The TBI Model System Center
What is a TBI Model System?
Since 1987, the US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) has provided funding for establishing a research and demonstration program through model systems of care for persons with Traumatic Brain Injury (TBI). The model systems of care provide comprehensive, coordinated care for persons with TBI for emergency medical services, acute neurotrauma services, inpatient rehabilitation, and long-term follow up.
Currently, 16 TBI Model System Centers across the United States are supported by this grant program for the 2007-2012 period. Each TBI Model System Center contributes data to the Traumatic Brain Injury National Data Center which maintains a standardized national database for innovative analyses of TBI treatment and outcomes.
Objectives of the TBIMS Center
- To demonstrate and evaluate the cost-benefit and service delivery outcomes of a comprehensive service delivery system for individuals with TBI
- To establish a research program to evaluate the development of a new database and conduct innovative analyses of research data
- To demonstrate and evaluate the development and application of improved and innovative methods essential to the care and rehabilitation of individuals with TBI
- To participate in national studies of the TBI Model System concept by contributing to the national TBI database as prescribed by the Secretary of Education
Who is Eligible to Participate in the Program?
The National Database includes information about the course of recovery and outcomes following TBI. Participants in the database have sustained a TBI, defined as damage to brain tissue caused by an external mechanical force as evidenced by loss of consciousness due to brain trauma, or post-traumatic amnesia (PTA), or skull fracture, or objective neurological findings that were a result of trauma. For inclusion in this database the person must:
- Be at least 16 years old
- Arrive at the acute care hospital emergency department within 24 hours of injury
- Receive both acute hospital care and inpatient rehabilitation within the defined Model System facilities
- Understand and sign informed consent
JFK-Johnson Rehabilitation Institute TBI Model System Rehabilitation Research
Beginning in 2002, the JFK-Johnson Rehabilitation Institute (JFK-JRI) in Edison, New Jersey has been awarded the Traumatic Brain Injury Model System (TBIMS) grant from the National Institute on Disability and Rehabilitation Research (NIDRR). This five-year grant allows JFK-JRI to pursue research regarding innovative assessment and rehabilitation approaches for persons with traumatic brain injury (TBI).
JFK-JRI strives to integrate the highest quality of clinical and research activities within an integrated model system of care in order to improve the lives of people with traumatic brain injury. Our clinical continuum of care includes two Level I Trauma Centers, two Level II Trauma Centers and two emergency departments; the acute Brain Trauma Unit and inpatient Extended Recovery Unit; Transitional Living; comprehensive post-acute Neurorehabilitation and an Intensive Cognitive Rehabilitation Program; and long-term follow-up and aftercare services. We enroll 35-40 TBIMS participants annually and conduct over 118 follow-up interviews.
Our site-specific research represents a sustained investigation of cerebral activation in patients with disorders of consciousness (DOC): vegetative state (VS) and minimally conscious state (MCS). At present, clinical judgment and experience guide diagnostic, prognostic and treatment decisions for individuals with DOC. However, we continue to struggle with diagnostic error, misinterpretation of behavioral findings, inability to predict functional outcome in individual cases, and uncertainty regarding the neural mechanisms of recovery. When combined with behavioral observations, functional neuroimaging strategies have the potential to improve clinical decision-making and patient care. Our prior research on fMRI activation patterns suggests that patients in MCS retain the neural circuits for receptive language and visual processing. We will test a novel fMRI protocol that is designed to reliably detect conscious awareness in patients who may be unable to execute behavioral signs of active cognitive processing, using a hierarchical stimulation paradigm that systematically assesses levels of cognitive processing in the auditory and visual systems. In light of provocative findings suggesting that cognitive processing may be maintained in patients who appear to be unconscious on bedside examination, we will extend our investigation to individuals with VS as well as those in MCS. We also predict that patients capable of activating multiple cortical networks will achieve more favorable cognitive and functional outcomes, a finding with direct implications for rehabilitation treatment planning.
Our second project extends our prior investigations of the effectiveness of specialized, post-acute brain injury rehabilitation. This project is driven by the question of how to characterize the course of post-acute brain injury rehabilitation, and its impact on the long term outcomes of people with brain injuries. Although there is increasing evidence that postacute brain injury rehabilitation can improve functional outcomes after TBI, population-based outcome studies have generally not considered the influence of different pathways of postacute rehabilitation on outcomes after TBI. We are proposing a longitudinal, observational study that will characterize postacute rehabilitation in the TBI Model Systems, and examine the pathways of postacute rehabilitation in relation to case-mix variables, patterns of service utilization, barriers to service delivery, and participants' perceived needs and satisfaction with treatment. We will examine the contribution of postacute rehabilitation to functional and psychosocial outcomes at one and two years after injury using multivariate analyses and causal modeling.
Our dissemination plan addresses the needs of clinicians, researchers, people with TBI and their families. These research and dissemination efforts should benefit people with disabilities through increased knowledge of functional level and prognosis for patients with DOC, increased knowledge of factors influencing access to postacute services and the impact of postacute rehabilitation on outcomes, and the application of evidence-based rehabilitation interventions after TBI.
|Keith D. Cicerone, Ph.D., Project Director|
|Tasha Mott, Ph.D., Co-Investigator|
|tmott@JFKHealth.org||(732) 906-2640 ext. 42205|
|Joanne Azulay, Ph.D., Co-Investigator|
|jazulay@JFKHealth.org||(732) 906-2640 ext.42208|
|Yelena Goldin, Ph.D., Co-Investigator|
|Kathleen Kalmar, Ph.D., Research Coordinator I|
|kkalmar@JFKHealth.org||(732) 321-7000 ext. 67762|
|Charlotte Trott, Ph.D., Research Coordinator II|
|ctrott@JFKHealth.org||(732) 906-2640 ext.42241|
|Jennifer Cotter, B.A., Data Manager|
|jcotter@JFKHealth.org||(732) 906-2640 ext 42203|
|Kathleen Carey, M.A., Data Collector|
|kacarey@JFKHealth.org||(732) 906-2640 ext. 42203|
|Rosanne Sevinsky, Research Assistant|
The current TBI Model System research at JFI-JRI reflects our ongoing clinical and research commitment to improve the functioning and quality of lives for people with TBI.
As part of our TBI MS work, JFK-JRI conducts individual research projects in the areas of imaging, states of consciousness, rehabilitation outcomes, and understanding mild TBI. In addition to independent projects, JFK-JRI participates in collaborative "module" research projects with other Model Systems centers across the country on topics such as post-TBI fatigue, medication treatments, and environmental variables that affect long-term outcome following TBI.
- The focus of our site-specific research proposal is on patients who exhibit a relatively prolonged disorder of consciousness (DOC), including Vegetative State (VS) and Minimally Conscious State (MCS). The proposed investigation of effectiveness of functional MRI for detection of conscious awareness in individuals with DOC, and its application to prognosis and rehabilitation planning, will evaluate an innovative approach that has already increased our knowledge and raised clinical, scientific and public awareness of the scope of this problem. The results of this research will increase our knowledge of preserved areas of functioning and mechanisms of recovery from DOC. This represents critical information for practitioners and family members who are often faced with critical — even life or death — decisions regarding patients' care.
- The focus of our collaborative module project is on clinical delivery and effectiveness of post-acute brain injury rehabilitation, and the long term outcomes of people with TBI with regard to the full participation in the community and their subjective well-being. The proposed investigation of postacute rehabilitation pathways will help to inform decisions regarding dispositions from acute rehabilitation, identify and evaluate the impact of barriers to service utilization, and increase our understanding of the contribution of rehabilitation to long term participation and community integration, psychosocial functioning, and life satisfaction after TBI.
For a complete list of independent and collaborative projects, visit http://www.msktc.org/researchcenter/detail/JFKTBI
Our Published Work
Researchers at the JFK-JRI TBI Model Systems Center publish on a wide range of topics relevant to individuals with TBI and their families. Our work aims to improve the quality of life of individuals with TBI with understanding, diagnosing and treating various difficulties people face after brain injury.
Links to some of these publications are provided below:
- Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs
- >A Randomized Controlled Trial of Holistic Neuropsychologic Rehabilitation After Traumatic Brain Injury
- Community Integration and Satisfaction With Functioning After Intensive Cognitive Rehabilitation for Traumatic Brain Injury
- Development of the Participation Assessment With Recombined Tools—Objective for Use After Traumatic Brain Injury
- Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury
- Vocational Interventions and Supports Following Job Placement for Persons with Traumatic Brain Injury
- Feasibility of a Brief Neuropsychologic Test Battery During Acute Inpatient Rehabilitation After Traumatic Brain Injury
- A Network Approach to Assessing Cognition in Disorders of Consciousness
- Participation as an Outcome of Traumatic Brain Injury Rehabilitation
- Perceived Self-Efficacy and Life Satisfaction After Traumatic Brain Injury
- The Predictive Validity of a Brief Inpatient Neuropsychologic Battery for Persons With Traumatic Brain Injury
- Vocational Services for Traumatic Brain Injury
Information for Consumers
In addition to fact sheets developed at JFK-JRI **, the Model Systems Knowledge Translation Center (MSKTC — msktc.org) is an excellent resource for individuals with TBI and their families. JKF-JRI Model Systems collaborated with MSKTC and made significant contributions to some* of the fact sheets provided below:
- Injury and Early Recovery | Printable PDF
- Impact on Functioning | Printable PDF
- TBI Recovery Process | Printable PDF
- Impact on Family Members and How They Can Help | Printable PDF
- Acute Inpatient Rehabilitation | Printable PDF
- Alcohol Use after TBI | Printable PDF
- Balance Problems after TBI | Printable PDF
- Cognitive Problems after TBI | Printable PDF
- Depression and Emotional Problems* after TBI | Printable PDF
- Driving after TBI* | Printable PDF
- Fatigue and TBI | Printable PDF
- Headaches | Printable PDF
- Returning to School | Printable PDF
- Seizures | Printable PDF
- Sexuality | Printable PDF
- Sleep and TBI | Printable PDF
- Vegetative and Minimally Conscious States after Severe Brain Injury** | Printable PDF
- Brain Imaging: Understanding the Basics** | Printable PDF