Dr. Robin Green and Dr. David Mikulis

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In a series of papers focusing on volumetric imaging, DTI and neuropsychological correlates, they demonstrated that the brain shows progressive losses during the chronic stages of injury, and moreover that such losses are ubiquitous across patients. They also showed that some of these losses (in the hippocampi in particular) are correlated with reduced cognitive stimulation, which opens new avenues of research for offsetting these losses and improving clinical outcomes, on which they are currently focused. They have also recently uncovered behavioral correlates of hippocampal losses and a further mechanism of volume loss, leading again to novel avenues of treatment to improve patient outcomes. Finally, the funding has also helped to create a database that is unique in the world – a longitudinal database of neuroimaging, cognitive and functional findings of nearly 200 patients assessed from 2 months to 2 years post-injury. The database is leading to a much clearer picture of the evolution of change in moderate-severe TBI patients in Canada, including, for example, increasing depression and anxiety across time. The database also allows for excellent retrospective research opportunities for trainees in the field of brain injury. Some of our findings have policy implications, including a redistribution of resources to encompass the chronic stages of injury, where there is scope for offsetting the accelerated aging and poor clinical outcomes currently seen, and which have importantly shown response to treatment. The findings also support a need for novel approaches to the delivery of treatment to patients in the chronic stages of injury in order to get treatment to patients all over Canada after they have left in-patient therapies, regardless of where they live.

These achievements were made possible by early work on the part of Dr. Mikulis who established one of the first functional neuroimaging labs in Canada in 1993. His lab embraced and supported numerous investigators including Dr. Green, who went on to develop a very successful neuroimaging lab focused on neurotrauma. Both researchers have “veteran” labs with unique strengths and capabilities. However, in today’s research environment, information growth is presenting significant challenges to this model of individual principle investigator driven research. In addition, it is becoming increasingly difficult to acquire and maintain all of the necessary skills to remain competitive. Furthermore, duplication of skills is expensive and inefficient. Forming collaborations has therefore become a key element to success. This is exactly the opportunity Dr. Green and Mikulis pursued enabled by PSI funding. Once started, it soon became obvious that the sum of their capabilities was greater than that of the individual parts. It did not take long for the collaboration to show productivity with 7 publications in only 2 years. This is a terrific example of how support for this paradigm of collaborative research can enhance the efficiency of the financial commitment all of which was made possible by support and sponsorship on the part of the PSI. Dr. Mikulis and Dr. Green are most grateful for the continuing support of the PSI.

Dr Green is a Canada Research Chair (tier II) in traumatic brain injury (TBI) and a senior scientist at Toronto Rehab – University Health Network, where she is head of the Brain Recovery and Discovery Team; she is also a clinical neuropsychologist. Her research focuses on the causes and treatments of neurodegeneration and its behavioural correlates in chronic TBI.

Dr. Mikulis is a Professor in the Dept. of Medical Imaging at the University of Toronto and the University Health Network, Director of the Functional Neuroimaging Research of the Joint Department of Medical Imaging. He is most recently Past President of the American Society of Functional Neuroradiology. His research has focused on translating advanced structural, functional, and neurovascular imaging methods into clinical applications. Several PSI grants have allowed for a very productive collaboration between Drs. Green and Mikulis. Their primary area of joint research funded by PSI has focused on a reconceptualization of traumatic brain injury as a progressive and neurodegenerative disorder.

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