NCIIA Proposal
Contact information:
Name of institution: Vanderbilt University
Contact Number / Email / PositionDave Weinberg / (401)-575-3626 / / Team Member
Erwin Yap / (615)-612-8012 / / Team Member
Dr. Joseph Cheng / (615)-322-1883 / / Principal Investigator
Mary Judd / (615)-322-4229 / / Administrative Contact
Project Title: Rehabilitation Database for Traumatic Brain Injury Patients
Abstract:
The sudden onset of traumatic brain injury, a form of acquired brain injury, is a stealer of normal livelihood. TBI is the major cause of disability worldwide and occurs when an outside force traumatically injures the brain. Impaired working memory, damaged executive function, confusion and forgetfulness are results of TBI. An education tool for TBI patients to rehabilitate from the syndrome is desirable.
We plan on creating an interactive website using a combination of PHP with SQL to provide a step by step rehabilitation tool for TBI patients. A secured database will store the patient’s information and track its progress by having the patients provide log-in information.
The objectives of the project are listed below:
1) To help the TBI patients become competitive in the job market after the injury.
2) To analyze patients’ strengths and weaknesses on an assembly process.
3) To focus on the steps of concern by adding more details and automatically provide feedback to the users.
Introduction:
Traumatic Brain Injury is damage to the brain resulting from external mechanical forces like rapid acceleration, impact, blast waves or projectile, which causes brain function to be permanently or temporarily impaired. TBI is one of the two subsets of acquired brain injury; the other one is caused by non-external forces like stroke and infection.
The sudden onset of traumatic brain injury is a stealer of normal livelihood. TBI is the major cause of disability and death worldwide. TBI occurs in falls (28%), car accidents (20%), struck by events (19%) and assaults (11%). TBI can happen to anyone and can happen in all age groups. Impaired working memory, damaged executive function, confusion and forgetfulness are results of TBI. Brain injury rehabilitation involves two processes: restorations of functions that can be restored and learning how to do things differently when functions cannot be restored to pre-injury level.
1.4 million people experience traumatic brain injury every year. Of the 1.4 million, 50,000 die, 235,000 are hospitalized and 1.1 million go through extensive rehab therapies (cdc.gov).
The goal of rehabilitation is to help the individual progress to the most independent level of functioning possible. Therapy will focus on regaining lost skills as well as learning ways to compensate for abilities that have been permanently changed because of the brain injury. Computer assisted programs and papers manuals have been helpful in the past in cognitive rehabilitation.
Cognitive rehabilitation is a systematically applied set of medical and therapeutic services designed to improve cognitive functioning and participation in activities that may be affected by difficulties in one or more cognitive domains. Because of attention problems, TBI patients must make a greater effort to perform non-automated tasks, a difficulty that contributes to behavioral inactivity (Grealy, 1999).
The interactive rehabilitation tool will act as a teleprompter with the assumption that affected patients still have an implicit memory. By providing a step-by-step simulation of a task, neurons in their brain are stimulated to help them remember previously held motor and sensory functions. The database will store patients’ information and track their learning. They can go back to where they previously stopped. The tool will provide feedback based on the patient’s strength and weaknesses. This method is better than the paper manual method because patients get to do hands-on product assembly and have more time in areas of concern. This tool will help patients go back to their normal lives and be competitive in the job market by having relearned skills.
History and Context:
We made a basic design of the website layout. There is a registration form for the patient to create an account with their personal information. The website will have a log-in tool for the patient so that we can track their progress using an SQL database. The website will have a log-in tool for the doctors and therapists to view the patients’ progress.
For the rehabilitation tool, we will have an interactive visualization of a task. It will show the patient how to do the task. The tool will allow the patient to go to specific steps by clicking the step number. There will also be a previous and next button to switch steps. On the last step, there will be a replay animation and exit tool buttons. The interactive tool will allow the patient to move the mouse and drag to simulate doing the task. Virtual reality exercise programs can improve cognitive rehabilitation from brain injury (Grealy, 1999).
Figure 1: Example of a task--folding a t-shirt
Team:
Our team is composed of Erwin Yap, David Weinberg and Dr. Joseph Cheng. Erwin is skilled in administration, project management, mathematics and medical research. He will conduct research to find other studies related to our project. He will make sure we meet all deadlines and not have policy issues with our project. Other duties will lie within quality assurance, where he will troubleshoot the website to ensure it works properly. David is skilled in web design, business, communication, cutting-edge presentations, innovation and enterprise. He will work on the website design and layout. He will work on a database which stores patients’ data and progress. He will find contacts that might be able to help us on the project, and construct the website with an aesthetically pleasing design. Dr. Cheng is an associate professor in the department of Neurosurgery. He is specialized in clinical interest in all aspects of spinal surgery such as treating degenerative disease, deformities and trauma. He has been an active member of many professional organizations related to neurosurgery. Dr. Cheng has been dealing with traumatic brain injuries patients for more than 20 years. He knows the physiology and different types of traumatic brain injury. He will be able to screen our clinical study and make sure we stick to our parameters. He also has contacts and resources in the Vanderbilt Medical Center. He can put us into contact with his clinical research assistant who can guide us in our clinical research, so that we can have an experimental group. He has educated us on the importance of doing prior research on a control baseline group. If there is not any data on a control group, then we have to include a baseline control for our experiment. He taught us the importance of screening for TBI symptoms. He suggested we use the MMSC exam, which we could either use one of the official website or we could incorporate it onto our website so we don’t have to outsource this tool. He also regulates the database of neurosurgery so he knows how php, sql and web interface function. Dr. Cheng has experience applying for an IRB for clinical research study, and said that when we are ready, his clinical research assistant can guide us on getting approved by the IRB. Dr. Cheng will be a valuable adviser because he wants to play an active role in our project and not just standby and let Erwin and I roam free. He makes sure we are goal oriented, and that our scope is not too broad, where we cannot realistically achieve results.
We believe that having a two-member team is a strong characteristic of our team. We have complimentary skill sets and more members will just drag our team down, damaging our efficient work ethic. We have also worked together on previous projects, which have ended successfully.
Work Plan and Outcomes:
We hope this project will turn out to be a great educational tool and a commercial tool. Short term memory is extremely important in an educational sense, so students could use this tool to improve their learning. On the other hand, workers with TBI can get back in the commercial industry with this tool, since it provides them an opportunity to be competitive with other workers. The industry would support a tool like this, since it would be a win-win situation for corporations because they have the opportunity of getting tax deductions from the government by hiring a TBI patient, similar to Wal-Mart’s employee plan. In the future, this type of educational tool can be used for other situations. Students can use this to learn materials from their courses. Workers can use this to learn proper skill techniques. Athletes can use this tool to simulate plays. Our project will be able to help the 1.1 million patients undergoing rehab or even the 235,000 that are hospitalized. There are also unreported TBI patients. These numbers will increase if they know that there is a sustainable treatment from the disease (cdc.gov).
Example Problem:
A patient had a car crash and damaged the frontal lobe of his brain. It affects his short-term memory. He used to work in a laundry service facility by folding shirts. With the damage, he cannot fold shirts efficiently anymore. He needs to relearn the skills of folding shirts quick. With this tool, as seen in figure 1, it will guide him to a step-by-step process of folding shirts. He will be monitored by the program by receiving feedbacks. Doctors and nurses will be able to see his progress.
Evaluation and Sustainability Plan:
We will have a database that stores patients’ information, progress and feedback for the doctors to view on a separate account. We will have an interactive, easily accessible and sustainable website that provides a step by step instruction on an assembly of a product. We will show statistics of the number of patient using our website and the number of doctor using our website and number of TBI patients that went back to the workforce because of the website. We seek approval from the human subjects committee so that we can work with TBI patients. Erwin, David, and Dr. Chang have agreed to work with TBI patients aged 18 and older to avoid extra consent barriers. Dr. Chang will judge our work based on how our goals are met, the quality and function of the database integrated into our PHP encoded website, the organization maintained week to week, and our effort to test our rehab tool on human patients.
Appendices:
Budget Justification:
Project Title / Rehabilitation Database for TBI PatientsInstitution / Vanderbilt University
PI / Dr. Joseph Cheng
Proposed Grant Period / 11/2009-05/2009
Fill in ONLY the yellow highlighted cells and the Justifications area, as total and percentages will automatically generate.
Round to the nearest whole dollar. For example, $274.95 would be entered as $275.
Please refer to the grant guidelines under Appendix Requirements for eligible/ineligible expenses.
Expense Category / Amount / Percent of Total
Equipment / - / 0.00%
(Describe briefly below in Justifications area.)
Materials & Supplies / - / 0.00%
(Describe briefly below in Justifications area.)
Student Stipend(s) - May not exceed $3,000 per student or $7,500 total / - / 0.00%
Travel Expenses / - / 0.00%
(Describe specifically below in Justifications area - re: # of trips and # of people traveling.)
Prototyping / - / 0.00%
Consulting / - / 0.00%
Other Expenses / - / 0.00%
(Describe very specifically below in Justifications area.)
Total / 0 / 100.00%
Total may not exceed $20,000. If you have received or plan to receive other funding for this project, please note this in a separate budget document.
Justifications - Use the space below to describe expense line items above.
Timeline:
November / Design the layout of the project website and the actual TBI rehab websiteDecember / Gather resources for web design, deciding which codes to use (ajax, php, sql etc), conduct further research on TBI patients
January / Decide which assemblies we want to rehab (ie: flashlight assembly, or cheeseburger assembly), start writing code for TBI web
February / Implement the database with the rehab visualization tool, which will provide real time feedback to the TBI patient, Create instruction manual for the website
March / Beta Testing, Troubleshoot and debug the web program until it runs smoothly
April / After our rehab tool is functional, we will work on making our tool aestically pleasing and professional looking, launch website
Team Expertise:
Our team is composed of Erwin Yap, David Weinberg and Dr. Joseph Cheng. Erwin is skilled in administration, project management, mathematics and medical research. David is skilled in web design, business, communication, cutting-edge presentations, innovation and enterprise. Dr. Cheng is an associate professor in the department of Neurosurgery. He is specialized in clinical interest in all aspects of spinal surgery such as treating degenerative disease, deformities and trauma. He also has a deep rooted knowledge in PHP and SQL, which is convenient considering those are the two languages David is familiar with as well.
References:
1. "Facts about Traumatic Brain Injury." Facts About TBI. Web. 8 Nov. 2009.
2. Grealy MA, Johnson DA, Rushton SK (1999) Improving cognitive function after brain injury: the use of exercise and virtual reality. Arch Phys Med Rehabil 80:661– 667.