Fitzpatrick College of Nursing Receives R01 Funding for Traumatic Brain Injury Rehabilitation Research

Drs. Helene Moriarty (left) and Laraine Winter

Professor Helene Moriarty, PhD, RN, FAAN, Diane and Robert Moritz Jr. Endowed Chair in Nursing Research in the Villanova University M. Louise Fitzpatrick College of Nursing (FCN), and Laraine Winter, PhD, FCN senior research associate, are principal investigators on an R01 funded by the National Institute for Nursing Research at the National Institutes of Health. The five-year, $3.3 million grant (R01NR018655) funds their research project, “A Randomized Controlled Trial of an Innovative In-home Rehabilitation Program for Persons with TBI and Their Families: Home-based Occupational-therapy and Management of the Environment (HOME for Us).” Dr. Moriarty also serves as nurse scientist at the Corporal Michael J. Crescenz VA Medical Center, where Dr. Winter is a research psychologist.

“As our Villanova Nursing research initiatives blaze new trails, we celebrate, along with our colleagues at the Corporal Michael J. Crescenz VA Medical Center, this major funding for such an innovative program. We expect the science produced by Drs. Moriarty and Winter - leaders in this area - to have a transformative impact on the lives of those with TBI and their families, addressing a wide sweeping, national health need,” says Donna S. Havens, PhD, RN, FAAN, Connelly Endowed Dean and Professor.

Traumatic brain injury (TBI) is a major public health problem for civilian and military populations, now recognized as a “silent epidemic.” TBI produces a broad range of cognitive, emotional, interpersonal, and physical symptoms that impede community reintegration (for instance, participation in family, work, school, other meaningful activities) and decrease quality of life. TBI also has a profound impact on family caregivers, who often struggle with depression, high levels of burden from caregiving demands, and many unmet needs.

The randomized controlled trial (RCT) will evaluate a unique rehabilitation approach called HOME for Us that addresses critical gaps in services and research for persons with chronic TBI symptoms (> 1 year post injury) and their families. HOME is distinct from standard TBI rehabilitation with respect to who (community-dwelling persons with TBI and their families), what (targeting the environment for intervention), when (chronic phase), and where (the home). The 8-session intervention targets the home environment (physical and social) to realign environmental demands to individual strengths and limitations. HOME engages persons with TBI and family caregivers in strategies to manage chronic TBI symptoms. It educates family members to reinforce and maintain intervention strategies, and also addresses family needs.

Dr. Moriarty notes, “Family members are the primary supports for persons with TBI and critical to the success of rehabilitation.  Yet typically, they are not systematically engaged in TBI rehabilitation. Findings from HOME could support reimbursement models that deliver TBI rehabilitation in the home and treat family members as an integral part of the system of care.”

The study will evaluate HOME in a rigorous trial that will advance knowledge in three ways: 1) test the intervention, first developed for veterans, to include civilians with chronic TBI symptoms, providing greater sample heterogeneity and generalizability of findings;  2) test intervention effects on family caregivers; and 3) test whether intervention effects for persons with TBI and their family caregivers at 4 months are maintained 6 months later. Outcomes for persons with TBI include community reintegration, quality of life, and ability to manage patient-identified TBI-related problems. Outcomes for family members include caregiver burden, depressive symptoms, and met family needs.

“Millions of Americans who experienced a TBI do not recover completely during post-acute rehabilitation, typically 1-2 years after the injury, leaving them to cope with the lasting symptoms and limitations,” Dr. Winter explains. “The focus of our intervention is on adapting the physical and social environment to achieve a better fit between the patient and the environment. Improving this fit is key to enhancing patients’ well-being and fuller participation in their families and communities.”

Patients with chronic TBI symptoms and their family caregivers represent a growing but underserved population. This study has the potential to benefit over 5.3 million persons who live with disabilities from TBI and their family caregivers and to transform the paradigm of care for TBI. 

This newly-funded work builds on the researchers’ prior NIH-funded (R21HD068857) RCT of the Veterans’ In-home Program (VIP) demonstrating that targeting the home environment for intervention is a powerful approach to enhance important outcomes in veterans with chronic TBI symptoms and their families. Findings revealed that VIP significantly increased veterans’ community reintegration and ability to manage patient-identified TBI-related problems. Furthermore, VIP significantly decreased depressive symptoms and caregiver burden in family members.