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Michael E. Selzer, MD, PhDMichael E. Selzer, MD, PhDDirectorDirector
Patricia A. Dorn, PhDPatricia A. Dorn, PhDDeputy DirectorDeputy Director
Office of Research and Development Office of Research and Development Joel Kupersmith, MD, CRADOJoel Kupersmith, MD, CRADO
Rehabilitation Research & Development ServiceRehabilitation Research & Development Service
2009 ORD Local Accountability for Research2009 ORD Local Accountability for Research
““To care for him who shall have borne the To care for him who shall have borne the battle, and for his widow and his orphan.”battle, and for his widow and his orphan.”
A. Lincoln, 1865
Mission of VA Research and DevelopmentMission of VA Research and Development
““To discover knowledge and create To discover knowledge and create innovations that advance the health and innovations that advance the health and care of veterans and the nation.”care of veterans and the nation.”
Department of Veterans AffairsDepartment of Veterans Affairs
To discover knowledge and create To discover knowledge and create innovations that restore veterans who innovations that restore veterans who have become disabled due to injury or have become disabled due to injury or disease to their greatest possible disease to their greatest possible functional capacityfunctional capacity
In their personsIn their persons
In their familiesIn their families
In their communitiesIn their communities
In their work placesIn their work places
Mission of Rehabilitation Research Mission of Rehabilitation Research and Developmentand Development
Tom Andriacchi – Center for Bone Tom Andriacchi – Center for Bone and Joint Rehabilitation (Palo Alto) and Joint Rehabilitation (Palo Alto)
Veterans Health AdministrationVeterans Health AdministrationOffice of Research & Office of Research &
DevelopmentDevelopmentJoel Kupersmith, CRADOJoel Kupersmith, CRADO
Tim O’Leary, Acting Deputy CRADOTim O’Leary, Acting Deputy CRADO
Veterans Health AdministrationVeterans Health AdministrationOffice of Research & Office of Research &
DevelopmentDevelopmentJoel Kupersmith, CRADOJoel Kupersmith, CRADO
Tim O’Leary, Acting Deputy CRADOTim O’Leary, Acting Deputy CRADO
Biomedical Biomedical LaboratoryLaboratory
R&DR&DRon PrzygodskiRon Przygodski
Biomedical Biomedical LaboratoryLaboratory
R&DR&DRon PrzygodskiRon Przygodski
Clinical Clinical ScienceScience
R&DR&DTim O’LearyTim O’Leary
Clinical Clinical ScienceScience
R&DR&DTim O’LearyTim O’Leary
Health Health ServicesServices
R&DR&DSeth EisenSeth Eisen
Health Health ServicesServices
R&DR&DSeth EisenSeth Eisen
RehabilitationRehabilitation
R&DR&D
Mickey SelzerMickey Selzer
Research-Funding ServicesResearch-Funding Services
VA Research Organization Fits an VA Research Organization Fits an Interdisciplinary Time Model of MedicineInterdisciplinary Time Model of Medicine
LimitationLimitationof Damageof Damage
BLR&DBLR&DCSR&DCSR&D
RestorationRestorationof Functionof Function
RR&DRR&D
PreventionPrevention
HSR&DHSR&D ImplementationImplementation
Steve Fausti – National Center for Steve Fausti – National Center for Rehabilitative Auditory Research (Portland)Rehabilitative Auditory Research (Portland)
Scope of Rehabilitation Scope of Rehabilitation Research and DevelopmentResearch and Development
REPAIR: REPAIR: Basic research to repair injured organs and Basic research to repair injured organs and
tissuestissues Translational research to bring basic discoveries Translational research to bring basic discoveries
to clinical useto clinical use
REPLACE: REPLACE: Prosthetics, orthotics and assistive device Prosthetics, orthotics and assistive device
research to replace what cannot be repairedresearch to replace what cannot be repaired
RESTORE: RESTORE: Physiological function Physiological function Social integration (including return to work)Social integration (including return to work)
Bruce Sangeorzan – Center for Limb Loss Bruce Sangeorzan – Center for Limb Loss Prevention and Prosthetic Engineering (Seattle) Prevention and Prosthetic Engineering (Seattle)
MoleculeCell, & Tissue
8%8%77%77%
15%15%
RRD RRD Portfolio as Portfolio as
of June, 2007of June, 2007
Levels of Functional RecoveryLevels of Functional Recovery
Scientific Program ManagersScientific Program ManagersScientific Program ManagersScientific Program Managers
SCI/SCI/Regen MedRegen Med
Audrey KalehuaAudrey Kalehua
SCI/SCI/Regen MedRegen Med
Audrey KalehuaAudrey Kalehua
Prosthetics/Prosthetics/Rehabil EngineeringRehabil Engineering
Bob JaegerBob Jaeger
Prosthetics/Prosthetics/Rehabil EngineeringRehabil Engineering
Bob JaegerBob Jaeger
Rehab R&D Scientific OrganizationRehab R&D Scientific Organization
Director, Director, Mickey SelzerMickey SelzerDeputy Director, Deputy Director, Tricia DornTricia Dorn
Aging/Aging/Neurodegen DisNeurodegen Dis
Tshaka CunninghamTshaka Cunningham
Aging/Aging/Neurodegen DisNeurodegen Dis
Tshaka CunninghamTshaka Cunningham
Brain Injury/Brain Injury/StrokeStroke
Jean LangloisJean Langlois
Brain Injury/Brain Injury/StrokeStroke
Jean LangloisJean Langlois
Social Reintegration/Social Reintegration/Mental HealthMental Health
Sunil Sen-GuptaSunil Sen-Gupta
Social Reintegration/Social Reintegration/Mental HealthMental Health
Sunil Sen-GuptaSunil Sen-Gupta
Career Develop/Career Develop/Special ProjectsSpecial ProjectsJay FreedmanJay Freedman
Musculoskel/Musculoskel/Med ComorbidityMed Comorbidity
Tom PierceTom Pierce
Musculoskel/Musculoskel/Med ComorbidityMed Comorbidity
Tom PierceTom Pierce
Neuroplasticity/Neuroplasticity/PT, OT, PT, OT, etc.etc.
PendingPending
Neuroplasticity/Neuroplasticity/PT, OT, PT, OT, etc.etc.
PendingPending
SensorySensorySystemsSystemsPendingPending
SensorySensorySystemsSystemsPendingPending
How the Rehabilitation Research How the Rehabilitation Research Mission is Carried OutMission is Carried Out
Merit Awards – Awards to VA investigators to Merit Awards – Awards to VA investigators to support individual research projects support individual research projects 3 yr, $750K total, $250K/yr3 yr, $750K total, $250K/yr
4 yr, $925K total, $300K max in any yr4 yr, $925K total, $300K max in any yr
Pilot Projects – support research leading to Merit Pilot Projects – support research leading to Merit projectproject 2 yrs max, $75K/yr2 yrs max, $75K/yr
CCenters enters oof f EExcellence (13) and xcellence (13) and RResearch esearch EEnhancement nhancement AAward ward PPrograms (5) – Groups of rograms (5) – Groups of scientists collaborating to achieve goals in a broad scientists collaborating to achieve goals in a broad area of concern to disabled veterans, area of concern to disabled veterans, e.g.e.g., SCI, limb , SCI, limb amputation, stroke, blindness, deafness, etc.amputation, stroke, blindness, deafness, etc. 5 yrs, Centers: $950K/yr, REAPs: $325K/yr5 yrs, Centers: $950K/yr, REAPs: $325K/yr
How the Rehabilitation Research How the Rehabilitation Research Mission is Carried OutMission is Carried Out
Career Development Awards – To support Career Development Awards – To support promising investigators starting out in VA promising investigators starting out in VA researchresearch CDA-1, 2yr, salary supportCDA-1, 2yr, salary support
CDA-2, 3 – 5 yr, salary support, operational CDA-2, 3 – 5 yr, salary support, operational funds up to $50K/yrfunds up to $50K/yr
Transition Award, salary supportTransition Award, salary support
Career Scientist and Senior Career Scientist Career Scientist and Senior Career Scientist Awards – To provide stable salary support Awards – To provide stable salary support for accomplished VA scientistsfor accomplished VA scientists
JJournal of ournal of RRehabilitation ehabilitation RResearch and esearch and DDevelopmentevelopment
Process of ReviewProcess of Review• Pre-ApplicationPre-Application
– LLetter etter OOf f IIntent Oct 15 and April 15, Assignment to Review Panel (may ntent Oct 15 and April 15, Assignment to Review Panel (may request panel)request panel)
• Submit Proposal: Dec 15 and June 15 Submit Proposal: Dec 15 and June 15
– Review: Feb/March and Aug/SeptReview: Feb/March and Aug/Sept
– Approved and Scored 1.0 - 5.0 (best-worst)Approved and Scored 1.0 - 5.0 (best-worst)
– No automatic pay line, but after review most awards made in sequence No automatic pay line, but after review most awards made in sequence of scoreof score
– Additional Proposals Funded Based on PriorityAdditional Proposals Funded Based on Priority
• Post-ReviewPost-Review
– Proposals to be funded enter Proposals to be funded enter JJust-ust-IIn-n-TTime process.ime process.
– Un-funded proposals revised for resubmission (max. 3 submissions)Un-funded proposals revised for resubmission (max. 3 submissions)
• Grants.gov/eRACommons on line submission for Merit and Pilot Grants.gov/eRACommons on line submission for Merit and Pilot Project applications onlyProject applications only
• Center and REAP applications by special solicitation onlyCenter and REAP applications by special solicitation only
Where We Are StrongWhere We Are Strong Opportunities For GrowthOpportunities For Growth
Level of Physical and Mental Level of Physical and Mental
FunctionFunction Stroke Stroke Spinal Cord InjurySpinal Cord Injury Sensory LossSensory Loss MusculoskeletalMusculoskeletal
Medical ComorbidityMedical Comorbidity Prosthetic and Assistive Prosthetic and Assistive
Device DevelopmentDevice Development
Level of Molecules, Cells and Level of Molecules, Cells and
Tissues; Regenerative Tissues; Regenerative MedicineMedicine Level of Social and Vocational Level of Social and Vocational
ReintegrationReintegration TBI-Specific ResearchTBI-Specific Research Translation of Prosthetic and Translation of Prosthetic and
Assistive Device Innovation Assistive Device Innovation
(and Other Interventions) into (and Other Interventions) into
Clinical UseClinical Use
Areas Of StrengthAreas Of StrengthAnd Opportunities For GrowthAnd Opportunities For Growth
Leslie Gonzalez-Rothi – Brain Rehabilitation Leslie Gonzalez-Rothi – Brain Rehabilitation Research Center (Gainesville)Research Center (Gainesville)
Electronic Ankle-Electronic Ankle-Foot Prosthesis May Foot Prosthesis May Improve Mobility of Improve Mobility of Veteran AmputeesVeteran Amputees
Prosthetic Retina May Restore Vision to Prosthetic Retina May Restore Vision to Veterans with Retinal DegenerationVeterans with Retinal Degeneration
Prosthetics Research to Restore Control of Prosthetics Research to Restore Control of Functions to Paralyzed VeteransFunctions to Paralyzed Veterans
Collaboration Among VA Scientists, DARPA, Collaboration Among VA Scientists, DARPA, and Industry may Restore Fine Upper Limb and Industry may Restore Fine Upper Limb
Control to Veteran AmputeesControl to Veteran Amputees
Community Based Exercise for Stroke RecoveryCommunity Based Exercise for Stroke Recovery A Pilot Study in Italy Suggested that Exercise A Pilot Study in Italy Suggested that Exercise
Conducted in Community Setting Provided Longer Conducted in Community Setting Provided Longer Lasting Improvement in Functional MeasuresLasting Improvement in Functional Measures Was this because of better compliance with Was this because of better compliance with
exercise or some other factor associated with exercise or some other factor associated with socialization?socialization?
Would the effect be seen in US Veterans?Would the effect be seen in US Veterans? RR&D Investigators are Now Doing a Study to RR&D Investigators are Now Doing a Study to
Answer these QuestionsAnswer these Questions Compare exercise in VFW Posts vs. hospital Compare exercise in VFW Posts vs. hospital
settingssettings Compare exercise program with sedentary Compare exercise program with sedentary
socializationsocialization
Research to Promote Research to Promote Social ReintegrationSocial Reintegration
SCI-Vocational Integration ProgramSCI-Vocational Integration Program Integrating Compensated Work Therapy Integrating Compensated Work Therapy
(Evidence–Based Supported Employment) with (Evidence–Based Supported Employment) with Comprehensive SCI RehabilitationComprehensive SCI Rehabilitation
VA SCI Strategic Healthcare GroupVA SCI Strategic Healthcare Group Focus on Factors Preventing Return to WorkFocus on Factors Preventing Return to Work
Workplace AccommodationsWorkplace Accommodations Psychological and Physical DisabilitiesPsychological and Physical Disabilities Drug Addiction when Applicable (Untreated Drug Addiction when Applicable (Untreated
Persons Excluded from Study)Persons Excluded from Study) Interventions, Including Counseling, Training, Interventions, Including Counseling, Training,
Health Status EducationHealth Status Education Comparison of Interventions to Obtain Best Comparison of Interventions to Obtain Best
OutcomesOutcomes
Research to Promote Research to Promote Vocational ReintegrationVocational Reintegration
Our Initiatives will: Our Initiatives will:
Develop Outcomes Measures for Social Develop Outcomes Measures for Social Reintegration Research.Reintegration Research.
Develop Meaningful and Appropriate Outcomes Develop Meaningful and Appropriate Outcomes Measures for Return to Work Research.Measures for Return to Work Research.
Determine the Best Incentive Structures to Determine the Best Incentive Structures to Optimize Social Reintegration and Return to Optimize Social Reintegration and Return to Work.Work.
These Innovations Could Revolutionize These Innovations Could Revolutionize Research in Social and Vocational Research in Social and Vocational Rehabilitation for VA and Nationwide.Rehabilitation for VA and Nationwide.
Research to Promote Social and Research to Promote Social and Vocational ReintegrationVocational Reintegration
Research on Regenerative MedicineResearch on Regenerative Medicine
Glickstein, Current Biology, Glickstein, Current Biology, 2008; MIT HST coursework2008; MIT HST coursework
Directed Directed differentiation differentiation of stem cells of stem cells into neuronsinto neurons
Mesenchymal stem cells Mesenchymal stem cells for bioengineered jointsfor bioengineered joints
Bioengineered boneBioengineered bone
Regenerative Medicine in SCIRegenerative Medicine in SCI
Tysseling-Mattiace et al., J Neurosci, Tysseling-Mattiace et al., J Neurosci, 2008; Taylor et al., J Neurosci, 20062008; Taylor et al., J Neurosci, 2006
Biopolymer Biopolymer scaffolds seeded scaffolds seeded with genetically with genetically engineered cells engineered cells producing producing neurotrophic factorsneurotrophic factors
Functional recovery Functional recovery post-transplantpost-transplant
Hemisection Hemisection model of SCImodel of SCI
How are We Addressing How are We Addressing the New Priorities?the New Priorities?
• SOTA on TBI SOTA on TBI (resource documents to be published in (resource documents to be published in JRRD; results to be published separately)JRRD; results to be published separately)
• RFAsRFAs– ORD-wide TBI solicitationORD-wide TBI solicitation
– Centers of Excellence and Research Enhancement Centers of Excellence and Research Enhancement Award Programs, intention is to increase numbers, Award Programs, intention is to increase numbers, Review January 27 – 28 Review January 27 – 28
• Regenerative MedicineRegenerative Medicine
• TBITBI
• Social Reintegration and Vocational RehabilitationSocial Reintegration and Vocational Rehabilitation
• Increased Collaborations Between ORD Research Increased Collaborations Between ORD Research Services, Between ORD and Prosthetics and Services, Between ORD and Prosthetics and Patient Care Services, and Between VA and Non-Patient Care Services, and Between VA and Non-VA InvestigatorsVA Investigators Hunter Peckham – Center for Functional Hunter Peckham – Center for Functional
Electrical Stimulation (Cleveland) Electrical Stimulation (Cleveland)
OEF/OIF 2007 ProjectsOIF/OEF 2007 ProjectsOIF/OEF 2007 Projects
OEF/OIF 2007 Projects
24%
19%
16%
12%
9%
7%
5%
3%
2%
2%
1%
SCI & Secondary Complications
Neuro-Rehabilitation
Amputation/Orthopedics/Prosthetics
Hearing/Tinnitus
Vision
Pain
TBI
Regenerative Medicine(Genomics/Proteomics)
Mental Health/Voc Rehab/SocialReintegration
Trauma (Poly Trauma)
Tele-Rehab
OIF/OEF 2008 ProjectsOIF/OEF 2008 Projects
2008 OEF/OIF Projects
28%
15%
9%11%
10%
7%
6%
5%
4%
4%
1%
SCI & Secondary Complications
TBI
Vision
Neuro-Rehabilitation
Hearing/Tinnitus
Regenerative Medicine(Genomics/Proteomics)
Amputation/Orthopedics/Prosthetics
Trauma (Poly Trauma)
Pain
Mental Health/Voc Rehab/SocialReintegration
Tele-Rehab
Rehab R&D Career Development ProgramRehab R&D Career Development Program
Bill Bauman – Center for Medical Bill Bauman – Center for Medical Consequences of SCI (Bronx) Consequences of SCI (Bronx)
• RR&D began offering Career program in RR&D began offering Career program in 19971997
• Over 100 awardees trainedOver 100 awardees trained
• Career program is growingCareer program is growing
• Currently receive over 30 applications per Currently receive over 30 applications per cyclecycle– ~ 5-fold increase over past 5 years~ 5-fold increase over past 5 years
• 18.9% Career Awards (all types)18.9% Career Awards (all types)• All awards Merit & Career (397), Career (75)All awards Merit & Career (397), Career (75)
• 12.6% Funds in Career Program12.6% Funds in Career Program• $6.9 mill of $54.7 mill$6.9 mill of $54.7 mill
• Typically fund at ~30Typically fund at ~30thth percentile percentile
Career Program Statistics FY07Career Program Statistics FY07
Joe Rizzo – Center for Innovative Joe Rizzo – Center for Innovative Visual Rehabilitation (Boston)Visual Rehabilitation (Boston)
• Spinal Cord InjurySpinal Cord Injury
• StrokeStroke
• Biomedical Engineering Biomedical Engineering
• Prosthetics / OrthoticsProsthetics / Orthotics
• Mental HealthMental Health
• Vocational RehabilitationVocational Rehabilitation
• HearingHearing
• VisionVision
Examples Career Development Examples Career Development Training Areas Training Areas
Ron Triolo – Center for Rehabilitation Ron Triolo – Center for Rehabilitation Engineering Platform Technology (Cleveland)Engineering Platform Technology (Cleveland)
Activities with VA Office of Activities with VA Office of Academic AffiliationsAcademic Affiliations
Rich Macko – Center for Task Oriented and Rich Macko – Center for Task Oriented and Robotics in Neurological Disease (Baltimore)Robotics in Neurological Disease (Baltimore)
• Polytrauma & Traumatic Brain Injury Polytrauma & Traumatic Brain Injury Advanced Fellowship ProgramAdvanced Fellowship Program
– Jointly supported by OAA & RR&DJointly supported by OAA & RR&D
– Provide post-residency MDs & post-doc associated Provide post-residency MDs & post-doc associated health professionals in-depth preparation in clinical health professionals in-depth preparation in clinical care, research & leadership in polytrauma, TBI & care, research & leadership in polytrauma, TBI & related neuroscience fieldsrelated neuroscience fields
– 2 year program, with possibility of 32 year program, with possibility of 3rdrd year upon year upon approvalapproval
• Rehabilitation Research Predoctoral FellowshipsRehabilitation Research Predoctoral Fellowships
• Assist withAssist with
– drafting announcementdrafting announcement
– dissemination to field and academic affiliatesdissemination to field and academic affiliates
– recommending reviewersrecommending reviewers
Activities with VA Office of Activities with VA Office of Academic AffiliationsAcademic Affiliations
Krish Satian – Center for Aging Krish Satian – Center for Aging Veterans with Vision Loss (Atlanta) Veterans with Vision Loss (Atlanta)
Honoring Exceptional Design & Engineering Honoring Exceptional Design & Engineering Achievements in Accessibility & Universal Design Achievements in Accessibility & Universal Design
that Empowers People of all Abilitiesthat Empowers People of all Abilities
• 2008 Lifetime Achievement Award to: 2008 Lifetime Achievement Award to: Jeff KocsisJeff Kocsis• 2008 Spirit of da Vinci Award to: 2008 Spirit of da Vinci Award to: Hugh HerrHugh Herr• 2007 Lifetime Achievement Award to: 2007 Lifetime Achievement Award to: Rory CooperRory Cooper
Da Vinci AwardsDa Vinci Awards
Rory Cooper – Center for Wheelchair Rory Cooper – Center for Wheelchair and Associated Rehab Engineering and Associated Rehab Engineering
Michael Selzer 202-461-1740; Michael Selzer 202-461-1740; [email protected] Dorn 202-461-1755; Patricia Dorn 202-461-1755; [email protected]
Program ManagersProgram ManagersTshaka Cunningham 202-461-1853; Tshaka Cunningham 202-461-1853; [email protected] Freedman 202-461-1699; Jay Freedman 202-461-1699; [email protected] Rober Jaeger 202-461-1751; Rober Jaeger 202-461-1751; [email protected] Audrey Kalehua 202-461-1749; Audrey Kalehua 202-461-1749; [email protected] Jean Langlois 202-461-1847; Jean Langlois 202-461-1847; [email protected] J. Thomas Pierce 202-461-1758; J. Thomas Pierce 202-461-1758; [email protected] Sunil Sen-Gupta 202-461-1754; Sunil Sen-Gupta 202-461-1754; [email protected]
Administrative OfficerAdministrative OfficerRicardo Gonzalez 202-461-1750; Ricardo Gonzalez 202-461-1750; [email protected]
Review AdministratorReview AdministratorTerri Carlton 202-461-1757; Terri Carlton 202-461-1757; [email protected]
THANK YOU !THANK YOU !
Steven Waxman – Center for Restoration Steven Waxman – Center for Restoration of Function in SCI and MS (West Haven)of Function in SCI and MS (West Haven)
