Rehabilitation after trauma

Head: Nada Andelic

The goal of this research unit is to generate research-based knowledge on short-term and long-term consequences of injuries related to trauma and their rehabilitation needs, where the main focus of research is on traumatic brain injury (TBI). The research conducted by this group is multidisciplinary and collaborative, where collaboration between intensive medicine, neurosurgery, neuroradiology, neuropsychology and rehabilitation in the acute care of TBI patients has been established over the last 10 years. TBI epidemiology, trends and challenges in TBI management and TBI outcomes is an important focus of research strategy. Between the year spans of 2005-2007, a prospective mapping of all moderate and severe TBIs in Eastern Norway was conducted (http://www.med.uio.no/klinmed/forskning/aktuelt/arrangementer/disputaser/2010/hadzic-andelic-nada.html). Follow-up studies of these patients have later been conducted on a 1-, 2- and 5-year post-injury, where factors such as disability and functioning, quality of life and socio-economic consequences were evaluated, resulting in 10 articles.

Lately, the research on early and late TBI rehabilitation, cost-effectiveness of rehabilitation, use of health services and patient' needs has been prioritized. Within this research project, collaboration with the Research Centre for Habilitation and Rehabilitation Models & Services (CHARM) and the Department of Health Management and Health Economics, University of Oslo is established, and the development of methodology for the evaluation of health economic TBI consequences is underway.

Furthermore, a research network consisting of both national and Scandinavian participants have been established in order to generate more knowledge on severe TBI. A national multi-centre study, involving University Hospitals in Oslo, Bergen, Trondheim and Tromsø and Rehabilitation departments at Sunnaas Hospital and Sørlandet Hospital, is currently ongoing to determine the effects of severe TBI on overall functioning. Recently, the Norwegian Air Ambulance Foundation has joined the research group and data from pre-hospital phase of TBI will be assessed in depth. A register of Norwegian TBI patients is also at the present being developed in collaboration with the National trauma register.

The research unit is utilizing advanced radiological methods (functional and volumetric MR) in a combination with genetic markers and clinical/neuropsychological evaluation methods to assess the underlying structural brain damage of the patients with mild TBI. These methods are used in order to better be able to identify structural damage occurring in patients with less severeTBI as this may be difficult to discover with less advanced methods. An ongoing research project, in collaboration with The Regional Core Facility in Translational MRI Neuroimaging (CRIN) and Anders M. Dale, Depts of Neuroradiology and Neurosciences, University of California, San Diego (UCSD) will develop MRI volumetric assessments of different anatomical structures and provide new insight into the mechanisms of cognitive dysfunction after mild TBI.

Furthermore, a strong focus is the mapping of what types of efforts that may be utilized to better the participation in daily activities and work for patients suffering of less severe TBI. In collaboration with Haukeland University Hospital, a randomized intervention study comparing the outcome of interdisciplinary follow-up programs in specialist health care vs. follow-up in primary health care regarding return to work is currently being conducted.

Individuals with multi trauma injuries is also been followed-up in a "5 year post injury" study, where the main focus is on physical and psychosocial functioning, return to work, and health related quality of life. Several aspects of the rehabilitation process underwent by the participants have been examined, which resulted in 7 articles, showing that a very small amount of participants regained full functioning and approximately 50% was able to return to work or studies. A 10-year follow-up study is underway.

The brain may also be damaged by internal causes. Acute aneurysmal subarachnoid hemorrhage (SAH) is the most common single cause in the younger age groups. Every year, around 400 individuals suffer aneurysmal SAH in Norway, and despite improved intensive and neurosurgical interventions, medical complications and sustained physical, mental, cognitive and social problems are frequent. Hence, approximately 50% of the subjects have not succeeded in return to work after 12 months. Hence, a controlled study evaluating the effect of early initiated rehabilitation on the frequency of complications and the level of physical and cognitive functioning after 12 months was initiated in 2012 in collaboration with the Neurosurgical department.

Furthermore, a great deal of research activity within the neuropsychological unit is performed in collaboration with the Faculty of Social Sciences, Department of Psychology, University of Oslo, where profs. Fjell and Walhovd are involved on a part-time basis. In the combination with clinical neuropsychological reports, advanced diagnostic methods is used in order to detect dementia and other neurological conditions at early stage of disease.  Several studies has evaluated if cognitive training may affect the brain structure in a way traceable by MRI, and in which degree such training may better memory function amongst healthy elderly, and elderly with mild memory problems. Studies are also being conducted to assess how memory is affected by specific and diffuse damage in different parts of the brain.

In addition to the abovementioned studies, several of our projects are also associated to the International classification for functioning, disability and health (ICF). Our unit has participated in the elaboration and evaluation of core sets of lumbar pain, stroke and TBI in collaboration with the ICF Research Branch at the University of Munich and the Guttmann Institute in Barcelona. This collaboration is part of an ongoing PhD project aiming to evaluate shoulder functioning within an ICF perspective. The ICF is furthermore used as a tool for analysis in multiple sub studies on individuals with TBI and multi trauma. Alongside this, our unit has an ongoing collaboration with the University of Gottingen in terms of development and testing of an instrument for self-reported functioning after traumatic brain injury: Quality of Life after Brain Injury (QOLIBRI). This instrument is included in studies on TBI at this research unit. http://www.qolibrinet.com/index.htm. 

Ongoing research projects 

• Rehabilitation after severe traumatic brain injury, a national multicentre study. Head of project Cecilie Røe
• A prospective study of long-term outcome after traumatic brain injury and health economic assessment of rehabilitation trajectories from early to later phases. Head of project Nada Andelic
• The course of functional recovery from 1 year to 2 years after moderate-to-severe TBI. Head of project Nada Andelic; Research fellow Marit Forslund
• Effect of interdisciplinary out patients' treatment in mild traumatic brain injury, a randomized study. Project manager OUS Cecilie Røe; Head of project Jan Sture Skouen; PhD fellow Eirik Vikane 
• Morphological brain damage and functional impairment following mild traumatic brain injury. Head of project Cecilie Røe; PhD fellow Torgeir Hellstrøm
• Training for dizziness after brain injury. Head of project Helene L. Søberg; PhD fellow Ingerid Kleffelgård
• Life 10 years after the accident. A prospective follow-up study of functioning and health related quality of life 10 years after multiple trauma. Head of project Helene L. Søberg
• Effect of early rehabilitation in patients with acute  subarachnoid hemorrhage. Head of the project Cecilie Røe in collaboration with Angelika Sorteberg, Dept of Neurosurgery; PhD fellow Tanja Karic