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					Rehabilitation Research & Development Service
    2009 ORD Local Accountability for Research
           Michael E. Selzer, MD, PhD
                    Director
              Patricia A. Dorn, PhD
                Deputy Director

      Office of Research and Development
          Joel Kupersmith, MD, CRADO
 Department of Veterans Affairs

 “To care for him who shall have borne the
  battle, and for his widow and his orphan.”
                            A. Lincoln, 1865

Mission of VA Research and Development
 “To discover knowledge and create
 innovations that advance the health and
 care of veterans and the nation.”
Mission of Rehabilitation Research
        and Development
 To discover knowledge and create
 innovations that restore veterans who
 have become disabled due to injury or
 disease to their greatest possible
 functional capacity
     In their persons
     In their families
     In their communities
     In their work places
                                 Tom Andriacchi – Center for Bone
                                 and Joint Rehabilitation (Palo Alto)
            Veterans Health Administration
                 Office of Research &
                     Development
               Joel Kupersmith, CRADO
          Tim O’Leary, Acting Deputy CRADO

             Research-Funding Services

  Biomedical     Clinical      Health     Rehabilitation
  Laboratory     Science      Services
                                              R&D
     R&D          R&D           R&D
Ron Przygodski Tim O’Leary   Seth Eisen   Mickey Selzer
   VA Research Organization Fits an
Interdisciplinary Time Model of Medicine



 Prevention      Limitation       Restoration
                 of Damage        of Function
                   BLR&D
                  CSR&D               RR&D

 HSR&D                  Implementation

                                       Steve Fausti – National Center for
                                    Rehabilitative Auditory Research (Portland)
   Scope of Rehabilitation
 Research and Development
 REPAIR:
   Basic research to repair injured organs and
    tissues
   Translational research to bring basic discoveries
    to clinical use
 REPLACE:
   Prosthetics, orthotics and assistive device
    research to replace what cannot be repaired
 RESTORE:
   Physiological function
   Social integration (including return to work)
                                        Bruce Sangeorzan – Center for Limb Loss
                                      Prevention and Prosthetic Engineering (Seattle)
       Levels of Functional Recovery


                          Molecule
                        Cell, & Tissue
                                  15%


                   8%
                               77%
 RRD Portfolio
as of June, 2007
Rehab R&D Scientific Organization

                           Director, Mickey Selzer
                         Deputy Director, Tricia Dorn


                   Scientific Program Managers

 Brain Injury/          Aging/              Prosthetics/                 SCI/
   Stroke           Neurodegen Dis       Rehabil Engineering          Regen Med
Jean Langlois     Tshaka Cunningham         Bob Jaeger              Audrey Kalehua


 Musculoskel/                 Career Develop/                Social Reintegration/
Med Comorbidity               Special Projects                  Mental Health
  Tom Pierce                   Jay Freedman                   Sunil Sen-Gupta


                    Sensory                      Neuroplasticity/
                    Systems                       PT, OT, etc.
                    Pending                         Pending
How the Rehabilitation Research
    Mission is Carried Out
 Merit Awards – Awards to VA investigators to
  support individual research projects
    3 yr, $750K total, $250K/yr
    4 yr, $925K total, $300K max in any yr
 Pilot Projects – support research leading to Merit
  project
    2 yrs max, $75K/yr
 Centers of Excellence (13) and Research
  Enhancement Award Programs (5) – Groups of
  scientists collaborating to achieve goals in a broad
  area of concern to disabled veterans, e.g., SCI, limb
  amputation, stroke, blindness, deafness, etc.
    5 yrs, Centers: $950K/yr, REAPs: $325K/yr
How the Rehabilitation Research
    Mission is Carried Out
 Career Development Awards – To support
  promising investigators starting out in VA
  research
   CDA-1, 2yr, salary support
   CDA-2, 3 – 5 yr, salary support, operational
    funds up to $50K/yr
   Transition Award, salary support
 Career Scientist and Senior Career Scientist
  Awards – To provide stable salary support
  for accomplished VA scientists
 Journal of Rehabilitation Research and
  Development
        Process of Review
• Pre-Application
   – Letter Of Intent Oct 15 and April 15, Assignment to Review Panel (may
     request panel)
• Submit Proposal: Dec 15 and June 15
   – Review: Feb/March and Aug/Sept
   – Approved and Scored 1.0 - 5.0 (best-worst)
   – No automatic pay line, but after review most awards made in sequence
     of score
   – Additional Proposals Funded Based on Priority
• Post-Review
   – Proposals to be funded enter Just-In-Time process.
   – Un-funded proposals revised for resubmission (max. 3 submissions)
• Grants.gov/eRACommons on line submission for Merit and Pilot
  Project applications only
• Center and REAP applications by special solicitation only
        Areas Of Strength
   And Opportunities For Growth

Where We Are Strong              Opportunities For Growth
 Level of Physical and Mental    Level of Molecules, Cells and
  Function                         Tissues; Regenerative
     Stroke                     Medicine
     Spinal Cord Injury          Level of Social and Vocational
     Sensory Loss                 Reintegration
     Musculoskeletal             TBI-Specific Research
 Medical Comorbidity             Translation of Prosthetic and
 Prosthetic and Assistive         Assistive Device Innovation
  Device Development               (and Other Interventions) into
                                   Clinical Use

                                              Leslie Gonzalez-Rothi – Brain Rehabilitation
                                                     Research Center (Gainesville)
  Electronic Ankle-
Foot Prosthesis May
 Improve Mobility of
  Veteran Amputees
Prosthetic Retina May Restore Vision to
  Veterans with Retinal Degeneration
Prosthetics Research to Restore Control of
     Functions to Paralyzed Veterans
Collaboration Among VA Scientists, DARPA,
 and Industry may Restore Fine Upper Limb
        Control to Veteran Amputees
        Research to Promote
        Social Reintegration
Community Based Exercise for Stroke Recovery
   A Pilot Study in Italy Suggested that Exercise
    Conducted in Community Setting Provided Longer
    Lasting Improvement in Functional Measures
      Was this because of better compliance with
       exercise or some other factor associated with
       socialization?
      Would the effect be seen in US Veterans?
   RR&D Investigators are Now Doing a Study to
    Answer these Questions
      Compare exercise in VFW Posts vs. hospital
       settings
      Compare exercise program with sedentary
       socialization
 Research to Promote
Vocational Reintegration
SCI-Vocational Integration Program
   Integrating Compensated Work Therapy
    (Evidence–Based Supported Employment) with
    Comprehensive SCI Rehabilitation
   VA SCI Strategic Healthcare Group
   Focus on Factors Preventing Return to Work
      Workplace Accommodations
      Psychological and Physical Disabilities
      Drug Addiction when Applicable (Untreated
       Persons Excluded from Study)
   Interventions, Including Counseling, Training,
    Health Status Education
   Comparison of Interventions to Obtain Best
    Outcomes
  Research to Promote Social and
     Vocational Reintegration
 Our Initiatives will:
    Develop Outcomes Measures for Social
     Reintegration Research.
    Develop Meaningful and Appropriate Outcomes
     Measures for Return to Work Research.
    Determine the Best Incentive Structures to
     Optimize Social Reintegration and Return to
     Work.
 These Innovations Could Revolutionize
  Research in Social and Vocational
  Rehabilitation for VA and Nationwide.
 Research on Regenerative Medicine




Mesenchymal stem cells
for bioengineered joints




                   Directed          Bioengineered bone
                   differentiation
                   of stem cells
                                       Glickstein, Current Biology,
                   into neurons        2008; MIT HST coursework
   Regenerative Medicine in SCI
                                          Biopolymer
                                          scaffolds seeded
                                          with genetically
                                          engineered cells
                                          producing
                                          neurotrophic factors
Hemisection
model of SCI




Tysseling-Mattiace et al., J Neurosci,   Functional recovery
2008; Taylor et al., J Neurosci, 2006    post-transplant
      How are We Addressing
        the New Priorities?
• SOTA on TBI (resource documents to be published in
  JRRD; results to be published separately)
• RFAs
   – ORD-wide TBI solicitation
   – Centers of Excellence and Research Enhancement
     Award Programs, intention is to increase numbers,
     Review January 27 – 28
      • Regenerative Medicine
      • TBI
      • Social Reintegration and Vocational Rehabilitation
• Increased Collaborations Between ORD Research
  Services, Between ORD and Prosthetics and
  Patient Care Services, and Between VA and Non-
  VA Investigators                                 Hunter Peckham – Center for Functional
                                                      Electrical Stimulation (Cleveland)
OIF/OEF 2007 Projects
 OEF/OIF 2007 Projects
OIF/OEF 2008 Projects
Rehab R&D Career Development Program


• RR&D began offering Career program in
  1997
• Over 100 awardees trained
• Career program is growing
• Currently receive over 30 applications per
  cycle
  – ~ 5-fold increase over past 5 years

                                          Bill Bauman – Center for Medical
                                           Consequences of SCI (Bronx)
Career Program Statistics FY07


• 18.9% Career Awards (all types)
  • All awards Merit & Career (397), Career (75)


• 12.6% Funds in Career Program
  • $6.9 mill of $54.7 mill


• Typically fund at ~30th percentile

                                       Joe Rizzo – Center for Innovative
                                         Visual Rehabilitation (Boston)
Examples Career Development
       Training Areas
      •   Spinal Cord Injury
      •   Stroke
      •   Biomedical Engineering
      •   Prosthetics / Orthotics
      •   Mental Health
      •   Vocational Rehabilitation
      •   Hearing
      •   Vision
                                  Ron Triolo – Center for Rehabilitation
                               Engineering Platform Technology (Cleveland)
 Activities with VA Office of
   Academic Affiliations
• Polytrauma & Traumatic Brain Injury
  Advanced Fellowship Program
    – Jointly supported by OAA & RR&D
    – Provide post-residency MDs & post-doc associated
      health professionals in-depth preparation in clinical
      care, research & leadership in polytrauma, TBI &
      related neuroscience fields
    – 2 year program, with possibility of 3rd year upon
      approval



                                     Rich Macko – Center for Task Oriented and
                                     Robotics in Neurological Disease (Baltimore)
 Activities with VA Office of
   Academic Affiliations

• Rehabilitation Research Predoctoral Fellowships
• Assist with
  – drafting announcement
  – dissemination to field and academic affiliates
  – recommending reviewers



                                       Krish Satian – Center for Aging
                                      Veterans with Vision Loss (Atlanta)
           Da Vinci Awards

    Honoring Exceptional Design & Engineering
   Achievements in Accessibility & Universal Design
         that Empowers People of all Abilities

• 2008 Lifetime Achievement Award to: Jeff Kocsis
• 2008 Spirit of da Vinci Award to: Hugh Herr
• 2007 Lifetime Achievement Award to: Rory Cooper



                                    Rory Cooper – Center for Wheelchair
                                     and Associated Rehab Engineering
THANK YOU !
Michael Selzer 202-461-1740; michael.selzer@va.gov
Patricia Dorn 202-461-1755; patricia.dorn@va.gov

Program Managers
Tshaka Cunningham 202-461-1853; tshaka.cunningham@va.gov
Jay Freedman 202-461-1699; jay.freedman@va.gov
Rober Jaeger 202-461-1751; robert.jaeger@va.gov
Audrey Kalehua 202-461-1749; audrey.kalehua@va.gov
Jean Langlois 202-461-1847; jean.langlois@va.gov
J. Thomas Pierce 202-461-1758; john.pierce3@va.gov
Sunil Sen-Gupta 202-461-1754; sunil.sen-gupta@va.gov

Administrative Officer
Ricardo Gonzalez 202-461-1750; ricardo.gonzalez@va.gov

Review Administrator
Terri Carlton 202-461-1757; terrilynn.carlton@va.gov
                                                   Steven Waxman – Center for Restoration
                                                   of Function in SCI and MS (West Haven)

				
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