New Center Proposal: NeuralInjury Center
Purpose
The proposed Neural Injury Center(NIC)will be a collaborative of faculty and facilities located on the campus of the University of Montana – Missoula (UM). The focus of the Center is to integrate existing scientific, educational and clinical expertise within different UM academic units to provide a centralized and unique combination of personnel and resources dedicated to serving military veterans with neurologicalinjury (e.g. traumatic brain injury [TBI], stroke, spinal cord injury etc.) as they progress from in-patient rehabilitation to the college campus, vocational training, employment and community living. The NIC will also offer support and education for family members and caregivers through on-campus opportunities and follow-up support. The NIC will provide veterans, on- and off-campus, with information regarding post traumatic stress disorder (PTSD) and TBI and provide an opportunity for anonymous screening, consultation, ongoing treatment if needed, and networking with existing community resources.In addition, the NICwill support basic and clinical research to translate laboratory discoveries into improved care for patients with TBI. The NICwill not duplicate existing services, but rather provide new opportunities and support for veterans, particularly those wishing to engage in the pursuit of educational goals.Currently no Center or facility provides a singular location for supporting the needs of the veteran and caregivers during their educational and vocational pursuits. The integration of these activities in an environment that also encompasses clinical trials and translational research among the Center’s collaborating scientists also sets the NIC apart from other programs.
The Center will be housed and administered within The College of Health Professions and Biomedical Sciences. Academic programs centrally involved will include the School of Physical Therapy and Rehabilitation Science, Department of Biomedical and Pharmaceutical Sciences, Department of Pharmacy Practice, Center for Structural and Functional Neuroscience, Department of Communicative Sciences and Disorders, Department of Health and Human Performance, School of Social Work and The Department of Psychology. The Center will be closely affiliated with The Nora Staael Evert Physical Therapy Clinic, which includes three integrated programs, UMPT Sports & Orthopedics, UMPT Neurological and Mobility Impairments, and the UMPT New Directions Wellness Center. The latter is a facility dedicated to providing fitness programs and education for the disabled.
Collaborating programs will likely include, but are not limited to, UM’s Veterans Office, UM’s Department of Health and Human Performance, UM’s Rural Institutes on Disabilities, UM’s Western Montana Health Education Center,the Community Medical Center Bridges Program, The Montana Neuroscience Institute Foundation, and the Montana Brain Injury Center. It is also anticipated that Center staff will form a close relationship with healthcare professionals at the Veteran’s Hospital in Fort Harrison, Providence St. Patrick Hospital and Community Medical Center in Missoula, and provide unique opportunities for the State’s newly accredited Family Medicine Residency of Western Montana..
Initial research focus:
1)Molecular mechanisms associated with brain injury.
2)The development of physical and pharmacological interventions for brain injury.
3)Cognitive and communication dysfunction following TBI.
4)Cognitive rehabilitation following TBI.
5)Understanding the relationships between concussion and TBI.
6)Vestibular and musculoskeletal impairments following TBI.
7)Neurophysiological examination of movement coordination deficits associated with brain injury.
Center Objectives
The Center’s objectives focus on service to, but are not limited to, military veterans, providing education to clients and families, and conducting research targeting TBI and associated disorders.
The service component will include coordinatingevaluative services for veterans, as indicated. Evaluative services mayinclude neuropsychological evaluations for the presence of cognitive impairment, and examinations for speech and movement disorders. Asneeds are identified, the veteran will be offered treatment within the physical therapy, speech pathologyand/or clinical psychology clinics on campus or referred to appropriate off-campus facilities.
The School of Pharmacy will be closely associated with the Center. Survivors of traumatic brain injury, stroke and spinal cord injury often present with complex medication regimens and unique therapy challenges. Clinical pharmacy expertise incorporated within neurorehabilitation teams can help ensure maximum efficacy of medications, identify important drug interactions, minimize adverse effects and provide patients and family members with education and support. It is expected that faculty and students in Pharmacy will expand their present efforts in the NSE Clinic to include this population.
The educational component will be multi-faceted. In addition, Center personnel will serve as veteran advocates and assist with organizing classroom and rehabilitation schedules. Education pertaining to the veteran’s disability will be available to family members, in an effort to increase understanding of the many factors that can contribute to a family member’s struggles, and in so doing, give family members the tools necessary to provide support in the most efficient
and effective manner. Importantly, the Center will also embark on programs aimed toward increasing public awareness of TBI.
Research efforts will be enhanced by the Center. The Research Program Director will ensure that there is communication among the various laboratories engaged in brain injury research. Monthly meetings and seminars among the investigators will occur and guidance will be provided to researchers relating to establishing collaborative teams, developing injury models,seeking funding opportunities, providing technical assistance, increasing translational research efforts and progressing work through preclinical development and clinical trials.
Center’s Activities and Productivity Expectations
A)Expectations of Center personnel (Departmental affiliation)
Center Director
The Director will be responsible for all daily operations and management of the Center. The Director will oversee and encourage research collaborations, seek Center funding, participate in ongoing personnel recruitment and oversee community public relations. The Director will also be responsible for coordinating on- and off-campus programs and developing collaborations regionally and nationally. The Director will report to the Dean of the College of Health Professions or his/her designate, which may initially be the Chair of The School of Physical Therapy and Rehabilitation Science.
Dr. Charles Leonard, a tenured professor and current Director of The Motor Control Research Laboratory will serve as the interim Director of the Center. Dr. Leonard received his Master’s degree from Duke University in Physical Therapy, and a Doctorate in Neuroscience from The Medical College of Pennsylvania. He received a National Institutes of Health post-doctoral fellowship to study at The Nobel Institute of Neurophysiology in Stockholm, Sweden. Prior to his academic career, Dr. Leonard founded and directed Tri-County Rehabilitation Centers, a series of out-patient physical rehabilitation centers located in Pennsylvania, New Jersey and Delaware that employed over 20 therapists and consulting physicians. Dr. Leonard has been at The University of Montana since 1990. His work uses clinical neurophysiological techniques such as electromyography and transcranial magnetic stimulation to examine neural mechanisms in the human that control muscle and joint coordination. He has developed several treatment interventions for neurological injury including a unique upper extremity robotic device with telerehabilitation capabilitiesthat was built in collaboration with Montana State University engineering faculty and students. He has patented a computerized electronic device that quantifies muscle properties and began a University spinoff medical device company, Neurogenic Technologies, Inc. in 2001. His work has been funded by The MJ Murdock Charitable Trust Foundation, NIH, NSF and NASA.
Research Program Director
The Research Program Director will be responsible for oversight of all research directives within the Center. With the exception of clinical trials, research will be done in existing UM laboratories and independently driven by each laboratory’s principal investigator (PI). Each PI will be responsible for personnel, equipment and space needs. The Director will be responsible for communication among the laboratories and be especially vigilant to potential collaborations and funding opportunities. The Director will be actively engaged in research with an emphasis in translational studies. Individual investigators will be responsible for alerting The Director to any work that has progressed to a need for clinical trials. The Director will then be responsible to organize this facet of the research program in collaboration with the PIs involved. The Director will also prepare a yearly report on the research efforts of the Center to be submitted to the Center Director. The Director will also facilitate the sharing of worldwide-published research relating to TBI. These periodic reviews will be distributed to Center personnel, Montana Neuroscience Institute Foundation members and Veterans’ organizations within the state.
Director of Community Outreach
The Director of Community Outreach will be responsible for public relations and communication. This will include, but is not limited to, communications with all veteran organizations within the state and region, the Montana University System and legislators. The Director will be responsible for creating and distributing content describing the Center’s activities. The Director will also be responsible for website development.
Clinical Director
The Clinical Director is responsible for coordinating integrated service and treatment opportunities between campus entities and the community, including specific treatment programs in The Nora Staael Evert Physical Therapy Clinic and New Directions Wellness Center. Working with the on-campus veteran’s office and appropriate on-campus experts, the Clinical Director will develop and promote a program designed to evaluate veterans for possible PTSD and TBI related problems. They will also oversee on-site treatment or arrange for off-campus treatment as needed. The Director will ensure that each veteran is assigned a patient advocate who will organize the veteran’s medical appointments and assist with compliance. The Director will also be the point person to link veterans with clinical researchers and appropriate clinical trials.
NOTE: At the outset, the Director of Community Outreach and the Clinical Director may be served by the same person.
B)Expectations of personnel without a departmental affiliation
Board of Directors/Scientific Advisory Committee
The Board will be comprised of academic, scientific, and medical personnel. At least one member will be an ethicist. The Board will advise on a number of topics including public relations, research directives, funding opportunities and facility development. The Board will provide a written report to the Center’s Director. It is expected that members will be appointed from the aforementioned groups on page one, but will also include other stakeholders as indicated.
Organization’s reporting line within the University
Relationship to the institutional mission, Departments involved, and how the Center will contribute to academic programs with respect to teaching, research and service
The Center’s focus on research and community service fit extremely well with the University’s mission.
The NICwill contribute to teaching, research and service in numerous ways. Teaching will be enhanced especially in clinically-related areas. One of the challenges for non-medical school based physical therapy, pharmacy, communication science, and clinical neuropsychology curriculums are the lack of daily contact with patient populations. As students rotate through our on-campus clinics it is anticipated that they will have the opportunity for observation and hands-on treatment of our wounded veterans. This experience will be invaluable.
Research will be a primary focus of the Center and it will facilitate increased interactions among scientists engaged in various aspects of brain injury. To our knowledge, there is no similar facility in the Northwest region that houses scientists engaged in such a wide range of research interests (from molecular to translational) within a single center devoted to TBI. It is anticipated that collaborations will result in increased funding opportunities and entrepreneurial activity. The Center will establish a new research emphasis on TBI and related brain injury.
Service to the community, the state of Montana and military veterans is another major focus and strength of the proposed Center. While many disparate services are available to veterans within the state, no single location or service provides the veteran with guidance for both their medical and educational needs. Importantly, our public outreach and educational efforts will seek to reach those veterans who may not know that they are experiencing a treatable problem. It is well-reported that many veterans believe cognitive and coordination problems are normal impairments post-combat. Others fear the stigma of asking for help. We hope to reach these individuals by providing public outreach and a facility where anonymous screening can take place. If needed, the Center can provide ongoing treatment without compromising their educational and vocational efforts.The Center’s location on the University of Montana campus and being in close proximity to Missoula College creates a perfect opportunity of convenience for the veteran and ease of collaborative efforts on the veteran’s behalf of medical and educational personnel. Center personnel will serve as the veteran’s medical advocate coordinating medical care and compliance. Further, it is envisioned that, using the Montana University System, the NICcould be a model established throughout the state to address clients with similar issues engaged in higher education.
The Center will also provide the opportunity to combine research and service by developing telerehabilitation technologies. Telerehabilitationand teletherapy are methods by which a patient’s physical, occupational and speech therapies can be monitored and progressed off-site (e.g. at home) by Center therapists and physicians.
Departments Involved:
School of Physical Therapy and Rehabilitation Science
Department of Biomedical and Pharmaceutical Sciences
Department of Pharmacy Practice
Department of Communicative Sciences and Disorders
Department of Health & Human Performance
Department of Psychology
School of Social Work
Center for Structural and Functional Neuroscience
Similar programs in Montana and surrounding region
The following programs are similar to the proposed Center only in that they provide services to military veterans. The Center’s Director and personnel will provide outreach and liaisons to all associated programs.
University of Montana Veterans’ Office (umt.edu/veterans) - Provides campus lounge for veterans and advice on GI bill.
VA Montana Health Care System (Montana.va.gov) - Provides TBI in-patient rehabilitation services (Fort Harrison, MT); Project ARCH (Access Received Closer to Home). Part of VA Montanahealth care system.
Veteran Services (wsd.dli.mt.gov/veterans) - Retraining and job service
VA Primary Care Telehealth Outreach Clinic, Hamilton, MT - Clinic provides computers to allow email contact with primary healthprovider in Missoulaso veteran does not have to travel.
Montana Veterans’ Affairs (montanadma.org)- Centralized information service center.
Wounded Warrior Project
Community Hospital Bridges Program
The Montana Neuroscience Institute Foundation and the Montana Brain Injury Center - Comprised of health care professionals and University researchers dedicated to building a
comprehensive resource for brain injury within the state of Montana.
University of Montana Rural Institute on Disabilities - Rural Health Research
Area Health Education Centers
Affiliated Faculty
Research
Douglas R. Allington, PharmD, BCPS Professor of Pharmacy Practice. Survivors of traumatic brain injury, stroke and spinal cord injury often present with complex medication regimens and unique therapy challenges. Clinical pharmacy expertise on neurorehabilitation teams can help ensure maximum efficacy of medications, identify important drug interactions, minimize adverse effects and provide patients and family members with education and support.
Richard Bridges, PhD, Professor and Chair Deptof Biomedical & Pharmaceutical Sciences
The role of central nervous system (CNS) transporters in CNS injury and protection. Transport mechanisms can contribute to excitotoxic changes post TBI. The work identifies pathological mechanisms enabling the identification of potential therapeutic interventions.
Matthew Bundle, PhD, Department of Health & Human Performance. Dr. Bundle’s work involves human biomechanics that includes evaluation of lower-extremity prosthetics in the disabled population, including world-class athletes.
Alessander dos-Santos, PT, PhD, Assistant Professor Physical Therapy and Rehabilitation Science - Neural processes involved in multi-muscle coordination of the human body for posture control. Individuals with TBI develop impairments in their ability to control balance. The work seeks to identify the causes of these impairments and possible ways to treat their effects.
Michael Kavanaugh, PhD, Dept of Biomedical & Pharmaceutical Sciences
The study of glutamate receptors and transporters in the brain. Glutamate is the most abundant neurotransmitter in the healthy brain, but several disease processes including TBI disrupt its regulation and lead to neuropathology. Dr. Kavanaugh has been funded continuously by the NIH for over twenty years for studies of glutamate transporters.
James Laskin, PT, PhD - School of Physical Therapy & Rehabilitation Science. Dr. Laskin is Co-Director of the Applied Physiology Laboratory; his interests include sports and recreation for people with physical disabilities; physical fitness for disabled populations; health promotion and secondary condition risk reduction.
Josh Lawrence, PhD, Dept of Biomedical & Pharmaceutical Sciences
The role of inhibitory neuron subtypes in normal brain function and in pathological states. Dr. Lawrence is particularly interested in inhibitory neurons that are vulnerable following TBI and the underlying mechanisms of vulnerability. Studies include the role of the septohippocampal system in learning deficits and endocannabinoid regulation after TBI.