About the TBIMS Centers
The Traumatic Brain Injury Model System (TBIMS) program was created and funded by the National Institute on Disability and Rehabilitation Research (NIDRR) in 1987 to demonstrate the benefits of a coordinated system of neurotrauma and rehabilitation care and conduct innovative research on all aspects of care for those who sustain traumatic brain injuries. Each Center systematically collects important data about each individual who meets criteria for inclusion in the TBI National Database and sends this information to the TBI National Data Center at KMRREC. The Centers are currently located at 16 sites throughout the United States that provide comprehensive systems of brain injury care to individuals who sustain a traumatic brain injury, from acute care through community re-entry. The mission of the TBIMS is to improve the lives of persons who experience traumatic brain injury, their families and communities by creating and disseminating new knowledge about the course, treatment and outcomes relating to their condition.University of Alabama
Birmingham, AL
Website: http://www.uab.edu/tbi
Project Director: Thomas Novack, Ph.D.
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The University of Alabama at Birmingham (UAB) Traumatic Brain Injury Care System operates within the Department of Physical Medicine and Rehabilitation at UAB Spain Rehabilitation Center. Two research projects are in progress: Problem-Solving for Caregivers of Persons with Traumatic Brain Injury is a randomized clinical trial designed to determine the effectiveness of problem-solving training for family caregivers of persons with traumatize brain injury (TBI). The project will determine how caregivers' problem solving abilities affect their duties and their health, and the adjustment of care recipients. It also will evaluate the effectiveness of problem-solving training. Timothy Elliott, PhD, is the investigator. : Sertraline to Decrease the Incidence and Severity of Depression During the First Year of Recovery after Traumatic Brain Injury is a double-blind, randomized placebo-controlled drug trial. The two objectives are to: a) determine the efficacy of treating or preventing major organic depression following traumatic brain injury (TBI) with sertraline; and b) evaluate and monitor the effect of sertraline on TBI recovery. Our long-term goal is to improve the standard of care for patients with TBI by improving the recognition and treatment of major depression after TBI. Jay Meythaler MD, JD and Tom Novack, PhD are the investigators. Our dissemination/utilization goal is to ensure that our target audience has access to TBI information generated by ongoing and prior research projects. Formats used include: 1) Internet web sites (www.uab.edu/tbi); 2) Fax information system, 3) Email distribution, 4) : TBI Inform information sheets, 5) a TBI newsletter, 6) Conferences, training and educational events (Professional and Consumers/families) and 7) an interactive CD and an evaluation program for materials developed during our prior grant.
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Santa Clara Valley Medical Center
San Jose, CA
Website: http://www.tbi-sci.org
Project Director: Jeffrey Englander, M.D.
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Individuals with TBI are a major portion of the clientele at SCVMC, a level 1 trauma center. Since 1976, SCVMC has provided categorical care in a Brain Injury program for inpatients and outpatients and was first an RSA, then a NIDRR-designated Model System for TBI since the inception of those programs. Based on input from individuals with TBI in our community, this grant's focus is on the "Health and Function" priority. Two studies are designed to better characterize the type and impact of fatigue post-TBI: 1) a cross-sectional study of individuals up to 15 years post-injury; 2) a longitudinal study focusing on the evolution of fatigue over the first 2 years post-injury. Both studies will assess fatigue levels and possible contributing factors - depression/affective disorders, sleep disturbance, activity, and neuroendocrine function. Two additional studies will characterize the impact of late posttraumatic seizures (LPTS) post-TBI. These studies will match subjects on demographic, severity of injury, and psychosocial characteristics and will: 1) utilize the TBIMS National Database to compare functional, vocational, and medical complication outcomes of those with and without LPTS; 2) in collaboration with Denver Health Medical Center, interview participants from a previously funded NIDRR grant on seizure risk identification to further evaluate barriers to the environment, transportation, and challenges in control of their seizures. Dissemination efforts will build on our already active Center for Outcome Measurements in Brain Injury (http://www.tbims.org/combi) in collaboration from at least 15 other centers. Additional dissemination will occur via other Internet resources; local, national, and international presentations; newsletters; and peer-reviewed publications.
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Craig Hospital
Englewood, CO
Website: http://www.craighospital.org
Project Director: Gale G. Whiteneck, Ph.D.
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The Rocky Mountain Regional Brain Injury System (RMRBIS) includes two Level I trauma centers with specialized acute neurotrauma care facilities (St. Anthony Hospital and Swedish Medical Center) and the rehabilitation and lifetime follow-up services of Craig Hospital. A research agenda is planned to address the federal priority with three projects: Project 1 - Modafinil for the Treatment of Fatigue and Excessive Daytime Sleepiness in Individuals with TBI - will determine if the medication Modafinil will reduce fatigue and sleepiness and improve cognitive function and quality of life in individuals with TBI using a randomized, double-blind, placebo-controlled crossover study design; Project 2 - Social Communication Skills Training for Individuals with TBI - will evaluate the efficacy of a specific, replicable treatment approach to address social communication and pragmatic skills in a group format for individuals with TBI using a randomized, deferred treatment control group study design. Project 3 - Outcomes and Environmental Factors in the Decades Following TBI - will evaluate long-term trends in TBI outcomes and environmental factors in an effort to better understand the process of living and aging with TBI using a cross-sectional survey study design. An ambitious dissemination plan complementing the three research studies will produce 12 consumer brochures, 10 newsletters, 8 national presentations, 4 scientific manuscripts, two courses for consumers and service providers, a training manual, a user workbook, and a comprehensive interactive website. Finally, the RMRBIS is committed to continue its exemplary contribution to the TBI Model Systems database.
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Spaulding Rehabilitation Hospital
Boston, MA
Website: http://www.spauldingrehab.org
Project Director: Mel Glenn, M.D.
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The Spaulding/Partners Traumatic Brain Injury Model System (TBIMS) at Harvard Medical School is a partnership among Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School. Also included are Community Rehab Care, Massachusetts Mentor, the Commonwealth of Massachusetts Statewide Head Injury Program, and the North Andover Specialty Care Center. In addition to participating in the collection of acute care, rehabilitation, and follow-up data as part of the TBIMS National Database, the Spaulding/Partners TBIMS is conducting a study that will take an important step toward the development of functional neuroimaging as a tool that may guide cognitive rehabilitation for individuals with TBI. Using functional magnetic resonance imaging (fMRI), the study consists of cross-sectional and longitudinal components: (1) In the cross-sectional component, regional brain activation during memorization of word lists is assessed, under spontaneous and trained/cued categorization strategy conditions. Activation of prefrontal cerebral cortical regions known to support the use of such a strategy will be compared in subjects with TBI and non-TBI controls;(2)In the longitudinal component, the ability of the fMRI findings to predict outcome among people with TBI who participate in a community integration program with a cognitive rehabilitation focus is being determined using regression analyses. The Spaulding/Partners TBIMS publishes research findings in professional journals and presents relevant papers and posters at local, regional, national, and international professional and/or consumer-oriented meetings. It also publishes an annual newsletter.
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Rehabilitation Institute of Michigan
Detroit, MI
Website: http://www.semtbis.org
Project Director: Robin Hanks, Ph.D.
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In the current grant cycle, the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS) addresses the research area "Full Access to Community Life". These projects also touch upon other priorities such as employment of persons with disabilities and use of technology. Three studies address enhancement of quality of life and community integration of TBI survivors and their family members. These projects propose to: 1) evaluate the efficacy of a peer-mentoring intervention, 2) investigate the dynamic system of survivor and significant other subjective well- being, and 3) examine the barriers to resumption of driving, fitness to drive, and community integration. The first study is a randomized controlled trial of a peer-mentoring program for both survivors and their caregivers. The second project involves 250 adults with TBI and their caregivers/significant others, exploring the relationship of survivor-caregiver situations with survivor distress and family dysfunction. Whether or not social support acts as a moderating influence upon the well-being of persons with TBI will also be examined. The third study examines correlates of driving after TBI: barriers, fitness to drive, and community integration. In addition to these studies, the SEMTBIS also continues to participate in clinical and systems analysis studies of the TBIMS by collecting and contributing data for submission to the TBIMS national data base. Participatory action is a central component of project implementation, evaluation, and dissemination. Dissemination activities continue to be a high priority for the SEMTBIS. These efforts include consumer newsletters, websites, publications, and presentations to students, consumers, and professionals.
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Mayo Medical Center
Rochester, MN
Website: http://mayoresearch.mayo.edu/mayo/research/tbims
Project Director: James F. Malec, Ph.D.
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During the current five year funding cycle, the Mayo Clinic TBI Model System (TBIMS) will continue to contribute to the TBI Model Systems National Data Base, conduct collaborative studies with other TBI Model Centers, and complete three local research studies. The three local research projects focus on: (1) Decision-making and outcomes related to inpatient and outpatient rehabilitation pathways; (2) Very long term (5-15+ years post-injury) process and outcomes for people with TBI identified through the Rochester Epidemiology Project; and (3) Telehealth-based (Internet) cognitive rehabilitation. In addition to professional publications and presentations, dissemination efforts will include the Mayo Clinic TBIMS web-site, the TBI Hotline, the newsletter (The Messenger), contributions to the COMBI web site and COMBI and TBIMS newsletters, and regular participation by Mayo Clinic TBIMS staff at all annual state BIA meetings in our extended 5-state geographical region. We are developing an Advocacy Training Program to help people with TBI and family and significant others in our region learn self-advocacy skills. To maintain continuous quality improvement and assess the regional impact of the Mayo TBIMS, feedback mechanisms are incorporated in many of these dissemination mechanisms, such as e-mail feedback from the Mayo TBIMS web site and feedback obtained through the Advocacy Training Program. People with TBI and their significant are involved at every level of the Mayo Clinic TBIMS-as staff, as advisors through the Mayo TBI Regional Advisory Council, through longstanding relationships with the BIA's in the five state region surrounding Mayo and through informal relationships with the people we serve.
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Methodist Rehabilitation Center
Jackson, MS
Website: http://www.methodistonline.org/
Project Director: Mark Sherer, Ph.D., ABPP
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The TBI Model System of Mississippi (TBIMSM) is a collaborative project of Methodist Rehabilitation Center (MRC) and the University of Mississippi Medical Center (UMC). Projects of the TBIMSM address the goals of the National Institute on Disability and Rehabilitation Research Long-Range Plan and the New Freedom Initiative. The TBIMSM will collect data on persons with TBI for submission to the TBI Model Systems National Database and conduct 3 local research projects. One research project will be a randomized, double-blind, placebo-controlled, (parallel-group) trial of a medication used to treat patients in the post-traumatic confusional state (PCS). Our clinical trial will provide important new guidance to clinicians treating these patients. A second research project will develop and conduct a trial of an intervention to improve the therapeutic alliances between persons with TBI and family members and post-acute brain injury rehabilitation (PABIR) programs. Therapeutic alliance is a major factor in outcome from treatment in PABIR programs. Our third research project will investigate the use of transcranial magnetic stimulation to improve characterization of motor disorders after TBI. This improved patient characterization which will lead to a trial of a new intervention to improve motor function after TBI. The TBIMSM will disseminate research findings to local and national consumers. Local dissemination projects will include: (1) a newsletter, (2) support groups, (3) the internet, (4) and workshops for persons with TBI, family, healthcare professionals and other. National dissemination projects will include: (1) presentation of findings at professional meetings, and (2) publication of findings in scholarly journals. The other project is online pharmacy without a prescription which provides Lasix online and there you can even buy diflucan with fast delivery.
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JFK Johnson Rehabilitation Institute
Edison, NJ
Website: http://www.njrehab.org
Project Director: Keith D. Cicerone, Ph.D.
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The New Jersey Traumatic Brain Injury Model System at JFK-Johnson Rehabilitation Institute addresses the spectrum of severity and needs of persons with TBI. The New Jersey TBI Model System resides within a statewide system of trauma care that is one of the most extensive and coherent in the nation. Two Level I trauma centers in central and northern New Jersey and two Level II Trauma Centers in southern and western New Jersey participate in the TBI Model System. Programs for brain injury rehabilitation at JFK-JRI include a 24 bed acute Brain Trauma Unit that includes coma assessment and intervention, a 45 bed Extended Recovery Unit for persons requiring prolonged in-patient treatment, a Transitional Living program to facilitate community-re-entry, and comprehensive postacute rehabilitation including a specialized Cognitive Rehabilitation program. The TBI Model System at JFK-JRI will conduct three research projects that reflect our commitment to meeting the needs of the individual at all levels of severity and recovery. One project investigates the relationship between neurobehavioral functioning and fMRI cerebral activation in persons with minimally conscious state (MCS), and the contribution of fMRI to the prediction of neurobehavioral and functional recovery one year after injury. The second project is a randomized controlled trial of holistic-comprehensive cognitive rehabilitation compared with conventional rehabilitation. This study, and our third qualitative research study, will also investigate factors that contribute to subjective well-being and quality of life after TBI rehabilitation. Dissemination and community outreach activities of the New Jersey TBI Model System will be conducted through collaboration with the state Department of Disability, the Division of Vocational Rehabilitation, and the New Jersey Brain Injury Association.
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Mount Sinai School of Medicine
New York, NY
Website: http://www.mssm.edu/nytbims
Project Director: Wayne A. Gordon, Ph.D.
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The New York Traumatic Brain Injury Model System (NYTBIMS) of the Department of Rehabilitation Medicine at Mount Sinai Medical Center (MSMC) in New York City (NYC) is a comprehensive program of care that meets the diverse needs of individuals with traumatic brain injury (TBI). There are three components in this system: (1) comprehensive clinical care, (2) research, and (3) dissemination, education and training. A unique aspect of the NYTBIMS is the involvement of individuals with TBI in all aspects of the program and its close relationship with the Research and Training Center on the Community Integration of Individuals with TBI. The clinical program consists of: a) the NYC Emergency Medical Service, which extricates individuals from their injury site to the Level I trauma center at Elmhurst Hospital Center, b) acute neurological services at Elmhurst or Mount Sinai and c) inpatient rehabilitation services at either Mount Sinai Hospital or Elmhurst. Subsequent outpatient rehabilitation services and long-term follow-up are provided at both institutions as well. The research program is designed to advance our current understanding of TBI to improve rehabilitation outcomes. Local research projects involving two prominent disabling conditions of TBI, depression and fatigue will be conducted. Through a variety of educational programs, dissemination, education and training will be provided for individuals with TBI, their families and health professionals. This includes the development of a public policy newsletter, our own consumer reports, publication of a patient/family newsletter and expansion of our website. In addition, the NYTBIMS will sponsor local, regional and national education/training programs.
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Carolinas Rehabilitation
Charlotte, NC
Website: http://www.carolinashealthcare.org
Project Director: Flora Hammond, M.D.
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The Carolinas Traumatic Brain Injury Rehabilitation and Research System (CTBIRRS) is a comprehensive service delivery and research system of Carolinas Rehabilitation serving individuals with newly acquired traumatic brain injury (TBI). For the research activities of this project, a comprehensive, rigorous approach is used to study post-traumatic irritability. In this approach to understanding irritability, we investigate the relationship to the caregiver as a component of the environment; the response to amantadine hydrochloride; and the nature of the problem as experienced by those in the community. The first study on caregiver environment assesses the relationship of post-traumatic irritability in individuals with TBI to caregiver, coping, mood, global health, life satisfaction, caregiver burden, social support, spirituality, family environment, and marital satisfaction. The amantadine study is a randomized, controlled trial to determine the role of amatadine on decreasing the severity, frequency, and caregiver distress of irritability. The third project applies Participatory Action Research methodology in a rigorous approach to engage individuals with TBI and their family members in helping to define and decipher the complex problem of irritability as they experience it. The research studies were developed with input from the TBI community, with continued community involvement along the course of the project through implementation to dissemination.
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Ohio State University
Columbus, OH
Website: http://www.ohiovalley.org
Project Director: John D. Corrigan, Ph.D.
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The Ohio Regional Traumatic Brain Injury Model System, located in the Department of Physical Medicine and Rehabilitation at Ohio State University, has been a TBI Model System since 1997. The program operates under the umbrella of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation, which provides consumer participation via its 30-member Advisory Council. Composed primarily of consumers from a multi-state region, the Advisory Council prioritizes needs, reviews funding opportunities, participates in implementation, monitors progress and evaluates program outcomes. The Ohio model system will conduct two local research projects addressing NIDRR's "Maintaining Health and Function" priority. Both projects concern substance abuse and persons with TBI. Study 1 is a randomized clinical trial testing interventions to promote retention in substance abuse treatment. This study employs intervention strategies found effective for clients with TBI when first engaging with a treatment program. Study 2 is a test of the validity of an instrument to objectively document the extent of a person's prior history of TBI. This instrument is intended for research on TBI as a mediating factor in substance abuse treatment. The Ohio Regional TBI Model System serves 2.4 million people in a 25-county area covering central and southern Ohio. All three Level I trauma centers in Central Ohio, and one of two Level II centers, are participants in the Ohio Regional TBI Model System. Brain injury rehabilitation is provided in a 24-bed, CARF-accredited, specialized Brain Injury Unit in the OSU Department of Physical Medicine and Rehabilitation. The center has developed innovative community integration programs, including: Team Brain Injury (follow-up case management), the TBI Network (substance abuse treatment), and Community Capacity Building (education and advocacy, operated in conjunction with the Brain Injury Association of Ohio).
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Moss Rehabilitation Research Institute
Philadelphia, PA
Website: http://www.einstein.edu/
Project Director: Tessa Hart, Ph.D.
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The Moss Traumatic Brain Injury Model System (TBIMS), directed by Tessa Hart, PhD and John Whyte, MD, PhD at the Moss Rehabilitation Research Institute (MRRI), leads an extensive collaborative network to provide comprehensive clinical TBI care; conduct research on outcomes and treatment of TBI; and develop educational products and programs for both professionals and consumers. In the Philadelphia/Southern New Jersey region, seven Trauma Centers and two nationally renowned rehabilitation facilities (MossRehab and Magee Rehabilitation) are partners in the clinical component of the Moss TBIMS, which includes lifelong care and innovative community-based programming. The research component of the Moss TBIMS includes participation in collaborative database projects as well as newly funded projects in key areas of successful previous research: (1) the use of assistive technology for cognitive and behavioral disabilities; (2) validation of an observational rating scale of attention dysfunction in TBI with multiple methods, including a psychostimulant treatment trial; and (3) exploring ways to improve the clinical- and cost-effectiveness of botulinum toxin for treating severe spasticity. Each of these projects includes a phase specially designed to evaluate the impact of the outcomes of the research on its intended consumers. The Moss TBIMS' dissemination programs, including three conferences, benefit from active collaborations among the Moss TBIMS and area rehabilitation facilities as well as consumer groups, notably the Brain Injury Association of Pennsylvania. The Moss TBIMS emphasizes consumer involvement via advisory participation in clinical program improvement, research design, and education/ outreach activities.
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University of Pittsburgh
Pittsburgh, PA
Website: http://www.upmc.edu
Project Director: Ross D. Zafonte, D.O.
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The University of Pittsburgh Medical Center (UPMC) is responsible for documenting clinical and rehabilitation experiences of traumatic brain injured patients who receive care at UPMC's Presbyterian Hospital and Rehabilitation Hospital. This database provides a rich resource for research studies to find novel approaches for cost effective care and services for individuals with TBI. Specific research projects include: (1) Robotics with stroke and TBI - Loss of motor control can impact the functional capacity and the sense of well-being of a person with a brain injury. Robot-assisted rehabilitation has been shown to enhance arm movement recovery and regain functional skills. Robotic assisted rehabilitation while utilizing the difference between perceived and true ability examines the unique advantage in understanding performance.; (2) Virtual case manager - Traumatic brain injury creates enduring cognitive and motor deficits for the survivor. When the family assumes the primary caregiver role, substantial economic, emotional, and social costs are overwhelming. The Virtual Case Manager (VCM) is a guide to resources such as healthcare and community services, and a framework to have their questions answered. (3) Personal powered mobility - Personal powered mobility is recognized as a component in successful rehabilitation. Driving an electric powered wheelchair (EPW) functionally and unsupervised is a determinant for employability, social access and self-esteem. One must have the motor skills to operate a standard movement-sensing joysticks (MSJ). This study is to develop and test a EPW control system which combines a force-sensing joystick and a head position monitor (HPM) that can be customized to address each individual's motor and perceptual deficits.
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North Texas Traumatic Brain Injury Model System
Dallas, TX
Website: http://www.utsouthwestern.edu
Project Director: Ramon Diaz-Arrastia, M.D., Ph.D.
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The North Texas Traumatic Brain Injury Model System (NT-TBIMS) is a collaboration between the two largest hospital systems in North Texas, the University of Texas Southwestern Medical Center (UTSW) and Baylor University Medical Center (BUMC). These two institutions account for over 80% of TBI admissions in North Texas, and have a commitment to excellence in research and clinical management of TBI. Approximately 100 patients each year will be enrolled in the TBI Model Systems National Database. Additionally, the NT-TBIMS proposes to conduct two research projects aimed at obtaining basic information about TBI which will be useful for developing novel therapies: (1) Genetic study. Outcome after TBI is difficult to predict based on factors such as severity of injury, age, or the occurrence of acute complications. This study aims to determine whether genetic factors influence recovery after TBI. DNA will be collected from patients enrolled in the NT TBIMS, and using allelic association analysis we will determine whether inheritance of polymorphic alleles of certain candidate genes is associated with unfavorable outcome; (2) fMRI study. We will test the hypothesis that fMRI is useful in elucidating the neural substrates and compensatory mechanisms underlying the cognitive impairment in TBI. Our specific aims are to identify the dysfunctional neural circuitry serving variety cognitive domains after TBI and to assess the correlation between brain activation patterns and temporal course of recovery. The NT-TBIMS will further provide for patient and family education and dissemination of research findings to the professional community by conducting seminars, presenting the results at professional meetings, and publishing in professional and lay journals devoted to TBI.
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Website: http://www.baylorhealth.com/Locations/bir.htm Project Director: Mary C. Carlile, MD
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Virginia Commonwealth University/Medical College of Virginia
Richmond, VA
Website: http://www.neuro.pmr.vcu.edu
Project Director: Jeffrey Kreutzer, Ph.D.
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The Virginia Commonwealth University (VCU) Traumatic Brain Injury Model System (TBIMS) has been an active collaborator in the brain injury model systems program since 1987. Since program inception, VCU has: extended the system of care; developed new partnerships with service providers and advocacy organizations; improved outcome measurement techniques, and explored the development of innovative interventions. Consumer involvement, community based rehabilitation, relevance, and active dissemination to consumer and professional audiences have been cornerstones of program development and implementation. During the next five years, VCU will continue to develop and provide educational programs about brain injury to survivors, family members, and professionals. Information booklets, e-mail list servers, workshops, and conference presentations are some of the methods used for dissemination of research findings and clinical care information. Completing scientifically relevant research is an important mission of the VCU TBIMS program and work is underway to carry out a series of studies. Depression will be the focus of two studies. First, we will work to establish reliable and valid diagnostic criteria. Second, we will evaluate the efficacy of two pharmacological interventions. Family support and research programs have long been a part of VCU's programs. We have developed a structured family support and education program. The program will be evaluated via standardized measures during the next five years. Another research project will evaluate the efficacy of a neurobehavioral intervention program implemented during the course of acute rehabilitation.
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University of Washington
Seattle, WA
Website: http://depts.washington.edu/rehab/tbi
Project Director: Kathy Bell, M.D.
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The University of Washington TBI Model System provides a comprehensive, integrated continuum of services to persons with acute and chronic TBI to a five-state area through its facilities at Harborview Medical Center and the University of Washington Medical Center. Three research proposals were included in the 2002 Model System proposal. The first project, The Effect of Community-Based Exercise on Symptoms of Depression in Persons with TBI, is a randomized, controlled trial to demonstrate the effects of aerobic exercise on depressive symptoms and community participation in persons with mild to moderate traumatic brain injury (PI: Kathleen Bell, MD). The second study, Understanding the Participant's Intervention Needs in Traumatic Brain Injury Vocational Rehabilitation, will document the risk of unemployment following TBI as compared to the general population and the natural history of job stability following TBI and will describe the demands of jobs held and how they relate to the abilities of individual injured (PI: Sureyya Dikmen, PhD). The final project, A Change in the Payment Environment: Evaluation of Medicare's Prospective Payment System on Access to Inpatient Rehabilitation for Patients with Traumatic Brain Injury, will investigate how the Medicare Prospective Payment System (PPS) for inpatient rehabilitation has altered care for patients with Traumatic Brain Injury (PI: Jeanne Hoffman, PhD). Dissemination efforts for this grant cycle will include an electronic newsletter, expansion of our website, a TBI Community Workshop, and presentations and papers in professional venues.
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