North Texas Traumatic Brain Injury Model System

The North Texas Traumatic Brain Injury Model System (NTTBIMS) is one of 16 sites in the United States comprising the oldest and largest longitudinal databases of persons with traumatic brain injury (TBI). The TBI Model Systems research program is funded by the National Institute for Disability, Independent Living, and Rehabilitation Research, part of the Administration for Community Living under the Department of Health and Human Services. The program began in 1997 to examine medical, social, and psychological outcomes for TBI.

Participants are enrolled while they are still in the hospital rehabilitation unit after sustaining a moderate to severe TBI and are followed for outcomes at 1, 2, 5, 10, 15, and 20 years after injury and every 5 years afterward. In addition to information about the original injury and hospitalization, participants are asked to report via telephone on their health and new or continuing health disorders, living arrangements, participation in work, school, and community, and to undergo short testing of cognitive and psychological states and abilities.

Collaboration

The NTTBIMS is unique among the participants in that it is a collaborative effort between the two largest providers of rehabilitation in Dallas – the University of Texas Southwestern Medical Center and Baylor Institute of Rehabilitation. Initially funded in 2002, the NTTBIMS now includes patients seen at the three Level I trauma centers: Parkland Memorial Hospital, Baylor Health Care System and John Peter Smith Hospital in Fort Worth. Patients are enrolled from the inpatient rehabilitation units at Parkland Hospital, Zale Lipshy University Hospital, and Baylor Institute of Rehabilitation.

The Model System program has enrolled 15,000 persons with TBI and has followed some of them for 20 years. In addition to collecting this data for the program, the centers participate in research projects at each site, as well as multi-center investigations. Each participating center must demonstrate the delivery of a coordinated system of acute neurotrauma and inpatient rehabilitation.

NTTBIMS Site Locations

  • University of Alabama at Birmingham Traumatic Brain Injury Care System, Birmingham, Alabama
  • Rocky Mountain Regional Brain Injury System, Englewood, Colorado
  • South Florida TBI Model Systems, Miami, Florida
  • Indiana University/Rehabilitation Hospital of Indiana, Indianapolis, Indiana
  • Spaulding-Harvard Traumatic Brain Injury Model System, Boston, Massachusetts
  • Mayo Clinic Traumatic Brain Injury Model System, Rochester, Minnesota
  • Northern New Jersey Traumatic Brain Injury System, West Orange, New Jersey
  • New York Traumatic Brain Injury Model System, New York, New York
  • Rusk Rehabilitation TBIMS at NYU, New York, New York
  • Ohio Regional TBI Model System, Columbus, Ohio
  • Moss TBI Model System, Elkins Park, Pennsylvania
  • University of Pittsburgh Medical Center Traumatic Brain Injury Model System, Pittsburgh, Pennsylvania
  • North Texas Traumatic Brain Injury Model System, Dallas, Texas
  • Institute for Rehabilitation and Research, Houston, Texas
  • Virginia Commonwealth TBI Model System, Richmond, Virginia
  • University of Washington Traumatic Brain Injury Model System, Seattle, Washington

Research Projects 2012 to Present

To examine comparative effectiveness of variations in clinical practices and patient outcomes across TBIMS rehabilitation centers, and to develop evidence-based practice guidelines for TBI rehabilitation.
PI: Shahid Shafi, M.D.

In this study, data was collected from all participating model systems sites to look for differences in patient outcomes after discharge. The study sought to find if different “doses” of therapy or other treatments resulted in patient improvement. Finally, the team hopes to develop guidelines for common treatment challenges on inpatient TBI units, either by evidence support or by the agreement of experts.

To demonstrate whether resting dopamine transporter binding, or the ability of the dopamine synapses to release dopamine in response to a drug challenge, will be predictive of patient response to methylphenidate treatment using single proton emission computed tomography (SPECT) imaging.
PI: Kyle Womack, M.D.

Because we don’t know which TBI patients might respond well to a neurostimulant that relies on the neurotransmitter dopamine, this study hopes to find whether it is possible to tell which patients can utilize neurostimulant medications, and which patients are resistant to the effects of these medications.

Multi-Center Projects

  • TWILIGHT (Treatment with Light after TBI): TBI patients often have difficulty sleeping after their injuries, which is thought to negatively affect their ability to participate in therapy and recovery. This study, led by the University of Washington (PI: Kathleen Bell, M.D., Jennifer Zumsteg, M.D., University of Washington TBIMS) seeks to report the effects of treating TBI patients with difficulty sleeping during inpatient rehabilitation with 30 minutes of bright light every morning. We are measuring the effects on sleeping by using actigraphs – wrist monitors that measure movement – before and during the treatment with phototherapy. In addition, we are looking to see if outcomes are improved for cognition, behavior, fatigue, and the ability to participate well in therapy. The sites involved are NTTBIMS, University of Washington, and Mt. Sinai in New York.
  • Long term Outcomes after TBI (PI: Flora Hammond, M.D., Indiana University TBIMS)
  • The Use of the Internet for those with TBI (PI: Cynthia Harrison-Felix, Ph.D., Rocky Mountain Regional Brain Injury System)

NTTBIMS Research Group

University of Texas Southwestern Medical Center

  • Kathleen R. Bell, M.D. (Co-Principal Investigator)
  • Kyle Womack, M.D. (Site Project Principal Investigator – Dopamine Transport)
  • Shannon Juengst, Ph.D. (Investigator)
  • Candice Osborne, Ph.D., OTR (Investigator)
  • Caryn Harper, M.S., CCRC (Project Manager)
  • John Thottakara, M.D. (Chief of Service, Parkland Hospital PM&R)
  • Ezequiel Cambranis (Research Coordinator)
  • Ramon Diaz-Arrastia, M.D., Ph.D. (Consultant, previous Project Director, University of Pennsylvania)

Baylor Institute of Rehabilitation

  • Shahid Shafi, M.D., MPH, FACS (Co-Principal Investigator)
  • Simon Driver, Ph.D. (Research Director)
  • Marie Dahdah, Ph.D. (Investigator)
  • Rosemary Dubiel, D.O. (Investigator)
  • Monica Bennett, Ph.D. (Statistician)
  • Cindy Dunklin, B.S., CCRC (Project Manager)
  • Libby Callendar, B.S. (Research Coordinator)