Restorative Neurology Clinic
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Avrielle Rykman Peltz, MA, OTR/L
Avrielle Rykman Peltz, MA, OTR/L
CENTER TEAM MEMBER

Avrielle Rykman Peltz, MA, OTR/L

Sr. Clinical Administrator
Robotics and Virtual Reality
Burke Medical Research Institute
Co-Founder and Chief Operating Officer
Restorative Neurology Clinic
Burke Medical Research Institute

Biography

My expertise as an occupational therapist is in neurological upper and lower limb recovery using cutting-edge robotic technology and standardized upper extremity assessments. I have been specializing in stroke/cerebral vascular accidents, spinal cord injury, brain injury, and pulmonary dysfunction for almost two decades. I am an exceptional recruiter and have spear-headed multiple national and international research studies funded by the National Institutes of Health, in collaboration with Burke Medical Research Institute, Weill Cornell Medical College, Massachusetts Institute of Technology, Harvard University, The Veterans’ Administration and private funding sources. My research experience has led me to become the Co-Founder and Chief Operating Officer of the Restorative Neurology Clinic at the Burke Medical Research Institute, which is a specialized rehabilitation clinic for treating people with neurological injuries and illnesses using cutting edge technologies based on highly effective proven research based protocols in the realm of facilitating neuroplasticity. I am an expert evaluator in the Fugl-Meyer Motor/Sensory Assessment and The WOLF motor and time assessment. I am certified to administer the NIH stroke scale, the Modified Rankin Scale and an expert in therapeutically treating patients with multiple diagnoses. I have conducted multiple experiments administering tDCS Brain Stimulation in neurological patients and also have been a professional clinical consultant on many published studies involving upper limb recovery and robotics. I have also travelled nationally and internationally to train other medical professionals in the field of neurological recovery and the use of robotics.

Contributions to Science

Neurological illnesses and injuries including Stroke, Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) are the leading causes of long term physiological disability worldwide. Those afflicted need and deserve long term maintenance for long term disability with the ultimate goals to gain independence in daily activities and decrease the burden of care for their loved ones and caregivers. However, changes in reimbursement have led to shortfalls in rehabilitation services including inadequate amount of time per therapy session, shorter lengths of stay in rehabilitation, and a focus on the minimum level of ability required to send a patient home. As a result, more often than not, occupational therapy and physical therapy are focusing on teaching someone new ways of doing things to compensate for dysfunction rather than therapeutic interventions that offer the potential to reduce disability by reducing impairment (e.g. Getting the paretic limb to move again). Logically, disability and handicap can only be maximally reduced when impairment is cured. Accordingly, if one loses the ability to use one’s dominant hand, one would also prefer to regain function in that hand (restoration) rather than learn how to use the normal, non-dominant hand (compensation). Moving forward rehabilitation teams need more tools in their tool bag to treat patients with neurological impairments in a timely manner and to offer the highest level of quality care.

Prior research has shown that despite brain or spinal cord damage, the central nervous system has the amazing ability to rewire new nerve connections to improve function, thus the term neuroplasticity. Research also has shown that repetitious movement is one strategy to enhance motor recovery and overall healing to expedite neuroplasticity in those with neurological impairment.

My early research work focused on facilitating neuroplasticity in the damaged brain by exploring the type of robotic interventions that would expedite quicker healing in neurological impaired individuals and explore proper dosage and frequency of training.

After proving through research that Robotics Therapy is an effective intervention that expedites neuroplasticity by offering repetitious movement, feedback, and continuous motor challenge, which is key to motor recovery, it also showed better outcomes than usual care and more cost effective in various settings. My later research has also shown to be an objective measuring tool in Kinematics of movement, which can be advantageous in predicting outcomes for patients and recovery timelines in future, as well as proving to insurers that people are improving. It may also bridge the gap between shorter rehabilitation time while still offering a more intensive remediation therapy for patients. Robotics therapy offers the opportunity for some patients to appreciate significant reduction in impairment, but it is not a panacea for all. Part of the challenge moving forward with my current research will be to prospectively identify those who benefit most, and add adjunctive therapies, such as non invasive brain stimulation and drugs to bring benefit to those who currently do not.

My current research will also explore new Robotic Devices for Lower Limb training and use of cutting edge technology with varied neurological diagnoses, which can be seen as a critical mechanism for standardizing experience dependent plasticity and may eventually become a standard part of the therapist’s “tool bag” that will only help patients get better quicker. Because of financial implications in the medical field, the rising demand of people in need and cutting edge technology available in our day and age, continued research based techniques including robotics need to be further explored, utilized more often in the therapeutic setting as a mainstream and billable therapy and should be spread worldwide to help as many people as possible.

Recent Publications

PUBLICATION: 
Journal Article
Putrino D, Zanders H, Hamilton T, Rykman A, Lee P, Edwards DJ
Games Health J. 2017 Sep 14. [Epub ahead of print]
Abstract on PubMed
PUBLICATION: 
Journal Article
Cortes M, Thickbroom GW, Elder J, Rykman A, Valls-Sole J, Pascual-Leone A, Edwards DJ.
Spinal Cord. 2017 Apr;55(4):362-366. doi: 10.1038/sc.2016.161. Epub 2016 Dec 20.
Abstract on PubMed
PUBLICATION: 
Journal Article
Thickbroom GW, Cortes M, Rykman A, Volpe BT, Fregni F, Krebs HI, Pascual-Leone A, Edwards DJ.
Neurology. 2015 Aug 11;85(6):517-20. doi: 10.1212/WNL.0000000000001828.
Abstract on PubMed