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Ibolja Cernak, MD, PhD, MSc, MHS

Professor & Chair, Canadian Military and Veterans' Clinical Rehabilitation Research

Rehabilitation Medicine

About Me

Ibolja (Ibi) Cernak was named Global's Woman of Vision in November 2015 for dedicating her career to helping soldiers and veterans. Cernak will be honoured at the 2016 Global News Woman of Vision Annual Awards Celebration on April 14, 2016 at the Edmonton Shaw Conference Centre. To order tickets, visit https://womanofvision2016.eventbrite.ca or call Currie Communications at 780.413.9570.

EXPERIENCE

• Currently, I am a Full Professor with Tenure and the Chair of Military and Veterans’ Clinical Rehabilitation at the Faculty of Rehabilitation.

• I have a broad multidisciplinary expertise, including an M.D., M.S. in Biomedical Engineering, M.S. in Homeland Security in Public Health Preparedness, Residency in Pathophysiology, and a Ph.D. in Neuroscience & Pathophysiology.

Previously, I was a 

o Medical Director and Principal Professional Staff (Tenured Professor Equivalent) at the Johns Hopkins University Applied Physics Laboratory (Laurel, MD, USA); 

o Associate Professor of Neuroscience at the Georgetown University, Washington DC (USA). 

o Professor of Clinical Pathophysiology in Belgrade (former Yugoslavia); 

o Visiting Professor at the 3rd Military Medical University, Chongqing, PR China; and

o Visiting Professor of Neuroscience at the James Cook University, Townsville, Australia. 

• I have over 20 years of experience in teaching Neuroscience, Medical Physiology, and Pathophysiology, and 25 years experience in both clinical and experimental traumatic brain injury and blast injury research with the emphasis on injury-induced long-term neurological and other functional deficits. 

• My current research is focusing on the mechanisms of traumatic brain injuries of different etiologies including ultrastructural damages of cellular organelles and related inflammation and neurodegeneration; stress-induced functional impairments; and the mechanisms of resilience to chronic stressors (such as extreme environmental conditions; changed nutrition; and social displacement; among others.).

• During the military actions in former Yugoslavia, on the battlefield, I volunteered as a member of first-responder teams, and also conducted controlled clinical research to characterize complex neuroendocrine, neurologic, biochemical, and metabolic responses to military injuries starting with the earliest post-traumatic time (0-5 minutes post-trauma). Further, I performed long-term clinical outcome studies (>6 months) concerning neurological deficits caused by explosion: I was the first to describe the clinical features of neurological deficits caused by blast exposures and defined blast-induced neurotrauma as a unique clinical entity. Additionally, I have conducted prospective clinical studies addressing neuroendocrine changes induced by acute, subacute, or chronic stress. 

• I have published over 200 research articles in international refereed journals, presented at over 300 professional meetings, have three patents pending, and am a member of several professional bodies; among others, including three Subject Committees of the Institute of Medicine of the U.S. National Academy of Sciences: on Long-term Consequences of Traumatic Brain Injury; Readjustment Problems of Military Personnel Returning from Iraq and Afghanistan; and Long-term Consequences of Blast Exposure as well as the NATO Health Factors and Medicine (HFM)-234 Research Task Group [RTG]) “Environmental Toxicology of Blast Exposures: Injury Metrics, Modeling, Methods and Standards”.

EDUCATION

o Medical Doctor (M.D.), University of Belgrade (Yugoslavia), 1984;

o Master in Biomedical Engineering (M.S.), University of Belgrade (Yugoslavia), 1988;

o Professional Specialty (Residency): Pathophysiology / Neurology, Military Medical Academy / University of Belgrade (Yugoslavia), 1989;

o Doctor of Philosophy (Ph.D.): Pathophysiology/Neuroscience, Military Medical Academy / University of Belgrade (Yugoslavia), 1990;

o Master in Homeland Security (M.H.S.), the Pennsylvania State University, College of Medicine, 2010.


Ibolja (Ibi) Cernak was named Global's Woman of Vision in November 2015 for dedicating her career to helping soldiers and veterans. Cernak will be honoured at the 2016 Global News Woman of Vision Annual Awards Celebration on April 14, 2016 at the Edmonton Shaw Conference Centre. To order tickets, visit https://womanofvision2016.eventbrite.ca or call Currie Communications at 780.413.9570

Research

Established in March 2012, the Canadian Military and Veterans’ Clinical Rehabilitation Research Chair (CMVCRRC) is the first of its kind in Canada dedicated to the rehabilitation of military personnel and veterans.

It is a unique endeavour in that it focuses on prevention, performance optimization, improved quality of life, and rehabilitation on a personalized level. 

VISION

To foster and/or lead collaboration between researchers in Alberta, Canada, and abroad, which will lead to better understanding of military health problems, and discovering novel and improved solutions to the medical and rehabilitation needs of Canada’s soldiers and veterans. 

MISSION

To develop and perform state-of-the-art clinical and experimental research studies for gaining critical scientific knowledge, which will enable performance optimization of military personnel and quality of life improvement in veterans. 

FOCUS

The Program includes both clinical (A) and experimental research (B), and focuses on: 

1. Military resilience as it relates to operational readiness and maintaining optimal health;

2. Mental health impairments due to military service;

3. Traumatic brain injury acquired in military operational environment.

These research directions address the most pressing health problems in Canadian Armed Forces (CAF). Currently, the CAF incorporate  64,000 Regular Force and 26,000 Reserve members, whereas the Veterans' population is estimated to approximately 620,000. Of the total active service and veteran population, an estimated 10-30% of the members have already developed or will develop mental health impairments (such as post-traumatic stress disorder / PTSD or major depressive disorder) due to operational stress, or will suffer from blast-induced traumatic brain injury (TBI). These types of injuries have historically proven difficult to detect and treat, and their diagnosis often come with negative social stigmas.

DELIVERABLES

New knowledge and technologies for:

• Improved diagnostic capabilities

• Improved protection from blast

• Enhanced success in training, 

• Improved methods for career development and task assignment

• Facilitated recovery from injury, 

• Measures preventing the onset of chronic health problems. 

A. CLINICAL RESEARCH

The ongoing clinical research studies measure resilience (mental and cognitive) of  military personnel at multiple time points in their career and in different operational environment aiming to identify those who are at risk from PTSD and other mental health impairments, or are developing consequences of multiple concussions / blast exposures. The accumulating data serves to develop a predictive system and a customized program for individuals at risk. 

There are three clinical studies addressing the problem of the effects of operational stressors on the health of military personnel, and subsequently developing military mental health problems and military TBI.

The majority of previous clinical studies that tried to explain the cause of operational stressor-induced health problems failed because the chosen parameters were:

• Taken only at one time point, and that time point rarely included deployment;

• Only questionnaires, which relied on self-reported information that could be easily modified by the participants and not reflecting the real situation;

• Limited set of biological indicators without any insight into cognitive and social status of the participants; and

• Analyzed in a fashion that ignored health and performance changes at individual level, and treated the information by grouping (averaging) the data; this often led to diminishing the significance of observed differences.  

Our research studies successfully addressed these issues, and we perform research in close collaboration with soldiers who are stakeholders of our research. 

We call our research approach "Science for Soldiers' Sake", avoiding the concept of "Science for Science Sake".

STUDY 1: Resilience Enhancement in Military Personnel Through Multiple Health Assessments (REIM)

Rationale & Research Design

• Resilience allows people to thrive in the face of adversity, recover from injury and reduce the probability of chronic health problems. 

• This study uses questionnaires, computerized tests and biological parameters to measure the resilience level of soldiers at multiple stages in their career.

o The questionnaires measure the soldier’s self-perception about their health (mental and physical), social and family support, and stress coping strategies;

o The computerized tests objectively establish the soldier’s cognitive capacity at the time of the measurements by measuring his/her motor precision, movement speed, information processing-speed, decision making, attention / focus, memory, problem solving skill, and emotional processing; and

o The biological measures include hormones and enzymes in saliva and urine that reflect the soldier’s body’s biological capacity to cope with stress.

• The information is used to: 

o Explain to the participant his/her mental health and physical status, and encourage self-management and self-development. This occurs through one-hour, one-on-one sessions the Chair has with each participant at every time point. 

o Alert the individual about the resilience decline; and 

o Preempt performance decline and health impairments through further diagnosis, customized training, and customized treatments. 

Structure / Design

In February 2013, we started a longitudinal, multi-year study that includes health assessments at different time points in one's military career: pre-deployment training (baseline / B1); deployment (B2); immediate re-adjustment after deployment - approximately 6-9 months after deployment (B3); 1-1.5 years after B3 (B4); and during the period of transitioning from active military service to a veteran (B5).

Progress

The study has been reviewed by the University of Alberta (UofA) Institutional Review Board (IRB) and approved on February 13, 2013.

• It has also been approved by the CAF Health Services Headquarters and coordinated by the DGMPRA Social Science Research Review Board, in accordance with CANFORGEN 198/08. 

• The pre-deployment (B1) assessment of 150 CAF personnel who volunteered for the study was conducted in CFBs Edmonton and Shilo from March to July 2013;

• The deployment, i.e., B2 baseline was completed at eight International Security Assistance Force (ISAF) bases in Afghanistan in October 2013;

• The post-deployment, early readjustment baseline was started early April 2014 and completed in July 2014. This assessment required travelling across Canada and testing at the following locations: Vancouver (BC), Shilo / Brandon (MB), Winnipeg (MB), Edmonton (AB), Ottawa (ON), Kingston (ON), Petawawa (ON), Trenton (ON), and Borden (ON). Due to financial limitations, no testing could be performed in Victoria, Halifax, and Montreal;

• Data entry and biological sample measurements from the B1 and B2 baselines are completed;

• Data entry and saliva analyses from the B3 baseline are in progress

Key Deliverable – A Predictive Model of Resiliency

The collected data will form a complex database with machine learning capability, and the system will be used to establish links between the individual components of resilience, performance level, and susceptibility toward mental health and/or physical health impairments. 

• The developed model, based on the established links, will have a predictive capability, i.e., an ability to identify the combination of changes in measured parameters that will project, with a relatively high-reliability, impacts on operational readiness and heightened need for preemptive intervention(s). 

• Additional data will be used to increase the predictive strength of the model and provide feedback to the participants about their resilience and health for the remainder of the study.

STUDY 2: Mental Health Impairments Due to Operational Stressors

Rationale & Structure / Design

• In our STUDY 1 we have identified approximately 30 participants who developed some type / level of mental health impairments due to their service in the CAF. The majority of the impairments are not stand-alone mental health problems; rather, they are part of a complex operational stress injury that often includes blast TBI also. This implies a relatively large number of both actively serving military personnel and veterans who might have developed some mental health impairment caused by operational stressors. 

• Volunteer military personnel / veterans with already developed mental health impairment will be included in this study that will use state-of-the-art technology for further diagnosis: 

o Functional magnetic resonance imaging (fMRI) of the brain; 

o Computerized assessment of cognitive function; and

o Blood /saliva tests measuring hormones and enzymes.

• Based on the findings, customized treatment programs will be developed and offered to participants.

• The outcome measures outlined above will be repeated 1 year after the first assessment to get insight into the progress of the mental health impairment and/or effects of the therapy. 

• The number of participants and the progress of this study depend on the available funds.

STUDY 3: Blast-induced Traumatic Brain Injury

Rationale 

• Traumatic brain injury (TBI) is of particular concern among military personnel due to increased risk of exposure to concussive injuries resulting from explosions or other military training and combat-related factors such as motor vehicle crashes and fall. 

• It has been estimated that roughly 23% of deployed CAF personnel have had concussion/mild TBI. This number could be much higher within the combat units. 

• The military-related concussions are also often repetitive. A recent study showed that out of 113 personnel experiencing more than one concussion between 2004 and 2008, 20% experienced the second concussion within 2 weeks of the first and 87% within 3 months after the first one. While the brain can fully recover after a single insult, repeated mild-intensity insults and their accumulating effects play important role in post-traumatic neurological impairments. 

• A majority of military concussions are blast related. Indeed, blast-induced neurotrauma (BINT), i.e., brain injury caused by blast exposure(s), causes the overwhelming majority of battlefield TBIs. It also represents a progressively increasing treat to civilians due to a growing risk of terrorist attacks and frequent use of explosives in industry (for example, in mining and construction sites, among others). 

• BINT, often accompanied by operational stress injuries such as post-traumatic stress disorder or major depression, and leads to chronic disabilities

• The majority of the STUDY 1 participants have been exposed multiple times to blast. 

• Many of them developed hearing impairment or loss, and often experience ringing in ear, headaches, memory problems and problems with concentrating, which are among hallmarks of BINT. 

• This implies a large number of both actively serving military personnel and veterans who might have neurological problems due to previous exposures to blast(s). 

• Further diagnosis of the causes of the above-listed neurological deficits and other health problems are needed to develop customized therapies that guarantee improvement.

Study Design

• Volunteer military personnel / veterans who have been exposed to blast(s) and show some sign of neurological dysfunction will be included in this study that will use state-of-the-art technology for further diagnosis: 

o Functional magnetic resonance imaging (fMRI) of the brain; 

o Computerized assessment of cognitive function; and

o Blood /saliva tests measuring hormones and enzymes.

• Based on the findings, customized treatment program will be developed and offered to participants.

• The outcome measures outlined above will be repeated 1 year after the first assessment to get insight into the progress of the mental health impairment and/or effects of the therapy.

• The number of participants and the progress of this study depend on the available funds.

B. BASIC SCIENCE RESEARCH

There are three experimental studies addressing the problem of military-relevant TBI: 

o Blast-induced traumatic brain injury (BINT);

o Blunt, impact or acceleration / deceleration-induced TBI (i.e., concussion); and

o Penetrating head injury (PHI)

STUDY 1: Blast-induced Traumatic Brain Injury (BINT)

Rationale

BINT been frequently called the “silent epidemic” of the modern warfare due to the overwhelming use of explosives in recent military actions, and long-term mental and physical impairments that blast exposure causes. The fact that explosives are also widely used in industry adds additional civilian perspective to this widespread military health problem.

• The body armour and helmets currently used in CAF and the militaries of allied countries, while successful in protecting soldiers from gunshots and shrapnel, do not protect from blast wave.

• Multiple exposures to low-intensity blasts can have accumulating pathological effects, which manifest years after the initial exposure.

• Due to its slow development, BINT is often under-diagnosed and the related neurological and mental health impairments unrecognized as injuries acquired during military services.

Goals

• Develop and validate animal models that reliably reproduce blast injuries seen in soldiers;

• Identify the most important mechanisms underlying BINT and its debilitating effects such as facilitated aging, neurodegenerative diseases such as Alzheimer Disease or Chronic Traumatic Encephalopathy (CTE) among others;

• Identify and test materials that reduce or prevent the effects of blast exposures;

• Develop diagnostic methods that are specific and sensitive to alert on pathological changes in the brain after blast exposures; and

• Develop and test novel therapies and training methods that improve or prevent blast-induced behavioral and neurological impairments.

Deliverables 

• Established Facility for Blunt and Blast Injury Research at the University of Alberta (UofA) that would gather researchers from the UofA, Alberta Province, Canada, and other countries;

• Joint experimental research studies with the Defense Research and Development Canada (DRDC) Suffield to leverage expertise and facilitate research accomplishment;

• Better diagnosis for soldiers exposed to blast;

• Identified materials providing better protection from blast; and

• Improved and timely treatment of blast-exposed soldiers. 

STUDY 2: Blunt impact or acceleration/deceleration-induced TBI - Concussion

Rationale

• Sport-related concussions are among leading health problems both in military and civilian young population. People involved in popular sports, including but not limited to, hockey, football, wrestling, boxing, rugby, soccer, lacrosse, downhill skiing, martial arts, horse riding, parachuting, among others, all risk exposure to brain injury that range from asymptomatic sub-concussive blows to symptomatic concussion or to moderate or severe TBI;

• Unfortunately, the episodes of concussions are often repeated. A previous study has demonstrated that during follow-up of 4251 player-seasons, 184 U.S. college football players (6.3%) had a concussion, and 12 (6.5%) of these players had a repeat concussion within the same season. Among professional football players, repeated concussions occurred among 4 percent and 20 percent of the sample at 2 weeks and 3 months, respectively;

• Soldiers often engage in contact sports, thus the incidence of concussion is estimated being at the level the high-school football-players experience; and

• Vehicle accidents are among most frequent causes of injury in non-deployment military environment. 

Goals

• Develop and validate animal models that reliably reproduce concussions caused by contact or by vehicle collision;

• Identify the most important mechanisms underlying concussion and its debilitating effects such as facilitated aging, neurodegenerative diseases such as Alzheimer Disease or Chronic Traumatic Encephalopathy (CTE) among others;

• Define similarities and differences between concussion and BINT to leverage diagnostic and treatment methods;

• Develop diagnostic methods that are specific and sensitive to alert on early pathological changes in the brain after concussion; and

• Develop and test novel therapies and training methods that improve or prevent behavioral and neurological impairments after concussion.

Deliverables 

• Established Facility for Blunt and Blast Injury Research at the University of Alberta (UofA) that would gather researchers from the UofA, Alberta Province, Canada, and other countries;

• Better early diagnosis for concussion-related neurological deficits;

• Improved and timely treatment of mental health and neurological impairments after concussion.

STUDY 3: Penetrating Head Injury (PHI)

Rationale

• Although the majority of killed in action (KIA) or wounded in action (WIA) in current military actions are caused by explosive weaponry, penetrating injuries due to projectiles and shrapnel still represent a substantial part of injuries among soldiers, especially among those with severe injuries.

• Unfortunately, a large number of experimental models used to understand the vital mechanisms of repair, recovery, and pathological consequences of PHI fails to reproduce military-relevant injury scenario; this significantly reduce the validity of diagnostic and treatment methods that are developed based on experimental findings.

Goals

• Develop and validate animal models that reliably reproduce PHI seen in soldiers;

• Identify the most important mechanisms underlying PHI and its debilitating effects such as post-traumatic epilepsy, motor disorders, and cognitive debilitation, among others;

• Develop diagnostic methods that are specific and sensitive to alert on delayed repair and recovery after PHI; and

• Develop and test novel therapies and training methods that improve or prevent behavioral and neurological impairments after PHI.

Deliverables 

• Established Facility for Blunt and Blast Injury Researchat the University of Alberta (UofA) that would gather researchers from the UofA, Alberta Province, Canada, and other countries;

• Better early diagnosis for complications and delayed repair and recovery after PHI; 

• Improved and timely treatment of mental health and neurological impairments after PHI.