Reaching for meaningful mind-body connections

ASU biomedical engineering research team explores new physical assessment task that helps predict cognitive decline

November 25, 2020

Just as our brains develop as we grow up, they can also decline as we age. Understanding how older adults’ brains change is important to help improve quality of life and advance interventions for people dealing with dementia.

Along with measuring memory, processing speed and attention, scientists can also use physical strength and activity tests to reveal more about the inner workings of an aging brain. Assistant Professor Sydney Schaefer works in the Motor Rehabilitation and Learning Lab. Sydney Schaefer, an Arizona State University assistant professor of biomedical engineering, conducts research on the aging brain and its connection to physical rehabilitative practices in the Motor Rehabilitation and Learning Lab. Schaefer and her research team recently developed a new functional reaching task that can better indicate cognitive ability in older adults and can even predict future decline. Photo by Erika Gronek/ASU Download Full Image

“Physical assessments may offer additional insight into brain function that cognitive assessments only partially reveal, so long as the physical assessment is designed accordingly,” said Sydney Schaefer, an assistant professor of biomedical engineering in the Ira A. Fulton Schools of Engineering at Arizona State University.

For example, arm and hand coordination is sensitive to cognitive aging, so observing a decrease in that coordination could indicate an oncoming decrease in cognitive function. However, incorrectly designed physical assessments could decrease confidence in these methods to identify dementia or Alzheimer’s disease risk, especially in early stages.

Questioning what we think we know

The existing literature of observational studies reports a statistically significant association between cognitive assessment performance and how firmly an older adult can physically grasp things, or their grip strength. There’s even a catchy phrase for it: “People who grip better, think better.”

Grip strength tests are conducted using a dynamometer, a device that converts the hand’s muscular strength into a measurement of force.

People with lower grip strength, after accounting for sex-based strength differences, tend to have lower cognitive assessment scores. But Schaefer says there’s a catch.

“This relationship ‘paved the way’ for the working hypothesis that motor and cognitive processes share functional and structural brain networks, and suggests that studying these collectively can give us insights into overall brain health,” Schaefer said. “However, our analyses in our recent paper in the International Journal of Geriatric Psychiatry show that even though the relationship is statistically significant, it is not necessarily functionally or clinically meaningful.”

Schaefer’s research team, including Andrew Hooyman, a biomedical engineering postdoctoral scholar, and others outside of ASU, analyzed publicly available open-source data sets to really put grip strength’s vigor to the test.

They found that the full range of possible grip strength scores would predict only a very narrow range of possible cognitive scores.

Hooyman was surprised at grip strength’s lack of clinical meaningfulness to predict cognitive abilities.

“Prior to our paper, there have been close to 20 different peer-reviewed articles reporting the significance of grip strength to predict cognition,” said Hooyman, who performed data analysis and simulations. “The primary aim of this paper is to demonstrate that although grip strength has been shown to be statistically significant, the overall relationship may not be meaningful, and as researchers we need to be mindful of that distinction.”

Schaefer and her team also conducted a more rigorous data analysis than previous studies conducted to investigate grip strength's association with cognition. Along with the data science approach to looking at the open-source data, the team’s multimodal approach included data simulations in the statistical programming language R and their own experimental data.

“Usually, most studies only use one or maybe two of these approaches at best,” Schaefer said. “The advantage of this multimodal approach is that it better evaluates the rigor and reproducibility of the findings and minimizes the likelihood that our results are spurious or unreplicable — in other words, not a fluke.”

Schaefer hadn’t previously worked on a project with this amount of data simulation, but having Hooyman on the team was instrumental to their success.

“Dr. Hooyman’s expertise has really allowed us to increase the rigor of our analyses to include more multimodal approaches like simulations,” Schaefer said. “He has really added a lot of new directions to our lab.”

Developing a new solution for real-world applications

Part of their findings in Schaefer’s Motor Rehabilitation and Learning Lab included developing a new method to assess cognition called a functional reaching task, which Schaefer says is “as simple and easy to administer as grip strength, costs less and has a stronger relationship with cognition.”

The functional reaching task developed by Schaefer’s lab involves a person using a spoon to scoop raw beans from one small cup to one of three target cups arranged in a semicircle around the starting cup. The person is timed using a simple stopwatch to see how long it takes to scoop and distribute 30 beans, two at a time, evenly among the three target cups.

Two photos depicting a person scooping beans out of one of four cups and depositing them in another of the four cups.

A depiction of the functional reaching task developed by Sydney Schaefer’s Motor Rehabilitation and Learning Lab. The participant scoops up raw beans with a spoon and moves them to one of three target cups. This image is adapted from “Dexterity and Reaching Motor Tasks” by Motor Rehabilitation and Learning Laboratory, which is licensed under CC BY 2.0.

“There’s nothing fancy about what we’re doing, which makes it incredibly scalable,” Schaefer said, noting it does not exhibit sex-based differences or involve wearable sensors or video capture technology as is the case in other assessments.

These are key features that make this assessment implementable now at a low cost and with minimal training. Schaefer and her team have begun testing how well people can administer this assessment on themselves at home, which means making it user-friendly is imperative.

Studying the motor behavior of reaching isn’t new, Schaefer said. It’s been around for nearly a century to help scientists understand how the brain controls movement, but not in such a functional way that reflects how humans move in daily life.

“The overwhelming majority of studies utilize a very constrained version of reaching in which the person is allowed to reach in only two dimensions, such as along a tabletop without lifting their arm off of it, and without having to grasp or manipulate objects,” Schaefer said.

While a two-dimensional reaching test can say a lot about neural control of limb movements, Schaefer said it doesn’t translate well to day-to-day life.

“So we have spent the last few years adapting this well-oiled paradigm into something that better reflects functional movement, and by doing so within older adult cohorts, we have stumbled upon its value in studying cognitive-motor interactions and aging.”

Encouraging scientists to consider a new approach

Schaefer’s team is validating this proof-of-concept assessment, but so far it has shown robust correlation to the three main cognition categories used by scientists: cognitively intact, mild cognitive impairment and early dementia.

It’s also a good example of why scientists should challenge themselves to consider whether the statistical significance of grip strength is also meaningful in clinical and real-world settings, and to incorporate multimodal and data science approaches to improve scientific rigor and reproducibility. It was the fact that Schaefer’s research team couldn’t replicate previous grip strength findings but they could replicate functional reaching results that sparked their analysis.

More importantly, functional reaching tasks show the ability to predict which adults will decline over time, whereas grip strength cannot do so. These findings were published in the Journal of Alzheimer’s Disease.

“Measuring grip strength at a single point in time really hasn’t shown this prognostic ability, whereas our task has,” Schaefer said. “Thus, it appears that our task has value in providing a ‘sneak peek’ into a person’s future cognitive or functional state.”

Working with a multidisciplinary team helped Schaefer’s team determine the functional reaching task’s translatability outside the lab.

Michael Malek-Ahmadi, a Banner Alzheimer’s Institute biostatistician, helped Schaefer and Hooyman by lending his expertise in working with large data sets and his knowledge about cognitive assessment based on his training in Alzheimer’s disease and related dementias.

Elizabeth Fauth, an associate professor at Utah State University and longtime collaborator with Schaefer’s lab, contributed expertise on gerontology (the study of old age) and population data and assisted the team in data analysis and interpretation.

“(Fauth’s) work focuses on declines in activities of daily living in older adults, which really helped us tackle the ‘so what?’ of our findings,” Schaefer said.

Schaefer’s team will continue to look at what the functional reaching task can tell the scientific community about aging brains and what mind-body connections are at play. Data science approaches like the ones she and her team are using are particularly timely during the pandemic when in-person data collection is severely limited.

“The clear relationship between our motor task and cognition opens the door to a number of other questions within rehabilitation, such as whether cognitive impairment interferes with motor rehabilitation, or whether cognitive training enhances motor function,” Schaefer said. “These are very relevant clinical questions, since it is well known that both cognitive and motor function decline with advancing age.”

Monique Clement

Lead communications specialist, Ira A. Fulton Schools of Engineering


PhD linguist, athlete goes from undocumented to unstoppable

November 25, 2020

Editor's note: This story is part of a series of profiles of notable fall 2020 graduates.

Cristian Lopez Villegas has achieved rare success in martial arts and in academia. But his journey was far from easy. Graduating ASU doctoral student Cristian Lopez Villegas stands outside a martial arts studio. / Photo by Josh Morris. Cristian Lopez Villegas, ASU doctoral graduate and martial arts enthusiast. Photo by Josh Morris. Download Full Image

A Brazilian jiujitsu enthusiast, Lopez Villegas went from feeling lost and failing most of his high school classes to winning on the mat and in the classroom. Through it all, Lopez Villegas focused on finding the good – in himself and others.

This fall, Lopez Villegas graduates with a PhD in linguistics and applied linguistics from Arizona State University. The doctoral journey can be arduous, pushing students to their mental capacities. In these times, Lopez Villegas turned to the disciplines learned through martial arts. One of the biggest helps was “that mental toughness of getting used to feeling overwhelmed,” Lopez Villegas told an interviewer for the Department of English’s newsletter in 2016. “You learn to keep your mind calm and your thoughts positive.”

So, did he ever think he would get here? Absolutely.

“I calibrated my compass toward the peak of Mount Linguistics – the doctorate – and never looked back,” he said. “As of a few days ago, I now stand upon this peak, up which I have been slowly trekking over half of my life. I am incredibly grateful to life for allowing me to reach this point.”

That perspective – one of gratitude – defines Lopez Villegas’s outlook. He has worked hard for what he has earned and in no way feels entitled. In fact, he is continually looking for a way to give back. As an athlete, he patiently mentored others in sport. As a language teacher, he applies lessons from martial arts to language arts. And he has found another cause to champion: animal well-being.

“Over the past 15 years, my life partner and I have devoted our lives and resources to helping abandoned and vulnerable animals,” he said. “Through volunteering with the Humane Society and various other organizations, we were able to take in dozens upon dozens of furry four-legged friends, provide them with love, restore them to health, and place them into loving homes.”

And, he added, “Many of the ‘unadoptable’ ones became permanent members of our family.”

Lopez Villegas won’t be hitting the job market after graduation; he’s already gainfully employed. He currently teaches English composition and ESL full-time at South Mountain Community College. We can expect that to be his “day job,” as Lopez Villegas is already preparing to reenter the world of athletics. “With a great vantage point, and invaluable tools and techniques acquired at Arizona State University, I will be planning and strategizing for my next journey,” he said.

Read on for more about how Lopez Villegas overcame adversity and reached his goals, one take-down at a time.

Cristian Lopez Villegas / South Mountain Community College profile photo

Cristian Lopez Villegas, South Mountain Community College profile photo

Question: What was your “aha” moment, when you realized you wanted to study in your field?

Answer: My “aha” moment was more like a series of micromoments of realization that occurred during a period of a few years. These brief moments of realization were profoundly impactful to me because they represented such a stark contrast to my overall life experience.

I am now slightly embarrassed to admit this, but growing up I was definitely not one of the “smart kids.” I was not even one of the “mediocre kids.” I was on the opposite end of the spectrum. Things had started off well in kindergarten and elementary school but as I entered junior high, my ability to succeed in the classroom was becoming more dismal by the semester. Upon reaching my junior year of high school, I was officially removed from the normal high school experience and placed in a program called “Opportunities.”

I wanted to be a good student. I only pretended that I didn’t care as a coping mechanism. I struggled with being able to concentrate on academic things. I had failed basically every single class, every semester. However, there were two classes in which I had straight As: P.E. and French. Somehow, while the smartest kids in the grade (a couple of which were in my French class) were yanking out the hairs of their heads trying to understand French grammar, I was like, “Excuse moi, puis je vous aider?” This unexplainable success in French was such a contrast to everything else, that I made a mental note of it.

A short period after that, I was slowly catching back up on credits, working independently and going to my high school once a week to check in, turn in projects, and pick up new books. During that time, I had been attending a youth organization and a mentor named Tim Benbow took me under his wing and exposed me to classic world literature, theology, philosophy, history, etc. He was, at the time, studying Greek and when I expressed some interest, he began making copies of his materials and giving them to me. Once again, as with French, somehow Greek kind of made sense to me and I soon found myself helping him understanding some of the Greek conjugations. To me, they seemed just like the Spanish my family and I spoke at home. That was my second mini “aha” moment where I made a mental note that I really liked studying language.

A couple of years later, I had managed to finish high school after doing an extra year. I was doing my general education at the local community college, when I stumbled onto a Spanish grammar class for Spanish speakers. Once again, spending a lot of hours thinking about words was greatly enjoyable. At this moment, those very difficult questions that haunt many young college students, “What will I be? What will I major in?” were answered: I would pursue a major in Spanish.

Upon transferring to the university to pursue my upper division curriculum, serendipity placed me in the classroom of Dr. Ronald Harmon, professor of Spanish and Portuguese linguistics. From the first day of my first semester, with linguistics courses – in this case, Spanish phonetics and phonology and Spanish syntax and morphology – I knew what I wanted to spend the rest of my life doing: studying human language from a scientific perspective.

Q: What’s something you learned while at ASU — in the classroom or otherwise — that surprised you, that changed your perspective?

A: I truly believe that Arizona State University is a beacon of light to all universities around the world for one simple reason. As stated by our university president, “ASU prides itself not on whom it excludes, but on whom it includes.” This perspective is so contrary to what most universities pursue. I am humbled and honored to have been part of such a revolutionary and daring university. 

Q: Why did you choose ASU?

A: I was in my junior year of college. The previous summer, I had participated in a study abroad program in the beautiful country of Brazil. While living there, I had met a special girl with whom I had established a strong friendship and connection. Over the course of the subsequent academic year, we remained in touch and I had been able to return to Brazil between semesters. After a year of a long-distance relationship, we decided to find a way to be close to each other.

Her brothers had been, prior to us meeting each other, living in Mesa, Arizona, through a high school foreign exchange program. They were now college students in the state and so the possibility of me transferring to an Arizona university came up. A few weeks later, my brother, a couple of friends, and I were driving through the California-Arizona desert. We visited Arizona State University and I immediately felt that this would be my new home. I remember seeing Hayden Library and being so impacted by its uniqueness. Then one hot summer day a few months later, I packed my car, and made the official move to the place I now call my home.

Q: Which professor taught you the most important lesson while at ASU?

A: I am one among the many students who have been greatly and positively impacted by (Regents Professor) Elly van Gelderen in the linguistics program. Professor van Gelderen is a world-recognized scholar in the fields of syntax and historical linguistics. She has published books and articles in the most prestigious publications and journals. And yet, it is her simplicity, humility, openness, positivity and kindness that attracts people to her the most. Observing her taught me that the secret to academic, professional and personal growth is to harbor and maintain childlike curiosity and excitement towards life and to the pursuit of understanding.

Q: What’s the best piece of advice you’d give to those still in school?

A: The advice that I now give my own students is the following:

1. For the bachelor’s, pursue a double major. One of the majors should be your passion regardless of whether it will lead you to a direct job. The other major should be something that you can enjoy and that leads to a direct, well-paying, stable and nonvulnerable career immediately upon graduation. My experience living through two recessions taught me the importance of having options, and of the importance of balancing one’s true passions with that which will provide you security.

2. View the academic experience as something that you will continue to develop throughout your entire life. Be an eternal student. Commit to continuously enhancing your education through additional degrees, certificates, licenses, etc. Always be willing to move on from where you are or have been, to change majors, change careers, change paths.

3. Don’t be in a rush. The time will come when you will finish your degree. Don’t be so focused on the end result that you are not fully present in your current stage. Be at peace with and enjoy whatever life stage you are in.

Q: What was your favorite spot for power studying?

A: At this moment in my life, I have been a full-time student at Arizona State University for 12 years. Naturally inclined towards adventure and exploration, I can assert pretty confidently that I have perhaps taken academic refuge in every tiny nook and cranny that the ASU Tempe campus offers. From the libraries, to random unused classrooms in various buildings, to the recreation center, to little hidden corners of the ASU Art Museum, the music halls… you name it. However, the spot that ultimately became most special to me, because it represented much of my final years here, is the little-known Graduate Student Computer Lab, a slightly hidden, password protected, dusty room on the third floor of the Durham Language and Literature building.

Q: What are your plans after graduation?

A: Over the last almost two decades, my goal and dream had been to finish the PhD. Now that this dream has become a reality, I am entering a new stage in life where I will need to re-imagine and recalculate my interests, goals and life purposes. There are a few areas of my life that had been put on the backburner. Now that the universe has blessed me with this PhD dream, I would like to place these other goals at the forefront. One of them is my life as an athlete and competitor in the sports of Brazilian jiujitsu and judo.

In the years prior to returning to ASU for the PhD, I spent five years as a full-time athlete, competitor and coach. My claim to fame was in 2008 when I won the bronze medal at the Brazilian Jiujitsu World Championship, the minor-professional league of that sport. After that achievement, I entered the major-professional league and had the opportunity to compete against many of the top world champions. However, life circumstances and my greater dream to finish the PhD led me to step away from full-time dedication to the sport. I now plan on returning and attempting to reach the dreams that I still have in this sport.

Q: If someone gave you $40 million to solve one problem on our planet, what would you tackle?

A: As a former undocumented immigrant, I grew up very aware of the financial, psychological and societal struggles that immigrants, ethnic minorities and other vulnerable groups experience throughout their lives. This unique experience made me highly aware and highly sensitive to the suffering and the injustices in the world. I have long fantasized about what I would do if came upon financial resources. Two main projects have been on my mind.

The first is the creation of a chain of “Centers for the Arts” established in low-income communities across the U.S. and the world. This Center for the Arts would be a place that provided professional level training in music, sports, languages, academics and trades. They would be free of charge and highly integrated with the public schools and local organizations. Children and teens from disadvantaged backgrounds would be taken in as apprentices to professionals and acquire ways of thinking and skills to open opportunities for upward mobility and self-realization.

Another cause that has been heavy on my heart is the plight of animals across the many facets of human civilization — food industry, labor, entertainment industry, clothing industry, science experimentation, animal testing, etc. I believe that one day in the future, humans will look back at our current and past societies and cringe in horror at the treatment we imposed on our most vulnerable fellow Earthlings. 

My desire is to contribute to the reconceptualization of our relationship and interaction with these fellow beings in order to help liberate them from human enslavement and abuse.

Kristen LaRue-Sandler

Manager, marketing + communications, Department of English