Innovative Technologies for Improved Medical Diagnoses, Rehabilitation and Warfighter Readiness
Abstract
The TTW program aims to support highly collaborative advanced technology projects by bringing together industry, academia and civilian medical centers including minority serving institutions with experience in solving defense and civilian health problems. Supported projects will focus on the 3 principal medical areas for defense health (Combat Casualty Care, Military Operational Medicine, and Clinical and Rehabilitative Medicine) with an emphasis on direct relevance to identified military needs, translational potential and clear strategy for product commercialization with a low to medium risk – high reward payoff. Additionally, for USU, the TTW program will cultivate, establish and leverage partnerships between USU faculty/investigators and industry, academia and civilian medical centers including minority serving institutions. Results from the TTW program will increase DoD’s workforce capability, DoD’s access to leading edge technologies and leverage industry knowledge and funded research data for warfighter medical needs. Surgical Critical Care (SC2i) will enroll critically ill patients, leveraging deep medical and –omics data to develop Clinical Decision Support Tools (CDSTs) that will improve clinical outcomes and lower resource utilization across military and civilian healthcare systems. The CDSTs will further assist readiness by either accelerating return to duty (abridged length-of-stay across the ICU, general ward, and rehabilitation continuum of care) and curbing medical resource burdens. Rehabilitation Sciences Research supports clinical and translational research efforts dedicated to enhancing the rehabilitative care of the wounded warrior, particularly those with orthopeadic trauma, amputation and neurological injury. Research focus areas include: 1)Identifying and mitigating barriers to successful rehabilitation, return to duty and community reintegration; 2) Improved pain management to support active participation in rehabilitation; 3) Applying Advanced Technologies to augment rehabilitation methods and outcomes assessments; 4) Developing and testing advanced technologies to restore individual functional independence; 5) Regenerative Rehabilitation translational products for war-related trauma. Musculoskeletal injuries (MSI) are the largest source of disability in the military and affect 800,000 Service Members annually, accounting for 25 million days of limited duty. Most concerning, the disability discharge rate for MSI has increased 13x between 1981 and 2005 (70 vs. 950 per 100,000 persons), and these trends have continued to increase in the Department of Defense (DoD) and Veterans Affairs Administration in the most recent decade. The Defense Health Agency recognized this unmet clinical/operational gap and funded the formation of the Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) organization in 2019. In the past two years since our inception, MIRROR has established a world-class infrastructure (data, regulatory, governance) that is compliant with the DoD for conducting research, expanded the number of studies from 14 to 37, formed partnerships with 24 military and academic centers, received $55 million in grant funding (with 10 applications pending for approximately $5 million), hosted 5 educational symposiums, generated 18 Post-Operative Rehabilitation Protocols to standardized care across the Tri-Service, and published 26 abstracts and 17 peer-reviewed publications. Furthermore, in order to ensure the safety/health of our Service Members and research subjects, we donated COVID-19 antibody kits which allowed us to achieve enrollment over 2100 subjects. Moving forward, we plan to executed on our current projects and continue to provide value through: (1) new research and operational support to new military treatment facilities, (2) close critical care injury/pain gaps (e.g., spine, knee, ankle, shoulder), evaluate novel imaging modalities (e.g., elastography), performing sub analyses to understand gender disparities, predisposition to injury, response to treatments, etc. MIRROR was also selected to host a 3-hour session at MHSRS since we received 5% of the abstracts, but this event was unfortunately canceled. The Photomedicine to Enhance Military Readiness program is a four-year, $22 million initiative with the Wellman Institute, DJO, Geneva Foundation, HJF, and Spaulding Rehabilitation. These teams are executing 9 clinical and translational research projects to deliver optimal dosimetry of photobiological therapy to enhance performance, reduce the potential for musculoskeletal injury, assist with nerve graft healing, enhance audiology function, etc. Projects are progressing and in various stages of device development, benchtop research, and regulatory review (Institutional Review Board (IRB) approval for clinical trials and Institutional Care and Use Committee (IACUC) approval for animal research). The team had 3 abstracts accepted to MHSRS and we continue to work on peripheral nerve repair and 3D collagen printing as a natural biomaterial. In addition these clinical and translational research projects, CRSR continues to provide leadership and coordination of the Military Treatment Facility Engagement Committee (MTFEC) within the Pain Management Collaboratory (PMC) Coordinating Center (PMC3), which is an $81 million inter-agency initiative to support a multi-component research effort focused on non-pharmacological approaches for pain management. Four ongoing pragmatic trials studying non-pharmacological approaches to pain for military service members and veterans have accomplished their stated milestones and in the process have provided feedback to DHA on improved policies and procedures to enhance clinical research execution within the DoD. CRSR has been a leader in the 30 institution NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium, which includes the Service Academy Longitudinal Outcomes Study (SALTOS). To date recruitment totals over 52,000 participants, including more than 22,000 Service Academy cadets and midshipmen, with just under 9,000 recorded concussions making this the largest study of its kind on the natural history and neurobiology of concussion. In FY21, the CARE Consortium has published 18 peer-reviewed manuscripts, with 17 additional manuscripts currently in review, and completed 12 virtual presentations to disseminate important findings from this cohort. Additional funding has been secured totaling $42.65 million for the longitudinal continuation study, CARE-SALTOS Integrated, which will follow cadets, midshipmen, and NCAA athletes post-graduation to determine intermediate and long-term impacts of concussion on health and military service. CRSR continued to maintain its efforts throughout the COVID-19 pandemic while keeping its subjects and research staff safe. Significant accomplishments during this time are (1) development of a mitigation return to research checklist. This check list, shared locally and nationally, is also followed at all U.S. Service Academies and WRNMMC. (2) Published the “COVID-19 Patient and Caregiver Rehabilitation Recovery Guide”, and distributed to not only families and military units downrange in English and Spanish but internationally to share with their family and friends suffering from the pandemic to allow them to stay mission focused; (3) developed the WRNMMC post-discharge COVID-19 patient registry, telehealth, multidisciplinary holistic intervention; (4) created the COVID-19 survivor peer support group. Notable other accomplishments include: (1) continuation of work through Joint Incentive Funding ($5.4M) between the DoD (USU) and VA (Miami) to miniaturize, optimize and clinically disseminate a wearable sensor augmented tele-rehabilitation tool for service members and veterans with lower limb amputation; (2) a successful large animal model for heterotopic ossification research; (3) Shailly Jariwala, Ph.D. was recognized as one of the internationally selected “Rising Stars of Regenerative Rehabilitation”; (4) two blue light emitting prototypes were developed to be used for mitigating infection after osseointegration of prosthetic limbs; (5) preliminary data suggests that Service Dog Training to augment the rehabilitation of individuals with physical and behavioral health injuries is associated with reduced suicide; (6) MIRROR published new clinical practice guidelines for the DoD, with triservice concurrence to standardize and optimize post-operative rehabilitation interventions following the top 11 orthopaedic musculoskeletal surgeries performed in the DHA. (7) Dr. Paul Pasquina, CRSR Director, was announced as the 2020 recipient of the AMSUS Lifetime Achievement Award.
Document Details
- Document Type
- Accomplishment
- Publication Date
- Oct 01, 2023
- Source ID
- 69958360c469fbee18a75019fab32158