Flinders University R21013 – commencement 5 May 2022
Research Team: Professor Maria Crotty, Professor Garry Stewart, Professor Susan Hillier, Associate Professor Maayken van den Berg, Dr Zoe Adey-Wakeling
Following a serious injury, a formal rehabilitation program is often needed to maximise recovery. Consumer feedback from Flinders Medical Centre Rehabilitation Unit consistently suggests that therapy should be more holistic and that creative approaches (such as music, dance and art) should be included. Dance provides a multidimensional intervention addressing physical and cognitive abilities. Harnessing motor coordination, social interaction, executive function and memory, it has been suggested as a useful approach in neurorehabilitation. Studies in stroke have suggested that the approach is complementary to rehabilitation therapies adding an experientially based approach to a task focused functional approach. Trials have suggested that a variety of dance styles will improve balance and gait speed. When delivered in the community, dance has lower dropout rates than other exercise programs. It has been suggested that this is in part due to the social activity as well as the variety inherent in dance which protect against boredom. In psychiatry and cancer studies dance therapy (also known as dance movement therapy) uses movement to explore a person’s emotions without language.
Adding dance to a rehabilitation program has the potential to reduce hospital lengths of stay and return people to their homes earlier by enhancing motivation, providing additional opportunities for movement and (when combined with interactive video) accelerating motor skill learning. An initial proof of concept study at Hampstead Rehabilitation Centre found encouraging engagement between clients and dancers with qualitative reports that both groups understood the importance of “learning to move better”. However, at present, insufficient evidence exists on the effects of dance on outcomes in early rehabilitation to recommend the approach to clinicians. In this study we will partner with dancers and consumers to assess the feasibility of integrating a dance program into the rehabilitation of patients with recent acquired brain injuries.
The aim of this feasibility study is to compare the effects of dance therapy in addition to usual care with conventional group-based physiotherapy in addition to usual care, on physical function in recently hospitalised adults with acquired brain injuries.
- To examine the effect of dance compared with conventional physiotherapy therapy on physical function, mobility, self-efficacy, quality of life and satisfaction.
- To understand patients’ preferences for dance therapy.
- To assess the acceptability, adherence and adverse events associated with a dance therapy program.
- To co-design with consumers, arts practitioners and clinical staff protocols and practice guidelines for the use of dance approaches for rehabilitation settings.
Flinders University R21011 – commencement 29 April 2022
Research Team: Professor Stacey George, Mrs Heather Block, Associate Professor Michelle Bellon and Dr Sarah Hunter
This project aims to:
- Investigate the barriers and enablers to implementing best practice approaches for managing agitation and aggression after TBI in hospital and rehabilitation settings.
- Develop a tailored implementation strategy to improve early treatment and rehabilitation to people with TBI, thereby improving their physical health and functional outcomes, by maximising engagement in rehabilitation.
- To investigate clinical staff’s level of knowledge, confidence, barriers and enablers to best practice TBI behaviour management approaches in hospital and rehabilitation settings.
- To understand the perspectives of people with TBI and their family member’s regarding their experience of management of agitation and aggression after TBI in hospital and rehabilitation settings.
- To investigate the gaps in current practice and clinical practice of guideline recommendations for TBI behaviour management in the hospital setting.
- To develop a tailored implementation strategy for adoption of best-practice TBI behaviour management approaches in hospital and rehabilitation settings.
This implementation strategy will focus on future scope to improve clinical care for people with TBI to support the transition and progress to rehabilitation.
Flinders University R21005 – commencement: 26 April 2022
Research Team: Associate Professor Kate Laver, Dr Claire Hutchinson, Professor Trish Williams and Dr Kisani Manuel
While there is increasing potential for home automation in long term care, uptake has been poor. Research in the field is developing but remains limited to a small number of studies with few participants. Despite potential for improved efficiencies in care, there is very little information about the economic outcomes of home automation for people with disabilities. This research will contribute to the field by sharing of how home automation can result in impact at the individual level (through case studies). It will also provide beneficial information for funding bodies and governments regarding the costs and social return on investment. This will allow more informed consideration of the costs, who will benefit and to what extent. It will aid decision making for LSS participants and health professionals. This information will be particularly useful to LSA who are asked to fund home automation with limited information about the implications for participants and the scheme. Longer term impact will not be able to be monitored within the proposed project however we will keep a record of all translational activities and report on dissemination to the various audiences
Our goal is to increase knowledge about the impact and social return on investment of home automation. Our target audience for research translation is broad comprising: funders of long-term care, health professionals, industry, researchers and potential recipients of home automation. By informing all of these groups with the findings of our research (knowledge) we hope that this will assist in improved decision making and better-informed practice when considering home automation for people with severe disabilities. We also think that this information could be interesting for members of the general public (who ultimately fund the LSS through vehicle registration) and so will develop a medial release in conjunction with our communications team and the LSA. We believe that we will be able to advise the LSA on scenarios which result in higher return on investment which will assist in the sustainability of the scheme. We will disseminate information via: infographics and a plain language summary which can be distributed via media to key stakeholders and members of the public, conference presentations, journal articles, a report to the LSA and a media release.
University of South Australia R21004 – commencement 26 April 2022
Research Team: Dr Brenton Hordacre, Dr Jeric Uy, Professor Susan Hillier, Dr Francois Fraysse and Dr Carolyn Murray
People with complex trauma injuries, such as lower-limb amputation, traumatic brain and spinal cord injury, frequently identify functional ambulation as one of their primary rehabilitation goals. Evidence suggests that best likelihood of restoring functional ambulation is through large doses of high intensity, task specific, training. Traditional therapy is either inadequate or very time consuming and costly, resulting in many people with complex trauma injuries enduring persistent disability that affects vocational, physical and mental health outcomes. Given these challenges, effective strategies to deliver high quality functional ambulation training following complex trauma injury is lacking. Novel technologies in gait rehabilitation provide a promising approach to achieve large doses of high intensity, task specific, mobility training. This might be our best opportunity to improve physical health outcomes and achieve mobility goals for people with complex trauma injuries. To investigate this solution, we will evaluate a new gait rehabilitation therapeutic technology, specifically designed for people with neurological and orthopaedic injury.
This equipment includes:
- Body weight support treadmill training to allow high doses of task specific therapy for people with moderate to severe impairments after complex trauma injuries;
- Robotic mechanical assistance to guide the lower limbs though a normal gait pattern for intense, salient, massed practice of step training;
- Enhanced visual and tactile feedback to facilitate motor learning; and
- Non-immersive virtual reality to increase engagement in rehabilitation and provide cognitive challenges that simulate mobilising in real world environments.
The specific aims of this study are to:
- Provide preliminary efficacy that body weight support treadmill training with mechanical assistance, augmented feedback and non-immersive virtual reality can improve physical health outcomes of activity, mobility and quality of life compared to traditional therapy in people with lower-limb amputation, traumatic brain and spinal cord injury.
- Provide evidence that body weight support treadmill training with mechanical assistance, augmented feedback and non-immersive virtual reality is feasible, acceptable, and safe in people with lower-limb amputation, traumatic brain and spinal cord injury.
Central Adelaide Local Health Network, Northern Sydney Local Health District and University of Sydney G2101 – commenced 21 April 2022
Research Team: Ms Deanne Wilson, Dr Joanne Glinsky, Professor Lisa Harvey, Ms Sheelagh Donohoe and Miss Annie Illman
A NSW team has been funded by iCARE NSW to develop clinical practice guidelines for the physiotherapy management of people with spinal cord injuries. Funding from the South Australian Lifetime Support Authority supports involvement of a South Australian team of physiotherapists to ensure the guidelines are relevant for use in the South Australian context, and to ensure the guidelines are implemented across South Australia. These clinical practice guidelines will use the evidence for different physiotherapy interventions to provide summaries and recommendations for physiotherapists and consumers. Physiotherapists along with other healthcare providers and people with spinal cord injuries will be involved in every step of the process to capture their perspectives and priorities, and to ensure consensus.
This project will produce the first clinical practice guidelines for the physiotherapy management of people with spinal cord injuries. There are no known similar guidelines that are specifically for physiotherapists. The project partners will be consumers with spinal cord injury, physiotherapists working in the spinal cord injury services throughout Australia including South Australia, physiotherapists and other health professionals working in the community, and senior spinal cord injury academics. Clinical Practice Guidelines are essential because keeping up to date and interpreting evidence is both difficult and time consuming for consumers, physiotherapists and academics. A recent mapping review published in Spinal Cord identified over 450 randomised controlled trials involving people with spinal cord injuries with nine of the top ten topic areas relevant to physiotherapists. We estimate that there are currently over 200 randomised controlled trials relevant to physiotherapy practice. Our clinical practice guidelines will summarise and interpret the evidence from these trials and make clear recommendations based on the best available evidence. Where evidence does not exist, we will seek consensus from the experts. This summary is essential for physiotherapists in South Australia to enable them to translate the evidence into practice. Support for our proposed clinical practice guidelines has been expressed by the South Australian spinal cord injury physiotherapists.
The planned outputs are national clinical practice guidelines for both physiotherapists and consumers. The planned outcomes are inclusion of the clinical practice guidelines into standard physiotherapy care across Australia.
University of Adelaide R21001 – commenced 10 March 2022
Research Team: Dr Diana Dorstyn, Dr Boris Fedoric
WorkGain, an approved provider under ReturnToWorkSA and the Lifetime Support Authority of SA, will evaluate their unique rehabilitation service. Since 2018, WorkGain has provided individualised work simulation programs to assist over 400 South Australians with a severe physical injury, and associated comorbidities, reach maximum work capacity as rapidly and safely as possible. WorkGain uses actual work tasks and settings, custom-designed to the individual, as a form of rehabilitation. This approach is distinct from the traditional model of rehabilitative care which involves broadly sourced work hardening placements In partnership with the School of Psychology at the University of Adelaide, injured workers who have received rehabilitation from WorkGain will be interviewed. The project will integrate their stories, including a description of their goals, program content and results of work simulation rehabilitation, with the perspectives of staff involved in the development and delivery of WorkGain's multidisciplinary service. The project will use clients’ self-identified solutions to enhance WorkGain’s rehabilitation processes and, ultimately, enhance employment outcomes for this complex cohort.
Our aims are to:
- Describe clients’ and professionals’ experiences of a work simulation rehabilitation program.
- Improve knowledge about the stakeholder perspective in vocational rehabilitation.
- Translate our findings by providing WorkGain with best practice strategies and approaches for implementation, as advised by our participants.
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.
University of Adelaide R21010 – commenced 19 January 2022
Research Team: Dr Matthew Baldock, Associate Professor Jeremy Woolley Dr Lisa Wundersitz and Ms Sally Edwards.
There are two main objectives of this project.
First, to determine the prevalence of the use of alcohol and drugs, including prescription medications, prior to involvement in road crashes requiring hospitalisation, and, second, to develop a possible methodology for determining the prevalence of the use of alcohol and drugs, including prescription medications, following involvement in crashes. The first objective will be achieved through analysis of a database of drivers, riders and pedestrians admitted to the Royal Adelaide Hospital following a road crash, and of a database of road crashes investigated at the scene by CASR.
The second objective will involve a literature review and the development of methodologies for two potential future projects. These are using CASR's access to medical records for those admitted to the RAH following a crash to allow for follow-up interviews with crash participants to enquire about post-crash alcohol and drug use and conducting follow-up interviews 12 months after the crash with crash participants interviewed as part of CASR's in-depth crash investigation program. A large proportion of LSA participants have been involved in road crashes so examining the alcohol and drug use of people seriously injured in road crashes is likely to be indicative of alcohol and drug use by LSA participants. This would therefore address the LSA research priority #2: Usage of prescribed and non-prescribed medications and alcohol among the LSA participants pre- and post-accident.
South Australian Health and Medical Research Institute (SAHMRI) GA00093 – commenced 11/09/2019
Research Team: Dr Ryan O’Hare Doig, Professor Brian Freeman, Dr Marcalee Alexander and Dr Ruth Marshal.
This project aims to provide high quality evidence around sexual health following spinal cord injury (SCI), which is an area with limited research and is inadequately addressed in current practice.
Individuals with a spinal cord injury (SCI) often report diminished sexual satisfaction and activity after injury, the psychological impacts of which have been demonstrated in previous research.
In order to develop successful treatment strategies, it is imperative to understand the biological mechanisms associated with the spectrum of sexual dysfunction that may occur following a spinal cord injury (SCI).
This research uses functional resonance imaging (fMRI) to provide a quantitative, objective tool to explore sexual functioning, which is a major benefit to participants and researchers, providing more in depth and accurate data rather than the subjective tools that are currently used.
The study will compare the spinal cord responses in able-bodied people with those of people with a complete spinal cord injury (SCI) to further explain the roles of the human spinal cord in mediating sexual responses.
The University of Adelaide GA00102 – commenced 1/04/2019
Research Team: Dr Diana Dorstyn, Associate Professor Rachel Roberts and Mr Peter Stewart.
This project aims to provide an evidence-based pathway to employment for individuals with a spinal cord injury (SCI) to help develop effective employment support services.
It builds on a pilot study previously conducted by the research team, which developed an online resource ‘Work and SCI’ for adults with traumatic spinal cord injury.
The resource will be supplemented with personalised counselling based on the principles of effective vocational rehabilitation, to be delivered by The Paraplegic and Quadriplegic Association of South Australia (PQSA).
A sample group of people with a spinal cord injury (SCI) will be provided with access to the ‘Work and SCI’ modules over a two month period, with half the sample also receiving assessment and coaching by a certified vocational counsellor.
Participants will be assessed using established measures, and the comparative effectiveness of the counselling and ‘Work and SCI’ interventions will be evaluated by comparing group changes in job-seeking behaviour.
Central Adelaide Local Health Network GA00046 – commenced 3/08/2017
Research Team: Dr Ruth Marshall, Associate Professor Jillian Clark, Professor James Middleton, Professor Alan Cass, Associate Professor Bamini Gopinath, Ms Denzil O’Brien and Elizabeth Dallaway.
This research consists of three complementary population-based studies.
The work involves the identification of demographics, injury causation and characteristics that impact functioning, health and wellbeing of people with spinal cord injury, and how these vary between Australian states and between countries.
The research aims to address the deficit of knowledge in relation to the ‘lived experience’ of people with spinal cord injury (SCI) and provides insight how age, race and socioeconomic status influence the quality of life and broader health outcomes of these individuals.
The proposed outcomes of these studies will provide a greater understanding of the challenges faced and needs required for such spinal cord injury (SCI) individuals.
South Australian Health and Medical Research Institute (SAHMRI) GA00044 – commenced 3/07/2017
Research Team: Dr Ryan O’Hare Doig, Associate Professor Jillian Clark, Professor Brain Freeman, Mr James Swift, Professor Dylan Bartholomeusz, Mr Ben Crouch and Ms Kari Hughes.
Project Discovery is clinical trial study for people living with spinal cord injury to help determine a new diagnostic and long-term prognostic approach to the care of people with these injuries.
The symptoms of spinal cord injury vary widely based on the location and severity of the damage along the spinal cord. As a result, prognosis also ranges considerably from full recovery in rare cases to permanent tetraplegia or paraplegia.
The study aims to address the lack of tools presently available to adequately predict prognosis of spinal cord injury (SCI) to guide treatment and rehabilitation efforts by trialling Positron Emission Tomography (PET) scans. The outcome of this analyses will ultimately result in a more precise and personalised approach to spinal cord injury patients.
Skin Tissue Engineering Pty Ltd GA00061 – commenced 01/09/2016
Research Team: Dr John Greenwood, Miss Bronwyn Dearman and Miss Amy Li.
‘Skin’ is a biotech company focused on delivering a paradigm shift in burn and wound care. The tissue culturing process will see the growth and production of a cultured composite skin (CCS) replacing the need for skin grafting.
The CCS process will replace skin grafts, the epidermal and dermal cells are first isolated from a small graft and then cultured before being seeded and grown in a biodegradable matrix which produces a bilayer skin ready for grafting over burn wounds for a 28 day period. The result of this following the 28 day cycle, will enable enough cultured composite skin (CCS) to cover an entire adult.