VCU's TBI MODEL SYSTEM GRANT
With an estimated annual incidence rate of 1.7 million, traumatic brain injury is a leading cause of death and disability in the United States. Annually, brain injury accounts for 53,000 deaths, 325,000 hospitalizations and more than one million visits to U. S. emergency rooms. Brain injury causes drastic life changes, with losses affecting survivors, their families, and society. An estimated 5.3 million people in the United States live with permanent brain injury-related disabilities. Estimates place the annual indirect and direct financial costs above $75 billion.
Traumatic Brain Injury Model Systems (TBIMS) and other researchers have expended considerable energy delineating outcomes. For example, researchers have thoroughly documented postinjury memory disturbance, executive skills dysfunction, slowness, visual dysfunction, poor coordination, impaired self-awareness, and behavioral disorders. Recent studies have identified a high prevalence of depression, with many survivors reporting feelings of hopelessness, diminished self-esteem, and social isolation. Undoubtedly brain injury also affects couples and family systems; caregivers commonly describe emotional distress, lack of respite, financial stress, and lack of community support.
The Virginia TBIMS program utilizes rigorous scientific methods to examine the benefits of two interventions. Projects focus on survivors and couples. One study examines a structured, curriculum-based approach to improve survivors’ resilience and adjustment. Examining the benefits of an intervention for couples is another major research area. Though many professionals agree that strengthening caregivers can enhance rehabilitation outcomes, there is little research regarding the benefits of interventions designed specifically to address the needs of couples after injury. We are also collecting data for the National Database and participating in a Collaborative Module project.
Home to this TBIMS program is Virginia Commonwealth University (VCU), a major provider of brain injury acute care and medical rehabilitation services for more than three decades. We have been an active collaborator in the brain injury model system program since 1987. Since program inception, we have: extended our system of care; developed new partnerships with service providers and advocacy organizations; improved outcome measurement techniques, and explored the development of innovative interventions. Consumer involvement, community based rehabilitation, relevance, and active dissemination to consumer and professional audiences have been cornerstones of program development and implementation.
Centrally located in Virginia, the university is a major provider of medical services to a large, culturally diverse population. As the state’s largest single provider, VCU Medical Center provides nearly one-third of Virginia’s indigent care. Uninsured patients represent 20 percent of all patients treated, substantiating our strong commitment to serve persons regardless of ability to pay. The VCU Rehabilitation Research Center and VCU Health System (VCUHS) are components of the VCU Medical Center, a major state-supported teaching institution. The more than 350 model systems manuscripts published by our interdisciplinary research team in the past 25 years substantiates assertions that the urban, academic health center setting is ideal for scientific research, innovation, collaboration, and dissemination.
COUPLES SKILL-BUILDING, SUPPORTIVE AND EDUCATIONAL PROGRAM
Partners (spouses, significant others) play an important role in rehabilitation and recovery after an acquired brain injury (ABI). ABI can be from a traumatic brain injury, stroke, aneurysm, anoxia, brain infection, or non-progressive brain tumor. After hospital discharge, survivors' partners often have questions or concerns; many are unsure where to turn for help. The VCU TBIMS Couples Support Program was developed to help individuals understand the benefits of education, support, and referral resources after hospital discharge. To be considered for the study, persons with ABI must be in a relationship.
The Couples Support Program was developed as a means of teaching survivors and their partners about the effects of brain injury and ways to adjust to their new life. The program also helps people locate community resources.
During the study, participants meet regularly with rehabilitation professionals. Educational materials and referral information are provided. Completion of surveys and questionnaires before and after program participation is required. Participants are compensated for their time and effort.
The Couples Study Flyer can be found here.
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ADJUSTMENT AND RESILIENCE PROGRAM
The recovery process after TBI can be difficult because of cognitive, behavioral, and emotional changes. Changes may include memory loss, attention problems, as well as behavior and emotional changes. The VCU Adjustment and Resilience Program was developed to help survivors learn how to better adjust to having a brain injury. People with TBI, aged 18 or older participated. Participants met regularly with a rehabilitation professional, and received information about brain injury, recovery, and how to get better. They also answered questions and filled out surveys. Enrollment is now complete for this project, and we are currently analyzing the results.
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THE NATIONAL DATABASE
Since 1987, model system researchers have been working hard to learn more about the effects of brain injury. They collect information from emergency room records, acute care physicians, and rehabilitation physicians. They also collect information from persons with brain injury. Information relating to the following categories is collected for the national database and analyzed -
·injury severity – CT scan results, Glasgow Coma Scale scores, types of surgery
·cause of injury
·duration of hospitalization and rehabilitation
·rehabilitation progress – ability to carry out activities of daily living independently
·work status before and after injury
Information from the database has helped model systems researchers learn how recovery is affected by factors such as age, cause of injury, injury severity and duration of hospitalization. As more information is entered into the database, researchers have greater opportunities to learn about effective treatment approaches.
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