Associate Professor of Physical Medicine and Rehabilitation
University of Kentucky
A. Personal Statement: My 23 years of experience as a clinician and researcher have afforded a diversity of knowledge relevant to translational science. As current director of a neurorehabilitation research program at the University of Kentucky, I have assembled an outstanding team of collaborators. Our main aim is to explore and refine pharmacological and non-pharmacological interventions to be applied in the clinical setting. A pillar of this work is the study of novel neuromodulatory interventions to promote motor recovery for neurological populations with severe motor deficit. In researching neuroplastic mechanisms underlying motor recovery, I have developed extensive knowledge of cutting-edge technologies and techniques such as neuronavigation, transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), peripheral nerve stimulation (PNS) and, transcutaneous direct current stimulation.
I have served as the Cardinal Hill Endowed Scholar of Stroke and Spinal Cord Injury since 2008. My background in leading large research teams includes serving as clinical rehabilitation team leader of an international consortium called the Walk Again Project. One of the many groundbreaking aims of this project included training several young adults with chronic spinal cord injury to use a brain-computer interface that enabled them to stand up and kick the opening ball of the 2014 Soccer World Cup Competition. I have also served as co-investigator on the EXCITE trial, which was the largest multicenter trial to date that examined effects of constraint-induced movement therapy in 222 patients after stroke. As my research program has enrolled over 250 stroke participants, I have specialized expertise in accounting for the interplay of factors unique to severe hemiparesis (eg, patterns of transcallosal inhibition; trajectories of neuroplastic change; spasticity management).
B. Positions and Honors
Positions and Employment
1992–1993 Resident in Physical Medicine and Rehabilitation Sao Paulo Rehabilitation Center (AACD),
Sao Paulo, Brazil
1999–2002 Clinical Fellow, Human Cortical Physiology Section, NINDS, NIH, Bethesda, MD
2002–2003 Assistant Instructor, Wake Forest University School of Medicine, Department of Neurology, Program for Rehabilitation, Winston-Salem, NC
2003–2004 Instructor, Wake Forest University School of Medicine, Department of Neurology Program for Rehabilitation, Winston-Salem, NC
2005–2008 Research Assistant Professor, Wake Forest University School of Medicine, Department of Neurology, Program for Rehabilitation, Winston-Salem, NC
2008–present Associate Professor, Cardinal Hill Endowed Research Scholar in Stroke and Spinal Cord Injury Neurorehabilitation, University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY
2008–present Faculty Associate, Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, Lexington, KY
2008–present Joint appointment Associate Professor, Department of Neurology, University of Kentucky, Lexington, KY
2017-present Vice Chair for Research, University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY
Other Experience and Professional Memberships
1991 Medical Licensure: Sao Paulo, Brazil
1994 Board Certification: Physical Medicine and Rehabilitation, Brazil
1990 Best Academic Subject Award (“Intracranial Tumors”), School of Medicine, University of Sao Paulo, Brazil
1993–1999 Research Scholarship, Ministry of Education, Japan
2000 Presidential Award, The American Society of Neurorehabilitation, “Facilitation of training-induced plasticity by D-Amphetamine in individuals unresponsive to motor training,” USA
2001 Best Clinical Fellow of Human Cortical Physiology Section, NINDS/ NIH, Bethesda, MD
2007 Research Excellence Award, Wake Forest University, Winston-Salem, NC
2009 ~2013 Wethington Award, University of Kentucky, Lexington, KY
2010 Department of Veterans Affairs Rehabilitation Research and Development Distinguished Service Award
2011 American Occupational Therapy Association Certificate of Appreciation
2011 UK Women’s Forum: Sarah Bennett Holmes Award Nominee
2015 Office of Undergraduate Research, University of Kentucky: Appreciation Award for Mentorship of Undergraduate Students
2015 Italian Ministry of Health Directorate-General for Research and Innovation in Healthcare: Certificate of Appreciation for Evaluation of Research Projects
2016 Award of Excellence, HealthSouth Cardinal Hill Rehabilitation Hospital
2017 US Department of Health and Human Services, Public Health Service, National Institutes of Health: Certificate of Appreciation. Acute Neural Injury and Epilepsy Section (2011-2017)
2017 University of Texas McGovern Medical School (TIRR), Department of Physical Medicine and Rehabilitation, Distinguished Lecturer
C. Contribution to Science
Neuroplasticity, task-oriented therapy and functional motor recovery: The concept that intense, repetitive practice of a specific functional task drives neuroplastic change has influenced modern concepts of stroke rehabilitation. I have thorough knowledge of spearheading human subjects research to advance basic science and clinical translation in this field. My strong scientific and clinical background qualifies me to lead a collaborative, multidisciplinary research team focused on maximizing function and participation after stroke.
a. Sawaki L, Butler A, Leng X, Wassenaar P, Mohammad Y, Blanton S, Sathian K, Nichols-Larsen D, Wolf S, Good D, and Wittenberg G. Constraint-induced movement therapy results in increased motor map area in subjects 3-9 months after stroke. Neurorehabil Neural Repair. 2008;22(5):505-513.
b. Wolf SL, Thompson PA, Winstein CJ, Miller JP, Blanton SR, Nichols-Larsen DS, Morris DM, Uswatte G, Taub E, Light KE, Sawaki L. The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy. Stroke. 2010;41(10):2309-2315.
c. Skubik-Peplaski C, Carrico C, Nichols L, Chelette KC, Sawaki L. Behavioral, neurophysiological and descriptive changes following occupation-based intervention. Am J Occup Ther. 2012; 66: e107-e113.
Participants with severe motor deficit. My research program is well equipped to conceive and implement strategies to optimize neuroplasticity-based interventions based on the interplay of factors unique to severe motor deficit. The majority of translational research in neurological patients has focused on mild to moderate motor impairment. The exclusion of severe motor deficit effectively sustains impairment, disability, lack of effective treatment, and marginalization for people with the greatest needs. My specific expertise is in the use of neuromodulatory interventions to promote motor recovery for neurological patients with severe motor deficit (ie, virtually no wrist and finger movements, or non-ambulatory).
a. Carrico C, Chelette II, KC, Westgate PM, Powell E, Nichols L, Fleischer A, Sawaki L. Nerve stimulation enhances task-oriented training in chronic, severe motor deficit after stroke: a randomized trial. Stroke. 2016 Jul;47(7):1879-84.
b. Carrico C, Westgate PM, Powell ES, Chelette KC, Nichols L, Pettigrew LC, Sawaki L. Nerve Stimulation Enhances Task-Oriented Training for Moderate-to-Severe Hemiparesis 3-12 Months After Stroke: A Randomized Trial. Am J Phys Med Rehabil. 2018 Nov;97(11):808-815.
c. Chelette K, Carrico C, Nichols L, Sawaki L. Long-term cortical reorganization following stroke in a single subject with severe motor impairment. NeuroRehabilitation. 2013;33:385-389.
d. Schildt CJ, Thomas SH, Powell ES, Sawaki L, Sunderam S. Closed-loop afferent electrical stimulation for recovery of hand function in individuals with motor incomplete spinal injury: early clinical results. Conf Proc IEEE Eng Med Biol Soc. 2016 Aug;2016:1552-1555.
Neuromodulatory techniques. Growing consensus indicates that coupling neuromodulation techniques with intensive motor therapy can optimize functional recovery. I have a history of researching neuromodulation (such as peripheral nerve stimulation (PNS) or transcranial direct current stimulation (tDCS) paired with intensive motor therapy to promote recovery for patients with neurological impairment. My overarching aim is to develop and optimize novel translational interventions that support participation in valued activities and community integration.
a. Sawaki L, Wu C, Kaelin-Lang A, Cohen LG. Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke. Stroke. 2006;37(1):246-247.
b. Carrico C, Chelette KC, Westgate PM, Salmon-Powell E, Nichols L, Sawaki L. Randomized trial of peripheral nerve stimulation to enhance modified constraint-induced therapy after stroke. Am J Phys Med Rehabil. 2016 June, 95(6), 397-406.
c. Chelette K, Carrico C, Nichols L, Salyers E, Sawaki L. Effects of electrode configurations in transcranial direct current stimulation after stroke. IEEE HEALTHCOM 2014 E-health in Neurosciences. 2014; 12-17.
d. Ward A, Carrico C, Powell E, Nichols L, Sawaki L. Enhancement of post-stroke neural plasticity with atomoxetine. Restor Neurol Neurosci. 2017;35(1):1-10.
Mechanisms underlying functional motor recovery: Further understanding of these mechanisms will enable the refinement of existing interventions as well as the development of new ones. My focus is to advance understanding of neuroplasticity as related to population-specific patterns of motor recovery in order to enable better tailoring of interventions to specific populations.
a. Sawaki L, Butler A, Leng X, Wassenaar PA, Mohammad Y, Blanton S, Sathian K, Nichols-Larsen DS, Wolf SL, Good DC, Wittenberg GF. Differential patterns of cortical reorganization following constraint-induced movement therapy during early and late period after stroke. NeuroRehabilitation. 2014 Jan 1;35(3):415-26.
b. Sawaki L, Wu C, Kaelin-Lang A, Cohen LG. Effects of somatosensory stimulation on use-dependent plasticity in chronic stroke. Stroke. 2006;37(1):246-247.
c. Wilson TW, Fleischer A, Archer D, Hayasaka S, Sawaki L. Oscillatory MEG motor activity reflects therapy-related plasticity in stroke patients. Neurorehabil Neural Repair. 2011;25(2):188-193.
Complete List of Published Work in MyBibliography: http://www.ncbi.nlm.nih.gov/sites/myncbi/lumy.sawaki.1/bibliography/40727507/public/?sort=date&direction=ascending
D. Research Support
Ongoing Research Support
StrokeNET 2U01NS086872~06 Feng & Schlaug (PIs) 08/15/18 – 07/31/21
Transcranial Direct Current Stimulation for Post-stroke Motor Recovery – a Phase II Study (TRANSPORT-II)
This is a phase II multi-center transcranial direct current stimulation (tDCS) dosing selection study to evaluate the efficacy, safety, tolerability and feasibility of 2 different tDCS doses and compared to sham tDCS.
NIH/NIA R01 AG061898 Van Eldik (PI) 09/01/18 – 08/31/21
First-in-human SAD & MAD trials for MW151, a novel Alzheimer’s disease drug candidate that attenuates proinflammatory cytokine dysregulation
This is a phase 1a single ascending dose and phase 1b multiple ascending dose clinical studies of a novel small molecule inhibitor of dysregulated neuroinflammation.
Role: Safety Monitor
1K01DA043652-01A1 Wesley (PI) 07/2018-06/20123
Neural Mechanisms of Cannabinoid-Impaired Decision Making in Emerging Adults
The proposed research will combine clinical pharmacology, brain stimulation, and neuroimaging to establish the neural mechanisms contributing to cannabinoid-impaired decision-making in emerging adults with cannabis use disorder
HealthSouth Rehabilitation Sawaki (PI) 09/18/17-08/17/19
Impact of Dynamic Body-weight Support (DBWS) on Inpatient Rehabilitation Outcomes Principal
The purpose of this research is to investigate whether dynamic bodyweight support (DBWS) during inpatient rehabilitation is associated with significantly more improvement on standardized tests of functional recovery than standard-of-care therapy in adults with neurological impairment.
Role in Project: PI
Recent Completed Research Support
1R21HD079747-01 Sunderam (PI) 07/08/15 – 12/30/18
A brain-machine interface to facilitate motor recovery from incomplete spinal cord injury
This project tests whether PNS in subjects with incomplete spinal cord injury can accelerate motor recovery when PNS is delivered in closed-loop (in response to subject’s volition). PNS is triggered by a brain-machine interface (BMI) that detects intent-to-move from suppression of the electroencephalogram (EEG) sensorimotor (“mu”) rhythm, which can occur with actual or imagined movement effort.
Alzheimer’s Association van Eldik (PI) 10/2016 - 09/2018
Phase 1b MAD Study of a Novel Drug (MW189) Targeting Neuroinflammation Effort
The investigational agent in this study is a CNS-penetrant, small molecule drug candidate (MW189),
that selectively suppresses overproduction of disease- and injury-induced glia PICs that are associated with
destructive glia inflammation/ neuron dysfunction cycles. This study is a phase 1b multiple ascending dose (MAD) trial with healthy human volunteers. Our hypothesis is that MW189 will exhibit attractive
safety and PK parameters in the phase 1b study that will enable a future phase 2a study in patients.
Role: Independent Safety Monitor
University of Kentucky Human Development Institute Sawaki (PI) 05/18/17-05/17/18
The Impact of Robot-Assisted Gait Training and Multidisciplinary Rehabilitation for Children with Cerebral Palsy
This project tests whether robot-assisted gait training will lead to more improvement in a variety of rehabilitation outcomes than a control condition (i.e., non robot-assisted gait training) for children with cerebral palsy who are admitted to pediatric outpatient therapy services at Cardinal Hill Rehabilitation Hospital.
Role in Project: PI
R01 NIH HD056002 Sawaki (PI) 07/01/08 – 06/30/14 Sensory-driven motor recovery in poorly recovered subacute stroke patients The major goal of this project is to evaluate the effectiveness of sustained PNS coupled with intensive task-oriented therapy to promote functional motor recovery in subacute stroke patients with severe motor deficits. Role: PI
NIDRR USED Grant H133G120086 Sawaki (PI) 10/01/12 – 09/31/15
Combining brain stimulation and peripheral nerve stimulation to improve upper extremity function after severe stroke
This project will determine whether the combination of tDCS and peripheral nerve stimulation (PNS) enhances post-stroke motor recovery when applied before intensive upper extremity motor training on a robot-assisted device (InMotion2). We will use TMS to measure cortical reorganization, as well as standardized tests of motor performance to measure upper extremity motor function, before and after intervention.
UK CCTS 2013 Pilot Research Program Sunderam (PI) 01/01/14–06/30/15
Development of a brain-machine interface to facilitate motor recovery from incomplete spinal cord injury
This project tests whether PNS in subjects with incomplete spinal cord injury can accelerate motor recovery when PNS is delivered in closed-loop.
UK CCTS 2013 Pilot Research Program Sawaki (PI) 08/08/13 – 06/30/15
Effects of transvertebral direct current stimulation in humans
This proposal investigated transvertebral direct current stimulation (tvDCS) to promote functional recovery and neuroplastic change in chronic spinal cord injury (SCI).
Eastern Kentucky University Sawaki (PI) 07/22/13 – 07/21/15
Comparing constraint-induced therapy and occupation-based intervention for optimal stroke recovery
The purpose of this study is to investigate motor performance change and neuroplastic change associated with either occupation-based intervention or modified constraint-induced therapy in chronic stroke.