The future of health care is interdisciplinary

Natalie Phillips
Professor, Department of Psychology

Associate Scientific Director, Canadian Consortium on Neurodegeneration in Aging

Neuropsychologist Natalie Phillips’ research explores the link between hearing and vision loss and cognition, to see how the changes play a role in the development of diseases like Alzheimer’s and dementia. Her work seeks to understand the complex relationship between our sensory and cognitive abilities.

Phillips comes from a large family in the Maritimes and was surrounded by aunts and uncles growing up. “I’ve always found older adults really interesting,” she says. “They have fascinating stories to tell. I was just generally interested in all the wisdom and experiences that they had.”

That interest led Phillips to study psychology and engage in research at the intersection of aging, cognition and brain function. What she hopes to achieve with her work is a sense of how older adults process speech and language as they age.

“As we get older, our hearing and vision decline and we tend to process information a little more slowly,” says Phillips.

“That can make it challenging for understanding speech. On the flipside, people have a lifetime of processing language, and have crystalized abilities when it comes to word knowledge and semantic relationships. I’m interested in how those two factors play out together in healthy older adults.”

Phillips’ team of researchers came together under the Canadian Consortium on Neurodegeneration in Aging, Canada’s largest research initiative for Alzheimer’s disease and other neurodegenerative disorders. The team includes an audiologist, an ENT surgeon, a vision rehabilitation specialist and a geriatric speechlanguage pathologist.

Having enough resources, in terms of funding, time and personnel, remains one of the biggest challenges. “We feel like we’re at the beginning of the process, so we recognize that it’s just going to take more work and effort,” says Phillips. “We have more questions than we have the resources to address, right now.”

One of the most groundbreaking moments of Phillips’ research career — other than the results that clearly indicate that older adults with poorer sensory function have more cognitive issues — has been coming up with one of the most widely used cognitive assessment tools, worldwide.

“In 2005, colleagues and I published a short cognitive screening test called the Montreal Cognitive Assessment (MoCA). We designed it as a tenminute cognitive screening test for mild cognitive impairment, which is considered to be a risk for developing Alzheimer’s disease,” she explains.

“That test is now used globally in over 40 languages; we did not expect that to happen! It’s been immensely gratifying, addressing a clinical need in that manner.”

Because there aren’t any proven pharmaceuticals that currently change the course of dementia and Alzheimer’s disease, Phillips is encouraged by the knowledge that there is good scientific evidence that lifestyle factors like managing hearing loss and cardiovascular disease, being physically fit, having a healthy diet and being socially engaged are important variables in lowering the risk for dementia.

Marta Kersten-Oertel
Assistant professor, Department of Computer Science and Software Engineering

Concordia University Research Chair in Applied Perception

Marta Kersten-Oertel’s research focuses on developing navigation tools to assist doctors in the operating room. The techniques developed in her lab are used to provide more intuitive depth and spatial perception of patient anatomy to better guide surgeons during invasive medical procedures.

What’s fascinating about her current field of research is how she got there, which was through an interest in the arts. “I ended up studying both art history and computer science,” she explains.

“I became interested in how art evolved, particularly from the Gothic period, when paintings were flat, to the Renaissance, where artists learned to use perspective cues to make 2D images look 3D. I was lucky enough to meet some great professors at Queen’s and apply these notions to medical images coming from, for example, MRI or CT scan.”

In the Applied Perception Lab at Concordia, Kersten-Oertel’s team is working on developing and testing novel visualization techniques (e.g. using augmented reality), new interaction methods and the application of novel display devices, (e.g. the Microsoft HoloLens) in the clinical and health domain. Their main goal is to be able to provide clinicians with new technologies to improve the way they’re able to diagnose, plan treatment and perform surgical interventions.

“We’ve been developing augmented reality tools for clinical tasks such as image-guided neurosurgery and breast reconstruction surgery,” she says.

“I think one of the things that stands out about how we do things is that we really try to get the stakeholders involved, work closely with clinicians and evaluate the technologies that we’re developing to ensure that they fit into clinical workflows, aid the surgeons in their tasks and ultimately improve patient care.”

Backed by a multidisciplinary approach that intersects psychology and human-computer interaction, and software engineering and the health sciences, the most challenging aspect of Kersten-Oertel’s work is ensuring that her team isn’t developing tools simply for novelty’s sake.

“This is sometimes difficult because it requires close communication and interaction with clinicians and it requires us to test systems in operating rooms,” says Kersten-Oertel, who’s also a member of Concordia’s PERFORM Centre. “As you can imagine, there are a lot of hurdles to this.”

Kersten-Oertel is thrilled when she’s able to move a technology developed in the lab to a place where clinicians can use them in practice. “It can be scary but when things work, or when clinicians get excited about what we’re doing, it’s so rewarding,” she says.

“In terms of our research, one interesting thing has been the fact that the gaming industry has pushed technologies that used to be so expensive to commercial products. This has really enabled us to explore virtual reality, augmented reality, gesture-based interfaces, eye-tracking and so much more in the lab, and look at how these technologies can help patients and the clinicians that care for them.”

Maryse Fortin
Assistant professor, Department of Health, Kinesiology and Applied Physiology

Research Member, PERFORM Centre

Maryse Fortin’s main area of research and clinical expertise is in musculoskeletal spine imaging and rehabilitation. Using advanced MRI technologies, she focuses on the role of the back’s muscles in the development and recurrence of low back pain as well as the different kinds of exercise that can be used to help prevent and treat it.

“Over the past decade, there’s been a lot of interest in the lumbar multifidus (LM) muscle and its role in low back pain. My research aims to clarify different aspects of the causal relationship between that pain and the LM muscle,” explains Fortin.

“I use different imaging techniques to investigate the morphology and the function of these muscles, and I also test different exercise programs. The overall goal is really to improve the treatment and management of low back pain, as well as other common spinal conditions.”

Fortin’s team’s approach is comprehensive and multidisciplinary; it includes examining different aspects of pain, including psychological factors such as a fear of movement.

My research is very interdisciplinary in nature because it combines imaging, rehabilitation, medicine and electrical engineering,” she says. “Working with engineers allows me to focus on standardizing some of the techniques that I use, and also automating them.”

Standardizing techniques worldwide is important because if everyone is using their own methods, it becomes difficult to compare studies and — most importantly — results.

“Using standardized and automated methods that we can share among researchers, like a code, helps everybody,” Fortin says.

“During my PhD, I developed an MRI technique that allowed me to quantify fat in spinal pathology that generated a lot of attention worldwide. With engineers, I was also able to develop a semi-automated way to get that same measure.”

On a global scale, Fortin believes that artificial intelligence and machine learning are powerful tools that will continue to play a key role in advancements in learning and research in medicine and health care.

Claudine Gauthier
Associate professor, Department of Physics

Michal and Renata Hornstein Chair in Cardiovascular Imaging, Montreal Heart Institute

Claudine Gauthier’s research explores how the brain is affected by cardiovascular disease through innovative techniques in MRI as a way to measure, and better understand, the complex causes of cardiovascular diseases as well as how to prevent and treat them.

“One of the problems that we have now is that we know what a lot of diseases look like — heart attacks, stroke, dementia — once irreversible damage has been done, not before. What I hope to achieve is the development of techniques that can be used to measure changes in the brain at the point where it’s already starting to change but not irreversibly,” explains Gauthier. “Right now, we don’t know what the brain looks like before damage happens, so we don’t have anything to target with preventative interventions.”

Gauthier’s team approaches cardiovascular disease by looking at brain-imaging markers that can be impacted by exercise and diet.

“What’s novel here is that what most people do is either look at markers that are easier to measure but might not be specific enough to be useful as real biomarkers [measurable indicators of the presence of a disease], or try to characterize the disease,” she says. “We’re trying to study this phase where people are still healthy but will develop disease later, to see if we can measure something useful that can be targeted by preventative interventions.”

A lot of what Gauthier’s physics department team does is extremely technical, with many other disciplines involved. “It’s in the realm of MR physics and bio-physical modeling; trying to have models of physiology that are quantitative and allow us to create biomarkers that are more specific.

“A lot of what we do is also physiology — trying to understand the underlying physiology of the process of aging, to see where we would have targets for biomarkers — and some of it is related more specifically to exercise physiology. Finally, there’s a lot of neuropsychology in there, because what we’re also targeting, more in the long-term, is cognitive health and aging.”

What makes her team’s work so challenging, though, is biology. “It’s always more complicated than you think it’s going to be,” says Gauthier. “Trying to understand, at a very fundamental level, not only all the physiological components that could be involved, but also all the physics of what you’re measuring.”

Making the team as multidisciplinary as possible helps achieve that, “so we can have more well-informed models that really take into account all of the disciplines that are required for this work.” Globally speaking, Gauthier is most excited by all of the new, genetic approaches in health research and the promise they may someday offer, including in the realm of optogenetics in brain imaging.