Grant Recipients
2017 Grant Recipients
Congratulations to our 2017 recipients!
Moving Ahead’s Small Seed Grant recipients are selected on the basis of project merit, the project’s consistency with the overall goals of Moving Ahead, and the project’s ability to progress our knowledge or understanding of psychosocial issues in TBI.
Every year the standard of applications is very high, with a significant number of applicants obtained.
The Moving Ahead NHMRC Centre for Research Excellence Small Seed Grant recipients for 2017 are:
Understanding the role of family dynamics in mood disorder after TBI
Dr Genevieve Rayner
What the study will be about:
Families are complex systems that change across the lifespan in response to shifting circumstances. The sudden experience of cognitive, physical, and social disability following a TBI is one such life-changing event, which can create domestic problems stemming from the need to restructure family dynamics and relationships. For instance, a romantic partner may have to relinquish their sexual needs and instead provide daily physical care; in other cases, children may become ‘parentified’ in order to support a mother or father with a TBI. That is, family systems adjust their functioning in an attempt to support a chronically ill member. These changes can be challenging for patients and caregivers alike, and may be linked to the high rate of depression in this population.
Our clinical experience in TBI rehabilitation suggests that family support is central to maximising outcomes after TBI. In this sense, family members represent an extension of the ‘team’ providing care to the patient after TBI. This means that in order to optimise patient rehabilitation and protect against depression, we need to better understand the role of family members and how they change post-TBI, including better ways to support family members.
Clear evidence for this, however, is lacking in part because few sensitive, objective tools are available to assess the structure and functioning of families. Furthermore, there are currently no TBI-specific measures to assess family functioning and capture the ways in which family dynamics underpin psychosocial (mal)adjustment to TBI.
This pilot study aims to characterise family functioning post-TBI using an interactive survey tailored to the cognitive, social, and psychological issues surrounding TBI, and understand the way in which changes to family dynamics impact patient outcomes, including the development of mood disorder.
What we have done:
We are currently working with software engineers to develop a sophisticated new tool to assess family dynamics after TBI, based on our successful development of a similar survey in epilepsy.
This approach is web-based and employs interactive dialogues and visual displays tailored to people with TBI to depict the closeness and quality of family relationships before and after the injury. The web-based method provides a less confronting medium to explore challenging issues at a pace and level set by the individual.
From 2018 we aim to prospectively study 100 adult clients presenting to the Trauma Rehabilitation Teams at Austin Health and Barwon Health, as well as their primary caregivers (N=200). We will also compare our innovative program to a generic measure of family functioning to establish its validity, and explore whether certain patterns of family dynamics lead to an increased risk of mood disorder after TBI.
Participants are randomised and allocated to either the experimental or control group for treatment and management. Those in the experimental group participate in meaningful occupation-based multisensory stimulations (OBMS) during two daily 30-minute individual therapy sessions with an occupational therapist, as well as transformation of their room into a sensory stimulating enriched environment (EE). Those in the control group follow the standard protocol at the hospital which consists of either one daily 30-minute individual session or a one-hour group occupational therapy session based on table-top activities or upper limb exercises.
Once the participants come out of PTA, measurements are taken regarding their cognitive, physical and sensory motor performance. These measures are taken again at the time of hospital discharge followed by a questionnaire after 6-months from the date of their TBI regarding their participation and function in daily life.
What we expect to find:
Consistent with the overall goals of Moving Ahead, this project takes an empirical approach to understanding and ultimately improving the psychosocial and mood outcomes of TBI, to the benefit of patient wellbeing.
This information will initially be used to directly inform clinical practice in the Trauma Rehabilitation Teams of Austin Health and Barwon Health. Through dissemination of the findings in publications and presentations, the findings will hopefully impact practice in other trauma centres worldwide by providing a sensitive and ‘whole-family’ approach to rehabilitation after TBI. We will do this by providing a robust evidence base for:
• Enhanced recognition of maladaptive family dysfunction after TBI by treating teams
• Early intervention, to prevent long-term maladaptation and mood disorder
Cognitive Behavioural Therapy for Sleep Disturbance and Fatigue Following Traumatic Brain Injury and Stroke
Lucy Ymer, Jennie Ponsford
What the study will be about:
Sleep disturbance and fatigue are among most frequent complaints after traumatic brain injury (TBI) and stroke, and contribute to functional, psychological and cognitive difficulties when returning to home, work, study or leisure activities. Currently, pharmacological treatments do not provide long-term benefits, however there is preliminary evidence supporting efficacy of psychological therapies, particularly cognitive behavioural therapy (CBT), in alleviating sleep and fatigue difficulties.
A recent pilot study conducted by Nguyen et al. (2017) supported the efficacy of a CBT program designed to treat both sleep and fatigue problems in TBI and stroke, compared to a “treatment as usual” control group. Whilst this study identified the benefits of the CBT intervention, it remains unclear whether these were specifically in response to CBT rather than therapist support. In order to establish this, comparison with an active control condition is necessary.
The aim of the current study is to (1) evaluate the efficacy of structured CBT-SF in alleviating sleep disturbance and fatigue following TBI and stroke compared to a Health Information (INFO) active control condition, and to (2) conduct a health economic analysis of the intervention to establish its cost-benefits.
What we have done:
Recruitment and data collection has recently begun, with 4 TBI participants and 3 stroke participants currently ongoing in the study. Data is being collected via self-report measures of sleep, fatigue, mood and health, as well as actigraphy data. A health service utilisation measure has been specifically developed for the health economic analysis of the intervention.
The INFO active control manual has been created for this study and piloted with one participant, and the CBT manual modified based on pilot study feedback. Participants are randomised into either the INFO or CBT intervention and complete 8 x 1-hour sessions of therapy approximately one week apart. They then have three research appointments after therapy, 2 months after therapy and 4 months after therapy to track the progression of symptoms across time.
What we expect to find:
We expect to find a significantly greater improvement for both sleep and fatigue symptoms across time for the individuals receiving the CBT intervention compared to the INFO intervention. We also expect the CBT intervention to be more cost-effective than the INFO intervention. We hope that our study will allow identification of the extent to which improvements are attributable to the CBT intervention over and above therapist attention. This evidence will provide more solid underpinnings for the implementation of the intervention for sleep and fatigue difficulties following TBI and stroke by clinicians.
Self-awareness of deficits in children and adolescents after Traumatic Brain Injury
Owen Lloyd, Tamara Ownsworth, Jenny Fleming and Melanie Zimmer-Gembeck
What the study is about:
A key factor found to influence psychosocial adjustment in adults with traumatic brain injuries (TBI) that has been largely overlooked in paediatric TBI is self-awareness. A systematic review by Lloyd et al. (2015) found preliminary support that children and adolescents with TBI experience impaired self-awareness. However, there was a lack of research on the course of recovery of impaired self-awareness and relationship to psychosocial outcomes. The paucity of research in this area may be due to a lack of reliable and validated tools designed specifically for the paediatric TBI population. This study aims to investigate changes in self-awareness following TBI in childhood and adolescence; examine the influence of neurodevelopmental (e.g., age at injury, injury severity, and cognitive deficits) and socio-environmental factors (e.g., family functioning and parenting style) on changes in self-awareness; and investigate the relationship between self-awareness and long-term adaptive functioning and psychosocial outcomes.
What we have done:
A new measure, the Paediatric Awareness Questionnaire (PAQ) has been developed, consisting of Child, Parent, and Clinician versions whereby respondents rate the child’s ease at performing functional activities. It consists of 37 items, derived to cover a range of functional areas typically affected by TBI: cognition, physical functioning, activities of daily living, interpersonal skills, and emotional/behavioural functioning. The measure has been found to have ‘good’ to ‘excellent’ internal consistency for the child and parent versions in both children with TBI and typically developing children, and to discriminate effectively between children with TBI and a typically developing control group (Lloyd et al., 2017). Results of preliminary factor analysis of the parent version of the PAQ indicate that the parent version of the PAQ assesses several distinct functional domains.
Recruitment and data collection for a cross-sectional study is ongoing. Preliminary findings indicate that children with poorer self-awareness on the PAQ are more likely to experience internalising and externalising problems. Clinically, this suggests that children’s behavioural and mental health problems may in part be related to a lack of self-awareness.
Recruitment and data collection for a longitudinal study to determine changes in self-awareness of deficits over the first 12 months following TBI has begun at the Lady Client Children’s Hospital in Brisbane. Participants complete the PAQ, as well as measures of their mood, behaviour, and daily functioning, and family functioning and parenting style within 3 months following their injury, and again at 6 and 12 months following their injury.
What we have found and expect to find:
The findings from this research will determine the clinical relevance of self-awareness deficits following TBI in children and adolescents by examining the link between self-awareness and mood, behaviour and functional outcomes, factors that influence changes in self-awareness after TBI, and the natural recovery of self-awareness following TBI. The project findings will have important implications for clinical practice in terms of determining the benefits of routine assessment of self-awareness and identifying children at greatest risk of poor psychosocial outcomes. The findings will also provide the essential groundwork for the development and evaluation of metacognitive interventions for improving children’s psychological adjustment and home and school reintegration after TBI.