After completing my clinical training, it was clear for me that patients suffering from devastating injuries will transitioned into a process involving family and societal support coupled by rehabilitation efforts. However, I realized current technology was not covering much of these needs, particularly in the area of neurological rehabilitation. Hence my interest to learn and be trained in neuromodulation techniques applied for recovery and restoration. When I came to the Neuromodulation Center my training began with the understanding of how energy (e.g. electrical, magnetic, ultrasound) can change brain activity, but more important I learned the rigor of clinical research methodology. Since then, I have been involved in the production of research supporting the use and applications of different noninvasive techniques for brain stimulation. My doctoral dissertation was developed in the Neuromodulation Center at Spaulding, I described the parameters of stimulation needed to efficiently modulate brain activity using a relatively new technique. After this accomplishment and due to my exposure to the neuromodulation community, I began teaching and training professionals from all over the world, I am active in presenting workshops and seminars in international meetings, and I have been invited to be member of expert panels for scientific societies. Currently, I am responsible for teaching and training new fellows from the neuromodulation lab.

While developing myself in the neurmodulation field, a growing interest in self-modulation attracted me to the research in the placebo effect, I was accepted in the Integrative Medicine research fellowship from HMS and Beth Israel. As a result, a completely new venue for research appeared in front of me. My Mentor, Professor Ted Kaptchuk introduced me to the understanding of placebo as a tool to improve health care and clinical research. Thanks to my background as clinician and neuroscientist I was able to develop a clinical trial in pediatric epilepsy and guided self-neuromodulation (this type of trial is challenging as kids need to learn how to self-modulate brain activity). The results of this research showed differences between objective outcomes from neurophysiology, and the powerful placebo effect in subjective measurements. This research was submitted for revision to a high impact journal, currently waiting for the response. I learned placebo can facilitate clinical outcomes, and how placebo can also improve the patient-physician relationship, now I want to keep exploring the placebo effect for pain control in the hospital environment. After a difficult period of back-and-forth with the IRB, I was able to launch a trial exploring the effects of placebo for pain control in spinal cord Injury. This is a feasibility trial and I am learning the difficulties involved for in-hospital research, the understanding of these issues is motivating me to develop a model for clinical research that can be implemented in such difficult environments. It is my goal to create a research program involving clinicians from the spinal cord injury unit, with the objective to translate this model into other units within Spaulding Hospital.

I was able to obtain some state-of-the-art equipment for my research, these include a high-density portable EEG/ERP system and a functional near-infrared spectroscopy unit (fNIRS), I am planning to use these technologies for in-hospital recordings of neurophysiology and cognitive-behavioral outcomes. The purpose of this is to obtain a realistic picture of patients neurocognitive functioning, as opposed to the type of recordings acquired in artificially-controlled conditions from the research laboratory. My goal is to capture some of the mechanisms behind the placebo effect, by approximating the reality of the clinical encounter and by getting point-of-care measurements. With the help and support from the Discovery Center on Chronic Pain Recovery I want to collect pilot data for successful grant applications. I have the honest desire to continue developing my career at SRH and to improve the understanding of placebo effect as a valuable tool in rehabilitation medicine.

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