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.
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:
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 USAMRMC'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.
Q1. What are CRMRP's chief accomplishments?
A1. 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).
Q2. What drives the research objectives for CRMRP?
A2. CRMRP research objectives are driven by:
Q3. What are some of the clinical gaps identified by CRMRP not filled by current technologies and methodologies?
A3. 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.
Q4. What products is CRMRP-sponsored research currently developing?
A4. CRMRP anticipates development of products in the following areas:
Q5. Do CRMRP and its partners abide by animal use guidelines in its research?
A5. 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.
Q6. Do civilians or military personnel participate as subjects in CRMRP's research?
A6. Yes, human subjects participate in CRMRP-sponsored research projects. CRMRP coordinates all human subject research through the US Army Medical Research and Materiel Command's (USAMRMC) 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, USAMRMC, and international regulatory requirements.
Q7. What organizations does CRMRP partner with?
A7. 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).
Q8. How do the programs at NIH and the VA work in coordination with this program?
A8. 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.
Q9. Does CRMRP-sponsored research involved the use of stem cells?
A9. 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.
Q10. Is CRMRP's research transparent or publically available?
Q11. Where does CRMRP receive its funding?
A11. 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.
Q12. What's on the horizon for CRMRP?
A12. 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.