Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 894-895, May 2008

Traumatic Brain Injury Model Systems of Care 2002−2007

  • Tamara Bushnik, PhD

      Affiliations

    • Corresponding Author InformationCorrespondence to Tamara Bushnik, PhD, Rehabilitation Research Center, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128

Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA.

Article Outline

Abstract 

Bushnik T. Traumatic Brain Injury Model Systems of Care 2002−2007.

During the years 2002 to 2007, 16 Traumatic Brain Injury Model Systems of Care (TBIMS) were funded by the National Institute on Disability and Rehabilitation Research to conduct site-specific and collaborative research projects, including contribution to a longitudinal database, within comprehensive systems of care specialized for people with traumatic brain injury. The TBIMS program has been in existence since 1987 and has undergone significant modifications over these years. Herein I provide an overview of the changes that occurred in the 2002−2007 funding cycle, the research initiatives that were carried out during that time, and brief descriptions of the 13 original TBIMS research articles included in this issue of Archives.

Key Words: Brain injuries, Rehabilitation

 

THE TRAUMATIC BRAIN INJURY Model Systems of Care (TBIMS) program has been funded, in its current format, since 1987 by the National Institute on Disability and Rehabilitation Research (NIDRR) in the Office of Special Education and Rehabilitative Services, U.S. Department of Education. The TBIMS program has grown from 4 centers to a maximum of 17 over the years; the 2002−2007 funding cycle saw 16 centers conducting service delivery and research activities under this program. The purpose of the TBIMS projects is to “generat[e] new knowledge through research to improve treatment and services delivery outcomes for individuals with TBI [traumatic brain injury]”1(p39573) through the following components:

•a multidisciplinary system of care for people with TBI encompassing the continuum from injury to reintegration to the community;

•a research program at each center consisting of no more than 3 local research studies that focus on the areas identified in the New Freedom Initiative and NIDRR's long-range plan;

•contributions to a longitudinal national database of people with TBI that contains detailed descriptions of acute hospitalization, rehabilitation, and long-term community outcomes;

•dissemination of research findings in appropriate formats to clinicians, researchers, and consumers; and

•collaboration with other TBIMS in research and dissemination efforts.1

A more detailed description of the components of the TBIMS program has been previously published2; updates relevant to the 2002−2007 cycle are provided here. The TBIMS national database, a longitudinal database intended to examine the natural course of recovery and outcomes after provision of a coordinated system of acute neurotrauma and inpatient rehabilitation care, contains information on over 7000 people with moderate to severe TBI who are up to 15 years postinjury. At the beginning of the funding cycle, the database underwent a dramatic revision, spurred by the recognition that some variables were no longer needed because the research question had been answered and because some variables could not adequately address the research area in question. In addition, when the database was originally conceived, follow-up data were obtained on an annual basis; extensive examinations of changes over time and a recognition of the resources required to obtain annual data led to the decision to restrict data collection to post-TBI years 1, 2, 5, 10, and every 5 years thereafter. The deletion of variables and the move to a less frequent follow-up schedule resulted in additional resources within the TBIMS that were used to develop collaborative modular projects within the first year of the funding cycle. The module projects were designed to be hypothesis-driven, be time-delimited, and to supplement the core database. Five module projects were initiated: a prospective observational examination of the effectiveness of deep venous thrombosis (DVT) screening and subsequent anticoagulation in lowering the rate of symptomatic DVT and complications from DVT, the development and validation of a measure of community participation, an examination of vocational services currently offered through the TBIMS and the subsequent development of a study of vocational interventions, establishment of the prevalence of emotional distress among survivors and family members and whether treatment is initiated, and development and validation of a brief neuropsychologic screening that can be administered within the first month post-TBI to people who may or may not have emerged from posttraumatic amnesia (PTA). The modular projects have been extremely productive and have resulted, or will result, in publications (2 are included in this issue); they have also served as a foundation for additional research within the TBIMS and as a basis for studies in other disability populations.

The 16 TBIMS conducted research that was focused on, and sometimes spanned, the 5 areas within NIDRR's long-range plan. The 13 articles that are contained in this issue of Archives are just a sampling of that work within the 2002−2007 funding cycle. Five of the articles fall primarily within the Full Access to Community Life area: the role of age at time of injury on functional outcomes at years 1 and 5 post-TBI,3 neuropsychologic and functional outcomes after complicated mild TBI,4 the impact of where someone lives on functional and psychosocial outcomes after TBI,5 how the resumption of driving after TBI affects community integration,6 and the effectiveness of problem-solving training to decrease depression in family caregivers of people with TBI.7 Four articles are within Associated Areas, which focuses on the development of new or assessment of existing TBI-related measures. Two articles resulted from the brief neuropsychologic screen module project, with the first assessing the feasibility and utility of the screening battery that was designed to be administered within the first month (±2wk) post-TBI irrespective of PTA status8 and the second examining the predictive validity of the screening battery to functional outcomes at 1 year post-TBI.9 In addition, Meachen et al10 report on the reliability and utility of the Brief Symptom Inventory–18 in a TBI sample, and Whyte et al11 provide new psychometric data on the Moss Attention Rating Scale (MARS) and report on the utility of the MARS in assessing change during the acute rehabilitation stay. The Maintaining Health and Function area is addressed by 2 articles: the utility of functional magnetic resonance imaging in people with chronic TBI to predict benefit from a memory rehabilitation program12 and a comparison of 2 techniques of botulinum toxin injection to relieve elbow flexor hypotonia.13 In the area of Integrating Individuals with Disabilities into the Workforce, Arango-Lasprilla et al14 used the national database to examine how race and ethnicity affects employment outcomes after TBI to better tailor job interventions. The Assistive and Universally Designed Technologies area is addressed by Spaeth et al,15 who show that people with TBI can learn to effectively maneuver an electric-powered wheelchair using a joystick designed to compensate for motor deficits.

We hope that this collection of articles will convey the depth and breadth of the work that is being carried on by the TBIMS. In this day and age, with TBI as the signature injury of the conflicts overseas and the sheer numbers of returning military personnel who will require ongoing inpatient and community rehabilitation services for TBI, the TBIMS program has shown expertise in providing high-quality clinical services and performing seminal research in TBI. The continuing work of the TBIMS program, as well as the potential for collaborative research with the appropriate military organizations, can only serve to improve outcomes for both civilian and military populations.

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References 

  1. National Institute on Disability and Rehabilitation Research. Disability and Rehabilitation Research Projects (DRRP) Program. 67 Federal Register 39572 (June 7, 2002).
  2. Bushnik T. Introduction: the Traumatic Brain Injury Model Systems of care. Arch Phys Med Rehabil. 2003;84:151–152
  3. Marquez de la Plata CD, Hart T, Hammond FM, et al. Impact of age on long-term recovery from traumatic brain injury. Arch Phys Med Rehabil. 2008;89:896–903
  4. Kashluba S, Hanks RA, Casey JE, Millis SR. Neuropsychologic and functional outcome after complicated mild traumatic brain injury. Arch Phys Med Rehabil. 2008;89:904–911
  5. Corrigan JD, Bogner JA. Neighborhood characteristics and outcomes following traumatic brain injury. Arch Phys Med Rehabil. 2008;89:912–921
  6. Rapport LJ, Coleman Bryer R, Hanks RA. Driving and community integration after traumatic brain injury. Arch Phys Med Rehabil. 2008;89:922–930
  7. Rivera PA, Elliott TR, Berry JW, Grant JS. Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:931–941
  8. Kalmar K, Novack TA, Nakase-Richardson R, et al. Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 2008;89:942–949
  9. Hanks RA, Millis SR, Ricker JH, et al. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. Arch Phys Med Rehabil. 2008;89:950–957
  10. Meachen SJ, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory−18 in persons with traumatic brain injury. Arch Phys Med Rehabil. 2008;89:958–965
  11. Whyte J, Hart T, Ellis CA, Chervoneva I. The Moss Attention Rating Scale for traumatic brain injury: further explorations of reliability and sensitivity to change. Arch Phys Med Rehabil. 2008;89:966–973
  12. Strangman GE, O'Neil-Pirozzi TM, Goldstein R, et al. Prediction of memory rehabilitation outcomes in traumatic brain injury using functional magnetic resonance imaging. Arch Phys Med Rehabil. 2008;89:974–981
  13. Mayer NH, Whyte J, Wannstedt G, Ellis CA. Comparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia. Arch Phys Med Rehabil. 2008;89:982–987
  14. Arango-Lasprilla JC, Ketchum JM, Williams K, et al. Racial differences in employment outcomes after traumatic brain injury. Arch Phys Med Rehabil. 2008;89:988–995
  15. Spaeth DM, Mahajan H, Karmarkar A, Collins D, Cooper RA, Boninger ML. Development of a wheelchair virtual driving environment: trials with subjects with traumatic brain injury. Arch Phys Med Rehabil. 2008;89:996–1003

 Supported in part by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant no. H133A070038).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

 Reprints are not available from the author.

PII: S0003-9993(08)00169-X

doi:10.1016/j.apmr.2008.03.001

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 5 , Pages 894-895, May 2008

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