VA Research Program in Traumatic Brain Injury

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VA Research Program in Traumatic Brain Injury
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Rich 60 Year History

• 3 Nobel Laureates, 6 Lasker Award Winners
• Important Discoveries and Inventions
• Devices
• Cardiac Pacemaker
• First liver transplant
• Radioimmunoassay
• CT Scanner
• Treatments
• First large scale clinical trial TB

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Rich 60 Year History (cont)

• Linked smoking with cancer of the respiratory
  tract and lung
• Developed the nicotine patch for smoking
  cessation
• Found that the insulin pump controls diabetics
  blood sugar and weight better than multiple daily
  injections
• Identified best treatments for colon cancer,
  psychoses, stable angina, high blood pressure and
  other conditions
• Developed the Seattle Foot, first prosthesis
  allowing amputees to run and jump

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Important Recent VA Research Advances

• Proper use of coronary angioplasty
• COURAGE trial
• Vaccine for Shingles
• Prolonged Exposure Therapy for PTSD
• Long term study of PTSD TBI starting
  pre-deployment
• Mechanism of Respiratory Distress Syndrome
• Mechanism of pain in spinal cord injury
• Effects of reduced work hours of medical
  residents on patient outcomes

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Intramural Research Program

• VA Research connected directly to nations
  largest health system (It is an Intramural
  research program)
• 70 of investigators are clinicians
• Links researchers directly veterans needs
• Facilitates implementation of research results
• Unique research resources include
• Electronic Health Record
• Cooperative Studies Program Clinical Trials
• Telemedicine
• Drug safety center
• Rehabilitation research

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TBI/Polytrauma Research
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Research in Traumatic Brain Injury

• Some issues in TBI
• Impact of blast Injury
• Potential treatments
• Screening and diagnosis
• Best screening approaches
• Imaging, biomarkers
• What is the long-term course?
• Treatment and rehabilitation

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TBI research areasBasic Research

• Injury mechanisms
• Nerve damage repair after brain injury
  effectiveness of interventions
• Adult stem cell technology to protect and reverse
  effects of brain trauma
• Spinal Cord Injury first
• Early gene triggers of neurodegeneration
• Neuroprotective factors
• Neuroplasticity
• Biomarkers

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TBI research areasDiagnosis

• VA TBI Screening Process evaluation
• Imaging
• fMRI, DTI, Magnetoencephalography (MEG)
• Quantitative image analysis
• Biomarkers
• Neuropyschologic measures
• Eye movement
• Auditory processing
• Balance Gait

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TBI research areasTreatment

• Magnetic brain stimulation
• Impact of rehabilitation strategies
• Cognitive rehabilitation
• Treatments
• Post Traumatic Epilepsy
• Memory
• Attention

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TBI research areasCare Delivery

• Clinical pathways after positive or negative
  screen
• Outcome measurement
• Inclusion and needs of care givers
• Tele rehabilitation (e.g. cognitive behavior
  therapy for chronic pain)
• Patient education

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Examples of TBI QUERI Projects (cont)

• Pain and emotional disorders with and without
  Polytrauma
• Assessing barriers and facilitators for full
  evaluation after positive TBI screen
• Examine post-deployment outcomes and care of
  veterans with mild TBI and PTSD.
• Treating insomnia in TBI
• Chronic headache after exposure to blasts

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Examples of TBI QUERI Projects (cont)

• Understanding and meeting caregiver needs to
  improve outcomes in TBI patients with polytrauma
• Community reintegration problems
• Treatment preferences among OIF/OEF veterans
• Education and web-based resources for staff and
  family caregivers
• Identifies TBI symptoms, treatment, and prognosis
• Describes rehabilitation process
• Prepares families for transition

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Mechanisms to Increase TBI Research

• Centers of Excellence
• Research Career Development Awards
• State of the Art Conferences
• RFAs
• Collaborative research

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Examples of Other VA-DOD Collaborative Studies

• Central Auditory Processing Disorders Associated
  With Blast Exposure (Walter Reed AMC and VAMC
  Portland)
• Regional Anesthesia Military Battlefield Pain
  Outcomes Study (Walter Reed AMC and Philadelphia
  VA)
• Sertraline vs. Placebo for Symptoms Following TBI
  (Wilford Hall Air Force MC, San Diego Naval MC, 4
  VA Medical Centers)
• Citalopram for Anxiety Disorders Following a
  Traumatic Brain Injury (Walter Reed AMC, Wilford
  Hall Air Force MC, and 3 VA Medical Centers)