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Benjamin Ramger

School: Duke University
Major: Neuroscience/Physical Therapy

My name is Ben Ramger, and I am a current senior at Duke University. I intend to graduate this May with a degree in Neuroscience and a minor in German. I was born and raised in Cary, North Carolina, where I attended Cary Academy for middle and high school. I have one younger brother, who is currently finishing his freshman year at North Carolina State University, and two wonderful, loving parents. Coming to Duke allowed me to explore many of my academic interests, but ultimately I ended up pursuing what I had felt was the most intriguing of fields: Neuroscience. To me, the brain is something so complex and sophisticated, yet so elegant, and the fact that every human perceives, understands, and remembers in a different way is truly fascinating. Outside of academics, I love staying active, and have been involved with club baseball as well as intramural basketball, football, and soccer. I have also worked in neuroscience research my four years at Duke, have tutored students studying German, and have been involved in numerous other student-led organizations from my dormitory’s House Council to the Duke Pre-Physical Therapy Association. This fall I will be enrolling in the Duke Doctor of Physical Therapy program, and I am excited to continue my path towards becoming a physical therapist. I hope to be able to conduct research in the future, and I will be interested to see what the future holds for the field of physical therapy.

Essay: Transcranial Magnetic Stimulation

I have been fortunate enough to experience or learn about some amazing pieces of technology for clinical research and therapeutic use in my four years at Duke, but one that I have found particularly fascinating and impactful is transcranial magnetic stimulation, or TMS. The idea behind TMS is that the induction of a magnetic field will cause neurons within outer regions of the brain to fire within a specific region of interest. TMS has been used for many years as a means of treating depression, but in recent years, it has been discovered that TMS can also be used to help stroke victims recover motor function. TMS also has many other potential applications, such as a way for patients following surgery or limb transplant/replant to recover motor function more quickly and more effectively. The possibilities for this relatively new technology brings a lot of optimism for physical therapists and patients alike, and I expect to see it utilized more in future years within physical therapy.
TMS has been around since the 1970’s, and has seen continuously increasing application since then. The tool that creates the stimulation is a hand-held device which houses two electric coils that are slightly angled toward each other. When the two coils have electricity flowing through them, they create an electric field, and as with all electric fields, a magnetic field is created that runs perpendicular to the original electric field. When the TMS device is held to the skull at an exact 90-degree angle to the region of interest within the brain, the magnetic field is able to travel through the skull into the brain. The induced magnetic field creates an electric current within the brain, altering the polarization of surrounding neurons. This change in polarization ultimately causes neurons to depolarize and action potentials to occur, which “activates” these neurons. This device essentially stimulates and activates specific regions of the brain, such as the motor cortex, to enhance recovery and stability of motor function. To pair this type of technique with other rehabilitative techniques following surgery, injury, or debilitating ailment can make the rehabilitation process more efficient and effective, allowing patients to get back to their normal lives more quickly. When delivered at low frequencies (about 5 Hz is all that is required to create the required activation for most treatment uses), TMS is harmless for both children and adults. Neuromodulation is becoming popular within clinical research circles given its efficacy and non-invasiveness, and recent research shows a promising future for making a big difference in the lives of disabled children and adults.
In recent years, researchers have begun to look into the use of TMS for post-stroke motor rehabilitation acceleration. Studies have found that following a stroke, the balance in interhemispheric processes is disrupted. In order to rebalance the cortical dynamics of the hemispheres, different frequencies of repetitive TMS (rTMS) can be applied to increase activity within the affected hemisphere while reducing activity and excitability in the opposite hemisphere1. Recent discoveries have shown that this technique can be effective for reducing pathological hyperactivity and improving motor rehabilitation in stroke patients2. There is also the idea that TMS can be used in engendering faster motor recovery following injury, brain disease, or even transplant, through a method known as paired associative stimulation (PAS)3,4. By stimulating the specific region of the somatosensory motor cortex associated with the affected area (i.e. hand or foot) using TMS while simultaneously electrically stimulating the transplanted or replanted hand or foot, the nervous system is able to more quickly reconnect signals between the brain and the hand or foot (which essentially induces Hebbian learning, or the concept of “fire together, wire together” where motor and sensory neurons for the same area fire at the same time and enhance connectivity). This would allow for potentially faster and more effective recovery following injury or surgery and could help patients reach a higher level of performance than ever before. TMS could possibly become a very popular method for treating concussions to decrease the severity of motor function degradation later in life, or for other degenerative diseases that subsequently affect motor function or control.
The ceiling is high for TMS, and the excitement over its potential is gaining momentum. I truly believe that given how safe and effective it is, TMS could become a staple of enhancing the lives of disabled children and adults. To be able to get back to a higher level of motor function more quickly and to have better over motor control following TMS would ensure patients a higher quality of life. Although TMS as it is now is expensive, running at about $500 per session, in the future I believe it can be an accessible and useful tool for rehabilitation and enhancement of motor function for patients of all ages. There is still much research to be done regarding how permanent its effects might be and how exactly it might be utilized on a patient-by-patient basis, but the future is bright for TMS.