said she appreciated the list of Research Plan themes but noted that basic science should be directly tied to rehabilitation. Dr. Cruz cited BACPAC as an example of basic science with clear rehabilitation ties, as deep phenotyping is used to identify proper interventions for different patients. Robert Sainburg, Ph.D., M.S., said that NCMRR has invested in basic science that underlies dysfunction for decades, in order to develop patient- and impairment-specific rehabilitative interventions.

Dr. Johnson asked which centers are leaving MR3. Dr. Cruz said some of the Medical Rehabilitation Research Resource (P2C) centers are leaving because of the move to the P50 structure. NCMRR is working to have the new P50 structure set up by this summer, when the current project period ends.

Dr. Johnson asked about the pros and cons of moving some awards to a centralized review. Dr. Cruz said that currently 75% to 80% of grants are reviewed at CSR; the rest are assessed at their respective ICs. Under centralization, grants will be reviewed via the same procedure and subjected to the same quality of review. The transition will take place for applications reviewed this summer. Dr. Cruz reiterated from Dr. Cernich’s presentation that staff are transitioning with grants, so that the same people are reviewing applications. Though the transition will present challenges, Dr. Cruz said that NCMRR is dedicated to quality and timely application reviews. Dr. Cernich added that CSR Director Noni Byrnes, Ph.D., is providing regular updates about the transition. Dr. Cernich also said that based on community input, NIH is working to have the level of specialty needed for application reviews. There will also be regular updates on performance metrics and the types of review panels.

Dr. Nitkin said that the research infrastructure program has been very successful, and he encouraged Board members to reach out to Joe Bonner, Ph.D., with questions about the shift National Advisory Board on Medical Rehabilitation Research | May 5, 2025 11 to centralized review. Dr. Nitkin noted that the NCMRR Research Plan will be applied across NIH to connect with colleagues across ICs who support rehabilitation research. The cooperation with NCMRR and other ICs has helped to make rehabilitation a transcendent issue across NIH.

Dawn M. Ehde, Ph.D., asked for additional information on career development awards and how they are moving forward under the centralized review process. Dr. Cruz said that individual K awards are still active, with corresponding NOFOs still accepting applications. Dr. Cruz said that those awards are an important part of the scientific landscape. Dr. Nitkin said that career development applications were formerly reviewed at IC study sections and will now be transferred to CSR review. The language of applications may need to change slightly to appeal to a wider panel, but Dr. Nitkin said he hopes that reviewers will continue to see the value of such applications. Dr. Cruz said that this was a good point. She noted that CSR has always reviewed fellowship applications, so there may not be much of a change in that particular process.

Ripples and Reflections: The Impacts of Mentorship (1:49:00)

Barbara Bregman, Ph.D., PT, Chair, NABMRR

Dr. Bregman is a physical therapist and neuroscientist who has conducted more than 25 years of NIH-supported research in central nervous system plasticity and recovery of function. Dr. Bregman shared insights from her mentors and her own mentorship experiences, and principles for growing the next generation of clinician–scientists.

When Dr. Bregman was a practicing physical therapist, she was always interested in neurorehabilitation and neonatal injuries. She shared her interests in those areas with leaders at The George Washington University, who helped place her in positions to receive referrals for strokes and neonatal injuries, spinal cord injuries, and brain injuries. These experiences instilled in her a valuable principle: Mentorship requires giving individuals the agency to develop in the directions they want to grow.

After her clinical practice, Dr. Bregman moved into a new role: as an educator in physical therapy helping to develop a physical therapy curriculum at Howard University. Dr. Bregman said that she is still in touch with some of her students. She added that the Dean of Howard University, Harley Flack, Ph.D., allowed her to focus on her own interests in neurorehabilitation.

Dr. Bregman was encouraged to apply for the Mentoring Academic-Research Careers (MARC) Faculty Predoctoral Fellowship to support her graduate work with Dr. Goldberger at the Medical College of Pennsylvania. The lab presented an unusual and valuable environment for Dr. Bregman’s graduate work. At that time, plasticity was not yet well accepted; instead, it was pushing scientific boundaries. Dr. Goldberger created a learning environment for individuals with varying research interests united by plasticity. Using lesions in neonatal kittens as an animal model, Dr. Bregman found that the time of injury is relevant to the return of function. Tactile placement behavior still developed when lesions were applied to neonatal kittens. However, the behavior was abolished when lesions were applied to the adult. Additional National Advisory Board on Medical Rehabilitation Research | May 5, 2025 12 experiments with retrograde tracing demonstrated regrowth at the injury site after neonatal injury, but no regrowth in adult animals.

After her doctoral training, Dr. Bregman began postdoctoral work under Paul Reier, Ph.D., then at the University of Maryland School of Medicine. Dr. Reier studied spinal cord injuries in adult rats and how stem cell transplantation contributes to central nervous system (CNS) plasticity. Dr. Bregman performed a series of experiments in which stem cells were transplanted into the sites of spinal cord injuries, which rescued immature axotomized neurons from retrograde cell death, supported generation of axons at the recovery site, and helped mediate recovery of function. Stem cell transplant also helped recover cells within the red nucleus. Within the spinal cord, stem cell transplants also supported the growth of supraspinal axons, caudal to transection after neonatal injury. The extent of recovery was greater in early lesions, but plasticity in the adult nervous system could be modified via stem cell transplant.

Following her postdoctoral training, Dr. Bregman took a faculty position at the University of Maryland, established her independent laboratory, and was awarded her first R01. Dr. Bregman fostered collaborations across institutions and structures, working in particular with Regeneron to show that brain-derived neurotropic factor (BDNF), neurotrophin-3 (NT-3), and NT-4 increased plasticity after injury in adults. Dr. Bregman also worked with Mariella Filbin, M.D., Ph.D., on experiments that demonstrated that transplanted neurotrophic factors increase cellular response to regeneration after injury. In her own lab, Dr. Bregman also continued to study increased growth in neonates and adults after stem cell transplant compared with injury alone. This work helped define both intrinsic and extrinsic factors that prevent regeneration strategies for repair. Intrinsic neuronal factors include cell death, atrophy, and lack of upregulation of regeneration-associated genes (RAGs). Extrinsic CNS environmental factors include reactive astrocytes, glial scarring, inhibitory extracellular matrix, cyst formation, and myelin-associated inhibitors.

Some of the lessons that Dr. Bregman learned from her mentors include: question authority (i.e., dogma); be bold, think big, and expect the unexpected; create a learning and growing environment; think critically, encouraging “what if” scenarios instead of focusing on what is not feasible; look for the positive parts of an idea and build from them; and, everyone has a voice, and every voice matters.

Dr. Bregman shared insights from her own experiences as a mentor. At Georgetown University Medical Center, she was awarded the NIH Institutional Training Grant T32 HD07459: Training in Recovery of Function After CNS Injury. Another important grant that Dr. Bregman received was an institutional K12 from NCMRR, which enabled her and Alex Dromerick, M.D., to launch the Neurorehabilitation and Restorative Neuroscience Training Network (NRNTN) as co-principal investigators (PIs) before Dr. Dromerick’s death. This program was an early-career development and mentorship program that targeted junior faculty interested in studying neurorehabilitation after nervous system injury and supported an impressive roster of clinical researchers who have developed impactful research careers.

Discussion (1:31:35)

Dr. Nitkin thanked Dr. Bregman for her presentation and grace in bringing together a community across disciplines.

Dr. Johnson praised Dr. Bregman for uplifting others during her career and expressed agreement with the principle that community is a necessary part of science.

Dr. Wheaton said that as the vice president of ASNR, he is happy to see who has engaged with the K12 program over the years. Dr. Bregman said that she appreciates ASNR for its ability to address the needs of many people across subspecialties, which make it an important collaborator to the program.

Kris Tjaden, Ph.D., CCC-SLP, asked for additional information about the professional coaching offered to scholars. Dr. Bregman said Ms. Dromerick is essential to scholars’ growth because she helps create a safe space for scholars to bring up issues they would not want to raise with their professional peers.

Dr. Zackowski asked how implementation and dissemination are incorporated into the scholars’ training. Dr. Bregman worked with Dorothy Edwards, Ph.D., and her colleagues from NIH StrokeNet to guide implementation and dissemination training. Dr. Bregman also works with Dr. Edwards on a P50 grant for young investigators studying cancer and maternal health, with a focus on community engagement.

Behavioral Interventions for Chronic Pain and Fatigue in Multiple Sclerosis (2:37:50)

Dawn Ehde, Ph.D., Professor, Nancy & Buster Alvord Endowed Professorship in Multiple Sclerosis Research; Chair, Department of Rehabilitation Medicine Mentoring Program; Vice Chair, Faculty Development, University of Washington School of Medicine

Dr. Ehde noted that her own career began thanks to a T32 from NCMRR. Her research investigates behavioral interventions for chronic pain and fatigue in patients with multiple sclerosis (MS). MS is a chronic inflammatory autoimmune disease that affects CNS. The disease causes demyelination, which produces many symptoms that often start in young to middle adulthood. MS is more common in women than in men. The field has seen an advent of disease-modifying therapies over the past 20 years, but many people still experience symptoms. These symptoms have commonalities among other rehabilitation populations, including those with traumatic brain injury (TBI) and spinal cord injury.

Dr. Ehde highlighted her collaborators—including Anna Kratz, Ph.D.; Nora Fritz, Ph.D., D.P.T., PT; and Melissa Day, Ph.D.—and a diverse funding portfolio. Dr. Ehde’s work is based on more than 15 years of engagement with the MS community. The lab also works with a Community Advisory Board (CAB) of 10 to 12 members, all of whom have MS or are affected by it. CAB members are paid, active research partners who make sure the lab’s work reflects their National Advisory Board on Medical Rehabilitation Research | May 5, 2025 14 experiences by guiding research priorities, providing feedback on study design, reviewing study materials and procedures, interpreting study results, and helping disseminate findings.

The lab studies pain and fatigue because these symptoms are often the patients’ most significant problem—and among the most overlooked. MS affects approximately 1 million Americans. Out of the many common symptoms of MS, fatigue is the most common, with 90% of patients experiencing it; 50% to 80% report pain. These symptoms affect daily activities and participation, personal relationships, and quality of life.

Dr. Ehde shared results from a study published in Multiple Sclerosis . From 2014 to 2018, the lab invited Seattle-based patients who were newly diagnosed with MS to be part of a study that studied symptoms, functional measures, and outcomes. The most common symptom was fatigue, but other common symptoms include depression, anxiety, and clinically significant pain Even though traditional treatments often focus on a sole symptom, many patients had at least two co-occurring symptoms.

An ongoing study, now in its fourth year, is optimizing detection and prediction of cognitive function in MS. The study, which includes three sites, is being conducted in collaboration with Dr. Kratz and Dr. Fritz. While neuropsychological tests are typically measured at one time, these tests do not capture the day-to-day variability often seen in people with MS, so Drs. Ehde, Katz, and Fritz began using longitudinal methods, especially to study whether ambulatory decline is related to cognitive function.

The study has enrolled 302 participants who fill out surveys, complete neuropsychological tests, report symptoms, and perform physical tests. Participants are then monitored at home for updates on pain, fatigue, mood, stress, perceived cognitive function, distractions, location, intake of substances, social participation, physical function, and falls. Participants also take cognitive tests on processing speed, working memory, and executive functioning, while accelerometers were used to monitor daytime activity and sleep. Initial analyses suggest that momentary symptoms and overall symptom burden are influenced by cognitive performance. Cognitive performance, processing speed, and working memory are also worse when a person experiences fatigue and pain. These results suggest the ways in which these symptoms all interact, with pain and fatigue playing important roles.

Behavioral interventions for pain and fatigue are implemented with the goal of giving people their lives back. Studies on chronic pain in the Cochrane Database System Review and American Psychologist have shown that behavioral interventions such as cognitive-behavioral therapy (CBT), mindfulness-based therapies, and acceptance and commitment are effective at improving pain outcomes, including pain intensity, pain interference, mood, sleep, and fatigue. Dr. Ehde’s lab is now examining the efficacy of CBT in patients with MS.

As part of the Take Charge trial, participants had phone-delivered self-management CBT interventions, 45- to 60-minute sessions with a licensed therapist to discuss chronic pain, fatigue, and mild to moderate depression. Participants learned to manage pain by understanding how thoughts and actions influence feeling and function. They also had sessions National Advisory Board on Medical Rehabilitation Research | May 5, 2025 15 with relaxation therapy and cognitive therapy, and learned about adaptive coping strategies. An evaluation of the trial published in the Archives of Physical Medicine and Rehabilitationreported that 47% of participants experienced clinically meaningful improvement in pain interference and 50% in fatigue impact and the improvements were durable for 6 to 12 months. Treatment adherence and satisfaction were high, with 86% of participants completing at least seven of the eight sessions and cited it as an important benefit to their treatment.

Dr. Ehde is also studying the effects of CBT on fatigue. In a randomized, statistician-blinded, parallel-arm trial whose results were published in The Lancet Neurology , fatigued MS patients were given modafinil, CBT, or a combination of the two for 12 weeks. All three treatments improved fatigue at 12 weeks, and CBT improved fatigue even after treatment ended. Across all treatments, 65% of patients reported meaningful improvement and the benefits of CBT persisted through the 24-week follow-up period, especially with respect to sleep habits.

Dr. Ehde is also working on a study to explore the role of CBT treatment to manage pain in those with MS, TBI, spinal cord injuries, and limb loss. Participants treated with CBT showed statistically and clinically significant improvement in pain up to 6 months later compared to those who received standard treatment.

Dr. Ehde is also interested in challenges to evidence-based pain care, in both general and rehabilitation populations. A study in the journal Pain Medicine has shown that in the general population, 37% are not aware of nonpharmaceutical pain treatments. Additionally, 72% of pain physicians reported an insufficient number of pain therapists, only 12% of psychologists and therapists consider themselves adequately trained to treat pain, and 35% of advanced registered nurse practitioners are also unaware of nonpharmaceutical pain treatments. These findings mirror observations in a 2024 national MS survey which indicated that less than 10% of patients use pain self-management tools due to a lack of familiarity, difficulty finding providers, and concerns about cost as barriers to care.

Dr. Ehde has studied whether digital interventions can address some of these barriers by developing the My MS Toolkit. My MS Toolkit is the only self-management toolkit of its kind. The resource provides worksheets, videos, and other tools to help people with MS manage their symptoms. In a pilot study detailed in Rehabilitation Psychology , 46% of patients had a clinically significant improvement in pain interference and fatigue, even if they only briefly visited the toolkit’s webpages. Dr. Ehde’s lab also developed a 15-minute-long coached version, which improved adherence and outcomes. The lab is currently working on ways to integrate the toolkit into broader clinical care. Dr. Ehde proposed that rehabilitation requires a continuum of processes, including self-directed pain and fatigue care, classes, groups, online therapies, and one-on-one traditional therapy. Providers also need to be equipped to discuss, recommend, and provide self-management tools.

Dr. Ehde closed her presentation by noting that people with MS, like many rehabilitation populations, often manage multiple co-occurring symptoms that influence one another. Behavioral treatments, when delivered in a patient-centered way, tend to improve not only the target symptom but also other symptoms and overall functioning. She suggested that the National Advisory Board on Medical Rehabilitation Research | May 5, 2025 16 rehabilitation field needs to move optimizing treatments via advancing mechanisms and precision medicine. Digital interventions should also be studied as promising options, but not as the only cure. Providers should also be able to offer stepped models of care, starting with selfguided interventions and moving to individualized interventions as needed. Finally, researchers and providers need to partner with the MS community to move effective treatments and interventions forward.

Discussion (3:16:12)

Dr. Nitkin noted that providers and researchers often focus on the trajectory of MS. He asked whether that is helpful for recommending treatment options. Dr. Ehde said that the Take Charge trial showed that providers should not assume which interventions will be effective for MS patients.

Dr. Johnson asked how the pain interference score Dr. Ehde employs differs from other scales used in the field. Dr. Ehde said that both the pain and fatigue interference measures she uses study how pain interferes with mood, social interaction, and daily activities; the focus is on interference with activities, as opposed to severity. Dr. Johnson asked how thoroughly study participants report on activities and whether detailed activity recording would be informative for future studies. Dr. Ehde said that participants report on some daily and household activities, and on their ability to move around. She said that studying activity in more detail could be useful for future studies.

Angel Hardy Heinz, MAPP, asked which tools advocates could use to spread the word about digital intervention solutions. Dr. Ehde acknowledged that awareness is a major barrier to access. Many patients are initially prescribed medications rather than references for selfmanagement or behavioral interventions. Dr. Ehde welcomed ideas for sharing tools such as My MS Toolkit, either by connecting with her or by sharing them at the Advisory Board meeting. Dr. Ehde noted that she works with the MS Society, which could facilitate community organization, but that she also recognizes that many providers are busy or are not sure how to connect patients to such interventions.

Sensors in Muscles: The Unsung Heroes of Neuromuscular Control? (3:24:20)

Francisco Valero-Cuevas, Ph.D., Professor, Division of Biokinesiology and Physical Therapy, University of Southern California

Dr. Valero-Cuevas shared research from his lab on the role that sensors within muscles have on neuromuscular control. Movement disorders that arise from neuromuscular and neurological conditions are diverse and largely categorized by the effect they have on natural movements. What is less understood is how sensory deficits may contribute to movement disorders.

The senses of taste, smell, hearing, vision, and touch all help people understand the world and navigate it; the sense of proprioception gauges the state of one’s body. Proprioception is perceived through the inner ear for balance as well as by mechanoreceptors in the joints and muscles. Mechanoreceptors include Golgi tendon organs, which sense tendon force, and muscle spindles, which sense muscle length and the velocity of a contraction.

Dr. Valero-Cuevas presented a simple action of finger extension as an example: When the finger extends, muscle spindles sense force in the tendon, how much the muscle is lengthening or shortening, and how quickly the action occurs. These sensors are also used in reflexive movements, such as the knee-jerk reflex. In this reflex, a stimulus is applied to the patellar tendon. The muscle spindle within the quadriceps is activated as the muscle contracts. This signal travels through afferent pathways to the spinal cord, which then sends a signal through efferent pathways to the hamstring to relax. This circuitry, which is operating all the time to enable upright posture, is thought to enable smooth movements; its disruption is thought to be involved in disorders such as cerebral palsy, Parkinson’s disease, and stroke.

Dr. Valero-Cuevas’ lab has recapitulated this circuitry using computer chips to simulate neurons, motors to simulate muscles, and mechanical systems to simulate human anatomy. In one simple two-muscle system, published in the Journal of Neural Engineering in two parts, the lab has been able to create robots with circuits similar to those found in nature. Another publication, in Nature Machine Intelligence, has also demonstrated the lab’s capability to record from the simulated neurons for the study of the stretch reflex, validate physiological concepts, and simulate neurological conditions with these systems.

The lab has also explored how stretch reflex circuits operate with multiple muscle circuits, which is further detailed in Dr. Valero-Cuevas’ textbook, Fundamentals of Neuromechanics . Specifically, the lab has studied movement in conditions when multiple muscles cross a single joint. This system extends the notion of reciprocal inhibition, in which the coordination of reflex pathways among synergistic muscles is crucial for movement. The nervous system and the spinal cord need to regulate reflex pathways across all muscles, which suggests that movement requires very strict coordination of reflex pathways. This goes against the idea of muscle redundancy, in which many muscle commands produce one joint’s torque. This model published in PLoS Computational Biology , has also enabled the lab to study how reciprocal inhibition works in the context of multiple muscles, and what roles the muscle spindles play in both able and impaired movement.

Other studies from the lab involve studying which muscle velocities activate muscle spindles in realistic movements of realistic limbs. In the a href="https://doi.org/10.1016/j.jbiomech.2017.05.019" target="_blank">Journal of Biomechanics, Dr. Valero-Cuevas and Daniel A. Hagen, Ph.D., M.S., created a computational model of an arm with 18 muscles that cross the shoulder, elbow, and wrist to simulate the movement of throwing a basketball. The model demonstrated how movement and rotation are produced, and that although the arm can have many possible trajectories—from rest to throwing the basketball—the cumulative velocities the arm muscles generate can be very different. These varying velocities demonstrate the need for muscle coordination and an aspect of movement disorders that is not well understood. Additional studies have shown distinct kinematic signatures at the level of individual muscles, which may explain individual performances in athletics and individual differences across movement disorders: similar, everyday movements can require different tuning of stretch reflexes across multiple muscles and multiple joints, which result in small differences that can stratify patients with movement disorders even as they produce movements that look apparently similar.

Lastly, the lab has explored how stretch reflexes can be fine-tuned in realistic limbs by simulating closed-loop systems. In a recent publication from the Proceedings of the National Academy of Sciences , Dr. Valero-Cuevas has studied the interactions between alpha and gamma motoneurons during realistic movement in 3D simulations of the rhesus macaque arm. As gain of reflex increased during muscle lengthening, the movement trajectory was disrupted in movement-dependent ways. These experiments thus show how movement through brainstemor CNS-mediated mechanisms can be affected by gain of reflexes.

Dr. Valero-Cuevas studied classic literature on reflex patterns to understand how these disruptions could be mitigated in nature. The review book, The Circuitry of the Human Spinal Cord: Its Role in Motor Control and Movement Disorders , proposed that amphibians and reptiles developed with a simple system in which muscle spindles and the muscle as a whole received descending commands from beta motoneurons. As evolution progressed, mammals developed a more complex system, with alpha and gamma motoneurons delivering descending commands to the muscle and the muscle spindle, respectively, to allow for finer control of movement. Recapitulating this alpha and gamma motoneuron coactivation demonstrated mitigated errors for most reflex gains within the closed system, which suggests that such circuitry is necessary to mitigate disruptions in movement.

While this alpha and gamma coactivation explained fine control of movement, the underlying circuitry was still not completely clear. Dr. Valero-Cuevas realized that alpha and gamma motoneurons have different circuitry, but their signals to the muscle and the muscle spindle need to arrive at the same time for proper movement control. The simulations also showed correction of movement errors, smooth movement in both closed- and open-loop simulations, and disruptions to movement as a training mechanism for the cerebellum to further fine-tune subsequent movements, rather than stop movement altogether.

Dr. Valero-Cuevas concluded his presentation by saying that computational models allow his lab to understand the function of sensors in muscles, the emergence of movement disorders, and the treatment of such disorders.

Discussion (4:05:20)

Dr. Sainburg asked whether different trajectories in the simulations Dr. Valero-Cuevas showed were generated by different types of commands. Dr. Valero-Cuevas said that was correct.

Dr. Sainburg said that he also noticed that gamma activation was labeled as dynamic and asked whether Dr. Valero-Cuevas worked with different ratios of static and dynamic, and whether there were ever times during simulated movement when segments were driven by external movements without descending commands. Dr. Valero-Cuevas said that the bona fide physics model addresses these issues. On secondary afferents, the simulations include only type 1A sensory fibers, which sets up the lab for additional studies of circuitry with greater complexity.

Words From Retiring Board Members (4:11:44)

Barbara Bregman (4:12:31)

Dr. Bregman thanked Drs. Cruz and Nitkin for everything they do. She said that she loved the interactive, interdisciplinary dialogues and the way conversations continue afterward. Dr. Bregman also thanked Drs. Cruz and Nitkin for making the role of Board Chair so easy. She asked what the chair can do to make their jobs easier in the future.

Dawn Ehde (4:13:18)

Dr. Ehde said she has enjoyed being with this group. She joined the Board during the COVID-19 pandemic and is now ending her membership during a strange time as well. Dr. Ehde said she has enjoyed getting to know people she does not normally interact with in the rehabilitation community. She highlighted that the Board values early-career trainees, including those with lived experience on the Board, and including diverse voices of people with disabilities. Dr. Ehde said that she will continue to help the Board however she can.

Francisco Valero-Cuevas (4:14:34)

Dr. Valero-Cuevas said that he remembered joining the Board during the COVID-19 pandemic, when all activities were remote and the sky seemed to be falling. He said that he will be eternally grateful for coming together with the rest of the Board and helping one another through the crisis of the pandemic. He thanked Board leaders for their determination and expressed his respect and admiration for the work they do; their work is not forgotten or taken for granted.

Jose Contreras-Vidal (4:15:35)

Dr. Contreras-Vidal said that it has been a privilege to work with the Advisory Board, and that he appreciates the time put into these meetings and running NCMRR. He said that he had also had the privilege of representing NCMRR at the National Advisory Child Health and Human Development (NACHHD) Council , and had learned so much from that experience. He values the work NCMRR does in terms of training and supporting the scientific enterprise. Dr. Contreras-Vidal said that he wants to stay connected and to continue NCMRR’s work of advancing training, setting standards, and bringing rehabilitation to the public. He said he appreciated working with his colleagues on the Board.

Michelle Johnson (4:16:54)

Dr. Johnson said that it has been a pleasure to serve on the Board; she thanked Board leaders and her colleagues for making her feel welcome. She said that she has also enjoyed the dialogue, discussion, and information on both NICHD and NCMRR. Dr. Johnson said it is great to see the passion that goes into making sure that rehabilitation science is heard and supported, considering how to build the next generation of rehabilitation scientists, and ensuring that engineers who are passionate about rehabilitation are part of NCMRR. She said that she will miss being a part of these meetings.

Robert Sainburg (4:18:35)

Dr. Sainburg echoed previous remarks and thanked Board leadership. Dr. Sainburg said it was amazing that he always looked forward to these meetings, given that he is someone who has trouble being quiet and sitting still. Dr. Sainburg said the Board brings together a broad set of approaches to rehabilitation science, which has helped him learn so much and expand the scope of how he views the scientific enterprise of NIH. He thanked the Board for this opportunity.

Dr. Nitkin said that certificates signed by NICHD leadership will be sent to all the retiring members. He said that he and Dr. Cruz appreciate the Board’s engagement, and that staying connected and driven drives their work as well. He said that the Board’s passion and drive for innovation and mentorship are needed now more than ever.

Dr. Bregman formally transferred the role of Board Chair to Dr. Zackowski. Dr. Zackowski said that she has learned a lot from the breadth of information shared at this meeting, and she expressed her excitement for this opportunity.

Topic Suggestions for Next Meeting (4:21:44)

Kathleen M. Zackowski, Ph.D., M.S., OTR, Chair, NABMRR
Recommended topics included:

• The new centralized NIH review process
• Updates from disability pride organizations and organizations that have been affected by the Advisory Board’s work
• Follow-up on themes of the NCMRR Research Plan
• Progress of K12 support

Adjournment (4:25:50)

Kathleen M. Zackowski, Ph.D., M.S., OTR, Chair, NABMRR
Theresa H. Cruz, Ph.D., Director, NCMRR
Ralph Nitkin, Ph.D., Deputy Director, NCMRR

Dr. Cruz thanked the Board members—especially those who are completing their tenure. Dr. Cruz said that the members’ thoughtful consideration and preparedness for meetings have allowed her and Dr. Nitkin to support both the Board and the broader field. She encouraged departing Board members to stay connected and asked for patience and flexibility moving forward, given that many proceedings are still undetermined.

Dr. Nitkin reiterated his gratitude for Board members’ energy and acknowledged the NIH and federal colleagues who joined the meeting. He thanked them for their interest in NCMRR activities and said that he hopes to meet them in person soon

Dr. Zackowski thanked everyone for their time and adjourned the meeting at 3:50 p.m. ET.