Rehabilitation Research & Development Service (RR&D)

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PURVIEW OF REHABILIATION RESEARCH & DEVELOPMENT SERVICE

Proposals submitted to the Rehabilitation Research & Development Service (RR&D) may include clinical, preclinical or applied rehabilitation research to enable translation into clinical practice to maximize Veterans’ functional independence, quality of life and participation in their lives and community.

Clinical studies may investigate interventions, techniques, or devices designed to restore or replace sensorimotor or psychological function and return Veterans’ functional independence and quality of life. Injuries, disorders and diseases with the potential to cause long term impairment and disability in the Veteran population are of interest, with emphasis on functional outcomes at the level of the Veteran. Examples of clinical studies not appropriate for review by RR&D evaluate the organization, cost, efficiency, or quality of care delivery at the provider or system level or the implementation of established clinically effective interventions.

Preclinical studies must demonstrate clear potential to translate findings to future clinical rehabilitation studies and care of Veterans. Preclinical studies in animals may include molecular, cellular, or physiological mechanisms, but only if linked to sensorimotor and behavioral outcomes.  Molecular and cellular studies can explore the mechanisms of action of a rehabilitative intervention, the causes of differing responses, or promote an understanding of any potential adverse effects and how these could be modulated to maximize recovery of function. Preclinical studies might also contribute to understanding the disease process to identify novel rehabilitation targets or develop new rehabilitative approaches. Examples of preclinical studies not appropriate for review by RR&D include foundational studies lacking interventions or behavioral outcomes that are pertinent to the animal.

Applied studies may develop medical products or technology prior to evaluating effectiveness in future clinical rehabilitation studies to improve the care of Veterans. Applied studies may include features such as design optimization, mechanical or durability testing, safety testing, integration, biocompatibility or biostability testing, etc., if required to establish feasibility prior to human application. They must demonstrate a clear pathway for translation to the clinic.

Proposals accepted by RR&D are reviewed by specific Subcommittees referred to as Scientific Review Groups (SRGs). Applicants may request a specific SRG; however, the final assignment is determined by the Service Director and is principally based on the most appropriate SRG to provide the best scientific review. SRGs may be divided at the discretion of the Service Director. The SRG acronyms used in Electronic Research Administration (eRA) Commons are listed in [brackets].

Investigators are strongly encouraged to contact a Scientific Program Manager prior to submitting their Letter of Intent, especially if their proposed work falls within the scope of more than one SRG.

RR&D Scientific Review Groups

Spinal Cord Injuries/Disorders (SCI/D) & Neuropathic Pain [RRDA]

The research interests of this program are twofold, addressing clinical and translational preclinical research on 1) SCI, Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS) focusing on the restoration of sensorimotor function of the Veteran (or animal); and 2) neuropathic pain, including pain management, pain assessment and the development of non-opioid approaches to treat pain resulting from injury or illness.

Pertinent SCI/D studies include the understanding and development of:

  • Treatment and prevention of long-term consequences of SCI/D (e.g. bone/muscle degeneration autonomic function, pain, chronic inflammation, motoneuron death, etc.);

  • Understanding spinal and central plasticity and the formation of proper connections without promoting pain and spasticity, and development and testing of treatment strategies (e.g. engineering, pharmacological, cellular, etc.) to regain sensorimotor function following SCI/D.

Studies involving acute aspects of SCI and its treatment are not appropriate for review.

The research direction of the pain program includes:

  • Assessing pain using functional measures (e.g., correlating subjective pain measures with objective measures of function such as ADL, gait kinetics and kinematics, range of motion, and Quality of Life or activity measures, etc.), and

  • Development of non-addictive therapies to manage pain by linking human painful conditions with genetic, molecular, and cellular mechanisms.

NOTE:  Other SRGs to consider include RRD5: Rehabilitation Engineering & Prosthetics/Orthotics for studies refining neural engineering approaches prior to testing in animal models or Veterans; and RRD2: Musculoskeletal Health & Function for studies focused on movement, function, and Veterans’ quality of life.

Please direct questions about Spinal Cord Injury and Neuropathic Pain research to Scientific Program Manager Audrey Kusiak, PhD.

Regenerative Rehabilitation Medicine [RRD0]

Research in the Regenerative Rehabilitation Medicine program includes studies implementing cell- or biological scaffold-based, tissue-engineering approaches to repair the neuro-musculoskeletal system, as well as methods to stimulate self-repair (e.g. wound healing, neurogenesis, etc.). Research should focus on Veteran-centric conditions that follow injuries, illness, and/or overuse incurred during active duty service (e.g. osteoarthritis, degenerative disorders, deconditioning, etc.). Appropriate studies include a proof of concept demonstrating functional efficacy (e.g. load- or weight-bearing, balance, sensation, motor function, etc.) as well as product development (long-term safety, biocompatibility, integration, etc.).

The research direction of the program includes:

  • Use of combination approaches (bioengineering and regenerative rehabilitative science) to develop and strengthen technologies to restore musculoskeletal and neural tissue.

  • Incorporating vascular and nervous tissue engineering to supply engineered musculoskeletal tissue with energy and innervation.

  • Taking advantage of endogenous repair to replace tissue.

  • Development of screens and large animal models for ease of translation

Please direct questions about Regenerative Rehabilitation Medicine research to Scientific Program Manager Audrey Kusiak, PhD.

Brain Injury: Traumatic Brain Health & Injury [RRD1/RRDB]

Research in the Brain Health & Injury program includes brain-related conditions that frequently occur in the Veteran population across the lifespan. These include traumatic brain injury (TBI) and related progressive neurological and mental health conditions, long-term effects on brain health from drugs of abuse, environmental exposures, epilepsy, stroke and other brain conditions. Diagnostic approaches should detect not only the condition, but also plastic changes in brain structure or function to objectively measure the efficacy of rehabilitation. Therapeutic approaches should focus on centrally-mediated improvement of sensorimotor, neurobehavioral, and/or cognitive outcomes following acquired brain injuries. Development of pharmacological interventions should augment rehabilitation to maximize recovery of function. Prior approval is required for the use of transgenic models.

Additional considerations for TBI and stroke include the following:

TBI

Research that focuses on therapies, diagnostics, prognostics, and models that are relevant to the Veteran with TBI are of the highest priority. The needs of these Veterans focus research on approaches that ameliorate the chronic effects TBI and improve functional outcomes. Preclinical and clinical studies not appropriate for review involve acute aspects of injury and/or acute treatment.

Research in this program also includes:

  • Longitudinal effects of TBI and repetitive brain injuries on clinically-relevant outcome measures

  • Diagnostic tools to detect mild TBI and predict functional outcome

  • Rehabilitative therapies for TBI-related PTSD

  • Understanding and treatment of TBI-related risk factors for suicide

  • Detection, cause, and therapeutic intervention of TBI-related dementia and other progressive neurological conditions

  • Interactions of prescription, nonprescription drugs, or supplements on functional recovery from TBI

Stroke

Ischemic stroke is one end result of chronic cardiovascular disease.  The use of clinically relevant animal models that simulate the effects of age or medical co-morbidities such as hypertension, diabetes, or hyperlipidemia on stroke severity and rehabilitation are encouraged. Young, healthy adult animal models are not appropriate for review.

NOTE: Other SRGs to consider include RRD2: Musculoskeletal Health & Function for studies of non-centrally mediated rehabilitative methods; RRD6: Chronic Medical Conditions & Aging for studies on impact of disability on older Veterans; RRD4: Behavioral Health & Social Reintegration for studies involving the development of rehabilitation-focused psychosocial measures; RRD3: Sensory Systems & Communication Disorders for studies involving sensory system rehabilitation and outcomes; and RRD0: Pain related to TBI or Stroke; RRDA: Regenerative medicine approaches to brain injury.

Please direct questions about Brain Health & Injury research to Scientific Program Manager Stuart Hoffman, PhD.

Musculoskeletal Health & Function [RRD2]

Research in the Musculoskeletal Health & Function program focuses on Veterans' long-term functional recovery from traumatic injury, as well as chronic limitations, particularly from military-acquired conditions and diseases.  The primary focus is on the musculoskeletal system and the ultimate restoration of movement, function, and Veterans’ quality of life.  A secondary focus is on restoration of function following any injury or disease, causing activity limitations in the Veteran. As a guideline, function is defined as occurring at the level of the Veteran, meaning not just a single organ or structure.  Generally, decreased function would typically lead to impaired movement and activity limitations.

Pre-clinical research studies can include methods of clinical biomechanics and muscular physiology as it relates to functional outcomes. Neurological rehabilitation that focuses on improved upper or lower extremity function (e.g.  gait) are appropriate for this review group.  Clinical outcomes research for prosthetic users are also appropriate because of the focus on Veteran function.

Examples of research include, but are not limited to, studies focusing on interventions such as:

  • exercise targeting sarcopenia;

  • musculoskeletal body composition;

  • functional ability (e.g. gait and ADL skills, etc);

  • the amelioration of musculoskeletal pain associated with injury and disease such as osteoarthritis and low back pain; or

  • interventions to modulate inflammation, especially targeting tissue stabilization/limb salvage.

NOTE: Other SRGs to consider include RRD6: Chronic Medical Conditions & Aging for research in older Veterans not focused on the musculoskeletal system and RRD5: Rehabilitation Engineering & Prosthetics/Orthotics for studies developing or enhancing rehabilitation device design.

Please direct questions about Musculoskeletal Health & Function research to Scientific Program Manager Timothy Brindle, PT, PhD.

Sensory Systems & Communication Disorders [RRD3]

Research in the multi-faceted Sensory Systems & Communication Disorders program addresses a broad range of rehabilitation research in some of the most common debilitating problems faced by Veterans, impacting their ability to interact with others through hearing, vision and speech.

Research may include the diagnosis, prevention, and treatment of sensory disorders related to:

  • Hearing sensitivity and auditory processing

  • Tinnitus and hyperacusis

  • Vestibular/balance system

  • Visual acuity and processing, such as diabetic- or age-related vision loss

  • Multisensory impairment, affecting vision and hearing, balance, or presence of tinnitus

  • Speech and language production and perception, such as aphasia, dysphagia, and dysarthria

  • Devices, apps, and sensory aids (e.g. hearing aids, cochlear implants, visual implants, augmentative and alternative communication) with testing and evaluation in animal models and clinical trials to improve Veteran rehabilitation outcomes.

Studies evaluating the effect of military exposure and trauma, including brain injury, that results in changes to sensory and communication ability are appropriate for review. Preclinical research (animal models) examining the development of novel methods to prevent, restore or replace sensory function may be appropriate if they include behavioral functional outcomes or diagnostic approaches that correlate with clinical evaluation of human sensory function. Purely mechanistic studies of the biological mechanisms underlying a sensory disorder are not appropriate for review.

NOTE: Other SRGs to consider include RRD1: Brain Health & Injury for studies with primary focus on central (non-sensory) effects of acquired brain injury; and RRD5: Rehabilitation Engineering & Prosthetics/Orthotics for early stage development of new devices, apps, and sensory aids to enhance sensory perception and outcomes.

Please direct questions about Sensory Systems & Communication Disorders research to Scientific Program Manager Lina Kubli, PhD.

Behavioral Health & Social Reintegration [RRD4]

The goal of the Behavioral Health & Social Reintegration Program is to develop interventions which will enable Veterans with physical or psychological disabling conditions to function more fully in society, embrace social situations, return to school, and find and maintain gainful employment. Current research in the program includes:

  • Supported employment for Veterans with psychological or physical health conditions

  • Development of measures to assess Veteran participation in society

  • Cognitive behavioral therapy interventions aiming to improve participation in society for Veterans with psychological health conditions

Future research needs to encourage progress in the field include, but are not limited to:

  • Suicide prevention through interventions aimed at improving participation in society

  • Refinement and validation of measures to assess participation and reintegration

  • Examining education, employment, recreation and family support as components of interventions enabling reintegration.

Applications submitted to this SRG require inclusion of functional outcomes documenting Veteran engagement in society. Animal models are not appropriate.

NOTE: Other SRGs to consider include RRD6: Chronic Medical Conditions & Aging for research on behavioral health and function in older Veterans; and RRD1: Brain Health & Injury for studies that seek to understand how acquired brain injury and its treatment can affect behavioral health.

Please direct questions about Behavioral Health & Social Reintegration research to Scientific Program Manager Cendrine Robinson, PhD.

Rehabilitation Engineering & Prosthetics/Orthotics [RRD5]

The Rehabilitation Engineering & Prosthetics/Orthotics program supports projects that will develop new or enhance existing devices, algorithms, or systems to improve Veteran rehabilitation outcomes, reduce treatment costs, or ideally both. Topic areas include, but are not limited to:

  • Design and optimization of prosthetics (both conventional and neural),

  • Orthotics /exoskeletons,

  • Functional electrical stimulation systems,

  • Wheelchairs and related technologies

  • Imaging techniques

  • Virtual or augmented reality systems or software

  • Telehealth /smartphone apps

  • Assistive robotics

  • Technologies for exercise and recreation,

  • Assistive devices or other technology-based method to improve Veteran health and function

Devices nearing translation to market with identified commercial partners are acceptable and encouraged.

NOTE: Applications may include clinical testing of new devices or technologies, but proposals that exclusively focus on the evaluation of existing devices or technologies will be referred to another SRG.

Please direct questions about Rehabilitation Engineering & Prosthetics/Orthotics research to Scientific Program Manager Brian Schulz, PhD.

Chronic Medical Conditions & Aging [RRD6]

Research submitted to the Chronic Medical Conditions & Aging SRG should focus on developing innovative rehabilitative strategies and interventions that will prevent, delay or alleviate the functional impact on daily life of multiple and complex chronic medical conditions commonly, but not exclusively occurring among aging Veterans and Veterans with disabilities.

Contributing chronic illnesses/conditions include, but are not limited to:

  • cardiopulmonary disorders (e.g. chronic respiratory condition, heart failure)

  • metabolism and metabolic disorders (e.g. obesity, diabetes)

  • kidney disorders (e.g. end-stage renal disease)

  • neurodegenerative disorders

  • movement disorders

  • cancer (restoring function and well-being before, during and after treatment)

  • urinary/fecal incontinence and sexual disorders

  • gait and balance problems

Areas of study may include clinical, preclinical (rehabilitation-relevant models), or applied rehabilitation research with strong potential for translation into clinical practice to address the rehabilitative health care needs and function of Veterans with chronic medical conditions. Study areas may include: personalized, multimodal, or combination therapies and adaptive rehabilitation interventions, techniques, and devices designed to maximize participation in daily life. Endpoints should assess function, independence and quality of life of aging Veterans with disabilities associated with chronic medical conditions in the context of their environment.

The scope of the research program includes:

  • Understanding the impacts of chronic medical conditions on functioning of older Veterans and Veterans with disabilities.

  • Designing and developing novel rehabilitation technologies and interventions that aim to prevent activity limitations, promote independence, participation and inclusion in everyday life of older Veterans and/or to limit or reverse the impact of already existing chronic medical conditions and impairments on Veterans.

  • Promoting novel therapeutic modalities to prevent the long-term physical consequences of chronic medical conditions and facilitating the rapid translation of such rehabilitative therapies into clinical use to optimize Veteran functioning and health.

  • Developing interventions that promote healthy aging, enhance daily function, and minimize age-related limitations (such as frailty or memory impairment) in older Veterans and Veterans with disabilities from chronic medical conditions.

  • Increase the quality of evidence for rehabilitation interventions in older Veterans with disabilities through increased focus on the design, dose, intensity, timing, mechanisms, and specified targets and functional outcomes of these interventions.

NOTE:  Other SRGs to consider RRD3: Sensory Systems & Communication Disorders for studies involving peripheral sensory organs; and RRD2: Musculoskeletal Health & Function for studies focused exclusively on the musculoskeletal system.

Please direct questions about Chronic Medical Conditions & Aging research to Scientific Program Manager Carole Sztalryd-Woodle, PhD.