Clinical Research Directory

Prognostic Model for Predicting Outcome After Moderate to Severe Paediatric Traumatic Brain Injury

Due to ethical and logistical challenges related to paediatric research, there is limited age-appropriate evidence for managing paediatric traumatic brain injury (pTBI). The prognostic models used for adult TBI research (IMPACT, CRASH), have been derived and validated from analysis of large international datasets which have undergone further validation in multiple prospective studies; the wide use of these prognostic models across neurotrauma research highlights the relative simplicity and the variables used for prediction making them applicable to both low and high resource set-ups. This has facilitated international collaborative research in adult TBI. At present, no such models exist for pTBI with most paediatric research continuing to use adult prognostic models. Though the variables used for these models show association with outcome in pTBI as well, there are multiple issues with this approach with the key difficulty being that younger age is expected to be associated with better outcome in these models; however, the balance between neuroplasticity and neurodevelopmental trajectory in children is difficult to predict with evidence suggesting worse neuro-developmental outcomes after TBI in younger children. Hence the adult models can either over- or under-predict neurological outcomes in pTBI and have never been validated in pTBI datasets. Given that the amount of data required to create pTBI predictive model is difficult to collect and reasonable validity of adult prognostic models in pTBI, investigators propose to create paediatric modification to the adult models and identify a robust pTBI predictive model for improved classification of injury severity to predict disease trajectory and outcome as well as stratification of patients for interventional research and benchmarking in pTBI to help with appropriate resource allocation for neuro-interventions towards improved outcomes. This will help identify age-appropriate benchmarks for pTBI research studies as well as complement an individual child's clinical assessment, treatment decisions, informing families and resource allocation.

Intensive Multimodal Neurorehabilitation Targeting Neuroplasticity in Pediatric Neurodevelopmental and Chromosomal Disorders

This observational study evaluates functional and developmental outcomes in pediatric participants undergoing a two week intensive multimodal neurorehabilitation program. The program is designed for children with neurodevelopmental disorders, including but not limited to cerebral palsy, autism spectrum disorder, developmental delay, hypoxic ischemic encephalopathy (HIE), and chromosomal or genetic abnormalities. Participants receive individualized therapy sessions for approximately 2.5 hours per day over a two week period. The intervention is not standardized but is tailored to each child's specific needs and may include components such as sensory integration, motor planning, reflex integration, oculomotor training, executive functioning activities, communication support, and other brain based therapeutic approaches. The purpose of this study is to observe changes in functional abilities, including attention, motor coordination, emotional regulation, communication, and activities of daily living. Outcomes are assessed using clinician observation and parent reported changes before and after the intensive program, with limited follow-up when available. This study does not assign participants to a specific treatment as part of a research protocol. Instead, it collects real world data from children already participating in a clinical therapy program to better understand potential benefits of intensive, individualized neurorehabilitation approaches.

Allopregnanolone in Chronic Complex Traumatic Brain Injury

This study will determine if allopregnanolone (ALLO) improves depression and pain symptoms in patients who have a history of mild traumatic brain injury (TBI) \[primary endpoints\]. The investigators will also determine if ALLO improves functional outcome \[secondary endpoint\]. Participants in this study will receive an intravenous infusion of either ALLO or placebo. Behavioral assessments will be conducted during the infusion and at several time points post-infusion.

Cognitive Rehabilitation for Treatment of Anger in Veterans With TBI and PTSD

This randomized clinical trial will enroll 100 Veteran-family/friend dyads to test the efficacy of CALM in treating anger in TBI and PTSD. The investigators hypothesize that compared to an active control group, Veterans randomized to the CALM group will demonstrate: * Significantly larger decreases in anger dysregulation, impulsivity, and executive dysfunction. * Significantly larger improvements in social and adaptive functioning including less aggression. * Significantly larger reduction in PTSD symptoms and suicidal ideation. The study targets Veterans who experience difficulties with anger and impulsivity due to TBI and PTSD. These issues are common, with up to 38% of Veterans with TBI also having PTSD. These conditions often make it challenging for Veterans to control their emotions and interact successfully in social and work settings. Our research will test the CALM (Cognitive Applications for Life Management) mobile app, which helps Veterans manage their goals, remember important tasks, and improve their attention. Initial tests of CALM have shown it can reduce levels of anger and related issues in Veterans. The investigators will conduct a study with 100 pairings of Veterans and a family member or friend. These pairs will be randomly assigned to one of two groups: one using the CALM mobile platform and the other receiving brain health education. Both groups will use their assigned intervention for three months and will receive support through videoconference calls at the beginning, middle, and end of the program.

Hemodynamic ABI Monitor

The goal of this observational study is to explore the relationship of heart function with the course and outcomes after traumatic brain injuries and nontraumatic intracerebral hemorrhage. The goal is to explore association between routinely collected hemodynamic and brain monitoring data. Participants already taking intervention A as part of their regular medical care and the investigators will follow up with participants 6 months after discharging the hospital.

Low-Tech Treatments for Obstructive Sleep Apnea

The overall purpose of this study is to compare changes in sleep outcomes in people with obstructive sleep apnea (OSA) depending on their participation in one of two behavioral interventions; both involve drinking water and breathing. A second purpose is to compare outcomes between people who have sustained a traumatic brain injury (TBI) and those with no history of TBI. The main questions it aims to answer are whether sleep quality improves after 3-months of high-resistance versus low-resistance exercises, and whether people have different outcomes depending on their history of TBI.

LearningRx Cognitive Training for Brain Injury

The purpose of this investigation is to conduct a series of case studies on the impact of LearningRx cognitive training on cognitive skills, daily functioning, and workplace self-efficacy for participants with Traumatic Brain Injury (TBI) /Acquired Brain Injury (ABI).

Spinal Stimulation and Gait Training to Improve Mobility in TBI

The purpose of this research study is to assess the effects of receiving transcutaneous spinal stimulation while performing walking exercises compared to completing walking exercises without spinal stimulation for individuals with hemiplegic TBI.