Monash University R2209

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.

Flinders University R2214

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.

Flinders University R2216

Research Team: Professor Stacey George, Associate Professor Maayken van den Berg, Dr Elizabeth Lynch, Associate Professor Belinda Lange, Dr Venu Kochiyil, Dr Sheruni Wijesundara.

Effective information provision supports active engagement in decision-making, recovery and adaptation to long term disability. There is currently no clear way of providing information ensuring it will be accessed, understood, and used by LSA participants, their families and carers. This project proposes a novel solution through the co-production and implementation of accessible tailored information for LSA participants in South Australia. Information needs related to adaptation and function to maximise independence and participation, and approaches to delivery, will be identified and prioritised by gaining the perspectives of people with serious trauma injuries, carers, families, health professionals and Service planners.

The Lifetime Support Authority (LSA) provides high quality treatment, care and support for people who are seriously injured in motor vehicle accidents. This treatment, care and support occurs at the acute, recovery and long-term phases following injury. Across this trajectory, information needs are high for the participant with the injury, their families and carers. High quality and effective health information provision plays an essential role in facilitating participants, and their supporters, to actively take a part in decision making about their care and rehabilitation, and also empower them to maximise the effective management of their long-term disability. Participants vary in terms of educational backgrounds, injury effects and information needs, which will change over time. Thus, information must be individually tailored to account for these factors. Specific information adapted to the participants’ personal needs could also facilitate behavioural changes to strengthen recovery and adaptation. Internationally, serious trauma injury survivors have identified a major gap in information related to participation including work (1,2) finances (2) and maintaining social relationships (1–3) and navigating recovery, including severity of injury, time to symptom resolution and adaptive strategies (4–6). International guidelines recommend education to facilitate self-awareness, self-management, and adaptation as an important component of intervention for serious trauma injury survivors (7). However, there is currently no clear way of providing tailored information ensuring it will be accessed, understood, and used by participants.

The University of Adelaide R2218

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.

The University of Adelaide R2223

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.

University of South Australia R2225

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.

Flinders University R2229

Research Team: Associate Professor Belinda Lange, Mrs Judith Hocking, Dr Richard Liebbrandt, Dr Candice Oster, Professor David Powers.

This project will conduct a clinical pilot trial of a motivational conversational agent – or chatbot – for brain injury rehabilitation. This conversational agent – called RehabChat – was co-designed and developed through extensive collaboration with clients with traumatic brain injury and brain injury rehabilitation clinicians.

This pilot trial will recruit clients with traumatic brain injury and clinicians as dyad pairs. The participants will use RehabChat alongside usual care and/or during therapy breaks to provide extra support and therapy-focused input for clients. Outcomes will assess if and how RehabChat assists clients during their recovery, any issue encountered and feedback for changes needing to be made.

People with traumatic brain injury may experience fatigue, decreased memory, difficulty participating in daily activities and low motivation. These symptoms can contribute to reduced functional independence. Recovery is possible through neuroplasticity in which the brain develops new neuronal pathways for learning skills and achieving rehabilitation goals. Multi-disciplinary brain injury rehabilitation enables clients to pursue meaningful goals. New approaches which leverage usual care are needed.

Conversational agents are a human-computer interface with which a person can have a conversation. The conversational agent can be accessed on an iPad and designed to meet a specific health need, such as rehabilitation.

A motivational conversational agent – called RehabChat – was developed for brain injury rehabilitation during Judith Hocking's PhD (completed March 2022). RehabChat was co-designed with clients with traumatic brain injury and clinicians, and then implemented in a feasibility pilot trial at a brain injury rehabilitation ambulatory care service. RehabChat showed potential for leveraging usual care and provided motivational support for clients. RehabChat could be used during structured therapy breaks and to support discharge and transitioning to independent living.

RehabChat is now ready to be tested in a clinical pilot trial with clients with traumatic brain injury in brain injury rehabilitation settings.

The University of Adelaide R2230

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.

The University of Adelaide R2231

Research Team: Dr John Baranoff, Kelly Anderson.

The aim of this research is to assess the feasibility, acceptability and effectiveness of a treatment package that combines the Progressive Goal Attainment Program (PGAP) and individualised vocational rehabilitation. The PGAP intervention is a structured and manualised intervention that has been extensively evaluated across a range of presentations; it has been shown to increase function and increase work readiness following injury. Recently, PGAP has been adapted to be applicable to acquired brain injury (ABI) by the developer of the program Professor Michael Sullivan (McGill University; personal communication). The vocational rehabilitation aspects of the proposed intervention will assist the consumer to transfer skills developed in PGAP to assist in return to work and assist in identifying and overcoming systemic barriers to employment for the individual. This will be a participatory research project in which the feasibility, acceptability, effectiveness and end user perspective are assessed.

According to ABS data, 1 in 45 Australians have an acquired brain injury (ABI) that either limits activity or participation. Individuals with ABI experience particular challenges relating to the intersection of multiple disability factors and social determinants (ABS). For example, young age and limitations in relation to employment and community participation are both significant issues faced by individuals with ABI. Previous research has reported that 20% – 60 % of individuals with ABI return to work when all levels of ABI are combined (Fure et al., 2021). There is an emerging literature on programs that assist in the vocational rehabilitation of individuals with ABI. A systematic review conducted by Donker-Cools et al. (2016) showed that work-directed interventions when coupled with educational and coaching were associated with improved return to work rates in comparison with other interventions. The Lifetime Support Authority (LSA) assists approximately 300 consumers in South Australia who have sustained an injury that severely impacts their daily functioning (personal communication). Of the 300 consumers, approximately 60% of these have ABI.

Although support services are available to participants in the scheme, we are proposing a structured, targeted and time-limited intervention that seeks to engage the consumer in a program to improve functional outcomes and participation. The PGAP component of the intervention is a 10-session cognitive behavioural intervention that aims to increase work-readiness and the additional vocational rehabilitation element will consist of up to 16 sessions to assist the individual to navigate the employment sector, as well as provide coaching regarding specific aspects of the return to work process such as explaining disability to a potential employer; the vocation rehabilitation element will further increase self-efficacy through a coaching approach, which in term will improve work readiness. The intervention will provide a framework for a larger scale pilot as the in the intervention is scalable with a defined structure, available training and a ready work force who can be provided with additional training to meet the specific needs of this group.

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.

Specifically:

  1. To examine the effect of dance compared with conventional physiotherapy therapy on physical function, mobility, self-efficacy, quality of life and satisfaction.
  2. To understand patients’ preferences for dance therapy.
  3. To assess the acceptability, adherence and adverse events associated with a dance therapy program.
  4. 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:

  1. Investigate the barriers and enablers to implementing best practice approaches for managing agitation and aggression after TBI in hospital and rehabilitation settings.
  2. 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.

    Objectives:

    • 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:

  1. Body weight support treadmill training to allow high doses of task specific therapy for people with moderate to severe impairments after complex trauma injuries;
  2. Robotic mechanical assistance to guide the lower limbs though a normal gait pattern for intense, salient, massed practice of step training;
  3. Enhanced visual and tactile feedback to facilitate motor learning; and
  4. 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:

  1. 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.
  2. 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.

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.

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.

Page last updated: 13 September 2022