Clinical and Rehabilitative Medicine Research Program (CRMRP)
To implement long-term strategies to develop knowledge and materiel products to reconstruct, rehabilitate, and provide definitive care for injured Service Members. The ultimate goal is to return the Service Member to duty and restore their quality of life.
The Nation's premier medical research organization responsible for restorative care and innovations that return each injured warfighter to full health and wellness.
Background and Environment
During Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), advancements in body armour and field medical care increased survival and changed the injury profile of Service Members. Relative to previous conflicts, OIF/OEF had a higher proportion of injuries sustained to unprotected body areas, specifically the extremities (55%) and the head and neck region (30%). Many Service Members were left with complicated traumatic injuries including: traumatic brain injury, spinal cord injuries, traumatic and complex injuries to the arms and legs, amputations, trauma to sensory systems and severe chronic pain. These types of injuries required a change in the focus of military medical research and development programs.
The Clinical and Rehabilitative Medicine Research Program (CRMRP) was established in 2008 to foster research and technology advances for regeneration, restoration and rehabilitation of traumatic injuries. The great successes of the Military Health System in saving the lives of Service Members who would previously not have survived, led to a new population of Service Members with major reconstructive and rehabilitative needs. The CRMRP seeks to fill this health care gap by fostering innovative methods and technologies to care for and return these wounded Service Members to duty and help them lead productive and fulfilling lives.
The CRMRP serves a number of critical roles in the Military Health System. First, CRMRP identifies gaps in the Military Health System's capability to provide restoration and rehabilitation of traumatic injuries. Based on the types of injuries suffered by Service Members, the CRMRP collaborates with other services, partner agencies and industry organizations to address the capability gaps by identifying and prioritizing research efforts. Lastly, the CRMRP tracks current state-of-the-art technologies, ensuring a diverse portfolio of research efforts with target focus areas that meet current medical needs. The CRMRP has four focus areas:
Key Themes and Messages
The CRMRP manages a core research program executed internally at Department of Defense laboratories and medical centers and externally by organizations such as universities and industry partners.
The goal of the CRMRP is to plan, coordinate, and monitor the science and technology program focused on definitive and rehabilitative care to bring the best medical solutions and latest medical technologies to our wounded warriors.
The CRMRP leverages the congressional special interest research programs administered by USAMRDC's CDMRP and TATRC. In addition, the CRMRP leverages research efforts in other federal laboratories, universities, and industry.
The CRMRP research program is coordinated with complementary programs at the National Institutes of Health and Department of Veterans Affairs.
Questions and Answers
What are CRMRP's chief accomplishments?
The CRMRP has funded many research efforts, to include the Armed Forces Institute of Regenerative Medicine (AFIRM). The efforts in the AFIRM have resulted in 6 face transplants and 10 hand transplants, as well as the initiation of multiple clinical trials in the field of regenerative medicine (Regenerative Medicine Portfolio). Additionally, the CRMRP funded research resulting in 9 commercially available products; 4 state-of-the-art prosthetics, a prosthetic pylon, and a pattern recognition device that enhances control of upper extremity prostheses (Neuromusculoskeletal Injury Rehabilitation Portfolio); an epidermal harvesting system for healthy skin grafts for wound/ burn sites and a scar reduction treatment (Regenerative Medicine Portfolio); and a non-surgical device for vision impairment that translates digital information into electrical stimulation for object identification (Sensory System Traumatic Injury Restoration & Rehabilitation Portfolio).
What drives the research objectives for CRMRP?
CRMRP research objectives are driven by:
- Leadership through documented Capability-Based Assessment
- Secretary of Defense Priorities
- Health Service Delivery - Concept of Operations Capabilities
- Prioritized Clinical Gaps developed annually by Scientific Working Groups composed of:
- Subject Matter Experts, Researchers and Clinicians from:
- Military Services (Air force, Army, and Navy)
- Governmental Agencies (NIH, VA, DoD Center of Excellence)
- Members of other headquarters' research directorates and divisions
- Subject Matter Experts, Researchers and Clinicians from:
What are some of the clinical gaps identified by CRMRP not filled by current technologies and methodologies?
Gaps are identified for each CRMRP area. Listed below is a summation for each area. For more information on the clinical gaps please see the CRMRP website https://crmrp.amedd.army.mil.
- Inability to optimally rehabilitate neuromusculoskeletal injuries to provide optimal function, reintegration, and quality of life (Neuromusculoskeletal Injuries)
- Inadequate pain management strategies to diagnose, prevent, and alleviate pain ranging from point of injury to chronic pain, while minimizing unwanted sequelae (Pain Management)
- Inability to either adequately regenerate tissue lost due to traumatic injury or to integrate artificial tissue replacements including bone, muscle, nerves, skin and vasculature. (Regenerative Medicine).
- Inability to adequately restore and/or rehabilitate hearing, vision and balance after traumatic injury. (Sensory Systems)
What products is CRMRP-sponsored research currently developing?
CRMRP anticipates development of products in the following areas:
- Pain Management
- New drugs and technologies and improved strategies for managing acute and chronic pain while reducing negative sequelae caused by pain medications
- Engineered, off-the-shelf skin replacements
- Biologic agents that reduce the progressive damage caused by severe burns
- Skin graft harvesting technologies and techniques that reduce the pain and limitations of current standards of care
- Reducing functional detriments associated with severe scarring and contraction
- Improving cosmetic appearance
- Traumatic Limb and Tissue Loss
- Building on advancements in neural interfaces, nanotechnology and prosthetic design to improve foot and knee prosthetics, control and tactile feedback
- Applying neural interfaces to limb prosthetics
- Engineered, off-the-shelf tissue scaffolds for rebuilding lost muscle and bone
- Biologic products to help the body regenerate missing or damaged nerve, muscle and bone tissue
- Face/Hand/Organ Transplantation
- Improving drugs and protocols to minimize transplant rejection
- Developing exercise and fitness systems and strategies for amputee and neuromusculoskeletal injury rehabilitation
- Sensory Systems
- Improving methods for diagnosing and treating sensory injuries
- Developing rehabilitative strategies and treatments of sensory dysfunctions due to TBI or other traumatic injuries
- Developing retinal and prosthetic devices to restore vision
Do CRMRP and its partners abide by animal use guidelines in its research?
All animal research is conducted in accordance with the Animal Welfare Act Regulations, DoD Instruction 3216.01, and procedures described in the Guide for the Care and Use of laboratory Animals. All intramural facilities are fully accredited by the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC). Extramural facilities are not required to be AAALAC accredited, but in the absence of accreditation, they are required to either hold a Public Health Service Assurance or provide written assurance that all DoD-sponsored animal studies will be conducted in accordance with the Guide, which is the basis for AAALAC accreditation.
Do civilians or military personnel participate as subjects in CRMRP's research?
Yes, human subjects participate in CRMRP-sponsored research projects. CRMRP coordinates all human subject research through the US Army Medical Research and Development Command's (USAMRDC) Office of Research Protections (ORP) and the Human Research Protection Office (HRPO) to ensure that all conducted, contracted, sponsored, supported or managed research involving human subjects or human anatomical substances are conducted in accordance with Federal, DoD, Army, USAMRDC, and international regulatory requirements.
What organizations does CRMRP partner with?
CRMRP partners with Department of Defense (DoD) laboratories and medical centers, DoD Congressional Special Interest Programs, DoD Hearing Center of Excellence, DoD Vision Center of Excellence, DoD-VA Extremity Trauma & Amputation Center of Excellence, Defense & Veterans Center for Integrative Pain Medicine, National Institutes of Health (NIH), Defense Advanced Research Projects Agency (DARPA), Veterans Administration (VA), and the AFIRM (including 30 different academic and industry partners).
How do the programs at NIH and the VA work in coordination with this program?
In addition to being stakeholders in and providing funding for AFIRM, the VA is also heavily involved in the CRMRP prosthetics and amputee rehabilitation research efforts. Both the VA and NIH provide representatives to serve on CRMRP's Advisory Boards, Scientific Working Groups and Program Announcement Review Panels.
Does CRMRP-sponsored research involved the use of stem cells?
CRMRP does fund research that uses adult stem cells derived from a variety of tissues, as well as stem cells recovered from amniotic fluid and umbilical cords.
Is CRMRP's research transparent or publically available?
Where does CRMRP receive its funding?
Historically, CRMRP's research funding was provided through the US Army and the Defense Health Program (DHP). Currently the majority of CRMRP's funding is provided through DoD Congressional Special Interest Programs.
What's on the horizon for CRMRP?
CRMRP will continue to focus on research to restore wounded warriors to full function. Additional emphasis will be placed on neuromuscular injuries, advancing pain management, regenerative medicine and restoring vision, hearing and balance.