Rehabilitation Medicine receives grant for brain injury care

Peter Esselman, Kathleen Bell (seated) and Sureyya Dikmen meet to confer on the model system for treating traumatic brain injury. Photo by Jordan Rehm.

The School of Medicine’s Department of Rehabilitation Medicine has been awarded $1.3 million by the National Institute on Disability and Rehabilitation Research to set up a model brain injury care system, making it the only department in the country to house three federally funded model care systems.

The grant, which started Oct. 1 and will run through September 2002, will fund several research and demonstration projects designed to improve the care received by people with moderate-to-severe traumatic brain injuries, particularly after they leave the hospital. The department also houses the Northwest Regional Spinal Cord Injury System and co-houses, with the Department of Surgery, the Burn Injury Rehabilitation Model System.

Brain injuries can result in a wide range of physical problems, including headaches, weakness, and seizures. But physical problems are only part of the story. Lasting impairments can also occur in less visible areas, such as attention, memory, thinking, emotional control and behavior.

“A lot of these problems are not obvious when the patient is discharged from the hospital,” said Dr. Sureyya S. Dikmen, principal investigator for the newly funded Traumatic Brain Injury Model System. “When the patient gets home, the problems start unfolding, and different ones come up over time.” Since the majority of those who sustain traumatic brain injuries are young and otherwise healthy, they must deal with these issues for most of their adult lives, and often without insurance funding.

The new system is one of 17 federally funded projects across the country that are designed to provide patient care, conduct research, and disseminate information about brain injury treatment and rehabilitation to health care providers, injury survivors and their families, and the general public.

The University’s existing brain injury care system incorporates the Level I regional trauma center at Harborview Medical Center, inpatient rehabilitation services at Harborview and UW Medical Center, subacute rehabilitation programs under the direction of UW faculty members, and outpatient neuropsychological, psychological, vocational and community integration services. Specialty clinics address issues such as wheelchair seating, assistive technology, balance disorders, and driver retraining for patients with disabilities.

But after leaving the hospital and returning to their home communites, many patients have trouble connecting with the care and services they need. They may lack funds or live in areas with few local resources, or they may simply not know how to go about finding the help they need.

Under the new grant, researchers will implement and evaluate an experimental follow-up program in which patients will be contacted by telephone at scheduled intervals after their discharge from the hospital. During these calls, research care managers will interview the patients to identify areas of concern, assess the severity and complexity of any problems identified, and provide appropriate assistance. Depending on the problem, this assistance could involve immediate reassurance and problem-solving over the phone; telephone consultation with professional staff (physicians, psychologists or vocational counselors); referral to services in the patient’s community; or, when necessary, referral back into the University’s care system.

“The idea is to get patients to stay in their home environments whenever possible, and to hook them up to community resources that are available there,” Dikmen said. “In a way it’s prevention—we want to deal with problems before they escalate.”

Researchers will evaluate the follow-up program with a randomized controlled trial, which will provide reliable information about its effectiveness. “Not many interventions are based on rigorous studies that are randomized and controlled,” Dikmen noted. The program is also responsive to cost containment concerns—telephone contacts are inexpensive compared to office or hospital visits—yet it will bring services to people who currently receive no care after they leave the hospital.

Other projects funded by the model system grant include studies of the public cost (through Medicare and Medicaid) of brain injury care and the development of a World Wide Web-based community resource directory of brain injury services.

“The creation of this model system reflects Dr. Dikmen’s long-standing and widely published work on traumatic brain injury, including the prevention of seizures after trauma and 20 years of studying the natural history of recovery from brain injury,” said Dr. Walter C. Stolov, chair of the Department of Rehabilitation Medicine. “It is also a direct result of the elaborate cooperation that exists between the Level I Trauma Center at Harborview, the Department of Neurological Surgery, and the Department of Rehabilitation Medicine.”

Neurological Surgery Chair H. Richard Winn noted that the new model system “dovetails superbly” with that department’s acute care and research program in traumatic brain injury.

Key personnel for the model system include Drs. Kathleen R. Bell and Peter C. Esselman, co-project directors and medical directors of traumatic brain injury patient care at UWMC and HMC, respectively; and Dr. Nancy R. Temkin, associate professor of neurological surgery and biostatistics, who has long collaborated with Dikmen in traumatic brain injury research and has led the statistical efforts for eight major multidisciplinary research programs. ¶

Anna Peekstok, Rehabilitation Medicine