CASBI is working to better understand the mechanisms of recovery from severe brain injury, thereby challenging long-held assumptions about the evaluation and care of brain-injured patients. To do this, CASBI has developed a plan to closely monitor the recovery process for patients following severe brain injuries. To implement this research strategy, we have launched a collaborative effort with The Rockefeller University Hospital, which includes the Clinical Translational Science Center (CTSC) of the Weill Cornell Medical College and the Center for Clinical and Translational Science (CCTS) at The Rockefeller University.
The Long-term Recovery Unit (LRU) provides a state-of-the-art setting in which to conduct pioneering studies of patients with severe brain injuries and to initiate new research in clinical and translational neuroethics, focusing on the prognosis and treatment of seriously brain-injured patients. Progress in the clinical understanding of severe brain injuries is expected to lead to clearer differentiation among disorders of consciousness and a changing view of what is appropriate in care and treatment. This ongoing research will present a new and evolving set of challenges to physicians, patients’ families, and ultimately, the recovering patients themselves.
In this vein, the LRU will serve to work synergistically with prospective epidemiological studies, which are aimed at following the natural history of patients with severe brain injuries and disorders of consciousness. The LRU is a model for facilities designed to overcome the profound infrastructure limitations that investigators now face in their attempts to understand the factors leading to recovery of consciousness and cognition following complex brain injury. The LRU also supports critical efforts to develop a new ethical framework and policy initiatives in the area of severe brain injury.
Preliminary research by members of our team has shown that a patient’s functional disabilities may be more serious than the patient’s structural brain injuries would indicate. To explore this theory, the scientists are analyzing data collected at each patient’s bedside on a 24-hour-a-day basis, including:
- Sophisticated measurements of electrical activity in the brain (dense multichannel electroencephalography)
- Multiple measurements associated with states of arousal (heart and respiratory activity, perspiration, and dilation/contraction of pupils)
- Changes in facial expression and other muscle movements (collected through videotaping and recording from sensors attached to limbs)
- Integrative analysis of multiple data streams using advanced signal processing and machine learning techniques
In‐depth medical research involving patients admitted to the collaborative study also includes periodic brain-imaging studies conducted at the Citigroup Brain Imaging Center (CBIC) at Weill Cornell. The CBIC is a state-of-the-art facility housing a cyclotron, a PET scanning system and two three Tesla MRIs. This sophisticated instrumentation provides the study leaders with the capability to conduct interval assessments of resting brain metabolism and changes in the structural integrity of brain gray and white matter structures. The proximity of the CBIC to the LRU is a key advantage of the collaborative studies done by CASBI.
The continuous data collection made possible by the Long-term Recovery Unit gives the scientists an unprecedented ability to study patients and to track their progress over time. Furthermore, by offering the biomedical research team frequent and extended contact with patients and their families, the LRU serves as a unique living laboratory in which to study a wide spectrum of related ethical questions that must be considered in treating patients with severe brain injuries.
Goals of this research initiative include:
- Identifying and quantifying the specific neurophysiologic changes that precede recovery of consciousness.
- Developing effective analytical methods to correlate physiological and behavioral data, in order to shed light on the underlying neurophysiology of the recovery process.
- Using aforementioned analytical studies to develop hypotheses about the yet‐unknown factors that lead to recovery.
- Using hypothesis generation as a starting point for the development of clinical markers to supervise patient care, including the targeting of therapeutic interventions.
- Using data collected in the LRU to augment ongoing epidemiological studies based on patient records from long‐term care facilities, public health authorities, and a multi-state registries. Using the LRU findings as a “filter” for these large data sets, the scientists hope to produce more accurate epidemiological reports.
- Learning how informed consent, informed refusal, and other concerns must be considered in planning the patient’s care and treatment.
- Correlating family observations with data collected in real time, generating potentially valuable clinical information for researchers and physicians.
Helping families make decisions that are consistent with articulated values and based on the clearest possible understanding of the individual patient’s potential to achieve recovery.