The Gillian Reny Stepping Strong Center for Trauma Innovation is pleased to announce the recipients of the 2022 Stepping Strong Innovator Awards.
Each year, the Stepping Strong Innovator Awards support research and innovation across the continuum of trauma care from prevention to treatment and recovery. The following individuals received this year’s awards:
Restoring function following peripheral nerve and spinal cord trauma is exceptionally challenging. While the peripheral nervous system does have some regenerative capability, the central nervous system is often irreversibly damaged following traumatic injury. Surgeons have developed nerve transfers as a method to reassign nerves that are still working after injury to control critical muscles. Patients can learn to control these muscles and gain function, but some critical muscle groups are not amenable to this strategy, as they are too far away (distal) from the site of injury, and oncoming regenerating nerves are too slow to reach the muscle before atrophy becomes permanent. A valuable tool in the surgeon’s arsenal is to use a nerve to “babysit” the distal muscle group until the regenerating nerve arrives. However, available nerves are scarce in these significant injuries.
With funding from the Stepping Strong Innovator Award, Brian Wainger, MD, PhD, and his team propose the use of motor neurons derived from induced pluripotent stem cells to provide support to distal muscles in a logical extension of the “babysitter” concept. In the past, motor neurons have been used in rodent models to preserve and activate muscles. Now, stem cells from human sources can be reliably turned into motor neurons to preserve muscles.
This research addresses key limitations to the clinical introduction of cell therapy. By providing the optimal dose of motor neurons to effectively innervate and preserve muscle, and with optimized parameters, this preservation leads to better nerve transfers in an injured animal model. Successful completion of this project establishes essential parameters for this and other stem cell therapies, creates a path to clinical introduction, and opens the door for more advanced rehabilitation and prosthetic technology.
The traumatic ripple effects of gun violence are far-reaching, particularly for children with loved ones involved in a shooting. Children who lose a caregiver due to gun violence are especially vulnerable. Currently, the available sources of mental health support in the wake of gun violence do not adequately address disrupted sleep, a condition that develops as a consequence of exposure to violence that may increase the risk of longer-term physical and mental health consequences following these traumatic events.
With funding from the Stepping Strong Innovator Award, co-investigators Rebecca Robbins, MMSci, PhD, MS, and Chana Sacks, MD, MPH, are creating a multimedia educational resource called “Sleep Superheroes,” which will be delivered in a just-in-time format by trained social workers. The goal with this pilot project is to cultivate healthy sleep and relaxation strategies among youth impacted by gun violence. A top priority in this intervention is the co-creative process that centers on youth, parents, and caregivers who have been impacted by gun violence, with a specific focus on those communities that are most affected.
Project objectives include identifying modifiable barriers to sleep health among children aged 6 to 12 years old who have experienced gun-related traumatic exposure; designing superhero characters and animated video storyboards; working with parents and caregivers impacted by gun violence to co-create Sleep Superheroes materials; and enlisting feedback from an interdisciplinary advisory board of gun violence prevention and sleep researchers. These inputs will be used to provide final adjustments to the Sleep Superheroes intervention, which will then be formally evaluated for its impact on sleep and mental health among youth impacted by gun violence.
About 36 million falls are reported among older adults each year, resulting in more than 34,000 deaths. These falls are costly, and they account for numerous emergency department (ED) visits. Because of crowding, ED staff often miss the opportunity to focus on preventing additional falls. Recognizing the urgency of the problem, and in an attempt to save lives, the ED at Massachusetts General Hospital (MGH) recently opened a Virtual Observation Unit (VOU) that provides observation-level care for ED patients in the comfort of their home. This program includes VOU (ED) nurses who assess patients via phone or video, community paramedics who visit patients in their homes, and emergency medicine physicians who conduct video visits.
Building on the early success of the MGH VOU program and given the lack of ED fall prevention programs nationwide, Shan Liu, MD, SD, and her team proposes to pilot a replicable ED VOU falls program that would: allow ED fall patients who have had an evaluation in the ED to return home if they are deemed safe to do so; perform a home safety evaluation; determine if they require physical therapy; and assess if patients have medications that could increase their risk of falling.
With funding from the Stepping Strong Innovator Award, Liu will assess if this program is safe, feasible, and acceptable. If the pilot program is successful, the program will expand to other Mass General Brigham EDs, partner with fall detection device companies, and potentially have fall patients evaluated for their falls in their home, avoiding the ED altogether. The overall goal of the program is to decrease the risk of an older person falling again, thus reducing the likelihood of serious injury and death related to falls.
Globally, more than four million injury-related deaths occur every year. Twenty to fifty million more individuals sustain non-fatal injuries that may result in chronic disability. Ninety percent of these injuries occur in low- to middle-income countries (LMICs), and yet many of these countries have health systems with limited capabilities to fully treat traumatic injuries.
Fortunately, military and civilian organizations have a mutual interest in building trauma capacity during conflict, disaster, and peacetime. Military healthcare systems exist in most nations with a military force, and civilian and military systems often collaborate to integrate efforts. Additionally, external military forces, such as those in the U.S. and the U.K., have security interests that drive the desire to build trauma capacity in partner nations.
In 2021, the White House issued the annual Interim National Security Strategic Guidance publication, outlining the critical need to strengthen alliances with existing partnerships. The Military Health System (MHS) directly supports these priorities through the Department of Defense policy on Global Health Engagement, specifically in trauma medicine. In 2022, there has been a call for the MHS to expand the support of these priorities through bilateral trauma capacity-building partnerships. Currently, however, there is no integrated framework to guide systematic collaboration to improve trauma care, nor does data exist to support the development of such a framework.
With funding from the Stepping Strong Innovator Award, Michelle Joseph, MBBS, BSc(Hons), MSc, PhD, FRCS, aims to establish structures for the following priorities: developing global practices for military and civilian trauma systems collaboration; discovering critical areas for integration within trauma systems; and identifying appropriate terminology to categorize levels of integration. Together, this data will inform the development of this novel integrated framework.
Amid a critical gap in trauma research funding, The Gillian Reny Stepping Strong Center for Trauma Innovation catalyzes multidisciplinary, multi-institutional collaboration to transform care for civilian and military heroes recovering from traumatic injury.
Learn more about the work we fund and stay connected to future Innovator Award opportunities.
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