Optimizing Rehabilitation Interventions (ORION) for Cognition Following Complex Traumatic Brain Injury
Abstract
Objectives and Rationale: Traumatic brain injury (TBI) has been called the “signature injury” of recent military conflicts, affecting 10-20% of those wounded during Service in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND). Of the more than 370,000 TBI diagnoses made within the US Military since the inception of OIF/OEF/OND, 2000 to 2010, roughly 82% were characterized as mild in severity. The number of diagnosed cases of mild TBI (mTBI) in military and Veteran health care settings continues to rise and may be a low estimate of the actual number of injuries. Most Service members and Veterans with mTBI recover completely in the weeks after injury. However, 10-20% of those with mTBI report persistent symptoms and impairments. These include psychiatric (e.g., depression, post-traumatic stress disorder, and substance abuse) and physical symptoms (e.g., headache, fatigue, and dizziness), emotional dysregulation, and cognitive impairments (e.g., reduced attention, memory, cognitive control, and judgment). These persistent post-concussive symptoms are not unique to mTBI; they are also associated with common co-occurring conditions such as post-traumatic stress disorder, other anxiety disorders, mood disorders, and chronic pain. Intrepid Spirit Centers (ISCs) and other Military Treatment Facilities (MTFs) have been designed to provide the most advanced care possible to returning military personnel suffering from TBI and other persistent symptoms and impairments. To do this, the IS centers and MTFs have developed and adapted a number of innovative treatment practices. The purpose of the proposed research is to identify the components of complex TBI treatment at IS centers and other MTFs and evaluate their effectiveness. Applicability and Impact of the Research: 1. What types of patients will it help, and how will it help them? The research will help patients with complex mTBI, which means a TBI and pain or a sensory system disorder, such as dizziness or problems with vision. The study will reveal which treatments delivered in which order are best for which persons with complex mTBI. 2. What are the potential clinical applications, benefits, and risks? The information that we proposed to collect is information from ongoing clinical care, so the results of the study will be able to directly influence the ongoing care received by Service members with mTBI and persistent symptoms. Another effect of the information will be likely to reduce variability in the treatments provided to Service members with mTBI and persistent symptoms. If we learn which interventions are most effective for particular types of injuries and symptoms, the effects of treatment programs could be stronger and the symptoms of Service members with mTBI could be reduced or resolved. Importantly, the real-world evidence developed in the study comes without any implementation barriers; the team that carried out the study knows the practices can be done with their patient population, unlike findings from medical journals. 3. What is the projected timeline it may take to achieve the expected patient-related outcome? The study will take 4 years to complete and, because of the design of the study, the evidence is primed to improve care immediately thereafter. 4. What are the likely contributions of the proposed research project to advancing the field of complex TBI? The proposal is likely to show what standard-of-care interventions are best and for whom, at what point in care the treatments are most effective, and how much of each treatment is best. 5. Briefly describe how the proposed project will benefit Service members, Veterans, and/or their family members. If we learn which interventions are most effective for particular types of injuries and symptoms, the effects of treatment programs could be stronger, and the symptoms of Service members with mTBI could be reduced or resolv
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910615
Entities
People
- Jacob Kean
Organizations
- United States Army
- University of Utah