Boston, MA: Local DVBIC Activities
Boston, MA: Local DVBIC Activities
The Veterans Affairs Boston Healthcare System (VABHS) is engaged in a number of research, clinical, and educational activities related to improving the lives of service members and veterans with traumatic brain injuries (TBIs):
I. Research:
The Polytrauma and TBI Research Center focuses on innovative ways to improve the diagnosis and treatment of various deficits related to TBI, in order to maximize functional outcome for patients with TBI and Polytrauma. There are several federally funded research projects:
1. Evaluating TBI Screening Instruments and Processes for Clinical Follow-up (VA HSR&D, 2009-2011): This is a study of approximately 300,000 OEF/OIF veterans from the national database. We will use the VA mild TBI clinical reminder and second level evaluation data obtained from VA Office of Patient Care Services (PCS) to identify participants and characteristics of the screening measure. In addition, patient characteristics, healthcare utilization, and cost data will be examined using VA Inpatient and Outpatient Medical datasets.
2. Using a Simulator to Enhance Cognitive Function after Brain Injury (VA Merit Review, 2007-2010): In this study individuals with self-reported driving impairments, who have sustained a TBI and/or have the diagnosis of Post Traumatic Stress Disorder, will undergo weekly driving simulator training. The goal of the study is to determine if simulation training improves driving behaviors and to determine if the intervention has a diffuse benefit by enhancing performance on cognitive and electrophysiological measures.
3. Characterization and Care Coordination of Polytrauma Patient (VA Merit Review, 2007-2010): The purpose of this retrospective chart review study is to describe the short-term durability of functional outcomes for veterans with TBI. A secondary objective is to identify factors that may limit functional independence and are associated with poor outcomes.
Publications (2006-2009):
- Lew HL, Poole JH, Guillory SB, Salerno RM, Leskin G, Sigford B: Persistent Problems after Traumatic Brain Injury: The Need for Long Term Follow-up and Care Coordination. JRRD. April 2006; 43(2): vii-x (Guest Editorial).
- Lew HL, Lin PH, Fu J, Wang S, Clark DJ, and Walker W: Characteristics and Treatment of Headache after Traumatic Brain Injury. Am J Phys Med Rehabil. July 2006; 85(5): 619-627. (Review Article)
- Lew HL, Poole JH, Salerno RM, Castaneda A, and Gray M: Prognostic Value of Evoked and Event-Related Potentials in Moderate to Severe Brain Injury. Journal of Head Trauma Rehabilitation. July 2006; Vol 21, No. 4, pp 350-360. (Review Article)
- Lew HL, Cifu DX, Sigford B, Scott S, Sayer N, Jaffee MS: Team approach to diagnosis and management of traumatic brain injury and its comorbidities: Journal of Rehabilitation Research & Development, Dec 2007, Vol. 44 Issue 7, pvii-xi. (Guest Editorial)
- Lew HL, Gray M, and Poole JH: Temporal Stability of Cognitive Event-Related Potentials in Traumatic Brain Injury (TBI) and Healthy Individuals. J Clinical Neurophysiology, Oct 2007; 24(5): 392-397
- Lew HL, Jerger JF, Guillory SB, Henry JA. Auditory Dysfunction in Traumatic Brain Injury. JRRD, 2007; 44(7): 921-927
- Goodrich GL, Kirby J, Cockerham G, Ingalla SP, Lew HL. Visual Function in Patients of a Polytrauma Rehabilitation Center: A Descriptive Study. Journal of Rehabilitation Research and Development (JRRD), 2007; 44(7): 929-936
- Lew HL, Poole JH, Vanderploeg RD, Goodrich GL, Dekelboum S, Guillory SB, Sigford B, Cifu DX. Program Development and Defining Characteristics of Returning Military in a VA Polytrauma Network Site. JRRD, 2007; 44(7): 1027-1034
- Lew HL, Vanderploeg RD, Moore DF, Schwab K, Friedman L, Yesavage J, Keane TM, Warden DL, Sigford BJ: Overlap of mild TBI and mental health conditions in returning OIF/OEF service members and veterans: JRRD, May 2008, Vol. 45 Issue 3, pxi-xvi. (Guest Editorial)
- Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Arch Phys Med Rehabil. 2008 Jan;89(1):163-70.
- Lew HL, Gray M, Poole JH. Simultaneous measurement of perceptual and motor cortical potentials: implications for assessing information processing in traumatic brain injury. Am J Phys Med Rehabil. 2009 Jan;88(1):1-6.
- Sayer NA, Cifu DX, McNamee S, Chiros CE, Sigford BJ, Scott S, Lew HL. Rehabilitation needs of combat-injured service members admitted to the VA Polytrauma Rehabilitation Centers: the role of PM&R in the care of wounded warriors. PM&R journal. 2009 Jan;1(1):23-8.
- Lew HL, Rosen PN, Thomander D, Poole JH. The potential utility of driving simulators in the cognitive rehabilitation of combat-returnees with traumatic brain injury. J Head Trauma Rehabil. 2009 Jan-Feb;24(1):51-6.
- Yang Z, Yan K, and Lew HL: An Unusual Cause of Abdominal Pain in an adult Patient with Severe Traumatic Brain Injury, Am J Phys Med Rehabil, October 2009; 88(10): 864-865
- Halbauer JD, Ashford JW, Zeitzer JM, Adamson MM, Lew HL, Yesavage, JA.Neuropsychiatric diagnosis and management of chronic sequelae of war-related mild to moderate traumatic brain injury. J Rehabil Res Dev. (November 2009, in press
- Kupersmith J, Ommaya A, Selzer M, Ruff R, Lew HL. Guest editorial for the TBI SOTA Special Issue. J Rehabil Res Dev. (November 2009, in press)
- Kupersmith J, Lew HL, Ommaya A, Jaffee M, Koroshetz W. Traumatic Brain Injury Research Opportunities: Results of a Department of Veterans Affairs Consensus Conference. J Rehabil Res Dev. (November 2009, in press)
- Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of Chronic Pain, Posttraumatic Stress Disorder and Persistent Post-concussive Symptoms in OEF/OIF Veterans: The Polytrauma Clinical Triad. J Rehabil Res Dev. 2009 (In Press).
- Lew HL, Garvert DW, Pogoda TK, Hsu PT, Devine JM, White DK, Myers P. Auditory and Visual Impairments in Patients with Blast-Related Traumatic Brain Injury: Effect of Dual Sensory Impairment on Functional Independence Measure. J Rehabil Res Dev. 2009 (In Press)
II. Clinical
PM&R Service at VABHS offers a comprehensive approach to rehabilitation across the continuum of inpatient and outpatient care. Extensive outpatient clinics (physical therapy, occupational therapy, audiology, vision care, neuropsychology, social work, medical, and bracing) are offered through this service as well a 6-bed CARF accredited CIIRP unit. The PM&R Service provides support to patients with neurological disorders, traumatic and non-traumatic brain injury, musculoskeletal/orthopedic disorders, cardiac disease, pulmonary disease, sensory impairment, and complex medical and psychiatric disorders.
III. Education:
Resident teaching is central to the PM&R Service at VABHS. Weekly lectures are offered on the topics of polytrauma, TBI, electromyography (EMG), and musculoskeletal medicine.
In 2009, the VA Central Office provided funding and established the nation’s inaugural “Polytrauma and TBI Fellowship Program” at VABHS, with Dr. Henry Lew as the fellowship program director.
Three fellows (audiologist, optometrist, and physiatrist) have enrolled in the program. Additionally, residents from Harvard Medical School, Boston University and Tufts University complete two or three month rotations within the PM&R Service including inpatient rehabilitation, inpatient consultation, and outpatient Polytrauma Network Site (PNS).
Internationally, Dr. Lew serves as an active member of the Education Committee for the International Society of Physical and Rehabilitation Medicine (ISPRM). Dr. Lew also served as Visiting Professor at the Chang Gung Medical School in Taiwan, teaching young physiatrists there about the diagnosis and treatment of TBI.
Resident’s Presentations (2009-present)
- Association of Academic Physiatrists. (Zaremski JL, Jayawardena V, and Lew HL: An Occult Presentation of Appendicitis in a Patient with Tetraplegia). Colorado Springs, February 2009. (Accepted for publication in AJPMR)
- Association of Academic Physiatrists. (Yang Z, Yan K, and Lew HL: An Unusual Presentation of Abdominal Pain in an Adult Patient with TBI). Colorado Springs, February 2009. (Accepted for publication in AJPMR)
- Association of Academic Physiatrists. (Wilcher D, Williams S, Yan K, and Lew HL: Employment of Mirror Therapy in Upper Extremity Traumatic Amputee with Phantom Limb Pain). Colorado Springs, February 2009.
- Association of Academic Physiatrists. (Aldahondo-Feliciano N, Webster H, Hanak J, and Lew HL: A Common but Sometimes Overlooked Presentation of Multiple Myeloma: Low Back Pain). Colorado Springs, February 2009.
- Association of Academic Physiatrists. (Lue AC, Hanak J, Yan K, and Lew HL: Botulinum Toxin Type A and Phenol Injections to the Lower Extremity in Adult Ambulators with Spasticity). Colorado Springs, February 2009.
updated 12/24/09