Rehabilitation Research & Development Service 2009 ORD Local Accountability for Research

1. Rehabilitation Research & Development Service2009 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

2. 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.”

3. 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)

4. Veterans Health Administration Office of Research & Development Joel Kupersmith, CRADO Tim O’Leary, Acting Deputy CRADO Research-Funding Services Biomedical Laboratory R&D Ron Przygodski Clinical Science R&D Tim O’Leary Health Services R&D Seth Eisen Rehabilitation R&D Mickey Selzer

5. VA Research Organization Fits an Interdisciplinary Time Model of Medicine Limitation of Damage BLR&D CSR&D Restoration of Function RR&D Prevention HSR&D Implementation Steve Fausti – National Center for Rehabilitative Auditory Research (Portland)

6. 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)

7. Social Integration Levels of Functional Recovery Physical and Mental Function Molecule Cell, & Tissue 15% 8% 77% RRD Portfolio as of June, 2007

8. Rehab R&D Scientific Organization Prosthetics/ Rehabil Engineering Bob Jaeger Sensory Systems Pending Director, Mickey Selzer Deputy Director, Tricia Dorn Scientific Program Managers SCI/ Regen Med Audrey Kalehua Aging/ Neurodegen Dis Tshaka Cunningham Brain Injury/ Stroke Jean Langlois Musculoskel/ Med Comorbidity Tom Pierce Social Reintegration/ Mental Health Sunil Sen-Gupta Career Develop/ Special Projects Jay Freedman Neuroplasticity/ PT, OT, etc. Pending

9. 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

10. 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

11. 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

12. Areas Of StrengthAnd Opportunities For Growth Leslie Gonzalez-Rothi – Brain Rehabilitation Research Center (Gainesville)

13. Electronic Ankle-Foot Prosthesis May Improve Mobility of Veteran Amputees

14. Prosthetic Retina May Restore Vision to Veterans with Retinal Degeneration

15. Prosthetics Research to Restore Control of Functions to Paralyzed Veterans

16. Collaboration Among VA Scientists, DARPA, and Industry may Restore Fine Upper Limb Control to Veteran Amputees

17. 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

18. 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

19. 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.

20. Research on Regenerative Medicine Mesenchymal stem cells for bioengineered joints Bioengineered bone Directed differentiation of stem cells into neurons Glickstein, Current Biology, 2008; MIT HST coursework

21. Regenerative Medicine in SCI Biopolymer scaffolds seeded with genetically engineered cells producing neurotrophic factors Hemisection model of SCI Functional recovery post-transplant Tysseling-Mattiace et al., J Neurosci, 2008; Taylor et al., J Neurosci, 2006

22. 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)

23. OEF/OIF 2007 Projects OIF/OEF 2007 Projects

24. OIF/OEF 2008 Projects

25. 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)

26. 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)

27. 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)

28. 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)

29. 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)

30. 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

31. 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)