Toronto Rehab Foundation
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1 INTEGRATED CLINICAL - RESEARCH CENTRE FOR CHRONIC BRAIN INJURY Toronto Rehab Foundation ROBIN GREEN, PH.D., C.PSYCH. Canada Research Chair (II) Traumatic Brain Injury University Health Network -Toronto Rehab University of Toronto
2 OVERVIEW PART 1: Why do we need a provincial brain injury centre? PART 2: The Centre PART 3: Our latest research
3 THE CLINICAL NEED
4 What is a moderate-severe TBI? (Not a concussion) Brain: Bleeding, swelling, removal of skull Coma: Hours to days to months
5 Invisible on the outside: Enduring effects Damaged on the inside: Unable to drive a car, ride a bike or play sports return to work return to school maintain relationships Isolation depression loneliness without purpose vulnerable
6 Scale? Estimated incidence of people living with ongoing (life-long) disability from brain injury Canadians: > 370,000 Ontarians: > 140,000
7 Who suffers? All ages, but traumatic brain injury is a leading cause of disability in young adults around the world prime of life; beginning of careers and families; decades of persisting disability from TBI
8 Brain Recovery: What we assume 5 months post-injury
9 Brain Recovery: What we assume 5 months post-injury 24+ months post-injury
10 Brain Recovery: What we observe 5 months post-injury 24+ months post-injury
11 Cognitive Recovery: What we assume TBI Plateau MAINTENANCE Recovery 1 month 6 months 1 year 2 year Time Post-Injury
12 l o f A b il it y Cognitive Recovery: What we observe TBI Plateau Recovery DECLINE 1 month 6 months 1 year 2 year Time Time Post-Injury
13 Depression: 2 months to 2 years after injury Percentage of TBI Patients with Moderate or Greater Depressive Symptoms on Beck Depression Inventory (N=76)
14 Percent anxiety Anxiety: 2 months to 2 years after injury 20% Percentage of TBI Patients with Moderate or Greater Anxiety Symptoms on Beck Anxiety Inventory (N = 76) 19.2% 15% 10% 5% 0% 12.2% 10.3% 10.5% Months post-injury *Base rate Generalized Anxiety Disorder in general population = 2.6% *
15 Treatment? Duration typically weeks to months Since disability is life-long, there is a gulf in treatment Therefore, there is a critical need for ongoing therapies, and research to improve therapies
16 INTEGRATED CLINICAL-RESEARCH CENTRE FOR CHRONIC BRAIN INJURY
17 Personnel and Partners Hired so far: Centre lead Clinical psychologist Consumer advisor Computer Programmer Space/Architectural advisor
18 Personnel and Partners Hired so far: Centre lead Clinical psychologist Consumer advisor Computer Programmer Space/Architectural advisor To be hired: therapists, post docs, junior scientists, research chair, engineer, admin staff
19 Personnel and Partners Hired so far: Centre lead Clinical psychologist Consumer advisor Computer Programmer Space/Architectural advisor To be hired: therapists, post docs, junior scientists, research chair, engineer, admin staff Collaborators include: March of Dimes, ABI system navigators, Ontario
20 Reaching patients across the province Remote, internet-based cognitive assessment Internet-based therapies (group)
21
22 THERAPIST
23 THERAPIST
24 Reaching patients across the province Remote, internet-based assessment Internet-based therapies (group) Automated - self-operating - tools No therapist required (sustainable) e.g., anger-management bracelet
25 Self operating tools Anger management bracelet: Affect Detection
26 Reaching patients across the province Remote, internet-based assessment Internet-based therapies (group) Automated - self-operating - tools No therapist required e.g., anger-management bracelet Automated, self-administered brain-games open source software (for scaling)
27 Brain games: Allocentric spatial navigation
28 Space?
29 Key Objectives of Centre Across province: clinical care through participation in research patients come to centre for care through their research participation, they help us to help others but note that research and clinical care are seamlessly intertwined oved brain, cognitive, emotional health; reduced family burden and reduced healthcare costs New model of healthcare for chronic brain injury Initial investment followed by sustainability Ongoing research: brain-repair to improve clinical outcome; refine interventions
30 Key Objectives of Centre Across province: clinical care through participation in research patients come to centre for care through their research participation, they help us to help others but note that research and clinical care are seamlessly intertwined Improved brain, cognitive, emotional health; reduced family burden and reduced healthcare costs New model of healthcare for chronic brain injury Initial investment followed by sustainability Ongoing research: brain-repair to improve clinical outcome; refine interventions
31 Key Objectives of Centre Across province: clinical care through participation in research patients come to centre for care through their research participation, they help us to help others but note that research and clinical care are seamlessly intertwined Improved brain, cognitive, emotional health; reduced family burden and reduced healthcare costs New model of healthcare for chronic brain injury ial investment followed by sustainability Ongoing research: brain-repair to improve clinical outcome; refine interventions
32 Key Objectives of Centre Across province: clinical care through participation in research patients come to centre for care through their research participation, they help us to help others but note that research and clinical care are seamlessly intertwined Improved brain, cognitive, emotional health; reduced family burden and reduced healthcare costs New model of healthcare for chronic brain injury Initial investment followed by sustainability Ongoing research: brain-repair to improve clinical outcome; refine interventions
33 Key Objectives of Centre Across province: clinical care through participation in research patients come to centre for care through their research participation, they help us to help others but note that research and clinical care are seamlessly intertwined Improved brain, cognitive, emotional health; reduced family burden and reduced healthcare costs New model of healthcare for chronic brain injury Initial investment followed by sustainability Ongoing research: brain-repair to improve clinical outcome; refine interventions
34 We have identified factors that we can treat RESEARCH: PRESENT/FUTURE
35 Approach Identify problems Identify causes of problems Identify treatments Demonstrate remote deliverability of treatments
36 Problem: Increasing Depression and Anxiety from 2 mos. to 2 years post-injury
37 Problem: Increasing Depression and Anxiety from 2 mos. to 2 years post-injury Treatment: Tele-cognitive behaviour therapy
38 Problem: Shrinkage of brain in chronic stages of brain injury
39 Problem: Shrinkage of brain in chronic stages of brain injury Cause: Elevated anxiety
40 Problem: Shrinkage of brain in chronic stages of brain injury Cause: Elevated anxiety Treatment: Cognitive behaviour therapy?
41 Problem: Shrinkage of brain in chronic stages of brain injury
42 Problem: Shrinkage of brain in chronic stages of brain injury Cause: Insufficient cognitive stimulation?
43 Problem: Shrinkage of brain in chronic stages of brain injury Cause: Insufficient cognitive stimulation? Treatment: Allocentric spatial navigation brain games?
44 The need for a clinical-research centre for chronic brain injury? - Many thousands in Ontario with chronic disability - Limited care after the first months of therapy, but suffering is life-long, often striking in prime of life The Centre - Hiring has commenced; many more hires needed - Patients are receiving clinical care remotely through research participation - Long-term: partially self-sustaining through automated delivery of treatments Research aims - In chronic stages of injury: prevent brain deterioration; improve emotional function; improve cognitive function; improve quality of life of patient/family - Employ interventions that are remotely deliverable (via internet) and costeffective (self-administrated)
45 The need for a clinical-research centre for chronic brain injury? - Many thousands in Ontario with chronic disability - Limited care after the first months of therapy, but suffering is life-long, often striking in prime of life The Centre - Hiring has commenced; many more hires needed - Patients are receiving clinical care remotely through research participation - Long-term: partially self-sustaining through automated delivery of treatments Research aims - In chronic stages of injury: prevent brain deterioration; improve emotional function; improve cognitive function; improve quality of life of patient/family - Employ interventions that are remotely deliverable (via internet) and costeffective (self-administrated)
46 The need for a clinical-research centre for chronic brain injury? - Many thousands in Ontario with chronic disability - Limited care after the first months/years of therapy, but suffering is life-long, often striking in prime of life The Centre - Hiring has commenced; many more hires needed - Patients are receiving clinical care remotely through research participation - Long-term: partially self-sustaining through automated delivery of treatments Research aims - In chronic stages of injury: prevent brain deterioration; improve emotional function; improve cognitive function; improve quality of life of patient/family - Employ interventions that are remotely deliverable (via internet) and costeffective (self-administrated) - long-term goal is maximum sustainability
47 THANK YOU
48 LAB Alexandra Arnold-Oatley Bojana Budisin Alana Changoor Brenda Colella Marika Dabek Diana Frasca Joanna Glazer Lily Miguel-Jaimes Greg Noack Lesley Ruttan Cristina Saverino Bhanu Sharma Deborah Tang Alex Terpstra Jennifer Tomaszczyk Brandon Vasquez COLLABORATORS Mark Bayley Joyce Chen Leo Ezerins Asaf Gilboa Alex Mihailidis David Mikulis Georges Monette Charles Tator Carmela Tartaglia Susan Jewell Craig Norman Joanne Zee
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