National Data and Statistical Center

Northern California TBI Model System

Individuals with TBI are a major portion of the clientele at SCVMC, a level 1 trauma center. Since 1976, SCVMC has provided categorical care in a Brain Injury program for inpatients and outpatients and was first an RSA, then a NIDRR-designated Model System for TBI since the inception of those programs. Over this time period, with the support of the county board of supervisors and hospital administration, NIDRR, and the community, the continuum of care has grown to encompass those with mild TBI, very severe injuries, and those transitioning into the community. Specialized programs have been designed to maximize the rehabilitation potential of those with TBI. Referral networks of individuals for inclusion into the Model System have been expanded to San Francisco General, trauma centers in the East Bay (Eden Hospital, John Muir Hospital), central valley (Doctors Hospital in Modesto and Modesto Memorial) and Santa Rosa (Santa Rosa Memorial). With our excellent follow-up capabilities we are now contacting people injured over 20 years ago to ascertain long-term outcomes.

Based on continued input from individuals with TBI in our community, this grant’s focus is on the “Health and Function” priority suggested by the US Department of Education. These individuals have identified fatigue as a significant daily challenge and one in which they would appreciate useful interventions. Our current studies have identified a strong association of fatigue with sleep disorders, depression, pain and cognitive challenges; the prevalence of pituitary dysfunction is high in this group as well but the level of dysfunction is not proportional to levels of fatigue.

The local community of individuals with TBI has also indicated their willingness to participate in studies relating to fatigue—they are eager to learn how to better manage this problem and prefer activity programs to pharmacologic interventions. Our site specific research effort will be a prospective randomized single-blind crossover study that evaluates the impact of a graduated physical activity program on fatigue and related factors of depression, sleep quality/ daytime drowsiness, cognitive function, and general health measures. We will participate in two module collaborative projects: “Enhancing the TBIMS core dataset to expand research on environmental influences affecting outcomes from TBI” and “A prospective study of the relationship between post TBI fatigue and insomnia”.

Dissemination efforts will build on our growing Center for Outcome Measurements in Brain Injury (COMBI) with cooperation and collaboration from at least 16 other centers from within the TBIMS program and other international contributors. Additional dissemination will occur via other Internet resources, local, national, international presentations, newsletters, and peer-reviewed publications. The strengths of SCVMC include: a model clinical service delivery program, a stable research staff experienced in the Model Systems; significant financial support from the hospital and county, an excellent follow-up record; proven leadership as chairs of the Dissemination and Data committees; and an excellent community network of services that has always included individuals with disabilities, both in paid and volunteer positions. Each of our staff members has contributed to the success of the TBI Model systems at multiple levels and is committed to continuing and improving in those collaborative efforts.