Highlighted research projects
About the Health, Disability and Compensation Research Program
The TAC's Health, Disability and Compensation Research Program invests in world-leading research that provides evidence-based insights that can be applied to improve the services we deliver to our clients. This includes substantial research into traumatic brain and spinal cord injuries.
Below are descriptions of recent and current projects.
Reducing behaviours of concern following ABI: positive behavioural supports (PBS+PLUS) intervention and evaluation
Behaviours of Concern (BoC) following brain injury present significant challenges for the person with brain injury, the people who care for and support them, service organisations and wider society. These behaviours contribute to social isolation, relationship breakdown and dislocation from accommodation, and create significant stress for the person with brain injury, their relatives and other carers, often over many years following injury.
Positive Behaviour Support (PBS) is an intervention based on a positive and collaborative approach to behaviour management in individuals with brain injury, and is designed to assess and address multi-faceted factors that may contribute to challenging behaviour following ABI.
This model of intervention aims to set collaborative goals towards a more meaningful life with the individual with ABI, identify barriers to achieving these and, in the process, identify the function served by the behaviour for the individual with ABI, and contributing factors relating to the brain injury, person and environment. It aims to teach and/or shape adaptive and co-operative social behaviours in the individual with ABI and promote independence and self-management, utilising natural supports as much as possible. This approach is the preferred model of the Victorian Department of Health and aligns philosophically with the TAC Independence Model.
The study was a randomised waitlist-controlled trial. The intervention group were treated over a 12-month period, followed by a 12-month follow-up period. The waitlist group commenced treatment after 12 months.
There was a significant reduction in BoC in the intervention group (including sexual behaviour, verbal aggression, physical aggression against others, inappropriate social behaviour and perseverative behaviours) across the course of the intervention and follow-up periods. Improvements were maintained over 8 months post-intervention. Participants achieved 92% of the 182 individualised goals set during the intervention period. However, the control group also showed a reduction in challenging behaviour during the 12-month period.
Family/carer’s efficacy or confidence in managing behaviours significantly improved and this was maintained at follow up. This improvement was not seen in the waitlist control group over the same period. There was a reduction in care support needs. Intervention was associated with lower alcohol use, a significant reduction in use of antipsychotic medication and anticonvulsants across the treatment and follow-up periods.
Qualitative interviews with participants indicated that the intervention was generally positively received, with 41/52 qualitative study participants feeling that the intervention positively influenced their lives. Qualitative interviews with clinicians who delivered the intervention indicated that it is an approach which aligned with their values and positively changed their practice.
Trial of smart home, mobile and wearable technologies following a traumatic brain injury
Traumatic brain injury (TBI) frequently results in cognitive impairment in the domain of executive functioning. This may be characterised by issues with prospective memory, planning, organisation and initiation of functional tasks. These issues can have a significant impact on a person’s level of independence following a TBI, and often leads to increased requirement for support from others. Technologies in the 21st century offer unprecedented opportunity to change the way support is provided to people with disability living in the community.
Technologies – including smart speakers, smart phones, tablets, smart home systems, wearable devices, and bespoke cognitive support technologies such as Sofihub – offer new approaches to assist with cognitive difficulties after a TBI. Within the rehabilitation field, many technology solutions have been developed and applied for retraining or compensation for physical impairments after brain injury.
Despite often being the most disabling aspect of a TBI, there has been less technology developed in relation to cognitive support needs. Although there is a growing range of mainstream and assistive technologies available that may address these needs, processes and evidence to select and guide their use to compensate for the functional impact of cognitive impairment is lacking.
To address the above issues, a multi-phase research project commenced to identify existing technologies and examine evidence regarding their use.
The rapid growth of technologies can create challenges for people with TBI, their families, and clinicians working with them in determining the optimal technology solution. Resources, education and training are needed for these groups to build their capability in technology selection, use, and other advisory services required. A suite of materials, webinars and workshops will become available.
Findings indicate the benefits for a shift away from the existing term ‘assistive technology’ to align with contemporary thinking about disability. On this basis, the research project team adopted the term ‘Performance Enhancing Technology’ (PET). A PET evaluation framework was developed to support decision-making in the planning, assessment, selection and customisation of technology solutions. An interactive scoring template was developed to complement the PET Framework to enable ranking and comparing suitability of multiple technologies to aid final product selection.
The PET Framework is now being applied in Phase 2 of this project to test and evaluate some of the shortlisted smart home, mobile and wearable technologies for people with executive function impairment following TBI.
Physiotherapy clinical guidelines for people with spinal cord injury: including Victoria in an Australia-wide project
Physiotherapy practice in spinal cord injury management can vary widely between clinicians, particularly in the community. Access to up-to-date evidence-based guidelines would help to standardise the service physiotherapists provide regardless of location or setting and ensure that consumers are provided with consistent physiotherapy interventions based on current evidence. Currently there are no physiotherapy guidelines in this field.
The Health, Disability and Compensation Research Team have commenced a project that is a NSW (iCare) initiative and aims to involve all of Australia and New Zealand. The aim of this project is to develop clinical practice guidelines for the physiotherapy management of people with spinal cord injuries.
Along with a guideline for clinicians, the project will produce a resource for consumers that will enable them to make evidence-based choices regarding physiotherapy interventions and assist them in making better decisions.
The recommendations in the guideline will help clinicians pinpoint the most effective interventions and more readily address the areas that consumers have identified as being important. The guideline will help to avoid disagreement and frustration among clinicians, funding agencies and consumers regarding what is, and what is not worthwhile to fund. An organised collection of evidence is an important resource, but risks being inaccessible to consumers. This guideline will consist of clear and succinct summaries, presented in plain language that will be easy for consumers and clinicians to understand.
The project has four phases:
1. Establishing the key questions for the guidelines
2. Develop guidelines
3. Translate guidelines into practice
4. Evaluate clinical guidelines in Victoria
This project is due for completion at the end of December 2022.