Flinders University R24038: Commenced 3/02/2025

Research Team: A/Prof Maayken van den Berg, Dr Claire Gough, Prof Stacey George, A/Prof Chris Barr, A/Prof Michelle Bellon, Ms Lauren Spear,

Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life. We propose to develop an intervention to support community participation and improve their quality of life, designed following the Medical Research Council design and evaluation of complex interventions recommendations, using a Person-Based approach, alongside Integrated Knowledge Translation principles. This intervention will be created with and for people with TBI, their carers, and health professionals involved in TBI rehabilitation. Strong theoretical underpinning, person-centeredness, and stakeholder engagement during planning and development of this project will ensure a feasible, acceptable, fit for purpose and implementable intervention.

Flinders University R24035: Commenced 1/02/2025

Research Team: Dr Ali Soltani, A/Prof Matthew Baldock, Prof James Harrison, A/Prof Courtney Ryder, A/Prof Ben Beck,

The research aims to analyse the burden costs of crashes, occurred in South Australia for the period of 2018 to 2024, focusing on both VRU (vulnerable road user- motorcyclists, pedal cyclists, and pedestrians) and non-vulnerable users. The study will start with existing crash data and request linkage with hospital data within one year. First, we'll assume that VRU crashes account for a non-trivial portion of the overall burden costs associated with injuries sustained in road crashes. To continue, the causes and solutions to VRU crashes are distinct. The project aims to: a) Enhance data capture/surveillance of severe road trauma in SA's VRU, b) Improve understanding of burden costs of road trauma (for VRU with sever non-fatal injuries), with the goal of suggesting better mitigation strategies.

Flinders University R24023: Commenced 30/01/2025Research Team: Dr Heather Block, Prof Stacey George, A/Prof Michelle Bellon, Dr Sarah Hunter, Dr Ali Dymmott, Ms Wendy Saunders

Following trauma injuries people experience long-term health and functional limitations, co-morbidities, reduced independence, and reduced quality of life (1-4). Survivors of trauma injuries face multiple barriers in accessing long-term comprehensive primary care, leading to poorer health outcomes. This is further exacerbated by system barriers due to disconnection between disability and primary care sectors.

Research Team: A/Prof Jeremy Woolley, Dr Ryan Quarrington, Mr Giulio Ponte, Dr James Thomson, Dr Thiru Govindan

Electric scooters (e-scooters) have had rapid uptake in Australia, initially driven by regulated hire schemes, but increasingly through privately owned devices. This has led to new safety challenges, and increased injuries and burden to the health system. Policy development has been reactionary due to limited data and research. This project aims to examine e-scooter crash causation and injury mechanisms through a world-first, in-depth investigation of e-scooter crashes, leveraging capabilities and expertise to identify hospital emergency department injury admissions and gather detailed crash data. The outcomes of this research will assist with developing effective policies, interventions and strategies to enhance safety.

Monash University R24022: Commenced 1/11/2024

Research Team: Dr Kate Gould, Ms Nadine Holgate, Ms Melissa Capo, Dr Belinda Renison, Dr Kim Trezise, Kathryn Ayles

Challenging Behaviours are significantly impactful and distressing after brain injury. Many clinicians also have great difficulty providing behavioural support due to a lack of confidence and training. We piloted a training program for South Australian public sector clinicians in an evidence-based behavioural intervention called PBS+PLUS, finding it was effective and impacted clinical practice. This project will extend the training to the SA private sector, unifying the treatment landscape. The frequency of training will be doubled and local supervisors will be coached through a train-the-trainer model. A research evaluation of the training package, clinician competence and client outcomes will be undertaken.

Flinders University R24009: Commenced 31/10/2024

Research Team: A/Prof Andrew Vakulin, Prof Mark Howard, Dr Claire Dunbar, A/Prof Amy Reynolds, A/Prof Nicole Lovato, Dr Duc Phuc Nguyen

Driver sleepiness contributes to 20% of road crashes. To reduce accidents, it is critical to develop technologies to help identify when drivers are sleepy, similar to blood alcohol levels, towards screening for sleepiness induced driving impairment. We have completed a promising pilot study using virtual reality goggle-based device to assess vestibular ocular motor reflexes (VOMS) which predicted sleepiness and driving impairment during sleep deprivation. In this proposed project we aim to validate and optimise the VOMS measures for detecting driver sleepiness. We also intend to consult our partners, stakeholders and consumers on best approach to translate and deploy this technology into the field. This is essential before this cutting-edge technology is translated into real world use towards preventing and reducing motor vehicle accidents and associated trauma and mortality.

The University of Adelaide R24020: Commenced 1/10/2024

Research Team: Dr Ryan Quarrington, A/Prof Boopalan Ramasamy, Ms Angela Walls, Mr Peter Eaton

Traumatic lower-limb amputation profoundly impacts mobility and quality of life for amputees. We will improve the design of lower-leg prosthetic sockets to enhance comfort and usability. We will identify the common issues amputees face with current prosthetics via detailed interviews and the residual limb geometry will be measured from MRI. This understanding will inform a new socket that fits better and is easily adjustable, which we will test on multiple amputees to ensure it meets diverse amputee needs. Our goal is to create a prosthetic socket that reduces discomfort and improves the quality of life for amputees.

Modbury Hospital, NALHN R24006: Commenced 6/11/2024

Research Team: Dr Michelle McDonnell, Dr Tamina Levy, Dr Nalinda Andraweera, Dr Shaopeng Wu, A/Prof Maayken van den Berg, Miss Gabrielle Hill.

This project will engage consumers with acquired brain injury (ABI) to understand their barriers and facilitators to accessing best practice management of care for this disabling condition. Through consumer involvement and semi-structured interviews with people with ABI who access care through Spasticity clinics across Adelaide, we will develop priority areas that align with best practice guidelines with regard to the provision of information regarding spasticity, goal setting and adherence to multi-disciplinary rehabilitation, including coordination of care across different service providers. The overarching aim is to improve clinical management and quality of life for people following ABI who develop spasticity.

Flinders University R23023 Prof Stacey George: Start Date 2 January 2024

Research Team: A/Prof Maayken van den Berg, Prof Stacey George, Dr Lauren Lines, A/Prof Grahame Simpson, Mrs Kate Dawes, Dr Brett Wilkinson.

Our previous LSA-funded study demonstrated the need for the development of age-appropriate educational technology to support and educate children and families after familial acquired brain injury (ABI), using flexible learning pathways and multi-media approaches (1).

Informed by a national survey and through co-design with consumers and clinicians, the digital solution ‘Brain Connect’ was developed, addressing the gap of timely education, intervention, and support across the rehabilitation continuum.

The proposed project will enhance the 'Brain Connect' platform through integration of educational resources, test usability and acceptability among LSA participants, their children and family, and produce a clinical user guide.

Central Adelaide Local Health Network R23026: Start Date 1 December 2023

Research Team: Prof Ruth Marshall, Prof Jillian Clark, Miss Elizabeth Potter, Ms Merrill Kent, Dr Mohit Arora, Prof James Middleton.

The global InSCI Community Survey, conducted in 2018-19, utilised the consensus framework of the World Health Organisation (WHO) International Classification of Function (ICF) to describe the lived experience of people living with spinal cord injury in Australia and 22 participating countries. The next step is to conduct a five-year follow-up survey in order to extend the potency of the original InSCI database to create positive consumer-driven change across multiple domains of health, function, life expectancy, quality of life, and socioeconomic advocacy for people living with SCI in Australia and over 40 participating countries.

Flinders University R23009: Commenced 1 September 2023

Research Team: A/Prof Kate Laver, Prof Maria Crotty, A/Prof Craig Whitehead, Dr Martie Botha, Ms Cindy Harrington, Dr Miia Rahja.

Frequent and prolonged hospitalisations of older people remain a global challenge for Governments who are facing an ageing population and scarce resources for health care. Older people with severe injuries following trauma have longer lengths of stay in hospital (mean 11.5 days) and are more likely to require inpatient rehabilitation (25%) to assist in recovery from injury. Best practice rehabilitation treatment models for older people after MVA are not known.

The aims of this research are:

• To understand the impact of trauma on older people.
• To design and implement a model of rehabilitation (based on best available evidence, consumer preferences and expert opinion) at SALHN and understand which patients are most likely to benefit.
• To evaluate outcomes of implementing the model including for the person (ADL and physical function, mortality, quality of life) and for the service (length of stay, hospital readmissions).

Flinders University R23016: Commenced 1 September 2023

Research Team: A/Prof Amy Reynolds, Prof Robert Adams, A/Prof Nicole Lovato, A/Prof Andrew Vakulin, Dr Tracey Sletten, Ms Sian Wanstall.

This project will implement and evaluate both a co-designed education program, and a sleep disorder screening and rapid intervention program our team have developed. This program, SleepCheck before Shift Work, is designed to increase awareness of the impact of sleep disorders on road safety in young workers, and promote help seeking for sleep problem in a demographic where 90% of treatable sleep disorders go undiagnosed and unmanaged. Our intent is to prevent road accidents attributable to sleep disorders in shift workers by ensuring that sufficient awareness and access to treatment is prioritised for young shift workers with sleep disorders.

The University of Adelaide R2223: Commenced 4 November 2022

Research Team: Dr Claire Jones, Dr Anna Leonard, Professor Nigel Jones.

Spinal cord injury is a traumatic event with substantial individual and societal consequences. Current surgical intervention removes bone fragments compressing the spinal cord but does not address cord compression by the surrounding membrane, and changes to cerebrospinal fluid pressure and flow, which are thought to occur along the spine as a result of swelling at the injury location. We will use our unique, world-leading large animal model of contusion SCI to characterise the interrelationship between intrathecal pressure, cerebrospinal fluid flow, tissue perfusion, spinal cord morphology and functional recovery. The outcomes of our study will lay the foundation for evaluating emerging and new surgical and clinical interventions that will alter the clinical management of SCI and prognostication of injury outcome.

Spinal cord injury (SCI) often results in profound neurological deficits such as tetraplegia and paraplegia, significantly impacting an individual’s physical, psychological and social well-being, as well as placing a substantial long-term financial burden on both the individual and the health care system. The only clinically accepted treatment pathways include early bony realignment with decompression, and blood pressure management, neither of which has been shown to consistently shift injury outcome. Indeed, dural compression of the swollen spinal cord often persists despite successful bony decompression, with spinal cord perfusion being limited by the balance between intrathecal pressure (ITP) and blood pressure. There is, however, recent promising data suggesting that monitoring the intrathecal space (with, for example implanted ITP transducers or magnetic resonance imaging), and intervening accordingly (by, for example, expanding the spinal dura via a duraplasty) may improve tissue perfusion and thereby improve functional outcomes. However, the complex relationship between injury severity, intrathecal space, and the efficacy of such interventions is not well defined. In the current proposal, we will use our unique, world-leading large animal model of contusion SCI to characterise the interrelationship between intrathecal pressure, cerebrospinal fluid flow, tissue perfusion, spinal cord morphology and functional recovery.

Monash University R2209: Commenced 5 October 2022

Research Team: Dr Kate Gould, Professor Jennie Ponsford, Liz Williams, Dr Tim Feeney, Melissa Capo, Dr Belinda Renison.

This project will improve quality of life and reduce challenging behaviours in people after acquired brain injury (ABI) by building the capacity of neurorehabilitation clinicians to deliver an evidence-based intervention (PBS+PLUS). Challenging behaviours, such as aggression and socially inappropriate behaviour, are common, pervasive and distressing after acquired brain injury (ABI). These behaviours interfere with community participation, relationships and psychosocial outcomes.

Our group recently undertook the world’s first randomised controlled trial to evaluate a 12-month, individualised, multi-component Positive Behaviour Support (PBS) intervention for post-ABI challenging behaviours (“PBS+PLUS”). Challenging behaviours of 49 people with severe ABI (TBI, stroke, brain tumour) reduced significantly during the intervention, which was maintained over 8-month follow-up. Close Others (COs; family, carers) significantly improved their self-efficacy in addressing the behaviours of persons with ABI. Furthermore, qualitative investigation revealed PBS+PLUS was positively received and valued by persons with ABI, COs and clinicians.

The University of Adelaide R2218: Commenced 26 July 2022

Research Team: Associate Professor Kade Davison, Professor Gaynor Parfitt, Dr Jocelyn Kernott, Dr Adrian Windsor, Mr Peter Wilson, Associate Professor Caroline Ellison.

Immersion Therapy is an underwater experience for people living with injury, chronic illness and/or disability. Using scuba equipment in a two-to-five-metre-deep pool environment, clients are guided through an individualised underwater experience by accredited allied health professionals. Previous research supported by the LSA showed this to be to be a positive, physically rewarding and socially supportive experience, that provides social, emotional and physical health benefits for participants. This project aims to identify the potential benefit of participating in Immersion Therapy for people with a spinal cord or brain injury at the critical timepoint of transitioning from hospital inpatient rehabilitation to community care.

People with a significant neurological injury and resulting permanent impairment need to adapt to a new way of life and a new sense of self-concept that includes varying degrees of physical, psychological and social challenges. The underwater environment of Immersion Therapy offers an opportunity to move and engage with their new self-concept in a therapeutic environment that challenges and enables them. It offers the buoyancy and temperature benefits of traditional hydrotherapy but to a greater extent and including the whole body and entirely unencumbered movement. The entire sensory experience of moving and simply ‘being’ is altered with changed perception of touch, movement, sound, sight, and no verbal communication. This allows them to experience and exercise their body in a manner that is not burdened with any comparable contrast to their pre-injury self-concept. The supportive client centred approach, coupled with rigorously established protocols supports people to challenge themselves in an entirely new manner. The next stage to establish if this promising opportunity can deliver benefits as an early intervention to improve recovery and mental health, improve transition into the community and increase positive outcomes and wellbeing, is to undertake a clinical trial with robust outcome measures as is proposed here.

Flinders University R2214: Commenced 18 July 2022

Research Team: Dr Courtney Ryder, Dr Holger Moller, Professor Rebecca Ivers, Professor James Harrison, Associate Professor Hossein Afzali.

Road safety has been a policy priority for decades, however the rate of road transport injuries in Australia are not declining. Health inequities exist in this area with Aboriginal and Torres Strait Islander peoples being overrepresented. This project will address this through collaborating with Aboriginal and Torres Strait Islander communities in South Australia and New South Wales and working with Big Data to understand the overall injury burden and access to compensation schemes. This project will detect areas for improvement, and design prevention initiatives to decrease transport injuries, improve access and health and wellbeing for Aboriginal and Torres Strait Islander communities.

Transport injury rates in Australia are not declining, over the last 9 years hospitalisation has increased, with no significant changes in ‘high treat to life’ hospitalisations. Transport injuries can result in ongoing treatment and lifelong disability, impacting an individual’s health related quality of life, functional and health and wellbeing outcomes for life. Significant health inequities are present in transport injuries with Aboriginal and Torres Strait Islander people being overrepresented, such as transport injuries being the second leading cause of death and fourth leading cause of injury. Despite this considerable burden, only a small body of research exists surrounding transport injuries in Aboriginal and Torres Strait Islander communities. In this literature the incidence, socioeconomic determinants, and overall burden of transport injuries is poorly defined. Limited exploration has occurred on how and if Aboriginal and Torres Strait Islander patients recovering from a serious injury access accident compensation support.

Certainly, no studies have examined this with a focus on Indigenous Knowledges and research methods, to provide appropriate contextualisation of outcomes for community, government and key stakeholders. Our project will change this, through understanding the whole patient journey for Aboriginal and Torres Strait Islander patients and create outcomes to inform access initiatives.

The University of Adelaide R2230: Commenced 13 July 2022

Research Team: Dr Ryan Quarrington, Dr Claire Jones, Dr Mario Mongiardini.

Cervical spine facet dislocation (CFD) is a neck injury that occurs during rollovers, often causing SCI. The biomechanics of CFD are unclear, so crash test dummies and neck injury criteria are unable to predict the risk of CFD occurring, limiting our ability to mitigate against the injury. We will build on our existing experimental work into understanding CFD, and complement it with dynamic finite element modelling, to produce the first experimental and computational models of the injury. These models will allow us to improve current neck injury criteria and crash test dummy design.

Cervical spine facet dislocation (CFD) is a devastating neck injury that is most often a result of motor-vehicle rollovers and causes tetraplegia in up to 87% of cases. Given the catastrophic outcomes of CFD, and the lack of treatments to reverse the effects of SCI, there is an urgent and unmet need to improve our ability to predict, and therefore mitigate against, CFD. However, neck injury risk during motor vehicle accidents (MVAs) is currently estimated using crash test dummies and neck injury criteria that do not address facet dislocation, partly due to a lack of understand of the biomechanics underlying CFD. This project will provide the first experimental and computational models of CFD, and data that can be used to inform improved neck injury criteria and crash test dummy design. These models can also be used to assess the efficacy of new neck injury prevention devices (MVA-related and otherwise), and for the development of new approaches to detection, treatment, and/or management of the injury. For example, it could be used to better understand the soft-tissue damage that is indicative of a transient CFD that has spontaneously reduced.

University of South Australia R2225: Commenced 8 July 2022

Research Team: Associate Professor Shylie Mackintosh, Dr Simon Mills, Dr Yong Hee Kim, Associate Professor Maayken van den Berg.

This project is a Longitudinal, observational study of 100 adults who are non-ambulant at acute hospital discharge after acquired brain injury (ABI). Mobility skills, activity levels, care costs and quality of life will be measured at acute hospital discharge, then after 3, 6 and 12 months.

Activity levels are critically important for recovery after ABI. However, for people with walking impairments after ABI, it can be very difficult to achieve sustained periods of physical activity such as time in standing. There is little information, and so many questions, on physical activity levels in this group as they leave acute care in hospital. Do activity levels differ between discharge settings such as home settings, inpatient rehabilitation, or care facilities? Can we assume that more activity occurs in inpatient rehabilitation? Is there an association between activity levels and quality of life and/or mobility skills? How do costs of care compare for varying levels of mobility impairment? Is there a difference in access to rehabilitation after traumatic brain injury to other causes of ABI? Criteria have been established for stroke to promote access to rehabilitation, but this has not occurred for traumatic brain injury, so access may differ for people with different causes of brain injury.

The University of Adelaide R21003: Commenced 9 March 2022

Research Team: Associate Professor Lyndsey Collins-Praino, Dr Anna Leonard, Dr Irina Baetu, Dr David Hobbs and Ms Kavi Savisankar.

CCD is a concerning yet clinically under-recognised complication within individuals who experience SCI. As such, an increasing number of SCI individuals with CCD go undiagnosed and may experience a reduced quality-of-life. Whilst there are well established tools for evaluating motor and sensory impairment globally, such as the American Spinal Cord Injury Association (ASIA) Impairment scale, there are no set clinical screening and management guidelines available for post-SCI CCD.

Aim 1: Survey clinicians regarding the prevalence of chronic cognitive dysfunction (CCD) and potential management strategies for individuals with spinal cord injury (SCI).

The lack of awareness of post-SCI CCD is also present in individuals with SCI. Accordingly, we need to determine if an SCI individual's perceived experience of CCD and its effect on their quality-of-life correlate with the findings from a formal cognitive testing.

Aim 2: Evaluate individuals with SCI for self-perceived CCD and identify the primary cognitive domains affected after SCI.

As cognition is a brain-centred function, it is essential to understand if intrinsic neuronal activity, either at baseline or during performance of a specific cognitive task, is altered within individuals with SCI. This understanding may provide critical insight into how SCI impacts function in brain regions known to be critical for cognitive function.

Aim 3: Investigate resting and task-based neuronal activity, during performance of a reinforcement learning task in individuals with SCI.

CT has been shown to improve cognition in multiple other neurological conditions, including stroke, dementia, and Parkinson’s disease, and may thus represent an effective treatment for CCD post-SCI. Moreover, due to its highly customisable nature, it can potentially be tailored for specific domains identified to be impaired in individuals, thus creating a personalised treatment approach.

Aim 4: Assess whether a targeted ‘serious games’ based cognitive training (CT) paradigm can lead to improvements in cognitive function in individuals with SCI.