Relationship between Research and Clinical Care

Traumatic brain injury (TBI) is a major contributor to death and disability. According to the Centers for Disease Control (CDC), approximately 5.3 million Americans live with TBI-related disabilities, and the number of individuals with TBI seeking treatment is increasing as survival rates improve.¹

The Drucker Brain Injury Center at MossRehab, designated a Model System of care by the National Institute on Disability and Rehabilitation Research (NIDRR), stands at the forefront of leading research and clinical excellence for traumatic brain injury.

Directed by Tessa Hart, PhD and John Whyte, MD, PhD, Director of the Moss Rehabilitation Research Institute, MossRehab’s Traumatic Brain Injury Model System (TBIMS) offers a full continuum of clinical care ranging from emergency and acute trauma and neurosurgical care through inpatient rehabilitation and post-acute services. Drs. Hart and Whyte, M agree that a commitment to reintegrating people with traumatic brain injury into the community is crucial to the quality care at MossRehab TBIMS. Opportunities to participate in research add significantly to the high level of care.

“Patients who are admitted to MossRehab know they are being treated in a center of excellence for traumatic brain injury,” states Dr. Hart. “We lead the way, both clinically and in the research world. Our staff includes individuals who are nationally and internationally renowned in traumatic brain injury research and care.”

The TBI Model System at MossRehab gains from collaboration with the other TBI Model Systems nationwide. In addition, they are “in regular communication with leading brain injury centers around the country sharing information” according to Dr. Whyte.

Drs. Hart and Whyte stress the significance of integrating clinical research  and patient care in the management of traumatic brain injury. In addition to creating new knowledge, clinical research translates into better patient care because the participating institution is well positioned to manage complex medical problems. “Research offers broad benefits in terms of outcomes and recovery for patients with traumatic brain injury,” notes Dr. Whyte.

Moss Rehabilitation Research Institute (MRRI) is the research arm of MossRehab. In the last year alone, MRRI scientists have published dozens of articles in peer-reviewed journals, ranging from treatment for depression following traumatic brain injury² to caregiver well-being³ to self-awareness following TBI⁴.  In addition, “the MossRehab TBI Model System has carried out a series of studies validating the Moss Attention Rating Scale (MARS) for traumatic brain injury,” states Dr. Hart. The MARS provides a reliable and quantitative and measure of attention-related behavior after TBI^{5, 6}.

Generating New Knowledge for Improved Treatments

MossRehab collaborates with other TBIMS centers to study the long-term outcomes of TBI, with over 9000 patients now enrolled in the project’s national database. Such findings will shape future studies in traumatic brain injury leading to evidence-based recommendations for coordinated acute neurotrauma, inpatient rehabilitation, and community reentry. “The longitudinal research that collectively comes out of model system centers allows us to prioritize what we should be working on and what problems remain,” asserts Dr. Whyte.

In addition to collaborating with other centers, MossRehab TBIMS is conducting site-specific research projects aimed at generating new knowledge.

One study, in cooperation with a TBI center in Denmark, seeks to answer whether shortened, less intensive TBI treatment adversely affects patient outcomes. Denmark and the United States share cultural norms that emphasize returning to society after disability, but Denmark’s national healthcare system provides significantly longer and more intensive rehabilitation following TBI.

Also underway is a pilot study of the effects of dextroamphetamine on a variety of cognitive outcomes in subacute TBI. Others include studies of post-TBI headache and vocational rehabilitation after brain injury.

Dissemination and Knowledge Translation to Clinicians and People with TBI

In addition to its research and clinical care functions, MossRehab TBI Model System disseminates and translates knowledge to clinical staff, as well as to people with TBI and their families. “The TBIMS Knowledge Translation Center at the University of Washington digests and distills collective research from Model Systems into education and recommendations about treatment for patients and clinicians,” states Dr. Whyte.

On the consumer side, MossRehab TBIMS partners with the Brain Injury Association of Pennsylvania on regional caregiver seminars and collaborates on conferences for consumers, clinicians and policy makers. In late 2009, MossRehab TBI Model System will conduct the “Connections to Life after Brain Injury” consumer conference in collaboration with major TBI rehabilitation facilities in southeastern Pennsylvania and southern New Jersey. Such opportunities for education and networking provide a complement to the cutting-edge research and excellent clinical service in MossRehab’s Model System of care.

References

 1  Centers for Disease Control (CDC). National Centers for Injury Prevention and Control. Available http://www.cdc.gov/ncipc/tbi/TBI.htm Accessed Sept 11, 2009.

2  Fann J, Hart T, Schomer K. Treatment for depression following traumatic brain injury: A systematic review of the evidence. J Neurotrauma, in press.

 3  Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. . Caregivers well-being after traumatic brain injury: A multi-center prospective investigation. Arch Phys Med Rehabil., 2009;90:939-946.

 4  Hart T, Seignourel PJ, Sherer M. A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury. Neuropsychological Rehabilitation, 2009;19:161-176.

 5  Whyte J, Hart T, Ellis C, Chervoneva I. The Moss Attention Rating Scale for traumatic brain injury: Further explorations of reliability and sensitivity to change. Arch Phys Med Rehabil., 2008;89:966-73.

 6  Hart T, Whyte J, Ellis C, Chervoneva I. Construct validity of an attention rating scale for traumatic brain injury. Neuropsychology, in press.