Faculty
Albert Lo
, MD, PHD, CPH
Asst Professor of Neurology:
BIO MED NEUROLOGY
Phone: +1 401 273 7100
Albert_Lo@brown.edu
Read Albert Lo's full Faculty Research Profile.
Research Interests
• Stroke rehabilitation Phase II/III Clinical Trials in Robotic Neurorehabilitation
• Multiple Sclerosis Clinical Pilot Studies Robotic Neurorehabilitation
• Neuroprotection in Multiple Sclerosis and animal models
• Investigations in Multiple Sclerosis Clinical Epidemiology
• Rhode Island Multiple Sclerosis Study (RIMMS)
• Mild traumatic brain injury: impact on attention, cognition and motor control
Biography
Albert C. Lo, M.D., Ph.D. is an Assistant Professor in the Departments of Clinical Neurosciences, Engineering, and Neuroscience of Brown University and is a Staff Neurologist at the Providence VA Medical Center. He is board certified by the American Board of Psychiatry and Neurology. Dr. Lo received his B.A. degree in Biochemistry from the University of California at Berkeley. He then received a C.P.H. degree from Harvard University and subsequently earned his M.D. and Ph.D. degree in neuroscience from the Wake Forest University School of Medicine in North Carolina. Dr. Lo completed his internship and neurology residency at Yale. From 2001 until 2007, Dr. Lo was on the faculty at the Yale School of Medicine in the Department of Neurology, and was director of the Multiple Sclerosis Clinic and Neurorehabilitation Research Laboratory at VA Connecticut Healthcare System West Haven. Dr. Lo serves on the VA Spinal Cord Injury Scientific Review Board, the Brown Biomedical Engineering Executive Advisory Council and Medical School Admission Committee, the VA Multiple Sclerosis Center of Excellence Research Advisory Panel, the American Academy of Neurology Author Panel for Practice Parameter Guidelines and the Executive Steering Committee of the Mandell MS Center in Hartford, Connecticut. He has authored 23 manuscripts and 4 book chapters. In 2004, Dr. Lo received the Presidential Early Career Award for Scientists and Engineers from the White House Office of Science and Technology Policy.
Interests
Stroke rehabilitation Clinical Trials Phase II/III in Robotic Neurorehabilitation
[Upper extremity with MIT-Manus system]
Robotic-assisted rehabilitation is a promising intervention for reversing upper extremity impairment in chronic stroke. Stroke is the leading cause of disability for older Americans. Much of this disability can be traced to the lasting neurological impairments in stroke survivors, particularly when the functional deficits affect the arm and hand. Currently there are no definite rehabilitative therapies for chronic stroke patients. Accordingly, there is a strong clinical impetus to develop interventions to restore neurological function, including during the chronic period of stroke recovery. Innovations in clinical robotic technology in conjunction with advances in the understanding of the potential for neurological recovery in the chronic stages of stroke now make it possible to test a promising new therapy using task-specific, robot-assisted neurorehabilitation for the upper-limb in chronic stroke patients. Preliminary studies have examined over 250 stroke patients using earlier version of the MIT-manus robot.
I am the principal investigator for a $4.8 mil phase II/III multi-centered clinical trial funded by the Veteran's Administration (Clinical Science Program and Rehabilitation Research and Development Services) to test the most advanced MIT-manus system (modules which include training of the shoulder, elbow, wrist and hand) in chronic stroke patients with moderate to severe upper-limb impairment. The trial was initiated in November of 2006. The 4 sites include VA Medical Centers in Baltimore MD, Gainesville FL, and Seattle WA, and West Haven CT. The study plans to enroll approximately 160 subjects over 3 years. As of July 2008, over a 100 stroke subjects have participated. This randomized-controlled trial for stroke rehabilitation using robotics has received various regional and national media coverage.
Multiple Sclerosis Clinical Pilot Studies Robotic Neurorehabilitation
[Lower extremity with Lokomat]
Ongoing walking impairment is a clinical problem and important source of disability for people with MS. MS patients even at the earliest stages of disease have observable gait problems, and over the lifetime of the disease, the majority of MS patients will progressively decline in their gait function. Robot-assisted rehabilitative devices are a promising technology for improving impairment in the lower extremity. We have completed studies on over 20 patients with MS using the Lokomat (a robot drive lower extremity orthotic) or the Ankle-bot (a device developed at MIT by Hermano Igo Krebs that assists with ankle flexion-extension and supination-pronation). These studies have systematically characterized gait abnormalities, as well as changes in strength, quality of life, fatigue and disability in MS following robot-assisted interventions.
Neuroprotection in Multiple Sclerosis and animal models
It is becoming increasingly clear that Multiple Sclerosis pathology involves significant neurodegeneration, and it is the neurodegeneration that most contributes to the ongoing disability in MS. We have conducted a number of preclinical studies for neuroprotection using experimental allergic encephalomyelitis (EAE), an animal model of MS, while at Yale University in the Laboratory of Dr. Stephen Waxman. In this model we have developed a well-calibrated and reproducible model of axon loss with the optic nerve and spinal cord tracts. We have been able to show robust axonal neuroprotection in EAE animals using sodium channel blocking agents. In addition there was improvement of spinal cord electrophysiological conduction and clinical paralysis compared to untreated EAE. The majority of the current FDA-approved agents for the treatment of Multiple Sclerosis act on immunomodulatory pathways. We have ongoing interest in conducting a clinical trial for neuroprotection in MS.
Investigations in Multiple Sclerosis Clinical Epidemiology
Multiple sclerosis is a heterogeneous chronic disease, which neither the course of the disease or a patient's response to therapy is predictable. As a result treatment patterns for MS can vary considerably. A systematic assessment aimed at understanding the current state of MS healthcare is critical to determining treatment patterns, including gaps in care and can potentially provide useful information to improve the regional and national healthcare delivery for people with MS. One approach that I have been pursing is to assess MS care using the North American Research Committee on Multiple Sclerosis (NARCOMS) Database to examine the delivery and pattern of MS healthcare. The NARCOMS patient registry is the largest and most comprehensive registry of MS patients in the world with over 24,000 active participants, and we have initiated a series of studies to further investigate the current state of MS epidemiology using this database, with a particular emphasis on veteran care.
in development
Rhode Island Multiple Sclerosis Study (RIMMS)
As an initial study of the Brown University Genebank initiative and in collaboration with Dr. Stephen Buka (Professor of Epidemiology), we have initiated a prospective, community-based longitudinal study of Multiple sclerosis in the state of Rhode Island.
Much of the understanding of multiple sclerosis (MS) epidemiology and clinical course has been derived from cohort studies collected outside the United States or from short-term pharmaceutical clinical trials. These sources of information may have inherent biases that limit their usefulness to typical patients in the community. A population-based study in the US that aims to combine rich epidemiologic and clinical data is critical to advancing both scientific understanding and providing accurate information to guide treatment. The RIMSS study proposes to establish a prospective population-based cohort study of multiple sclerosis (MS) in Rhode Island. Overall goals include enumerate and provide accurate data on incident and prevalent cases of MS and clinically isolated syndrome and collect demographic and diagnostic data from medical records.
Evolving phases of the study will include baseline assessments on a random stratified sample of approximately 400 new incident and prevalent cases of MS and CIS to approximate the longitudinal course of these conditions using a balanced and informative cross-sectional design. In doing so, we will be able to describe the prevalence of physical disability, cognitive disability, symptomatic areas, and magnetic imaging changes by disease subtypes (relapsing-remitting MS, secondary progressive MS, primary progressive MS, CIS) and duration of disease, and treatment with disease modifying agents. Finally, we will initiate the longitudinal assessments of the 400 subjects with comprehensive baseline assessments. This phase will also enroll and follow the unaffected siblings to examine the development of MS or other autoimmune disorders. The scope of multidisciplinary study provides an opportunity to build a unique national MS cohort based in Rhode Island to clearly capture critical information in order to better understand the clinical and epidemiological sciences MS.
Mild traumatic brain injury: impact on attention, cognition and motor control
Investigators: Stephen Correia, Leigh Hochberg, Albert Lo, Stephen Mernoff, Michael Worden.
There is currently no brief, reliable, valid, and easily administered test to gauge attention and executive cognitive capabilities following mild traumatic brain injury (mTBI).
mTBI occurs frequently in sports and in combat environments and is associated with declines in attention, mental processing speed, reaction time, and executive functions, that are important in sports and crucial in combat situations where detection and reaction to threatening vs. non-threatening targets is vital. To date, no objective measure has been widely adopted to predict safe and efficacious resumption of play or combat duty. The current gold standard for assessing cognitive functioning following mTBI is neuropsychological testing, which can take up to three hours to administer and have uncertain validity for predicting successful return action. We plan to develop a brief, reliable, valid, and easily administered computerized assessment of attention, cognition and motor reaction.