As the Brain Injury Association of Michigan believes that research is critically important to the long term needs of people with brain injuries, we have specifically included research as part of our mission statement. Our mission statement reads "To enhance the lives of those affected by brain injury through education, advocacy, research, and local support groups; and to reduce the incidence of brain injury through prevention". The Association has limited ability to be actively involved in research, and therefore, encourages and assists in research by representing its interest in brain injury through participation in state and regional research projects, including state TBI State Implementation Partnership Grant, Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), Ohio Regional TBI Model System, Protection and Advocacy Services (MPAS), Traumatic Brain Injury Model Systems (TBIMS), and the The Institute for Rehabilitation and Research (TIRR). Partners: Department of Community Health, Family Independence Agency) Michigan TBI Statistics and Service Need. Data on Michigan hospitalizations and deaths in which TBI was a diagnosis or contributing cause have been analyzed annually since 1999. On average, there are 1,551 deaths and 9,430 nonfatal hospitalizations of Michigan residents with a diagnosis of TBI every year. Michigan incidence data show that the elderly and youth experience TBI hospitalization and emergency department visits disproportionately to their percentage of the population. Annually, 1,880 children 0 to 19 years of age in Michigan are hospitalized and 167 die due to TBI. More than half (56%) of TBI-related ED visits are from individuals under 25 years of age. The most frequent causes of TBI in Michigan are falls, motor vehicle crashes, being struck by or striking an object, and violence (assault and self inflicted). Additional analysis revealed age and sex differences in the leading causes of TBI. Infants and the elderly are particularly at risk of falling and sustaining a TBI that leads to at least a visit to the ED. Of particular concern is the finding that 31% of fatal TBIs among children less than 5 years of age are assault-related. Within the public sector, the state of Michigan has no one agency that provides specialized services for persons with TBI. Rather, individuals with TBI can be served through public health, behavioral health, or social service agencies - presenting a confusing array of agencies and eligibility processes for survivors, family members, and even professionals trying to refer individuals for services. A unique feature of Michigan, however, is the availability of complete, comprehensive, life-long resource support through No Fault auto insurance for individuals who sustain a TBI from an automobile crash. However, only about 33% of Michigan residents with TBI are injured in an auto crash. For the remaining individuals, Medicaid often becomes the payment source for services needed over the long term. The main state and local public agencies and programs that provide or pay for services appropriate for individuals with TBI include Medicaid, Community Mental Health Services Programs (CMHSP), Department of Human Services (DHS), Early Intervention and Special Education Services, and Michigan Rehabilitation Services (MRS). The lack of coordination of services for individuals with TBI and their families is a central problem highlighted by Michigan’s TBI Needs Assessment report of 2004, titled Addressing Michigan’s Public Service Gaps for Persons with Traumatic Brain Injury (www.michigan.gov/tbi). The Needs Assessment concluded that, “Individuals with TBI need someone who will assist them to develop a care plan. They also need assistance in coordinating services across agencies and advocacy on their behalf. Finally, they need help to follow-up with services to ensure the requested services were delivered.” Michigan TBI Project. MDCH is the major human service agency in Michigan that houses most services relevant for persons with TBI and their families. MDCH first received a TBI planning grant from HRSA in 1998, and successfully acquired TBI State Partnership Implementation, and Post-Demonstration Grants from the federal government since then. In collaboration with MPHI and BIAMI, MDCH undertook systems change activities throughout the Planning, Implementation and Post Demonstration Grant periods. Some of the accomplishments during the past ten years include the following: Inter-organization Collaboration Experience. Michigan TBI Project’s success to date is due to strong collaboration. In addition to collaboration described below, the TBI Project has engaged in continuous education and outreach throughout the state, including the following constituencies: special education professionals, Michigan High School Athletic Association, School Principals, CMHSPs, the Michigan Tribal Health Directors Association, veterans and Armed-Services personnel, and TBI providers and consumers via annual BIAMI conferences. These and other outreach efforts have yielded participation in the project at local and state levels. State-level collaborative structures and processes. Interagency coordination at multiple levels is crucial to meet Michigan’s TBI goals and objectives. Each of the main agencies involved with the project are represented on the TBI Council, including: DHS, MDE, BIAMI, MPHI and the following programs within the MDCH: Mental Health and Substance Abuse Administration, Medicaid, Long Term Care Operations/Policy, and Injury Prevention. MDCH – which determines Medicaid policy – has close working relationships to the many agencies that implement Medicaid programming, including: DHS, MDE, CMHSPs, MI Choice Waiver Agencies, and others. This may partially explain Michigan’s success in bringing agencies together to collaborate on TBI systems change initiatives. MPHI also has a historical and close working relationship with many departments of the MDCH through contracts for project work. At the county level, agencies are expected to collaborate when serving individuals with TBI. Public and private partnerships. In Michigan, an estimated 30-40% of individuals with brain injury are served by the uncapped benefits of Michigan’s No Fault insurance system. Because of this, Michigan has numerous high-quality private TBI treatment and rehabilitation providers. These providers continue to be resources for the TBI Project as they serve on the TBI Council and Committees, which guide all systems change activities and educational material development. They provide information on evidence-based best practices of rehabilitation and community integration for people with TBI. They have shared cost and service data with the project. And moreover have committed to serving beneficiaries of the new TBI Waiver program. Three providers, in particular (Special Tree Rehabilitation System, Inc., Rainbow Rehabilitation Centers and Hope Network Rehabilitation Services) have worked extensively on the TBI Project for the past 10 years. Consumer and provider participation. Consumers and providers have made valuable contributions to Michigan’s TBI Project and will continue to do so. There are three mechanisms of consumer and provider participation: 1) providing guidance and monitoring through the TBI Council and committees, 2) providing evaluative data on project products and service system enhancements, and 3) as targets of project educational efforts and system improvement. During the TBI Grants, both consumers and providers assisted by pilot testing and evaluating project products. Consumers and providers on the training committee are frequently tapped to produce materials identifying survivor issues. Indeed, video images of four providers serving on the TBI Council appear in the training curricula, providing examples of common situations and possible service solutions. Provider feedback will be solicited on the TBI Waiver implementation and all other public systems changes. Consumer feedback will be solicited continuously through use of the consumer satisfaction and feedback tool. Of note, Dr. Claudia Osborn, a nationally renowned TBI advocate, serves on the TBI Council. In addition to BIAMI, MDCH has close working relationships with other advocacy organizations including the Disability Resources Council, MPAS, and Centers for Independent Living. In partnership with BIAMI, MDCH has reached out to the Michigan Department of Military and Veterans Affairs (DMVA) to improve services for Michigan veterans with TBI. Procedures for pooling information resources. A number of agencies and organizations have provided and continue to provide data to the TBI Project, including: vital statistics and other incidence data compiled by MDCH, claims data provided by BCBSM, Medicaid claims and encounter data (Medicaid is now building queries into its Data Warehouse which will enable the provision of regular reports on TBI service use to the TBI Council and project staff), and service use and cost data provided by a private TBI rehabilitation provider. The MDCH TBI Project constantly solicits information from TBI Council members and project partners. In turn, data provided to the project are summarized quarterly for dissemination and use by the TBI Council. Moreover the project collects information and produces materials summarizing resources for individuals with TBI and their Families, including our highly rated: Michigan Resource Guide for Individuals with Traumatic Brain Injury and their Families, and brochures for consumers, caretakers, and veterans. All public materials and information prepared by the project for both consumers and public service providers can be accessed online at www.michigan.gov/tbi. Periodically informational campaigns are conducted to spread awareness of these resources. In addition, printed materials are distributed via annual BIAMI conferences. Collaboration with other states. The project also ensures adoption of best practices through: interaction with TBI Project leaders in other states, attendance at state and national conferences, use of the resources assembled by TBI Technical Assistance Center and memberships with the National Association of State Head Injury Administrators (NASHIA) and review of the TBI literature. The Michigan’s web-based provider training, for example, was developed with participation of TBI Project leaders in Nebraska; participation permission has been granted to incorporate multi-media materials prepared by Florida; and cultural competence content drew heavily on the work of Minnesota. Materials referenced in the training include those prepared by the CDC, findings from the NIH Consensus Development Conference on Rehabilitation of Persons with TBI (1999), TBI NET of the Mount Sinai School of Medicine, as well as published research articles and texts. Other examples of products developed by Michigan based on the experience of other states and a review of literature include the HELPS TBI screening tool and Michigan’s consumer satisfaction and feedback tool. Evidence of the quality of Michigan’s training materials is demonstrated by their adoption or planned adoption in other states (Kansas and South Carolina). Moreover the American Academy for the Certification of Brain Injury Specialists (AACBIS), which offers a voluntary national certification program, was so impressed with Michigan’s web training that it solicited Michigan’s project partner, MPHI, to develop an on-line AACBIS curriculum. Pediatric Focus. For the 2009-2013 TBI State Program Implementation Partnership Grants submitted to HRSA, children and youth have been identified as a special population group for extra outreach and programming. For several years, the Michigan Department of Education (MDE) has also been an excellent and dedicated project partner, with a TBI Council member from the MDE and two members representing local school districts. These partners have been instrumental in connecting the project with curriculum developers, school nurse associations and school health coordinators. In the new federal grant period, the project plans to work with MDE to add TBI issues to the curriculum in the areas of life skills/parenting (primarily for education on shaken babies), driver’s education, general health and safety, and safe sports. Additionally, BIAMI has an ongoing relationship with the Michigan High School Athletic Association (MHSAA). The project has been working with the MHSAA to distribute the CDC’s Heads Up concussion awareness materials and will continue to provide concussion education, including concussion recovery, to players and their families through this organization. The project is also beginning, and will continue, to reach out with sports safety education to sports clubs and academies outside of public schools such as YMCAs, martial arts schools, boxing clubs, etc….” (Partners: Wayne State University, Rehabilitation Institute of Michigan) The Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), housed at the Rehabilitation Institute of Michigan, is a program of research that studies a variety of topics related to TBI recovery and outcome. Since 1987 SEMTBIS has conducted innovated research projects and contributed to the establishment and maintenance of a standardized National Database for analysis of TBI treatment and outcomes. At SEMTBIS we are involved in local and collaborative research efforts. Our research findings are shared with TBI survivors, families, caregivers, and health care professionals locally, nationally, and internationally. The SEMTBIS has two main research projects and will contribute to two TBIMS module projects. Additionally, the SEMTBIS continues to participate in longitudinal data collection that is submitted quarterly to the TBIMS national database. SEMTBIS, is a federally funded TBI "model system" (TBIMS) of care for individuals who sustain a traumatic brain injury and is a joint effort between Rehabilitation Institute of Michigan, Wayne State University's School of Medicine, and local acute care hospitals. The potential benefits of participation in a TBIMS include: The primary purpose of the SEMTBIS is to expand and enhance our comprehensive, multidisciplinary model system of care, largely through involvement in innovative research activities aimed to improve outcomes for persons with TBI and their families. Research findings are utilized to develop, implement, and improve current intervention strategies, as well as to create and expand service delivery options. SEMTBIS conducts ground-breaking research in the field of physical medicine and rehabilitation, sharing the resulting innovations with other traumatic brain injury professionals and researchers throughout the world. This ongoing research is vital to future advances in the treatment of brain injury. A variety of new research projects were proposed by SEMTBIS staff and approved for funding by the National Institute on Disability and Rehabilitation Research (NIDRR) during the next grant period: Utility of MRI Techniques in Prediction of TBI Outcome This project aims to develop multivariable imaging models using three innovative techniques (i.e., Diffusion Tensor Imaging, Susceptibility Weighted Imaging, and Magnetic Resonance Spectroscopy), to improve the prediction of neurobehavioral and functional outcomes at two key time points – discharge from inpatient hospitalization and one year post injury. It will also examine the depth of lesion model, which assumes that the deeper the lesion the greater the disability. This is a Phase IIa clinical drug trial designed to establish optimal dosage of minocycline given acutely following TBI. The study will gather preliminary functional outcome data in an attempt to conduct a clinical feasibility assessment with this drug. Minocycline is in the family of antibiotics and may act as a neuroprotectant agent following traumatic brain injury. Sexuality after TBI This project examines the frequency, type, and severity of changes in sexual function associated with TBI. Participants in this project will have been previously enrolled in the Southeastern Michigan Traumatic Brain Injury System and have agreed to answer various questionnaires related to sexual function following traumatic brain injury. They will answer questionnaires at two time points, 6 month and 1 year after having sustained a TBI. In addition to conducting innovative research, the SEMTBIS will continue to expand and enhance the existing TBI model system of care through the implementation and development of several initiatives. These activities include, but are not limited to, developing consumer education classes, enhancing the SEMTBIS website (www.semtbis.org), continuing to build collaborative relationships with the Brain Injury Association of Michigan and Michigan's TBI Advisory group, disseminating the SEMTBIS newsletter "Thinking Cap", participating in local, state, and national TBI conferences, and publishing manuscripts and other written materials related to multiple aspects of TBI that may be of interest to survivors, families, caregivers and professionals. The current TBIMS grant cycle assures many opportunities to expand TBI knowledge through local and collaborative research, as well as offers the prospect of enhancing current TBI services and community outreach activities. Neuroanatomical Correlates of Positive Psychology Among People with Traumatic Brain Injury: A Biopsychosocial Model – A NIDRR funded Field Initiated Research Project The main objectives of this study are to identify how the images of the brain (MRI) relate to character strengths that underlie resiliency after traumatic brain injury (TBI) and the extent to which these characteristics relate to satisfaction with life and community integration. Participants in the research project will be 6 months to 2 years post injury after having sustained a traumatic brain injury. Subjective Fatigue in Persons with TBI: A Collaborative Field Initiated Project with Santa Clara Valley Medical Center Fatigue is one of the most commonly reported symptom following TBI and is associated with increased depression, pain, sleep disorders, cognitive challenges and decreased quality of life. Although there are many scales to measure fatigue in other diagnostic groups, there have been no scales specifically for use in the TBI population, especially in the community setting. This study will use existing fatigue scales to develop a valid, multidimensional assessment of fatigue for use with community-based individuals with TBI. For more information about SEMTBIS and/or the TBIMS program, please contact Carole Koviak, RN, MSA, SEMTBIS Coordinator at (313) 745-9737 or e-mail ckoviak@dmc.org. The Traumatic Brain Injury (TBI) Model Systems program is funded by the National Institute on Disability and Rehabilitation Research (NIDRR) and has the mission to improve the quality of life of people who experience TBI and their families by creating and disseminating new knowledge about the course, treatment and outcomes of this condition. At the heart of the program is a long-term, longitudinal study of patients who receive rehabilitation for TBI. Consenting patients are followed 1, 2, 5, 10 and every 5 years thereafter to learn about the long-term effects of moderate and severe TBI. Founded in 1987, there are currently 14 TBI Model System centers around the country. The Ohio Regional TBI Model System was first funded in 1997 and was recently selected to continue as a Model Systems Center for the next 5-year cycle. The Ohio Regional TBI Model System is located in the Department of Physical Medicine and Rehabilitation at the Ohio State University Medical Center. John D. Corrigan, PhD, is the Principal Investigator (PI), Jennifer Bogner, PhD, is the co-PI and Director of Research, and W. Jerry Mysiw, MD, is the Medical Director. The project operates under the umbrella of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation, which provides a means for consumer participation via its 30-member Advisory Council. Composed primarily of consumers from a multi-state region, the Advisory Council prioritizes needs, reviews funding opportunities, participates in grant implementation, monitors progress and evaluates program outcomes. The Ohio Regional TBI Model System serves a catchment area consisting of 2.5 million people in a 25-county area covering central and southern Ohio. All three Level I trauma centers in the region, and one of two Level II centers, are participants in the Ohio Regional TBI Model System. Brain injury rehabilitation is provided in the 24-bed, CARF-accredited, specialized Brain Injury Unit in the OSU Department of Physical Medicine and Rehabilitation. Post-acute treatment and follow-up are provided through the department’s Brain Injury Clinic, the outpatient NeuroRehabilitation program, and the TBI Network, a specialized treatment program for persons with TBI and substance use disorders. Over its 10 years of involvement in the TBI Model Systems Program, the Ohio Regional TBI Model System has recruited almost 600 patients into the National Dataset, and more than 200 5-year follow-ups have been completed. By the end of the upcoming funding cycle we expect to have enrolled 900 patients from the OSU Medical Center in the longitudinal study. The Ohio Regional TBI Model System has made other valuable contributions to the TBI Model Systems via local and multi-center research projects and participation in leadership positions among the Model Systems Centers. For the upcoming 5-year cycle of funding, Dr. Corrigan has been elected by his fellow Project Directors to Chair the TBI Model Systems Executive Committee. Among other responsibilities, he will represent the centers’ concerns to the public, funding bodies and other national organizations concerned with the long-term effects of TBI. (Partners: Michigan Protection and Advocacy)
What is Michigan Protection and Advocacy Service, Inc. (MPAS) Michigan Protection and Advocacy Service, Inc. (MPAS) is the
federally designated protection and advocacy (P&A) system in
Michigan. The P&A system is a nationwide network of nonprofit
corporations and state agencies providing information and advocacy to
individuals with disabilities. Under federal law, each state and
territory must designate a P&A program. Federal mandates require that P&A programs have access to a full
range of remedies for the individuals they serve, including information
and referral, training, negotiation, monitoring, administrative
actions, and legal remedies. In addition, Federal law gives P&A
programs access to individuals, their records, and programs when
necessary to carry out their mission of investigating and redressing
abuse and neglect of P&A customers. Focus Areas MPAS provides advocacy assistance for individuals with TBI on a wide array of issues. Some of those issues include accessing public services, advocating for community-based placements for individuals in congregate care settings (i.e. nursing homes, rehabilitation facilities), investigating allegations of abuse or neglect, accessing special education services for school-age individuals, accessing veterans services, and providing information & referral. MPAS will address these focus areas in several ways: investigation, direct representation, training, technical assistance, information and referral, and system-based advocacy. The Traumatic Brain Injury Model System (TBIMS) program was created and funded by the National Institute on Disability and Rehabilitation Research (NIDRR) in 1987 to demonstrate the benefits of a coordinated system of neurotrauma and rehabilitation care and conduct innovative research on all aspects of care for those who sustain traumatic brain injuries. Each Center systematically collects important data about each individual who meets criteria for inclusion in the TBI National Database and sends this information to the TBI National Data & Statistical Center at Craig Hospital in Denver, CO. The Centers are currently located at 16 sites throughout the United States that provide comprehensive systems of brain injury care to individuals who sustain a traumatic brain injury, from acute care through community re-entry. The mission of the TBIMS is to improve the lives of persons who experience traumatic brain injury, their families and communities by creating and disseminating new knowledge about the course, treatment and outcomes relating to their condition.
The National Institute on Disability and Rehabilitation Research (NIDRR) has awarded the Brain Injury Research Center (BIRC) at TIRR Memorial Hermann a center grant to study community integration for persons with traumatic brain injury (TBI). This large grant designates BIRC as the only national Rehabilitation Research and Training Center (RRTC) on Developing Strategies to Foster Community Integration and Participation for Individuals With Traumatic Brain Injury. NIDRR RRTC sites conduct research projects but also provide education and technical assistant to persons with injury, family members, healthcare providers, and others. This the second community integration RRTC awarded to TIRR and the fourth TBI RRTC awarded to TIRR overall. Dr. Angelle Sander, Director of BIRC and Associate Professor of Physical Medicine and Rehabilitation at Baylor College of Medicine, is the Principal Investigator (PI) for this new project. This is the third major TBI grant for which Dr. Sander has served as PI. She will direct all grant activities and be actively involved in all research and training projects. Dr. Mark Sherer, Director of Research at TIRR and Clinical Professor of Physical Medicine and Rehabilitation at Baylor College of Medicine and at the University of Texas Medical School at Houston will serve as Director of Research for the RRTC. He will have overall responsibility for all research projects and will serve as PI for one of the projects. Dr. Allison Clark, TIRR Investigator and Assistant Professor of Physical Medicine and Rehabilitation at Baylor College of Medicine, will serve as Director of Training for the grant. Drs. Lynne Davis and Laura Ritter will each take leadership roles for research projects and Terri Hudler-Hull will assist with training and technical assistance projects. There will be three research projects conducted as part of this grant. The first will be a study of the effectiveness of contextualized memory intervention for improving functional memory and community integration after TBI. This project is being conducted at TIRR and at Wayne State University. Participants will be recruited from Ben Taub General Hospital in Houston and from Rehabilitation Institute of Michigan in Detroit. The memory intervention will be provided in participants’ homes and will address the memory problems that are of the greater concern to the person with TBI and family members. The therapy will be individualized for each participant to capitalize on strengths and maximize use of environmental supports. The second research project will test the effectiveness of a case coordination intervention to improve compliance with vocational rehabilitation services and eventual return to work. This intervention will be closely coordinated with the Texas Department of Assistive and Rehabilitative Services (DARS). Participants will be recruited from Memorial Hermann Hospital in Houston. The final research project will develop a new way of classifying TBI. At present, persons with TBI are classified based on the initial severity of injury as determined by the degree of disturbance of consciousness or the duration of disturbed consciousness. However, persons with the same initial severity of injury can have very different outcomes and very different needs for treatment. The new classification system will be based on symptoms experienced by the person with injury, available supports, barriers, and other factors. We expect that persons in the same classification group will have similar outcomes and that group classifications with be helpful in guiding treatment. Participants to validate the classification system will be recruited at TIRR, the Michael E. DeBakey VA Medical Center in Houston, Wayne State University/Rehabilitation Institute of Michigan, and University of Alabama Birmingham/Spain Rehabilitation. In addition to the three research projects, the RRTC will include five training projects. For the first training project, TBI support specialists at 3 state brain injury associations (Brain Injury Association of Michigan, Brain Injury Association of Florida, and the Alabama Head Injury Foundation) will receive training in the use of evidence-based strategies with TBI survivors and their caregivers for managing cognitive and behavioral impairments. Fully-accessible online workshops for persons with TBI and their caregivers on the evidence-based strategies will also be developed. For the second training project, outreach and general education will be provided to staff at community organizations in order to create increased opportunities for consumer participation in community-based leisure activities. The third training project will focus on training of non-specialist professionals, including clinical social workers, clinical psychologists, substance abuse counselors, and post-secondary educators, on special issues in provision of services to persons with TBI and their families. In the fourth training project, persons with TBI will be trained in the use of the internet for social networking. Finally, for the fifth training project, training in use of the new TBI classification system will be provided to vocational counselors and other rehabilitation services providers. The overall goal of the RRTC is to improve community integration and participation outcomes for persons with TBI. To ensure that this goal is met, the RRTC leadership team will collaborate with other leading TBI rehabilitation programs around the country, a range of expert consultants, persons with TBI and their family members, the Brain Injury Associations in Texas, Michigan, and Florida, and the Alabama Head Injury Foundation. Updates on the progress of the RRTC will be provided over the next five years.Research Partnerships
Michigan TBI State Implementation Partnership Grant
In addition, management level staff from Blue Cross/Blue Shield of Michigan (BCBSM) participates on the TBI Council and data on TBI services reimbursed by them have been shared with the project. Activities proposed in the 2009-2013 Implementation Partnership Grant to HRSA involve reaching out to new private partners, namely hospital emergency departments.Southeastern Michigan Traumatic Brain Injury System (SEMTBIS)
Currently Funded Projects
Safety and Feasibility of Minocycline in the Treatment of TBICollaborative Modules within the overall TBIMS Project
Additional TBI Research at Rehabilitation Institute of Michigan
The Ohio Regional Traumatic Brain Injury Model System
Michigan Protection and Advocacy Services (MPAS)
Traumatic Brain Injury Model System (TBIMS)
The Institute for Rehabilitation and Research (TIRR)
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