The North Texas Traumatic Brain Injury Model System is one of 16 sites in the United States comprising the oldest and largest longitudinal databases of persons with traumatic brain injury (TBI). The TBI Model Systems research program is funded by the National Institute for Disability, Independent Living, and Rehabilitation Research, which is located in the Administration for Community Living under the Department of Health and Human Services. Started in 1997, this program sought to examine medical, social, and psychological outcomes for TBI.

Participants are enrolled while they are still in the hospital rehabilitation unit after sustaining a moderate to severe TBI and are followed for outcomes at 1, 2, 5, 10, 15, and 20 years after injury and every five years afterward. In addition to information about the original injury and hospitalization, participants are asked to report on their health and new or continuing health disorders, living arrangements, participation in work, school, and community, and to undergo short testing of cognitive and psychological states and abilities by telephone.

Collaboration

The North Texas Traumatic Brain Injury Model System (NTTBIMS) is unique among the participants in that it is a collaborative effort between the two largest providers of rehabilitation in Dallas – the University of Texas Southwestern Medical Center and Baylor Institute of Rehabilitation. Initially funded in 2002, the NTTBIMS now includes patients seen at the three Level I trauma centers: Parkland Health & Hospital System, Baylor Health Care System and John Peter Smith Hospital in Fort Worth. Patients are enrolled from the inpatient rehabilitation units at Parkland Hospital, Zale Lipshy University Hospital, and Baylor Scott & White Institute of Rehabilitation.

The Model System program has enrolled more than 15,600 persons with TBI and has followed some of them for 20 years. In addition to collecting this data for the program, the centers participate in research projects at each site, as well as multi-center investigations. Each participating center must demonstrate the delivery of a coordinated system of acute neurotrauma and inpatient rehabilitation.

Research Team

University of Texas Southwestern Medical Center

• Shanti Pinto, M.D. (Principal Investigator)
• Kathleen R. Bell, M.D. (Investigator)
• Kan Ding, M.D. (Investigator)
• Kristin Wilmoth, Ph.D. (Investigator)
• Brittany Wright, Ph.D. (Post-Doctoral Fellow)
• Carlos Arauz (Research Coordinator)
• Petra Gonzales (Research Coordinator)

Baylor Scott & White Institute of Rehabilitation

• Simon Driver, Ph.D. (Principal Investigator)
• Rosemary Dubiel, D.O. (Investigator)
• Cindy Dunklin, B.S., CCRC (Project Manager)
• Librada Callender, Ph.D., MPH, CCRC (Epidemiologist)
• Monica Bennett, Ph.D. (Biostatistician)

NTTBIMS Site Locations

• Georgia Model Brain Injury System, Shepherd Center, Atlanta, Georgia
• University of Alabama at Birmingham Traumatic Brain Injury Care System, Birmingham, Alabama
• Rocky Mountain Regional Brain Injury System, Englewood, Colorado
• Indiana University/Rehabilitation Hospital of Indiana, Indianapolis, Indiana
• Spaulding-Harvard Traumatic Brain Injury Model System, Boston, Massachusetts
• Mayo Clinic Traumatic Brain Injury Model System, Rochester, Minnesota
• Northern New Jersey Traumatic Brain Injury System, West Orange, New Jersey
• New York Traumatic Brain Injury Model System, New York, New York
• Rusk Rehabilitation TBIMS at NYU, New York, New York
• Ohio Regional TBI Model System, Columbus, Ohio
• Moss TBI Model System, Elkins Park, Pennsylvania
• Southeastern Michigan Traumatic Brain Injury System at Wayne State University, Detroit, Michigan
• North Texas Traumatic Brain Injury Model System, Dallas, Texas
• Institute for Rehabilitation and Research, Houston, Texas
• Virginia Commonwealth TBI Model System, Richmond, Virginia
• University of Washington Traumatic Brain Injury Model System, Seattle, Washington

Research Projects 2022 - 2027

1. The goal of this project is to improve the health and function of individuals with traumatic brain injury (TBI) through evidence-based clinical care and innovative research. The objectives are to: (1) provide comprehensive rehabilitation to individuals with TBI, (2) assess long-term outcomes of individuals with TBI, (3) expand delivery of an evidence-based weight-loss intervention to enhance access and reach underserved groups (site-specific project), and (4) disseminate findings to stakeholders. Project outcomes include: (1) provision of a comprehensive continuum of care for individuals with TBI, (2) enrollment of 35 participants per year into the TBI Model System with high rates of follow-up, (3) efficacy data supporting telehealth delivery of a weight-loss intervention following TBI that is scalable across the United States, (4) culturally relevant Spanish and English versions of the weight-loss program for people with TBI, and (5) resources for individuals with TBI and their care partners. Project outputs include a scalable weight-loss intervention, plain language factsheets disseminated locally and through the Model Systems Knowledge Translation Center, scientific papers and presentations of study results, stakeholder and student workshops, and educational resources on TBI for individuals and care partners.

Research Projects 2017 - 2022

1. Efficacy of an Evidence-based Weight Loss Intervention post TBI. Weight gain is common among people with TBI, with 70 percent of NTX-TBIMS patients being overweight/obese 10-years post injury. Weight gain greatly increases the risk of chronic diseases such as diabetes, metabolic syndrome, pulmonary and heart disease. There is evidence that interventions that improve physical activity and healthy eating behaviors concurrently offer greatest potential for weight-loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight-loss program that has been used extensively with the general population, but not with people with TBI. We want to see if the GLB-TBI improves weight and secondary outcomes (step count, waist circumference, blood pressure, HbA1c and lipid panel, functional measures, risk of diabetes, and quality of life) at 3, 6, and 12 months from baseline. We also want to study the ease with which participants complete this program, and whether or not smartphone assistance helps to keep people on track. (PI: Simon Driver, Ph.D., Investigator: Shannon Juengst, Ph.D.)
2. Module Project: Care partners of adults with TBI report substantial burden, emotional distress, and a need for more resources and skills training to manage the transition from hospital to home. We will assess the feasibility and efficacy of Problem Solving Training for care partners during inpatient rehabilitation to reduce burden and depressive symptoms, and to improve coping across the critical transition from inpatient rehabilitation to the community.

Research Projects 2012 - 2017

1. To examine comparative effectiveness of variations in clinical practices and patient outcomes across TBIMS rehabilitation centers, and to develop evidence-based practice guidelines for TBI rehabilitation (PI: Shahid Shafi, M.D.) - Completed.
2. To demonstrate whether resting dopamine transporter binding, or the ability of the dopamine synapses to release dopamine in response to a drug challenge, will be predictive of patient response to methylphenidate treatment using single proton emission computed tomography (SPECT) imaging. Because we don’t know which TBI patients might respond well to a neurostimulant that relies on the neurotransmitter dopamine, this study hopes to find whether it is possible to tell which patients can utilize neurostimulant medications, and which patients are resistant to the effects of these medications. We are analyzing these results now. (PI: Kyle Womack, M.D.)