Spinal Cord Injury and PTSD: A Model System Investigation

A Model System investigation


Baylor Scott & White Institute for Rehabilitation (BSWIR) and Research Institute (BSWRI) have long been recognized as leaders in medical rehabilitation. Together with Baylor University Medical Center-Trauma, the Dallas-based hospital and research center recently received a five-year, $2.2 million Spinal Cord Injury Model System (SCIMS) grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).


The Baylor Scott & White Spinal Cord Injury Model System (BSW-SCIMS), one of only 14 such programs in the country, will conduct innovative research designed to improve the outcomes and quality of life for persons with SCI and participate in collaborative, multi-site research with other SCI Model System centers. The Baylor Scott & White rehabilitation network offers the largest continuum of specialized care to individuals with SCI in North Texas and surrounding states.


“This important grant will allow us to leverage our experience and understanding of SCI to explore new avenues of treatment and better address the complex short- and long-term needs of this patient population,” said Project Director, Ann Marie Warren, PhD, ABPP-Rp, Research Center Director - Behavioral Health, BSWRI.


Studying the Emotional impact of SCI


Dr. Warren and Co-Project Director, Rita Hamilton, D.O., chief medical officer, BSWIR, will lead the BSW-SCIMS team in investigating a number of new avenues of treatment. The principal study will examine the psychological impact of SCI – specifically post-traumatic stress disorder (PTSD) -- and whether early intervention using a specialized treatment known as “brief prolonged exposure therapy” can prevent or mitigate this issue.


PTSD affects an estimated 60% of individuals with SCI, compared to only 7% of the general U.S. population.1 Symptoms may include heightened anxiety, depression, intrusive memories of the trauma surrounding the injury and other psychological factors. This can be exacerbated by an individual’s feelings of loss, isolation and dependence, as well as pain and other complications.


“While the physical outcomes of SCI have been studied extensively, the psychological and emotional consequences have not,” according to Dr. Hamilton. “We do know, however, that prolonged exposure therapy (PE) is a well-documented and effective treatment for PTSD across multiple traumas, such as combat, assaults, motor vehicle collisions and natural disasters. We now have the opportunity to study how this intervention may be used to prevent or treat PTSD among patients in the acute rehabilitation setting.”


The BSW-SCIMS study, “Prevention of Posttraumatic Stress: A randomized controlled trial of Modified Brief Prolonged Exposure Therapy (Brief PE) During Inpatient Rehabilitation Post SCI,” will be led by Dr. Warren, Mark Powers, PhD, and Seema Sikka, M.D. The team will examine the efficacy of the modified Brief PE intervention in reducing PTSD symptoms (primary outcome) and improving depression, general anxiety, pain and quality of life (secondary outcome) both at one, three and six months from baseline. In addition, the team will assess the feasibility and fidelity of delivering Brief PE to people with SCI.


An estimated 200 people will participate in the study. Participants will be randomly assigned during inpatient rehabilitation to either three 60-minute sessions of Brief PE (intervention group) or treatment as usual (control group). “This study builds on our prior experience with PTSD treatment in SCI and, if positive results are observed, will validate a PTSD prevention approach that can be easily disseminated to other rehabilitation settings,” said Dr. Warren.



Sharing Knowledge to Improve Outcomes

The BSW-SCIMS will also contribute to the National SCIMS Statistical Center, the world's largest and oldest SCI database, which tracks a wide range of outcomes and long-term consequences of SCI. This helps to identify factors that may hinder the recovery and/or ability of persons with SCI to pursue full, productive lives, leading to new studies that address ways to overcome these obstacles.

In addition to Drs. Hamilton, Warren, Powers and Sikka, the BSW-SCIMS team includes co-investigators Simon Driver, PhD, and Chad Swank, P.T., PhD; biostatistician Monica Bennett, PhD; project manager Librada Callender, MPH, CCRC; interventionist Megan Douglas, PhD; and research coordinators Jacqueline Nguyen, MPH, Chista Ochoa, MPH, and Erina Sarker, MPH.


Learn more about the life-changing research at BSWIR.


1.) Mark B. Powers, Jamie R. Pogue, Nicholas E. Curcio, Sarita Patel, Andrea Wierzchowski, Estrella V. Thomas, Ann Marie Warren, Maris Adams, Emma Turner, Emily Carl, Katherine Froehlich-Grobe, Seema Sikka, Michael Foreman, Kiara Leonard, Megan Douglas, Monica Bennett, Simon Driver. (2021) Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial. Contemporary Clinical Trials Communications. https://doi.org/10.1016/j.conctc.2021.100763.