Rehabilitation after trauma research group

Leader: Nada Andelic

The goal of this research group is to generate knowledge of the mechanisms and consequences of trauma, patient care, trends and challenges in treatment and rehabilitation including the patient's healthcare needs with the main focus being on traumatic brain injuries (TBIs). The research conducted by this group is multidisciplinary and collaborative, where collaboration between genetics, intensive medicine, neurosurgery, neuroradiology, neuropsychology and rehabilitation has been established over the last 10 years.

The main aims of the research group:

  • To better understand the mechanisms, course and consequences of TBI and multiple traumas by using translational research strategy.
  • To develop and build evidence - based efficient protocols for the rehabilitation implementation
  • To strengthen existing and initiate new national and international research collaborations on trauma/TBI research.

 The specific aims of the research group are to generate research-based knowledge on:

  • The biomarkers of TBI and the severity of injuries including morphological changes in the brain.
  • Short-term and long-term outcomes and recovery process (physical, cognitive and psychosocial functioning, return to work, and health related quality of life).
  • The organization of patient care, rehabilitation trajectories and cost-effect of rehabilitation interventions.
  • Patients needs for health care services.

Previous TBI research and collaborators

Several large prospective cohort studies on adult populations with moderate-to-severe TBI residing in South-East of Norway have been conducted in the last decade in collaboration with Sunnaas Rehabilitation Hospital (SRH) and Sørlandet Hospital, Kristiansand. Four PhD degrees have been completed. The studies have addressed the incidence and risk factors of TBI, and factors modulating the medical, emotional, neurocognitive and rehabilitation outcomes in a longitudinal perspective. As reestablishing optimal quality of life for persons with TBI is the ultimate goal of rehabilitation, the research has also focused on trajectories and predictors of health related quality of life. Because the TBI population is young and sustains disability across the entire life-span, the studies included long-term follow-ups. Such designs have previously been lacking in international research. Several interventional studies have also been conducted, including early rehabilitation in a continuous chain of treatment after severe TBI at Oslo University Hospital (OUH).­­ A national multicenter study on rehabilitation after severe TBI, involving all four Regional University Hospitals in Norway, has also been completed.  It has added to our understanding of the epidemiology, olfactory dysfunction, course of recovery and functional recovery in adults and elderly with severe TBI. Genetic susceptibility and relevant biomarkers were also investigated.

In collaboration with the Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), the Department of Health Management and Health Economics, University of Oslo, University of Deusto, Bilbao, Spain and  Virginia Commonwealth University, Richmond, USA,  the of methodology for the evaluation of health economic TBI consequences and rehabilitation trajectories has been developed. The organization of services, their effectiveness and costs are also of major importance. Hence, the research group is a main consortium participant in the CHARM building a competency platform in rehabilitation services research.

Severe injuries have obviously the greatest consequences for the individual, and their perspective on rehabilitation services and social factors that affect life after injury is important. The Norwegian Research Council (NRC) funded project "Transitions in rehabilitation: Biographical reconstruction, experiential knowledge and professional expertise" outgoing from Oslo and Akershus University College of Applied Sciences in collaboration with the Rehabilitation after trauma research group may contribute to gain more knowledge on this area. 

Main ongoing projects

Morphological brain damage and functional impairment following mild traumatic brain injury

Principal investigators Cecilie Røe and Nada Andelic; PhD fellow Torgeir Hellstrøm

This project is utilizing advanced radiological methods (functional and volumetric MR) in a combination with genetic markers and clinical and neuropsychological evaluation in order to assess the underlying structural brain damage of the patients with mild TBI. In collaboration with the Regional Core Facility in Translational MRI Neuroimaging and Anders M. Dale, Depts. of Neuroradiology and Neurosciences, University of California, San Diego (UCSD), we will develop MRI volumetric assessments of different anatomical structures and provide new insight into the mechanisms of cognitive dysfunction after mild TBI.

Center-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI)

Principal investigator at the OUH, Ulleval Study Site of Center-TBI: Nada Andelic

Granted by the European Union's Seventh Framework Programme for Research and Development

Members of the present research network are currently participating in a large-scale study funded by the European Union, the CENTER-TBI, 2013-2020 (https://www.center-tbi.eu/). CENTER-TBI aims to collect information on the injuries, clinical care and outcome of over 5000 patients across the European Union. The project is led by Profs. Andrew Maas (Belgium) and David Menon (UK) and involves TBI researchers from over 20 countries and 70 study sites. The main aims of the project are to improve the characterization and classification of TBI and health care delivery and treatment of TBI through the identification of the most effective clinical interventions and the provision of high quality evidence in support of treatment recommendations and guidelines. Our research network is particularly involved in Work Package 14 “Transition of care”, exploring structural variations in timing of transitions and clinical interventions approaches across Europe, and the effect of this on patient outcomes.

The family as a resource for improved patient and family functioning after traumatic brain injury. A randomized controlled trial of a family centered intervention.

Principal investigator: Helene Lundgaard Søberg; PhD fellow Mari S. Rasmussen

Granted by the ExtraStiftelsen Helse og Rehabilitering

Because family members play an integral role in the patient's recovery, it is crucial to recognize the scope of the TBI experience and provide multidisciplinary rehabilitation within the context of the family system. This project is an RCT aimed to determine the effectiveness of a multi-professional theoretically based family-centred intervention, the Traumatic Brain Injury Family-Systems Intervention (TBIFSI), with the goal of improving self-efficacy and health-related quality of life.  The project is cooperation between the Department of Physical medicine and Rehabilitation at Oslo University Hospital (OUS), prof. Juan Arango at BioCruces Health Research Institute, Cruces University Hospital, Bilbao, Spain, Bærum municipality and the Norwegian User Organization for Injured Persons (Personskadeforbundet).

The effect evaluation of combined cognitive and vocational interventions after mild-to-moderate traumatic brain injury: a randomized controlled trial and qualitative process evaluation

Principal Investigator: Nada Andelic

Granted by the NRC

This project is an randomized controlled trial (RCT) which will explore the effect of combined manualized cognitive rehabilitation efforts and supported employment in real-life competitive work settings for patients with mild and moderate TBI who have not returned to work 8 weeks post-injury. The project combines the rehabilitation and vocational science perspectives; it involves multidisciplinary collaboration, and explores the efficacy of increased cross-sectorial collaboration between specialized health care services and the welfare system. In addition, the study aims at generating knowledge of the RTW-process for persons with TBI and the workplaces, and to disseminate this knowledge in order to create new multidisciplinary and collaborative practices. Project collaborators include OUS, Sunnaas Rehabilitation Hospital (SRH), Oslo and Akershus University College of Applied Science (Work Research Institute), NAV Department of Vocational Rehabilitation and the User Organization. International collaborators are from the Monash University, Melbourne, Australia, University of San Diego and Virginia Commonwealth University, Richmond, USA.

Traumatic brain injury; needs and treatment options in the chronic phase. A randomized controlled community-based intervention.

Principal investigator: Cecilie Røe

Granted by the NRC

This project is an RCT study which will explore goal-oriented and patient-centered rehabilitation program for patients with chronic TBI. The project is based on current knowledge of common symptom profiles, as well as individually identified symptoms and functional limitations. The project will be conducted in the patient’s home environment and include the patient’s family and local health care providers. The results will be analyzed with regards to effect, process, and cost-benefit. The study takes aim to improve patients’ mental and physical health, as well as the burden of their TBI.  Project findings will have innovation potential in establishing new modes of collaboration and knowledge transition between specialized acute and post-acute neurosurgical and rehabilitation facilities, and rehabilitation services in the municipalities. Collaborators include OUS, Sunnaas Rehabilitation Hospital, the User organization, Norwegian Research School for Research and development of municipal health and Care (MUNI-Health-Care), Norwegian University of Science and Technology Gjøvik and the University of North Norway. International collaborations are from   Philadelphia Research and Education Foundation and Virginia Commonwealth University, Richmond, USA.

Other projects:

  • Vestibular Rehabilitation for Patients with Dizziness and Balance Problems after Traumatic Brain Injury (TBI). Collaboration with Principal investigator Helene L. Søberg; PhD fellow Ingerid Kleffelgård.
  • Effect of early rehabilitation in patients with acute subarachnoid hemorrhage. Collaboration with Neurosurgical Department, OUS. Principal investigators Cecilie Røe and Angelika Sorteberg; PhD fellow Tanja Karic
  • Effect of adapted physical activity and goal-setting on physical and mental health. Collaboration with Beitostølen Health Sport Center. Principal investigators at OUH, Cecilie Røe and Erik Bautz-Holter. PhD student Line Preede.
  • A 10-year follow-up after moderate and severe TBI. Collaboration with Sunnaas Rehabilitation Hospital. Principal investigators Nada Andelic and Solrun Sigurdardottir
  • Oslo Traumatic Brain Injury Outcome and Rehabilitation Research Group (OBIOR ) - research network encompassing the TBI research groups from OUH and Sunnaas Rehabilitation Hospital.