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Traumatic Brain Injury Model System

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Brain Injury Research Center

The Brain Injury Research Center (BIRC) brings together world-renowned investigators to study the complicated facets of recovery from brain injury. BIRC has leveraged resources from the National Institute on Disability and Rehabilitation Research (NIDRR) and the National Institutes of Health to conduct research that predicts participation outcomes after traumatic brain injury (TBI) and leads to interventions that improve these outcomes.

BIRC currently holds $2.2 million in funding from NIDRR, and has been funded as a Rehabilitation Research and Training Center for every five-year cycle since 1993. The Brain Injury and Stroke Program at TIRR Memorial Hermann has been designated a Traumatic Brain Injury Model System for nearly three decades.

Researchers at BIRC are developing and testing treatments to improve cognition, emotional wellbeing and participation. Current investigations include trials of pharmacologic and behavioral interventions to improve memory in persons with traumatic brain injury, a psychotherapy trial to decrease emotional distress after TBI, assessment of caregiver outcomes, a trial of a resource facilitation intervention to improve return to work after TBI, and development of a new classification system for persons with TBI that will help guide treatment, among other studies. They have created educational materials on sexuality, social communication and caregiver management of TBI that are used in rehabilitation programs around the world. These resources are available at

Information on extensive educational resources available through BIRC can be found on the BIRC website, The TBI Community. Get more information on BIRC scientists and staff or view recent scholarly publications by BIRC scientists on the BIRC website.

Currently Funded Projects at BIRC

Texas Traumatic Brain Injury Model System at TIRR Memorial Hermann

NIDRR grant # H133A070043, 2007-2012, now in no-cost extension 2012-2013

The NIDRR funded TBI Model Systems program is a collaboration of top TBI rehabilitation research programs across the United States. All programs contribute to a large database on TBI recovery and conduct local and collaborative research projects. The TBI Model System site at TIRR and BIRC was initially funded in 1987. During the immediate past funding cycle (2007-2012), we conducted two research projects that are currently being completed through a no-cost extension period of this grant, we are completing two research projects.

Sexuality After Traumatic Brain Injury

This project is a collaborative effort among research centers at TIRR, the Mayo Clinic, Craig Hospital, Carolinas Rehabilitation Institute, Wayne State University/Rehabilitation Institute of Michigan, and Rehabilitation Institute of Chicago. BIRC Director, Dr. Angelle M. Sander, is the overall Principal Investigator and other TIRR investigators are Dr. Mark Sherer and Dr. Allison Clark. Collaborators form other sites include Drs. David Ripley, Flora Hammond, and Robin Hanks. The goal of this project is to determine the frequency, type and severity of changes in sexual functioning associated with Traumatic Brain Injury (TBI).

Accomplishments thus far include publication of three scientific papers, numerous presentations at professional and consumer meetings, development of a fact sheet ( and an educational manual for persons with TBI and significant others on sexuality after TBI, as well as creation of a brochure for rehabilitation professionals.

Social Communication Project

This local TIRR BIRC project is a randomized controlled trial of an intervention to improve social communication for persons with TBI. The Principal Investigator is Dr. Margaret Struchen and other TIRR investigators are Drs. Allison N. Clark, Lynne C. Davis, Mark Sherer, and Angelle M. Sander.

Dr. Todd Nick of the University of Arkansas for Medical Sciences serves as the project biostatistician. This project is just completing data collection. Manuals on social communication after TBI for persons with TBI and rehabilitation providers have been published and disseminated.

Texas Traumatic Brain Injury Model System at TIRR Memorial Hermann

NIDRR grant # H133A120020, 2012-2017

This competitive renewal of our TBI Model Systems funding will allow us to continue our local and national research efforts to improve outcomes for persons with TBI. We continue to enroll new participants for the TBI Model Systems National Database and to collect long-term outcome data for previously enrolled participants. As one of the original TBI Model Systems sites, we are one of only four centers now collecting 20 year post-injury outcome data.

Acceptance and Commitment Therapy (ACT) to Reduce Emotional Distress after TBI

Our local project for this funding cycle is led by Dr. Angelle Sander. Collaborators include BIRC investigators Drs. David Arciniegas, Mark Sherer, Allison Clark, and Kacey Maestas as well as Dr. Robyn Walser, a nationally recognized expert on ACT, and Dr.

Todd Nick, our biostatistician. This trial will be the first application of ACT therapy to test its ability reduce emotional distress and improve community participation in persons with TBI.

Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation in Persons With Traumatic Brain Injury

NIDRR grant #H133B090023, 2009-2014

This NIDRR research and training project is led by Dr. Angelle Sander while Dr. Mark Sherer serves as Director of Research and Dr. Allison Clark serves as Director of Training. Other BIRC scientists collaborating on this project include Drs. Lynne Davis, Kacey Maestas, Laurie van Veldhoven, and Teona Amble. Research and dissemination projects from the RRTC are listed below. More information on this program can be found at

  • Training Project 1 developed an online course for persons with TBI and their family members about how to compensate for cognitive and emotional problems in daily life
  • Training Project 2 provides outreach, general education and technical assistance to staff at community institutions that offer opportunities for participation in leisure activities and social networking. Download the brochure detailing how to work with persons with TBI in the community
  • Training Project 3 provides training and education to non-specialist healthcare and educational professionals in the needs of persons with TBI and how to adapt services to meet the needs of persons with TBI. Online courses have been created for social workers and clinical psychologists. Educational manuals on working with persons with TBI are being created for educators and for substance abuse counselors.
  • Training Project 4 develops and conducts training sessions for persons with TBI and their caregivers on how to use the Internet and social networking websites.
  • Training Project 5 develops a user-friendly web-based TBI classification utility to generate case conceptualizations and treatment recommendations, and provides training and technical assistance to support the use of the utility.
  • Research Project 1 is a randomized controlled trial of a community-based contextualized intervention to improve memory and memory-related participation activities. This trial compares the effectiveness of a contextualized memory intervention provided in the participant's home to standard instruction in use of a memory notebook for improving functional memory and community participation.
  • Research Project 2 is a randomized controlled trial of an extended resource facilitation  service to maximize access to and benefit from state vocational rehabilitation services. This trial compares employment outcomes for persons receiving a resource facilitation intervention to those only receiving a referral for state vocational rehabilitation services.
  • Research Project 3 develops a comprehensive list of symptoms of TBI and, based on this list, creates a classification system for persons with TBI utilizing symptoms, and barriers and facilitators for community integration. This system deploys an innovative, user-friendly, web-based application. Training and technical assistance activities facilitate the widespread dissemination of educational materials on evidence-based strategies for improving function and participation after TBI.

TBI Model System Collaborative Study of Amantadine for Post TBI Irritability and Aggression

NIDRR grant # H133A080035, 2008-2013

The multicenter project is a clinical trial of the effectiveness of amantadine to reduce irritability and aggression in persons with TBI that is led by Dr. Flora Hammond at the Indiana University Medical School and the Rehabilitation Institute of Indiana. Dr. Mark Sherer serves as principal investigator for the TIRR site. Participant enrollment for this project is complete and we will soon begin data analysis.

Quality of Life of Caregivers of Traumatic Brain Injury

CareQOL, NIH grant # R013658-01, 2012-2017

This multicenter project is led by Dr. Noelle Carlozzi at the University of Michigan. Dr. Angelle Sander is the site PI for TIRR. The project will develop and validate a measure of quality of life for caregivers of persons with TBI. TIRR's role includes conducting focus groups to generate items for the measure and developing item banks to caregivers of persons with TBI for the validation study. Dr. Sander will be involved with selecting items for the measure and interpreting and disseminating data.


Research Highlights

Multicenter Evaluation of Memory Remediation After Traumatic Brain Injury with Donepezil (MEMRI-TBI-D)


Funded by the National Institute on Disability and Rehabilitation Research (NIDRR) from 2013 to 2018, this study evaluates the effectiveness of the acetylcholinesterase inhibitor donepezil for improving cognitive memory test performance, everyday memory function and participation outcomes in persons with traumatic brain injury.

Development and Validation of a Classification System of Symptoms and Characteristics to Guide 1959 Treatment Assignment for Persons with TBI Living in the Community

CO-INVESTIGATORS: Angelle Sander, Ph.D., and Lynne Davis, Ph.D.

Researchers are developing a new classification system for persons with TBI who are in the post-hospital period of recovery, a system that will help clinicians conceptualize the key concerns for this population and aid in developing treatment plans. NIDRR has funded the study from 2009 to 2015.

Effectiveness of Acceptance and Commitment Therapy for Reducing Emotional Distress and Improving Participation in the Community for Persons with TBI

CO-INVESTIGATORS: Mark Sherer, Ph.D., ABPP, FACRM, Allison Clark, Ph.D., and David Arciniegas, M.D.

The major goal of this project is to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT), a psychotherapy combining acceptance of thoughts and feelings with living out values, for reducing emotional distress in persons with traumatic brain injury. If successful, the study will provide a foundation for future multicenter comparative effectiveness trials in which ACT can be evaluated in comparison to traditional cognitive behavioral therapy and psychotropic medications.