Current Projects
Long-term Impact of Military-Relevant Traumatic Brain Injury Consortium (LIMBIC)- Chronic Effects of Neurotrauma Consortium (CENC) Prospective Longitudinal Study (PLS)
Funded Congressionally Directed Medical Research Program/Department of Veterans Affairs, October 2019 through September 2024 ($50m)
William Walker (VCU), SATX site PI: Melissa Guerra, SATX site co-PI: Alicia Swan
The major goals of this project are to understand the long-term impact of combat exposure and mTBI on functional outcomes among veterans.
Project MARCH: Multisite-Advancement of Research on Chronic Post-traumatic Headache
Funded Congressionally Directed Medical Research Program/Department of Veterans Affairs, October 2021 through September 2025 ($13.6m)
Study PI: Don McGeary (UTHSCSA); SATX site PI: Ashley Lujan, SATX site co-PI: Alicia Swan
This is a randomized-clinical trial (RCT) to investigate cognitive behavioral therapy (online versus in-person) to treat post-TBI headache.Consortium PI: David Cifu (VCU); Study PI: William Walker (VCU), SATX site PI: Melissa Guerra, SATX site co-PI: Alicia Swan
The major goals of this project are to understand the long-term impact of combat exposure and mTBI on functional outcomes among veterans.
Factors Associated with Outcomes in Patients with Vestibular Symptoms Related to Traumatic Brain Injury
PI: Faith Akin; Co-PI Mary Jo Pugh (SLC VA/Utah) co-I: Alicia Swan
Funded Congressionally Directed Medical Research Program, Psychological Health/Traumatic Brain Injury Research Program, October 2017 through September 2022 ($1.1m)
Status: Analyses ongoing
This project seeks to determine factors associated with outcomes in Veterans with vestibular-specific and non-specific dizziness symptoms related to traumatic brain injury.
Polytrauma Clinic Patient Database Review
PI: Alicia Swan; RAs: Liz Sanford, Allison Wright
Unfunded secondary analyses of clinic data, December 2019 - Present
The purpose of this study is to examine trends in outcomes among polytrauma patients to enhance understanding of outcomes following military service. During routine outpatient clinical care, [list outcome measures] are collected. However, these data have not been rigorously evaluated as indices of outcomes among these former warfighters. Leveraging this existing clinical data, this study team will evaluate long term outcomes among these Veterans with the intent of informing enhanced clinical practice. Retrospective cohort study utilizing data collected during routine clinical care to investigator long-term outcomes among Post-9/11 Veterans. Obtain data collected during routine clinical care among Polytrauma to evaluate outcomes among Post-9/11 Veterans. Leveraging this existing clinical data, this study team will evaluate long term outcomes among these Veterans with the intent of informing enhanced clinical practice.
Post-Deployment Accelerated Comprehensive Evaluation and Rehabilitation (PACER) Program: Early Evidence for Effective and Comprehensive Rehabilitation After Mild Traumatic Brain Injury Among Late-Career Special Operators
PI: Melissa Guerra(VA); co-PI: Alicia Swan; Knowledge Translation Specialist:
Robert Sandoval, PhD, PT (VA); Outcomes Manager: Dillon Bomer, DPT; Statistician and Data Analyst: Liz Sanford, PhD (VA)
Funded Quality Enhancement Research Initiative (QUERI) by the Department of Veterans Health Affairs [IETP], October 2021 through September 2024 ($500,000)
Status: Data collection and analyses ongoing
OBJECTIVE: This study is a program evaluation of the Post-deployment Accelerated Comprehensive Evaluation and Rehabilitation (PACER) program, a rehabilitation program for Special Operators (Green Berets, Rangers, SEALs, PJs, MARSOC) who have recently experienced mild traumatic brain injury. This study aims to examine the effectiveness of the program in reducing physical health, mental health, and functional decrements before and after participation in the intensive, three-week rehabilitation program.
RESEARCH PLAN: Compare measures of neurobehavioral symptoms disruption (NSI), sleep quality (PSQI, ISI), post-traumatic symptom severity (PCL-5), depression symptoms (PHQ-9), anxiety concerns (GAD-7) and pain (Pain Efficacy Scale) among others at intake and following the intensive, inpatient 3-week program.
METHODS: The retrospective secondary data analysis project leverages existing data collected for clinical purposes.
CLINICAL RELEVANCE: This program evaluation seeks to demonstrate efficacy and efficiency of the existing PACER program. The findings will help to characterize the impact of such therapeutic approaches in ameliorating mental health, physical health, and functional challenges among patients with a history of mild traumatic brain injury.
The Long-Term Impact of Traumatic Brain Injury on Reentry after Incarceration: A Vulnerability Assessment
PI: Chantal Fahmy (UTSA, Criminology); Co-PI: Alicia Swan; RA: Allison Wright
Funded Brain Health Consortium Seed grant award, September 2022 through August 2023 ($15k)
Status: Analyses ongoing
The study has four main goals: (1) examine the reliability and validity of the online version of the OSU-TBI-ID (i.e., relative to the gold standard interview) then further explore its utility via a subsample of face-to-face interviews in a group of recently released individuals, with an emphasis on military veterans; (2) investigate and establish the potential negative health consequences (e.g., anxiety, violence, self-worth, aggression, depression, suicidal thoughts, etc.) associated with incurring a TBI and/or spending time incarcerated; (3) highlight the strengths and barriers related to protective and system-level responses for people with TBI released from incarceration, including overall reintegration goals [e.g., stable employment, safe housing, and supportive interactions with parole officers and Bexar County Reentry Center (BCRC) personnel]; and (4) provide initial evidence for external funders that health—particularly TBI and general health—is an appropriate framework and worthy of inquiry in the study of consequences of incarceration among vulnerable populations. Through these four overarching goals, the current study aims to fill the profound gaps in knowledge about how reentering citizens navigate the challenges inherent during reintegration, particularly when they have experienced multiple TBIs, inclusive of involvement in combat and/or incarcerated settings, which tend to be violent.
Effect of mild traumatic brain injury on predictive processing in language comprehension
PI: Nicole Wicha (UTSA, Department of Neuroscience, Developmental and Regenerative Biology); co-I: Alicia Swan; co-I: Rocio Norman (SLP, UT Health SA)
Funded Brain Health Consortium Seed grant award, September 2022 through August 2023 ($15k)
Status: Analyses ongoing
The objectives of this seed grant are to 1) develop a tailored paradigm to measure predictive language comprehension, 2) identify mTBI phenotypes that are likely to lead to prediction deficits, and 3) acquire pilot electrophysiology data. The team fuses expertise in neurobiology of language (Wicha, COS), speech-language pathology after TBI (Norman, UT Health) and meta-analysis of TBI factors (Swan, HCAP) with the long-term goal of informing clinical practice by quantifying the effect of mTBI on language comprehension.
Understanding Cervicogenic Dizziness after mild traumatic brain injury among military servicemembers
PI: Matt Hammerle (DPT, Brain Injury Rehab Service, San Antonio Military Medical Center); Statistician/Subject Matter Expert: Alicia Swan
Unfunded collaboration, October 2016 - Present
Status: Analyses ongoing, grant submission underway
The objective of this study is to explore cervicogenic dizziness and headache associated with mTBI among servicemembers.
Former Projects
The Epidemiology of Epilepsy and Traumatic Brain Injury: Severity, Mechanism, and Outcomes
Funded Congressionally Directed Medical Research Program, Epilepsy Idea Development Award (October 2016 through September 2023)
PI: Mary Jo Pugh; co-I/VA site PI: Alicia Swan
The major goals of this project are to understand the development of epilepsy among Veterans with mild TBI, the impact of multiple mild TBI, blast-related TBI, and the impact of mild TBI and/or epilepsy on functional outcomes.