Jacob Kean

Researchers from Indiana University Medical Center and the Department of Veterans Affairs will be looking at how to adapt the VA's extensive telemedicine network to assess and treat veterans with mild traumatic brain injuries. Mobile technologies likely will be a key part of the process.

The VA Rehabilitation Research and Development Service has presented a five-year, $920,000 career development award to Jacob Kean, visiting assistant research professor of physical medicine and rehabilitation at IU Medical Center in Indianapolis. About 180,000 veterans of recent wars have suffered mild to moderate brain injury in service, according to the VA. Some 10 to 20 percent of them experience ongoing symptoms, including chronic headaches, lack of concentration, depression and sleeplessness.

"There have been many other studies on mild brain injury symptoms, but none on self-management related to the condition," Kean says in a university press release. "Our healthcare system has never considered brain injury to be a chronic condition, but victims experience lifelong consequences, including neuro-degeneration and other progressive problems."

In addition, the VA's telehealth network has largely been built to treat chronic conditions that necessitate collection of physical measures such as weight, blood sugar and heart rate. "Mild brain injury, by contrast, generally involves measuring symptoms related to feelings and emotions," Kean says.

The researchers will spend the first 18 months of the contract developing a conceptual framework for managing self-measurement of symptoms that are more qualitative than quantitative. They then will attempt to build an algorithm to assess whether patients are good at managing their conditions. That's where mobile might come in.

"It may be that the patient will get an iPad in a waiting room and answer five to eight questions, which in turn are informed by an algorithm that includes 200 questions," according to Kean. "So, in a span of two minutes, they're measured against a broad continuum … using an ultra-brief assessment that's very precise and provides data that informs the clinical interaction."

The idea is to match patients to the right kind of care, such as finding a peer support group for someone who is good at making positive lifestyle changes but has trouble maintaining progress. "We know there are super self-managers and there are very poor self-managers, but first we need to conceptualize self-management to understand whether the steps we’re asking our veterans to take are going in the right direction or the wrong direction," Kean explains.

Text messaging may be part of the equation, as well, such as to collect data before patients show up at a VA facility, the researchers suggest.

Kean's team will test their assessment strategy at five hospitals for veterans and active-duty service members: Walter Reed National Military Medical Center in Bethesda, Md.; Richard L. Roudebush VA Medical Center in Indianapolis; Michael E. DeBakey VA Medical Center in Houston; Brooke Army Medical Center in San Antonio, Texas; and Hunter Holmes McGuire VA Medical Center in Richmond, Va. The grant period begins July 1.