Purview for Rehabilitation Research Development and Translation Broad Portfolio

The mission of the Rehabilitation Research Development and Translation Broad Portfolio (RRDT) aims to maximize Veterans' functional independence, quality of life, and participation in their lives and community across the lifespan. Grounded in the International Classification of Functioning, Disability and Health (ICF) framework which supports Whole Health principles, rehabilitation research and development recognizes a person's level of functioning as a dynamic interaction between the Veteran's health conditions, environmental factors, and personal attributes. Consistent with this framework, RRDT expects study endpoints to include measures of functioning at the level of the Veteran (or animal in pre-clinical studies) and in social and environmental contexts. Important themes for rehabilitation research include primary and secondary prevention, improvement, restoration, and replacement of lost or deteriorating function (e.g., physical, behavioral, mental, sensory, and social).

Preclinical studies in the RRDT Broad Portfolio must demonstrate clear potential to translate findings to future clinical rehabilitation studies and care of or support for Veterans. In vitro and ex vivo preclinical studies and those in animals may include molecular, cellular, or physiological mechanisms, but only if linked to sensorimotor, functional, and behavioral outcomes. Preclinical studies that are appropriate for the Rehabilitation Research Development and Translation Broad Portfolio include molecular, genetic, or cellular research exploring the mechanisms of action of a rehabilitative intervention (e.g. pharmacologic approaches), the causes of differing responses, and/or understanding potential adverse effects and how to modulate to maximize recovery of function.

Clinical studies may investigate interventions, techniques, devices, or systems designed to restore, replace, or improve sensorimotor function or mental health and return or enhance Veterans' functional autonomy and quality of life. Injuries, disorders, and diseases with the potential to cause long term impairment and disability in the Veteran population are of interest, with emphasis on functional outcomes at the level of the Veteran and within applicable social and environmental contexts.

Applied studies may develop medical products or technologies prior to evaluating effectiveness in future clinical rehabilitation research to improve the health, care, daily functioning, and community reintegration of Veterans. Applied studies may include features such as design optimization, mechanical or durability testing, safety testing, integration, biocompatibility or biostability testing, etc., if required to establish feasibility or safety prior to human application.

RRDT Broad Portfolio SRG Subcommittees include:

• RRDA Spinal Cord Injuries/Disorders & Neuropathic Pain
• RRD0 Regenerative Medicine
• RRD2 Musculoskeletal Health and Function
• RRD3 Sensory Systems & Communication Disorders
• RRD5 Rehabilitation Engineering, Assistive Technology, & Prosthetic/Orthotics
• RRD6 Chronic Medical Conditions and Aging
• RRD 8/9: Career Development Awards
• RD7: Research Career Scientist

Related Rehabilitation Research SRG Subcommittees managed in other ORD Broad Portfolios:

• RRD1 Brain Health and Injury
• RRD4 Behavioral Health and Social Reintegration

Scope of Rehabilitation Research Development and Translation

Product Development and Technologies

• Designing and developing novel rehabilitation technologies, including devices, biologicals, and interventions that aim to prevent activity limitations, promote independence, participation, and inclusion in everyday life of Veterans and/or to limit or reverse the impact of already existing chronic medical or mental health conditions and impairments on Veterans.
• Advancing mobile technologies, software/apps, and shared decision making or patient decision aid tools utilizing person-centered functional outcomes and perception of environmental supports and barriers, as well as telemedicine or mHealth approaches to delivering treatment, to monitor progress, or to enhance adherence to treatment.
• Designing and optimizing assistive devices and prosthetics (both conventional and neural), orthotics /exoskeletons, neural stimulation or recording systems, neuromusculo-skeletal modeling and automatic control strategies, wheelchairs and related technologies, imaging techniques, virtual or augmented reality systems or software, telehealth /smartphone apps, assistive robotics, technologies for exercise and recreation.
• Personalizing rehabilitative technology and interventions that account for sex, gender, ethnicity, etc., with the Veteran's needs taken into consideration.

Promoting Health Across the Lifespan

• Developing interventions that promote healthy aging, enhance daily function, and minimize age-related limitations (such as frailty or memory impairment) in older Veterans and Veterans with disabilities from chronic medical conditions.
• Testing novel rehabilitation technologies and interventions that aim to prevent activity limitations, promote independence, participation, and inclusion in everyday life of older Veterans and/or to limit or reverse the impact of already existing chronic medical conditions and impairments on Veterans.
• Promoting novel therapeutic modalities to prevent the long-term physical consequences of chronic medical conditions and facilitating the rapid translation of such rehabilitative therapies into clinical use to optimize Veteran functioning and health.
• Increase the quality of evidence for rehabilitation interventions in older Veterans with disabilities through increased focus on the design, dose, intensity, timing, mechanisms, and specified targets and functional outcomes of these interventions.

Multi-Modal Approaches to Neurorehabilitation and Sensory Function

• Developing and testing of novel mind-body rehabilitative approaches to strengthen newly formed neural connections (e.g., regaining control of movement of a paralyzed limb).
• Understanding spinal and central plasticity and the formation of proper connections without promoting pain and spasticity, and developing and testing of treatment strategies (e.g., engineering, pharmacological, cellular, etc.) to regain sensorimotor function following SCI/D.
• Incorporating multidisciplinary team science multimodal approaches that promote plasticity and sensorimotor function, particularly the combination of physical therapy with regenerative, pharmacological, or stimulation treatments.
• Advancing diagnosis, prevention, and treatment of sensory disorders related to hearing sensitivity and auditory processing, tinnitus and hyperacusis, vestibular/balance system, visual acuity and processing, multisensory impairment, and speech and language production and perception such as aphasia, dysphagia, and dysarthria.
• Testing devices, apps, and sensory aids (e.g., hearing aids, cochlear implants, visual neuroprostheses, augmentative and alternative communication systems) with testing and evaluation in animal models and clinical trials to improve Veteran rehabilitation outcomes.
• Using combined approaches (bioengineering and regenerative rehabilitative science) to develop and strengthen interventions for restoring musculoskeletal and neural tissue.
• Incorporating vascular and nervous tissue engineering to supply engineered musculoskeletal tissue with energy and innervation.

Social Reintegration for Veterans in a Behavioral and Mental Health Context

• Promoting recovery following incarceration, substance use disorders, personal and/or sexual violence, psychiatric hospitalization, homelessness, or unemployment/underemployment, and fostering reintegration, employment, education, housing (e.g., VA domiciliary programs), independence, social connections, safe spaces to prevent re-incarceration, homelessness, unemployment, and substance use addictions.
• Identifying root causes and developing novel prevention and treatment approaches and improving current interventions to enhance community reintegration and social participation for post-deployment Veterans, their families and caregivers as well as Veterans recovering from severe psychiatric, medical, or chronic disabled conditions.
• Developing innovative vocational rehabilitation approaches to enhance gainful employment and education advancement for post-deployment Veterans,
• Veterans with physical or psychological disabilities, Veterans with substance use addictions, and justice-involved and/or homeless-experienced Veterans.
• Developing and translating device-based rehabilitative therapies for neuropsychiatric illnesses affecting Veterans, including PTSD, mood disorders, substance use, traumatic brain injury, psychosis, and cognitive decline. Such therapies can include methods of brain stimulation targeting neural circuitry implicated in such conditions and resulting functional impairment, e.g. transcranial magnetic, electrical, or ultrasound stimulation. Device-based therapies can be used alone or in combination with standard behavioral or medication treatments.
• Developing novel approaches to improve current standard practice of psychosocial interventions including the use of technology, enhanced human interactions, combinations of validated interventions, ecological momentary assessments, mHealth, and artificial intelligence to enhance the effectiveness of improving physical and psychosocial functioning among Veterans with complex psychiatric conditions and multiple cooccurring mental illness diagnoses.
• Creating new paradigms or refining and validating current measures to assess and evaluate social participation and community reintegration.

Research that does not fit Rehabilitation Research Development and Translation Broad Portfolio

Examples below are considered outside the purview of rehabilitation research across all condition-specific scientific areas:

• Studies with endpoints limited to measures of function at the body structure level only (i.e., symptoms).
• Purely mechanistic studies of the biological processes underlying a sensory disorder or other disease without treatment implications or translational pathway.
• Foundational studies lacking interventions or behavioral outcomes that are pertinent to the animal.
• Clinical studies that focus only on reduction of clinical symptoms without treatment or functional implications.
• Exploratory or epidemiological studies without future goals for developing effective rehabilitation interventions.

RRDT Scientific Review Groups

Spinal Cord Injuries/Disorders (SCI/D) & Neuropathic Pain [RRDA]

The research interests of this program are twofold, addressing clinical and translational preclinical research on 1) SCI, Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS) focusing on the restoration of sensorimotor function of the Veteran (or animal); and 2) neuropathic pain, including pain management, pain assessment and the development of non-opioid approaches to treat pain resulting from injury or illness.

Pertinent SCI/D studies include the understanding and development of: Treatment and prevention of long-term consequences of SCI/D (e.g. bone/muscle degeneration autonomic function, pain, chronic inflammation, motoneuron death, etc.); Understanding spinal and central plasticity and the formation of proper connections without promoting pain and spasticity, and development and testing of treatment strategies (e.g. engineering, pharmacological, cellular, etc.) to regain sensorimotor function following SCI/D.

Studies involving acute aspects of SCI and its treatment are not appropriate for review. The research direction of the pain program includes Assessing pain using functional measures (e.g., correlating subjective pain measures with objective measures of function such as ADL, gait kinetics and kinematics, range of motion, and Quality of Life or activity measures, etc.), and Development of non-addictive therapies to manage pain by linking human painful conditions with genetic, molecular, and cellular mechanisms.

Please direct questions about Spinal Cord Injury and Neuropathic Pain research to Scientific Program Manager Audrey Kusiak, PhD..

Regenerative Rehabilitation Medicine [RRD0]

Research in the Regenerative Rehabilitation Medicine program includes studies implementing cell- or biological scaffold-based, tissue-engineering approaches to repair the neuro-musculoskeletal system, as well as methods to stimulate self-repair (e.g. wound healing, neurogenesis, etc.). Research should focus on Veteran-centric conditions that follow injuries, illness, and/or overuse incurred during active duty service (e.g. osteoarthritis, degenerative disorders, deconditioning, etc.). Appropriate studies include a proof of concept demonstrating functional efficacy (e.g. load- or weight-bearing, balance, sensation, motor function, etc.) as well as product development (long-term safety, biocompatibility, integration, etc.).

The research direction of the program includes: Use of combination approaches (bioengineering and regenerative rehabilitative science) to develop and strengthen technologies to restore musculoskeletal and neural tissue; Incorporating vascular and nervous tissue engineering to supply engineered musculoskeletal tissue with energy and innervation; Taking advantage of endogenous repair to replace tissue;Development of screens and large animal models for ease of translation

Please direct questions about Regenerative Rehabilitation Medicine research to Scientific Program Manager Audrey Kusiak, PhD.

Musculoskeletal Health & Function [RRD2]

Research in the Musculoskeletal Health & Function program focuses on Veterans' long-term functional recovery from traumatic injury, as well as chronic limitations, particularly from military-acquired conditions and diseases. The primary focus is on the musculoskeletal system and the ultimate restoration of movement, function, and Veterans' quality of life. A secondary focus is on restoration of function following any injury or disease, causing activity limitations in the Veteran. As a guideline, function is defined as occurring at the level of the Veteran, meaning not just a single organ or structure. Generally, decreased function would typically lead to impaired movement and activity limitations.

Pre-clinical research studies can include methods of clinical biomechanics and muscular physiology as it relates to functional outcomes. Neurological rehabilitation that focuses on improved upper or lower extremity function (e.g. gait) are appropriate for this review group. Clinical outcomes research for prosthetic users are also appropriate because of the focus on Veteran function.

Examples of research include, but are not limited to, studies focusing on interventions such as exercise targeting sarcopenia, musculoskeletal body composition, functional ability (e.g. gait and ADL skills, etc), the amelioration of musculoskeletal pain associated with injury and disease such as osteoarthritis and low back pain, or interventions to modulate inflammation, especially targeting tissue stabilization/limb salvage.

Please direct questions about Musculoskeletal Health & Function research to Scientific Program Manager Timothy Brindle, PT, PhD.

Sensory Systems & Communication Disorders [RRD3]

Research in the multi-faceted Sensory Systems & Communication Disorders program addresses a broad range of rehabilitation research in some of the most common debilitating problems faced by Veterans, impacting their ability to interact with others through hearing, vision and speech.

Research may include the diagnosis, prevention, and treatment of sensory disorders related to Hearing sensitivity and auditory processing; Tinnitus and hyperacusis; Vestibular/balance system; Visual acuity and processing, such as diabetic- or age-related vision loss; Multisensory impairment, affecting vision and hearing, balance, or presence of tinnitus; Speech and language production and perception, such as aphasia, dysphagia, and dysarthria Devices, apps, and sensory aids (e.g. hearing aids, cochlear implants, visual implants, augmentative and alternative communication) with testing and evaluation in animal models and clinical trials to improve Veteran rehabilitation outcomes.

Studies evaluating the effect of military exposure and trauma, including brain injury, that results in changes to sensory and communication ability are appropriate for review. Preclinical research (animal models) examining the development of novel methods to prevent, restore or replace sensory function may be appropriate if they include behavioral functional outcomes or diagnostic approaches that correlate with clinical evaluation of human sensory function. Purely mechanistic studies of the biological mechanisms underlying a sensory disorder are not appropriate for review.

Please direct questions about Sensory Systems & Communication Disorders research to Scientific Program Manager Lina Kubli, PhD.

Rehabilitation Engineering & Prosthetics/Orthotics [RRD5]

The Rehabilitation Engineering & Prosthetics/Orthotics program supports projects that will develop new or enhance existing devices, algorithms, or systems to improve Veteran rehabilitation outcomes, reduce treatment costs, or ideally both. Topic areas include, but are not limited to Design and optimization of prosthetics (both conventional and neural); Orthotics /exoskeletons; Functional electrical stimulation systems; Wheelchairs and related technologies; Imaging techniques; Virtual or augmented reality systems or software; Telehealth /smartphone apps; Assistive robotics; Technologies for exercise and recreation; Assistive devices or other technology-based method to improve Veteran health and function; Devices nearing translation to market with identified commercial partners are acceptable and encouraged.

NOTE: Applications may include clinical testing of new devices or technologies, but proposals that exclusively focus on the evaluation of existing devices or technologies will be referred to another SRG.

Please direct questions about Rehabilitation Engineering & Prosthetics/Orthotics research to Scientific Program Manager Brian Schulz, PhD.

Chronic Medical Conditions & Aging [RRD6]

Research submitted to the Chronic Medical Conditions & Aging SRG should focus on developing innovative rehabilitative strategies and interventions that will prevent, delay or alleviate the functional impact on daily life of multiple and complex chronic medical conditions commonly, but not exclusively occurring among aging Veterans and Veterans with disabilities.

Contributing chronic illnesses/conditions include, but are not limited to cardiopulmonary disorders (e.g. chronic respiratory condition, heart failure); metabolism and metabolic disorders (e.g. obesity, diabetes); kidney disorders (e.g. end-stage renal disease) neurodegenerative disorders; movement disorders; cancer (restoring function and well-being before, during and after treatment); urinary/fecal incontinence and sexual disorders; gait and balance problems.

Areas of study may include clinical, preclinical (rehabilitation-relevant models), or applied rehabilitation research with strong potential for translation into clinical practice to address the rehabilitative health care needs and function of Veterans with chronic medical conditions. Study areas may include: personalized, multimodal, or combination therapies and adaptive rehabilitation interventions, techniques, and devices designed to maximize participation in daily life. Endpoints should assess function, independence and quality of life of aging Veterans with disabilities associated with chronic medical conditions in the context of their environment.

Please direct questions about Chronic Medical Conditions & Aging research to Scientific Program Manager Carole Sztalryd-Woodle, PhD.

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