“I can crack an egg with one hand,” boasts l3-year-old Hadley Lucca (pictured below) with a smile as wide as her face. For most of her life, Hadley has done a lot of things with just one hand. She suffered a stroke when she was a baby that significantly weakened the right side of her body. Since her mother enrolled her in a research study with University of Minnesota rehabilitation neuroscientist Bernadette Gillick, Ph.D., M.S.P.T., P.T., six years ago, Hadley has started using her right hand more frequently. That makes it a lot easier to ride her favorite horse, hone her hockey skills, and be less self-conscious about participating in all kinds of activities.
An innovative therapy improved Hadley Lucca’s hand function, allowing her to keep her hands in her hockey gloves and stay in the game. (Photo: Brady Willette)
In a first-of-its-kind study designed to enhance motor skills in children who, like Hadley, have stroke-induced cerebral palsy (CP), Gillick and her team applied noninvasive brain stimulation and temporarily restrained the use of each child’s dominant hand to encourage use of the hand more affected by CP.
The stimulation, known as transcranial direct current stimulation, or tDCS, is painless — “It’s kind of like a buzz, like an electric toothbrush,” Hadley says — and is meant to activate the brain cells around the area of the stroke that are still alive.
Gillick’s group found that the treatment combination significantly improved hand function and had few, if any, side effects. The team recently has extended the study to infants who have suffered a stroke.
“I like to think that we are all very neuroplastic, that we all have the potential for recovery, no matter what age we are,” says Gillick, a McKnight Land Grant Professor in the Medical School’s Department of Rehabilitation Medicine. “The children with whom I work have shown me that. They have the potential to make significant changes. It’s pretty powerful to see what can happen, especially with the motivation and energies of a child.”
Today the University is doubling down on the immense potential of brain adaptability, bringing together a team of clinicians and researchers to form its new Masonic Institute for the Developing Brain. It’s designed to capitalize on the most sensitive periods of brain development in a person’s life: the first 1,000 days and adolescence.
The Masonic Institute for the Developing Brain — named in recognition of a $35 million gift from Minnesota Masonic Charities, the University’s largest donor — will be located at the former Shriners Healthcare for Children site on East River Parkway in Minneapolis, near the U’s Twin Cities campus.
Its mission: unite a deep and broad group of experts — from the Medical School, College of Education and Human Development, and beyond — to learn more about typical brain development and then tackle complex brain conditions that can result when that process goes off track.
The following examples describe the kind of work the institute will perform to keep kids’ brains at their best.
The many layers of autism
Suma Jacob, M.D., Ph.D., believes the U’s collaborative environment is key to advancing knowledge about autism. (Photo: Karl Raschke)
The more researchers and clinicians learn about autism, the more its complexity amazes them. As experts piece together what they know about genetic risk, biological factors, brain imaging, and observed behaviors, the picture is slowly coming together, says Suma Jacob, M.D., Ph.D., an associate professor in the Medical School’s Department of Psychiatry.
“We are now getting better at connecting many layers,” Jacob says. “This integration gives us new clues to which things may be really important, which things may change, and what things we need to target in order to develop interventions.”
The U’s Infant Brain Imaging Study, which tracks the brain development of very young children via magnetic resonance imaging, is one study that’s shedding new light on autism spectrum disorders. So far, brain images obtained through the study have predicted which children will develop autism with 80 percent accuracy. The researchers believe that identifying at-risk children sooner will lead to earlier interventions that may be able to mitigate symptoms of autism long term.
And the SPARK study, the largest study of autism ever attempted in the United States, is designed to identify genes and genetic risk. (There are more than 25 study sites nationally; Jacob leads the U arm of the study.) SPARK collects and analyzes saliva samples and surveys about medical history from people diagnosed with autism and their family members.
Jacob believes the U’s collaborative environment will be key to advancing knowledge about autism and other complex brain conditions affecting children and young adults.
“One of the things that makes the U unique is the community of colleagues who are motivated to work together on autism,” she says. “Having a place where you interact with people frequently, where you share resources, is essential to do the work.”
Finding light again
A painting by Uma Oswald represents hope after a dark time. (Image: courtesy of Uma Oswald)
Uma Oswald’s art has always stood out.
“My mom still has my very first drawing from when I was 3,” Oswald says. “I drew a family portrait. She always brags about how good it is.”
She kept drawing — and impressing. Then, somewhere along the line, Oswald’s drawings of colorful shapes and patterns turned dark. Very dark.
Her family was deeply concerned, though Oswald herself didn’t view her art as disturbing or scary. “I would paint from my emotions. That’s just how I felt inside,” she recalls. “To me, that was normal.”
Yet Oswald knew something wasn’t right with her brain. She suffered from depression, anxiety, and paranoid thoughts. But not until her freshman year of college, after three visits to the emergency room in a month, was Oswald diagnosed with schizoaffective disorder. A relative of schizophrenia, it is characterized primarily by hallucinations or delusions, combined with symptoms of a mood disorder such as mania or depression.
The diagnosis was difficult to hear but also a relief: it meant that she would get the right therapy and medications to help her deal with it.
“It’s hard to find the balance of getting people to understand that it’s a serious mental illness,” Oswald says, “but also understand that I can manage it.”
And those feelings can be isolating. Oswald joined a U of M pilot study, led by the Medical School Department of Psychiatry’s Aimee Murray, Psy.D., and Sophia Vinogradov, M.D., that connected people who have schizophrenia and like illnesses through social media platforms and gave them a safe space to talk about what’s going on in their lives.
“I felt less alone,” Oswald says. “There were other people in the same realm of disability. We all had our different backgrounds, but we could still relate to each other.”
Today Oswald, 23, attends the School of the Art Institute of Chicago on scholarship, has an internship, and works a part-time job as a notetaker for students who have disabilities. She’s thinking about going to graduate school and hopes to become an independent video game developer one day. She hasn’t painted for a while.
“Now they’re hard for me to look at,” she says of the dark paintings from her teen years, “not because I recognize them as disturbing, but because I equate them with that time period, when I was having a hard time.”
Stressed from the very start
After a scary start to life, Beau Buehner is now a thriving kindergartner. (Photos: courtesy of Emiley Buehner)
Beau Buehner entered the world at 10 pounds 13 ounces and full of fluid, the result of a rare condition called congenital chylothorax. Lymphatic fluid was building up between his lungs and chest wall, impeding his ability to breathe.
“He turned purple on us,” says his mom, Emiley Buehner. “We didn’t know what our future was going to hold.”
After seven days on extracorporeal membrane oxygenation in the neonatal intensive care unit (NICU) at M Health Fairview University of Minnesota Masonic Children’s Hospital, and with three chest tubes to drain fluid from each side of his body, Beau weighed in at 7 pounds 2 ounces.
“The first time he was stable enough for me to hold him, he was 13 days old,” Emiley Buehner says. “It was one of the best moments of my life. His blood pressure went down, his heart rate went down — he just relaxed. We both needed that.”
As he got stronger, the NICU staff encouraged Emiley to take part in more “kangaroo care”; the skin-to-skin contact supports babies’ brain development and reduces stress.
Stress negatively affects physical health, even in very young children. It has detrimental effects on the developing brain and immune system, says Maria Kroupina, Ph.D., an expert in early childhood mental health and director of the children’s hospital’s Birth to Three Program, which supports pediatric patients and their families who are at high risk of toxic stress, including those facing long hospitalizations or chronic health issues.
“Stress can be a normal part of life,” Kroupina says. “When we talk about toxic stress for a young child, it’s prolonged and severe. Stress can be tolerable if something is really painful but the parents are still there. But it can be toxic if the child is going through the experience alone, if parents are not available or if they are so distressed that they cannot provide help.”
Beau spent three months in the NICU, with his mom by his side, before he was able to go home to the family ranch near Killdeer, North Dakota. Chylothorax is no longer a problem for the kindergartner, who recently was diagnosed with an auditory processing disorder but is learning to read and do math alongside his peers.
“He’s such a sweet boy,” Emiley says. “I’m forever grateful to the hospital for keeping Beau with us.”
Getting ready to learn
Educators and child development experts increasingly understand that a child’s executive function skills — such as impulse control, sustained focus, and flexible problem-solving — are better predictors of kindergarten readiness and academic success than IQ is.
“Kids with these foundational skills do better in school,” says Philip Zelazo, Ph.D., Nancy M. and John E. Lindahl Professor in the U’s College of Education and Human Development. “But too many kids are coming to school without them.”
Philip Zelazo, Ph.D., and Stephanie Carlson, Ph.D., observe a child using their app aimed at assessing executive function. (Photo: Jayme Halbritter)
Zelazo and his research partner, Distinguished McKnight University Professor Stephanie Carlson, Ph.D., aim to close the opportunity gap by finding better ways (including a recently patented app) to assess executive function and help at-risk children. They are making progress in understanding the brain circuitry behind it all, too.
Their research shows that it’s possible to improve executive function after 20-minute sessions in which children practice pausing, reflecting on a problem, and talking through it using rules. They found changes in brain function as well: children who had gone through the training also showed a more mature pattern of brain activation.
Zelazo and Carlson now have developed a classroom curriculum that helps young children practice mindfulness through exercises such as focused breathing.
“This helps children understand the difference between being active and being calm,” says Zelazo, “which can help them learn to relax, control their emotions and behavior, and improve their focus on tasks.”
Fighting the effects of fetal alcohol exposure
Macie Kappauf loves Barbies. Loves them. And she has to have them.
“Those fingers are pretty sticky,” Sherry Kappauf says of 7-year-old Macie. “It’s not so much premeditated, but it’s the mentality of ‘I saw it. I like it. It must be mine.’”
Self-regulation is one of the challenges Macie faces, likely due to prenatal alcohol exposure. Sherry and Jeff Kappauf are parents to 13 children, nine of whom they adopted. Six of the couple’s adopted children have been diagnosed with fetal alcohol spectrum disorders (FASD), including Macie.
So when the Kappaufs heard about a U study that aims to help improve memory and executive function (like planning, organizing, and, yes, self-regulating) in children affected by FASD, they were quick to sign on.
“Once upon a time, I wanted to be a scientist, to help find cures for diseases. I wound up being a mom, and they just let me in on that science portion,” Sherry Kappauf says with a laugh.
Macie Kappauf took part in a study to evaluate whether the nutrient choline can improve memory and attention in kids who have fetal alcohol spectrum disorders. Results so far suggest that it can. (Photo: courtesy of Jeff and Sherry Kappauf)
U researchers believe that supplementing the nutrient choline at a sensitive time during a child’s brain development could confer lifelong benefits.
“What we’re hoping is that, by affecting these attention and memory systems early on, it allows these children then to do everything from that point forward just a little bit better,” says Jeffrey Wozniak, Ph.D., a Medical School psychiatry professor and coprincipal investigator on the study. “All of development is additive, meaning that early interventions can be quite powerful in the long run.”
The U team observed small but significant changes, most notably in the 2- to 3-year-old participants: The choline recipients showed higher nonverbal intelligence, better working memory, fewer behavioral symptoms, and better attention than their peers who did not get it. A four-year follow-up study showed more separation between the choline group and the placebo group.
“That’s exactly what we would expect to see with developmental change,” Wozniak says. “It should result in a widening of the gap.”