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In addition to contributing data to the TBIMS National Database, each TBI Model System center is required to conduct a site specific research project. In the 2012-2017 funding cycle, our site specific research project was:
Looking for Consciousness: A Novel Functional Neuroimaging Approach for Detection of Visual Cognition in Patients with Severe TBI and Disorders of Consciousness
The over-arching goal of this project it to develop new ways of using advanced fMRI in patients with disorders of consciousness (DoC), including assessment of their ability to follow commands and to communicate, without the need for overt behavioral responses. This is critically important, particularly in persons who retain conscious awareness but are believed to be unconscious based on routine clinical examination. This project compares: 1) traditional neurobehavioral assessment methods of measuring consciousness using the Coma Recovery Scale-Revised (CRS-R) and 2) family beliefs of the same with the novel neuroimaging techniques that we are developing. The development of our fMRI paradigms builds upon previous work in the field which assesses function of anatomically dissociable cognitive processes. By specifically engaging in one of these processes, we are investigating whether the resulting pattern of brain activity can confirm that the patient is able to understand and perform the task, verifying the ability to follow commands. By linking each process with a yes/no response, the pattern of activity associated with that cognitive process can act as a proxy for a yes/no response. For example, if the patient is told to look at the word “Yes” if the answer to a question (such as “Is your name Jack?”) is yes, then observation of a brain pattern associated with reading the word, “Yes,” (as opposed to other patterns of brain activity) demonstrates that the patient is answering the question correctly. The major advance over previous neuroimaging work that we are striving for is to employ tasks that are easier to manage for persons who have experienced severe acquired brain injury. We expect that the availability of standardized neurobehavioral and neuroimaging findings, coupled with the family’s observations, will inform the clinician’s judgment concerning command-following and communication ability.
A requirement of all TBI Model System centers is participation in multi-center ‘module studies’ with other TBIMS centers. In the 2012-2017 funding cycle, the SH-TBIMS co-led one module study and participated in four additional module studies.
CO-LEAD CENTER
Development of an Extended Measure of Global Function to Support Clinical Trials Originating in Acute Rehabilitation
The aim of this study was to develop an outcome measure whose items span a range suitable for clinical trials originating in acute rehabilitation (i.e. including patients with disorders of consciousness), and continuing to at least 1 year post-injury, and to examine candidate behaviors for marking the emergence from the minimally conscious state during this interval.
Co-Principal Investigator: Joseph T. Giacino, PhD (Spaulding-Harvard TBI Model System)
Co-Principal Investigator: John Whyte, MD, PhD (Moss TBI Model System)
PARTICIPATING CENTER
Cognitive Testing in the TBI Model Systems
This study addressed two goals: (1) Provide data needed to make informed decisions about the appropriateness of each subtest of a neuropsychological assessment tool called the Brief Test of Adult Cognition by Telephone (BTACT) for potential adoption in the TBIMS national database, and (2) Examine the relationship between health and cognitive functioning in TBIMS participants and compare this to a matched non-TBI sample.
Principal Investigator: Kristen Dams-O’Connor, PhD (New York TBIMS)
Following the success of this project, the BTACT was adopted as a data element in the TBIMS National Database study assessments performed at enrollment during the inpatient rehabilitation stay and during the follow-up assessments completed at 1-, 2-, and 5-years after injury, and every 5 years thereafter. In order to characterize patterns of cognitive function over time in individuals 2-4 years and 5-7 years post-injury, the New York TBI Model System is leading another multi-center project in the current funding cycle, Trajectories of Cognitive Functioning Years after TBI.
Internet Use and Online Social Participation Among Individuals with TBI
The purpose of this study was to characterize the cause(s) leading to or potentially contributing to death among older adults who survive a moderate-severe TBI and to determine whether there are cognitive, medical and/or psychological variables collected at time of last follow-up that differ between those who die and those who survive.
The results of this study were published in the Journal of Head Trauma and Rehabilitation (Baker-Sparr, et al., 2018).
Principal Investigator: Christina Baker-Sparr, BA (Rocky Mountain Regional Brain Injury System)
Co-Principal Investigators: Dave Mellick, MA and Gale Whiteneck, PhD (Rocky Mountain Regional Brain Injury System)
Statins and Outcome after TBI: An Observational Study
The purpose of this study was to determine whether statin use and (for statin users) degree of statin adherence at the time of injury and/or after is associated with functional recovery from TBI.
Principal Investigator: John Whyte, MD, PhD (Moss TBI Model System)
Understanding Causes of Death in the TBI Model Systems
The purpose of this study was to characterize the cause(s) leading to or potentially contributing to death among older adults who survive a moderate-severe TBI and to determine whether there are cognitive, medical and/or psychological variables collected at time of last follow-up that differ between those who die and those who survive.
The results of this study were published in the Journal of Head Trauma and Rehabilitation (O’Neil-Pirozzi, et al., 2018).
Principal Investigator: Kristen Dams-O’Connor, PhD (New York TBIMS)
Co-Principal Investigator: Therese O’Neil-Pirozzi, ScD, CCC-SLP (Spaulding-Harvard TBI Model System)
