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CTSAs In Focus

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An Eye to the Future: Training the Next Generation of Researchers

ADVANCING RESEARCH FROM LAB TO PATIENT

The infrastructure needed for clinical studies exists in places like the Brain, Behavior and Performance Unit (BBPU) at the Washington University in St. Louis Institute of Clinical and Translational Sciences — a CTSA consortium member. "The BBPU really permits junior investigators to do patient-oriented research," said unit director Joel S. Perlmutter. "We provide support for getting the initial findings, so that they can use those results to apply to traditional sources of funding." Without this kind of support, applying basic scientific findings to human studies would be a much more challenging proposition. "The BBPU makes this kind of effort move forward in a much more efficient manner," Perlmutter explained. "It really enhances the chances of bringing research findings to patients."

The BBPU provides collaboration, consultation and training for clinical research studies of the nervous system. Kurt Thoroughman is one of many basic researchers taking advantage of these resources. A biomedical engineer interested in how the brain's complex wiring controls movement, Thoroughman has designed several experimental setups that give visual feedback to people as they perform certain movements. Such feedback tells them, for example, if they are moving a hand in the correct direction — if not, people automatically adapt the arm movement according to the feedback. "Over the years, we have come up with very precise tasks and tests of human performance," he explained. "Previously, it was thought that what you learn can change but how you learn it is fixed. But we discovered that both what and how you learn can change very quickly."

With graduate student Jennifer Semrau, Thoroughman decided to try the tests they had developed on Parkinson's disease patients. In particular, Semrau was interested in finding out whether the disease affects the brain's ability to adapt to a changing environment. With advice from staff at the BBPU, Semrau designed a protocol in which Parkinson's patients train on a computer to move a stylus from one point to another. After a while, the computer begins "tricking" them by giving them odd visual cues — for example, indicating that they are moving the stylus at an angle when in fact they are moving it in a horizontal line. The patients then adapt their movements to such cues.

A research coordinator helped Semrau obtain IRB approval, and a patient coordinator recruited suitable subjects with the aid of an extensive patient database. The BBPU has been instrumental in countless similar studies, providing training and assistance to scientists who would otherwise have little opportunity to work with patients. In parallel, the Institute of Clinical and Translational Sciences provides a number of didactic courses for translational researchers, including a master's degree in clinical investigation. "We don't try to reproduce those courses at the BBPU," Perlmutter said. "Instead we provide hands-on experience, as well as assistance with IRB applications, regulatory procedures and how to design a study protocol. We are really marrying the didactic with the practical."

Semrau had a unique opportunity to take findings developed in a basic research laboratory to Parkinson's patients. But once basic findings are translated to patient research, there is one more step in the continuum of translational and clinical science. If that research is to benefit human health, it has to reach out to communities.