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 preclinical, clinical or applied rehabilitation research with strong implications for translation into clinical practice to advance the rehabilitative health care of Veterans. Study areas appropriate for review by the RR&D service include: injuries, disorders and diseases with the potential to cause long term impairment and disability in the Veteran population; rehabilitation interventions, techniques, and devices designed to maximize motor, sensory, and psychological recovery; and endpoints that include functional outcomes of Veteran participants.

Proposals accepted by RR&D are reviewed by specific Subcommittees referred to as Scientific Review Groups (SRG). 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 encouraged to contact the Scientific Program Manager prior to submitting their Letter of Intent.

A. Spinal Cord Injury (SCI) and Neuropathic Pain [RRDA]

The research interests of this portfolio are twofold and address: 1) Clinical and applied research (in clinically relevant animal models) on SCI, Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS) focusing on the restoration of sensori-motor function of the individual/animal; and 2) Clinical and applied research (in relevant animal models) on neuropathic pain, including pain management, pain assessment and the development of novel analgesics to treat pain as a result of injury and/or illness. Pertinent studies include the understanding and development of the:

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

  • Neuroplasticity, including imaging the spinal cord and brain to assess white matter integrity ( e.g. to prognosticate functional outcomes), and

  • The development, and testing of treatment strategies (e.g. engineering, pharmacological, cellular, etc.) to regain sensorimotor function following SCI/D.

The research direction of the portfolio includes:

  • Understanding spinal and central plasticity and how to harness the body's own ability to repair itself following SCI/D

  • Assessing pain using functional measures. (For example, correlating subjective pain measures with objective measures of function such as ADL, gait kinetics and kinematics, range of motion, and QoL measures, etc.)

  • Development of non-addictive therapies to manage pain, including screening techniques and animal models.

The Spinal Cord Injury and Neuropathic Pain program is managed by Audrey Kusiak, PhD.

B. Regenerative Medicine [RRD0]

Research in the area of regenerative medicine 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 related to injuries, illness, and/or overuse incurred during active duty training/deployment (e.g. osteoarthritis, degenerative disorders, deconditioning, etc.). Studies should include a proof of concept component demonstrating functional efficacy (e.g. load- or weight-bearing, balance, sensation, motor function, etc.). Examples include applied research (animal models) examining the development of novel methods to regenerate, repair, or replace bone, muscle, tendon, cartilage, intervertebral disc, menisci, and neural tissue.

The research direction of the portfolio includes:

  • Use of integrated approaches (bioengineering and regenerative rehabilitative science) to develop and strengthen technologies to repair 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.

The Regenerative Medicine program is managed by Audrey Kusiak, PhD.

C. Brain Injury: Traumatic Brain Injury (TBI) and Stroke [RRD1/RRDB]

Research in this portfolio focuses on Neurological Disorder specifically related to TBI and stroke rehabilitation and/or treatments to enhance recovery from these events. This includes, but is not limited to, studies aimed at improved diagnosis of functional disability associated with these conditions, as well as chronic Central Nervous System (CNS) changes due to the injury. Animal and human studies evaluating novel treatments either alone or in combination with other therapies, and application of neuroimaging studies to rehabilitation of stroke and TBI are also included. With respect to TBI, research focuses on the chronic effects of the injury from the post-acute period to throughout the lifespan.

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 concentrate the purview of this panel on neuro-rehabilitation and the chronic effects TBI. Preclinical and clinical studies involving acute aspects of the injury and/or acute treatment development are not appropriate for this panel. Some examples of TBI research areas important to the RR&D Service include:

  • Longitudinal effects of TBI and repetitive brain injuries on clinical outcome measures

  • Development of therapies to improve sensorimotor, neurobehavioral, and/or cognitive outcomes after TBI

  • Development of pharmacological adjuncts to rehabilitation to maximize recovery of function

  • Diagnostic tools to detect mild TBI and predict outcome

  • Development of tools to detect plastic changes in brain structure or function to objectively measure the efficacy of rehabilitation.

Stroke

Ischemic stroke is one of the end results of chronic cardiovascular disease. Because the VA provides health care to Veterans across their lifespans, the morbidities that accompany aging, such as stroke, are part of RR&D's research mission. Some examples of stroke research areas of interest to the RR&D Service include:

  • Development of clinically relevant animal models that simulate the effects of age on stroke severity and rehabilitation; young adult animal models are not appropriate for this panel

  • Novel therapeutic methods to centrally improve gait and balance.

  • Development of tools to detect plastic changes in brain function or structure to objectively measure the efficacy of rehabilitation

The Brain Injury program is managed by Stuart Hoffman, PhD.

Note: Studies of TBI and stroke rehabilitation that include the initial development of neuroprosthetics should be submitted to Rehabilitation Engineering & Prosthetics/Orthotics; studies of non-centrally mediated rehabilitative methods of these conditions should be submitted to Musculoskeletal/Orthopedic Rehabilitation; and studies involving the development of psychosocial measures for use in rehabilitation settings should be submitted to Psychological Health & Social Reintegration. Studies involving neuropathic pain and TBI should be submitted to Neuropathic Pain. TBI/Stroke studies involving tissue engineering should be submitted to Regenerative Medicine. Studies involving the peripheral sense organs and peripheral sensory rehabilitative techniques should be submitted to Sensory Systems/Communication Disorders.

D. Musculoskeletal/Orthopedic Rehabilitation [RRD2]

Research in this portfolio focuses on clinical and non-clinical improvements applicable to Veterans' recovery from traumatic injury and chronic limitations, particularly military-acquired conditions and diseases. Examples of research include, but are not limited to, research focusing on interventions such as exercise targeting sarcopenia, musculoskeletal body composition, functional ability (e.g. reducing falls) and autonomic function following neurological and metabolic disease; metabolism and metabolic disorders including nutrition as it relates to prevention and recovery from trauma or disease; the amelioration of vascular, cutaneous and musculoskeletal pain associated with trauma and disease; interventions to modulate inflammation, especially targeting tissue stabilization/limb salvation and wound care. Pre-clinical research studies can include methods of clinical biomechanics, muscular and cardiovascular physiology and metabolism, as it relates to functional outcomes. Research should have a clear translatable path toward improving the health and quality of life for Veterans.

The Musculoskeletal/Orthopedic Rehabilitation program is managed by Timothy Brindle, PhD.

E. Sensory Systems/Communication Disorders [RRD3]

Research in this multi-faceted portfolio address 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, speech, and vision. Research encompasses, but is not limited to, the diagnosis and treatment of disorders related to:

  • Hearing sensitivity and auditory processing, including research in noise, blast, age-related hearing loss, devices, and aural rehabilitation

  • Tinnitus

  • Speech and language production and perception, including aphasia, dysphagia, and dysarthria

  • Visual acuity and processing, including blast, age-related vision loss, diabetic neuropathy, devices, and low vision/blind rehabilitation

  • Vestibular/balance system

  • Multisensory impairment

This portfolio may include studies evaluating the effect of combat exposure and trauma resulting in changes to sensory and communication ability. Research should have a clear translatable path toward improving the health and quality of life for Veterans. Animal studies that are exploratory preclinical evaluating basic molecular, genomic and physiological mechanisms are not appropriate for the sensory portfolio in RR&D. In general, research projects should be clinical or translational in nature, and not basic biomedical research involving development of cell lines, new targets, or animal models.

Questions about the Sensory Systems/Communication Disorders program may be directed to Lina Kubli, PhD

F. Psychological Health & Social Reintegration [RRD4]

The goal of the Psychological Health and Social Reintegration Program is to develop interventions which will improve the psychological health status of Veterans and enable them to function more fully in society, embrace social situations, return to school, and find and maintain gainful employment.
Research in this portfolio includes projects:

  • Related to the use of supported employment in Veterans with psychological health conditions

  • The use of telehealth to provide psychological health interventions in a variety of Veteran populations

  • Development of measures to assess Veteran participation in society

  • Research on cognitive behavioral therapy for Veterans with psychological health conditions

Future research needs to encourage progress in the field include, but are not limited to, further refinement and validation of measures to assess participation and reintegration; examining education, vocational rehabilitation, employment and family support as a means to reintegration; and the development of evidence-based interventions enabling reintegration. This portfolio focuses beyond improvement of symptoms alone, requiring inclusion of functional outcomes documenting Veteran engagement in society. Animal models are not appropriate.

The Psychological Health & Social Reintegration program is managed by Shirley Groer, PhD.

G. Rehabilitation Engineering & Prosthetics/Orthotics [RRD5]

Research to develop new or improve existing devices, algorithms, or systems to improve Veteran health outcomes, reduce treatment costs, or ideally both is of interest. Studies supported span research domains ranging from improvements in foundational science techniques and systems, to prevention and screening, treatment, and follow-up care. Research topic areas include, but are not limited to:

  • The design and optimization of prosthetics (both conventional and neural),

  • Orthotics /exoskeletons,

  • Functional electrical stimulation systems,

  • Wheelchairs and related technologies,

  • Imaging techniques,

  • Surgical implants,

  • Virtual or augmented reality systems or software,

  • Telehealth /smartphone apps,

  • Rehabilitation and assistive robotics,

  • Technologies for exercise and recreation,

  • Assistive devices or any other technology-based method to improve Veteran health. Proposals may include limited clinical testing of new devices or technologies, but proposals that exclusively focus on the evaluation of existing devices or technologies will not be reviewed by this panel.

The Rehabilitation Engineering & Prosthetics/Orthotics program is managed by Brian Schulz, PhD.

H. Chronic Medical Conditions & Aging [RRD6]

Research in this portfolio addresses disabilities of increasing prevalence among Veterans cared for by the VA, those related to multiple and complex chronic medical conditions or the natural consequences of aging. The primary goal of the program is to sponsor preclinical, applied and clinical studies of new diagnostic, prognostic, and therapeutic approaches including pharmaceuticals, natural products, and other therapies or therapeutic combinations with a clear translatable path toward  improving functional abilities or preventing disability among older Veterans or those with multiple and complex chronic medical conditions. Studies of basic biomedical research exploring disease mechanisms or development of cell lines, new targets, or animal models are not appropriate for this panel.

The scope of the Chronic Medical Conditions and Aging Rehabilitation Research Program includes:

  • Understanding the impacts on functioning for Veterans suffering from multiple and complex chronic medical conditions such as, but not limited to:

    •  cardiopulmonary disorders
    •  metabolism and metabolic disorders as it relates to diabetes
    •  kidney disorders

  • Promoting discovery of novel therapies to prevent the long-term physical consequences of multiple and complex chronic medical conditions to facilitate the rapid translation of such therapies into clinical use to optimize Veteran functioning and health.

  • Improving care and quality of life for older Veterans by supporting research that promotes health aging, enhances daily function and minimizes the consequences of aging such as frailty, incontinence, memory impairment.

The Chronic Medical Conditions & Aging program is managed by Karen Lohmann Siegel, PT, MA..