Traumatic Brain Injury Rehabilitation Research | NYU Langone Health

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Rusk Rehabilitation Research Traumatic Brain Injury Rehabilitation Research

Traumatic Brain Injury Rehabilitation Research

The Traumatic Brain Injury Model System at NYU Langone’s Rusk Rehabilitation is a collaborative endeavor that includes NYU Langone Ambulatory Care Center East 38th Street, NYU Langone Orthopedic Hospital, NYU Langone Hospital—Brooklyn, NYC Health + Hospitals/Bellevue, and several other trauma and medical centers throughout New York City.

The goals of the research program include generating new knowledge and scientific evidence to improve outcomes for people with traumatic brain injuries through the development of innovative interventions, clinical assessment and outcomes tools, and expanded service delivery options.

Traumatic Brain Injury Clinical Studies

Our research benefits from the diversity inherent in our patient population. The research team considers the effect of race and culture on the care patients with traumatic injury have access to, as well as their effect on outcomes, and often work with people who have been living with traumatic brain injuries for many years.

Traumatic Brain Injury Model System

Rusk Rehabilitation’s Traumatic Brain Injury Model System provides comprehensive care to meet the diverse needs of people with traumatic brain injury in its catchment area. The system consists of three components: comprehensive clinical care, research and our contribution of data to the National Traumatic Brain Injury Model Systems Database, and dissemination, education, and training. The research component of the National Traumatic Brain Injury Model Systems Database is designed to advance the understanding of traumatic brain injury and its consequences.

Researchers collect information by abstracting medical and administrative records, interviewing patients when they are admitted to or discharged from the rehabilitation units at Bellevue, NYU Langone Orthopedic Hospital, and NYU Langone Hospital—Brooklyn, and interviewing patients annually beginning about a year after the date of injury for the first 2 years, and then at 5 years, 10 years, and every 5 years thereafter. The data documents each patient’s medical, functional, psychological, and social status, and use of health services. We contribute this data to the National Traumatic Brain Injury Model Systems Database for analysis of pooled data from all 16 federally funded model systems of traumatic brain injury care.

Traumatic Brain Injury as a Chronic Condition

Using a mixed method exploratory sequential approach, our researchers are investigating traumatic brain injury as a chronic condition among a diverse group of patients and the barriers and facilitators they encounter when managing the condition. We plan to recruit 130 participants who include people with medically confirmed traumatic brain injury, people who have not been medically confirmed for traumatic brain injury, caregivers, and 20 clinicians and healthcare professionals, and ask each to complete a survey, an interview, or both. Quantitative and qualitative data are collected online, by telephone, or in person. The researchers examine quality of life, community participation, and medical care to develop culturally tailored toolkits that include clinical care recommendations and educational materials for all socio-ecologic model levels according to this study’s findings.

Risk Factors Patients with Traumatic Brain Injury Encounter at Bellevue

This study evaluates the risk factors patients with traumatic brain injury encounter at Bellevue while receiving inpatient rehabilitation. Our team was surprised by the number of risks this patient population faces, especially patients who are from marginalized groups. We want to take a closer look at the vulnerable groups this patient population belongs to and whether being in a marginalized group has an effect on the functional outcomes that result from their inpatient rehabilitation.

Cultural Identity and Acculturation in Rehabilitation Education and Adherence

Research suggests that a number of factors may strongly contribute to healthcare disparities among culturally diverse minorities, including limited English proficiency, poor health literacy, and reduced trust in the healthcare providers. The first step toward reducing disparities in traumatic brain injury rehabilitation for racial and ethnic minorities is to assess people’s cultural identity and level of acculturation. In addition, it is essential to collect and examine data on factors known to moderate healthcare outcomes in minorities, such as health literacy and trust in providers.

The proposed study is based on Bellevue’s quality improvement surveys regarding culture, race and ethnicity, acculturation, family support, trust in healthcare providers, and health and language literacy in patients with traumatic brain injuries. The study seeks to define the modifiable and non-modifiable factors that affect whether a patient understands why it is important to return for outpatient treatment after being discharged.

Participation in Minimal Risk Research

The recruitment population for the Traumatic Brain Injury Model System is large and varied. Some of these patients are racial and ethnic minorities, uninsured, undocumented, or homeless. This study seeks to analyze information about patients with traumatic brain injuries who are eligible for the National Traumatic Brain Injury Model Systems Database to see if we can identify the predicting factors that influence their decision to participate in the study. Based on our study’s findings, we plan to determine strategies for increasing participation, including modifying study recruitment or educational materials. This study also explores the vulnerable groups to which these patients belong and whether membership in multiple marginalized groups plays a role in their decision to participate.

Alexithymia Prevalence

Research has linked alexithymia that occurs after traumatic brain injury to a wide range of negative outcomes, including poor emotional (anxiety, depression, and aggression) and psychosocial functioning (impaired emotion perception, empathy, and relationship quality) and coping (avoidant coping and suicide ideation); caregiver burnout; somatization; prolonged post-concussion symptoms; and reduced quality of life. We are one of the participants in this Traumatic Brain Injury Model Systems module study. It is critical that the data collected represent all levels of injury and impairment to ensure the sample is not biased. The research assesses the level of alexithymia one year and two years after traumatic brain injury. It also examines the breadth of outcomes after traumatic brain injury affected by alexithymia in a cohort of people who are enrolled in the National Traumatic Brain Injury Model Systems Database.

Menopause in Women with Traumatic Brain Injury

The spectrum of menopause symptoms ranges from those closely associated with hormone levels, such as hot flashes and vaginal dryness, to broader psychosocial and affective symptoms, such as depression and anxiety. We are one of the participants in this Traumatic Brain Injury Model Systems module study. The study seeks to examine differences in hot flashes, vaginal dryness, sexual dysfunction, sleep disturbance, and fatigue in women with traumatic brain injury compared with women who don’t have traumatic brain injury. Researchers plan to test whether traumatic brain injury and its severity moderates the relationship between menopause status and symptom severity. They also intend on determining whether the timing of the final menstrual period is significantly different in women with traumatic brain injury compared with those who have not sustained the injury.

Chronic Pain After Moderate to Severe Traumatic Brain Injury

A large number of people who sustain a traumatic brain injury experience chronic pain—lasting at least three months—that may or may not be directly related to their injury. Research shows that more than 70 percent of nonmilitary people and 80 percent of active military and veterans report chronic pain after a traumatic brain injury. The prevalence of chronic pain after traumatic brain injury is associated with poor outcomes and affects physical function, concentration and memory, and sleep, and can cause depression, anxiety, and irritability.

We are participating in a study that seeks to classify the type of chronic pain people experience and track its prevalence, duration, and associations with demographics; determine the severity of the brain injury; catalog the patient’s level of functioning; and examine comorbidities in participants in the National Traumatic Brain Injury Model Systems Database. Researchers plan to compare chronic pain phenotype characteristics across two outcomes: impact of chronic pain on daily life and overall perceptions of improvement. They also intend to identify treatment practices by clinicians who treat comorbid traumatic brain injury and chronic pain to determine gaps in availability and accessibility of multidisciplinary pain treatment, highlighting underserved populations where applicable.

BeHealthy: Chronic Disease Management for Traumatic Brain Injury

This five-year study, funded by the National Institute of Disability, Independent Living, and Rehabilitation Research, includes all 16 federally funded traumatic brain injury model systems. The study’s purpose is to develop new knowledge and information about potential characteristics and adaptability of evidence-based chronic disease models for people with traumatic brain injury, and to develop a model to improve long-term outcomes after brain injury that can be used by healthcare providers and policymakers.

Traumatic Brain Injury Grants

Our research has been supported by grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) in the Administration for Community Living.

Traumatic Brain Injury Research Training

The Traumatic Brain Injury Model System’s clinical research laboratory collaborates with Rusk Rehabilitation’s Rehabilitation Clinical Psychology Internship and Psychology Postdoctoral Fellowship in Rehabilitation Research. In addition, we offer trainees opportunities to assist with clinical research being conducted in our laboratory.

Our Research Faculty and Team

The Traumatic Brain Injury Model System research team includes principal investigator Tamara Bushnik, PhD, and co-investigators Steven R. Flanagan, MD, and Brian S. Im, MD. The research team includes associate research scientist Michelle Smith, MPH, CHES; research coordinators Olga Garduno-Ortega and Natalie Jenkins, MA; research associate Alejandro Zarate; and numerous volunteers.

Contact Us

To learn more about the Traumatic Brain Injury Model System, please contact Dr. Bushnik at tamara.bushnik@nyulangone.org. You can also contact Michelle Smith at michelle.smith@nyulangone.org.

Recent Publications

COVID-19 and Visual Disability: Can't Look and Now Don't Touch

Rizzo, John-Ross; Beheshti, Mahya; Fang, Yi; Flanagan, Steven; Giudice, Nicholas A

PM&R. 2021 Apr ; 13:415-421

Primary Language and Participation Outcomes in Hispanics With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Sander, Angelle M; Ketchum, Jessica M; Lequerica, Anthony H; Pappadis, Monique R; Bushnik, Tamara; Hammond, Flora M; Sevigny, Mitch

Journal of head trauma rehabilitation. 2021 Feb 22;

Global decrease in brain sodium concentration after mild traumatic brain injury

Gerhalter, Teresa; Chen, Anna M; Dehkharghani, Seena; Peralta, Rosemary; Adlparvar, Fatemeh; Babb, James S; Bushnik, Tamara; Silver, Jonathan M; Im, Brian S; Wall, Stephen P; Brown, Ryan; Baete, Steven H; Kirov, Ivan I; Madelin, Guillaume

Brain communications. 2021 Apr ; 3:fcab051

Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures

Kalpakjian, Claire Z; Kreschmer, Jodi M; Slavin, Mary D; Kisala, Pamela A; Quint, Elisabeth H; Chiaravalloti, Nancy D; Jenkins, Natalie; Bushnik, Tamara; Amtmann, Dagmar; Tulsky, David S; Madrid, Roxanne; Parten, Rebecca; Evitts, Michael; Grawi, Carolyn L

Journal of women's health (Larchmont, N.Y. : 2002). 2020 Nov ; 29:1427-1436

Emotional and autonomic processing of olfactory stimuli is compromised in patients with a history of mild traumatic brain injury

Hilz, Max J; Wang, Ruihao; Liu, Mao; Muresanu, Dafin; Flanagan, Steven; Winder, Klemens; Hösl, Katharina M; Hummel, Thomas

Journal of neurotrauma. 2020 Jan 01; 37:125-138

Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities Item Banks and Short Forms

Heinemann, Allen W; Kisala, Pamela A; Boulton, Aaron J; Sherer, Mark; Sander, Angelle M; Chiaravalloti, Nancy; Bushnik, Tamara; Hanks, Robin; Roth, Elliot; Tulsky, David S

Archives of physical medicine & rehabilitation. 2020 Jan ; 101:20-32

Measuring Pain in TBI: Development of the TBI-QOL Pain Interference Item Bank and Short Form

Carlozzi, Noelle E; Kisala, Pamela A; Boulton, Aaron J; Roth, Elliot; Kratz, Anna L; Sherer, Mark; Sander, Angelle M; Heinemann, Allen W; Chiaravalloti, Nancy D; Bushnik, Tamara; Tulsky, David S

Archives of physical medicine & rehabilitation. 2020 Jan ; 101:11-19

MTBI Identification From Diffusion MR Images Using Bag of Adversarial Visual Features

Minaee, Shervin; Wang, Yao; Aygar, Alp; Chung, Sohae; Wang, Xiuyuan; Lui, Yvonne W; Fieremans, Els; Flanagan, Steven; Rath, Joseph

IEEE transactions on medical imaging. 2019 Nov ; 38:2545-2555