In 2002, the JFK Johnson Rehabilitation Institute (JRI) in Edison, New Jersey was awarded a Traumatic Brain Injury Model System (TBIMS) grant from the National Institute on Disability and Rehabilitation Research (NIDRR). This five-year grant allows JRI to pursue research regarding innovative assessment and rehabilitation approaches for persons with traumatic brain injury (TBI).

What is a TBI Model System?

Since 1987, the US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) has provided funding for establishing a research and demonstration program through model systems of care for persons with TBI. The model systems of care provide comprehensive, coordinated care for persons with traumatic brain injuries for emergency medical services, acute neurotrauma services, inpatient rehabilitation, and long-term follow up.

Currently, 16 TBI Model System Centers across the United States are supported by this grant program for the 2002-2007 period. Each TBI Model System Center contributes data to the Traumatic Brain Injury National Data Center which maintains a standardized national database for innovative analyses of TBI treatment and outcomes.

Objectives of the TBIMS Center

• To demonstrate and evaluate the cost-benefit and service delivery outcomes of a comprehensive service delivery system for individuals with TBI
• To establish a research program to evaluate the development of a new database and conduct innovative analyses of research data
• To demonstrate and evaluate the development and application of improved and innovative methods essential to the care and rehabilitation of individuals with TBI
• To participate in national studies of the TBI Model System concept by contributing to the national TBI database as prescribed by the Secretary of Education

Who is Eligible to Participate in the Program?

The National Database includes information about the course of recovery and outcomes following TBI. Participants in the database have sustained a TBI, as defined by damage to brain tissue caused by an external mechanical force as evidenced by loss of consciousness due to brain trauma, or post-traumatic amnesia (PTA), or skull fracture, or objective neurological findings that were a result of trauma. For inclusion in this database the person must:

• Be at least 16 years old
• Arrive at the acute care hospital emergency department within 24 hours of injury
• Receive both acute hospital care and inpatient rehabilitation within the defined Model System facilities
• Understand and sign informed consent

Rehabilitation Research at the TBI Model System

In addition to providing a comprehensive system of care and participating in the national database for persons with TBI, the JFK Johnson Rehabilitation Institute conducts specific research projects as part of the TBI Model System project. These projects focus on:

• Issues related to recovery for individuals who are in a Minimally Conscious State (MCS)
• The effectiveness of an integrated program of cognitive rehabilitation for persons with TBI
• Quality of life issues that consider the individual's perspective related to community integration and satisfaction with functioning following TBI.

The JFK Coma Recovery Scale

The JFK Coma Recovery Scale- Revised (CRS-R) is a standardized behavioral assessment instrument designed to measure neurobehavioral function in patients with disorders of consciousness (DOC). The CRS-R is comprised of six subscales addressing auditory, visual, motor, oromotor/verbal, communication and arousal functions. Subscale items are hierarchically-arranged, corresponding to brain stem, subcortical and cortically-mediated functions. Administration and scoring guidelines are manualized and the scale is intended for use by medical and allied health professionals. The CRS-R has sound psychometric characteristics, capacity to detect subtle clinical changes, diagnostic sensitivity and is available in 9 languages. The scale is well-represented in the scientific literature and has been used to investigate diagnostic accuracy, the relationship between behavioral and neurophysiologic markers of consciousness, outcome prediction and treatment effectiveness.