Research

Overview | Research studies | Research collaborations

Overview

Download current MERRC projects and collaborations  (PDF, 0.04 MB)

Research studies

Longitudinal Follow Up Study (LFS) - Ongoing

Overview: To follow a large cohort of individuals who have sustained moderate to severe TBI, over a 30-year period

Aim: To provide a comprehensive picture of the post-injury changes experienced over time on the individuals who sustain these injuries and their families, in a wide variety of cognitive, physical, emotional, and psychosocial areas, and identify predictive factors.

Outcome patterns following TBI – a US collaborative study - Ongoing

Overview: MERRC has collaborated with researchers from the University of Houston USA, on a project developing models predicting outcome in subgroups of patients with moderate to severe TBI.

Aim: To develop treatments for these various patient subgroups. Measures discriminating subgroups are being administered on rehabilitation admission to see whether they are predictive of outcome subgroup membership at one-year post-injury.

Ageing and dementia in TBI - Ongoing

Overview: There are currently more individuals aging with TBI, and more individuals sustaining injuries at an advanced age. This has led researchers to focus on how the biological aging process may manifest in the context of an already vulnerable and traumatised brain. Foremost within this field of research is the question as to whether a brain injury may increase risk of dementia and Alzheimer’s disease (AD).

Aim: To examine outcomes in individuals who have sustained a TBI at least 10 years prior, through completing a battery of cognitive tests, an MRI, PET scans and a blood test to review genetic risk factors.

Further studies are now underway to identify risk factors for dementia in the TBI cohort and develop intervention strategies to mitigate these risks.

Aim: To identify and mitigate risk factors for dementia following moderate-severe TBI.

The nature and biological underpinnings of psychiatric disorders after TBI - Ongoing

Overview: Psychiatric disorders are common after TBI and are associated with poorer outcome. However the long-term trajectory and causes of these disorders are poorly understood.

Aim: This ongoing prospective study is tracking the evolution of psychiatric disorders over ten years following TBI, and identifying associated factors, including pre-injury diagnoses, demographic, genetic and imaging factors. A recent added component is an examination of a transdiagnostic approach to understanding psychiatric disorders.

Early Vocational Intervention following trauma Study (EVIRS) - Ongoing

Overview: Multi-component interventions that commence in the early weeks after injury and continue after the client has returned to the community are likely to be most effective in achieving return to work for individuals experiencing major trauma causing orthopaedic, brain and/or spinal cord injury. In particular, an early vocational intervention service includes early contact with the injured individual and the employer, with a focus on assessing and addressing individual barriers to return to work within a multi-disciplinary rehabilitation program.

Aim: To pilot and evaluate in a randomised controlled trial, a dedicated, integrated early intervention vocational rehabilitation specialist (EIVRS) service delivering early rehabilitation across inpatient settings at Epworth and Austin Health.

Health Literacy Study- Ongoing

Overview: Given that individuals who sustain a TBI often experience cognitive impairment, the likelihood of low health literacy among persons with brain injuries may be even higher than the general population.

Aim: To examine, in collaboration with a group from University of Houston, USA, levels of health literacy within a TBI population compared to healthy controls, and determine whether poor health literacy may impact health outcomes.

Managing fatigue and sleep disturbance following TBI - Ongoing

Overview: TBI and ABI frequently result in fatigue, daytime sleepiness and/or sleep problems which can interfere with the person’s lifestyle, sometimes over many years.

Aim: to evaluate in a randomised controlled trial, the efficacy of adapted Cognitive Behavioural Therapy for Sleep and Fatigue (CBT-SF) in reducing fatigue, daytime sleepiness and/or sleep disturbance after TBI and stroke, and effectiveness of telehealth delivery.

Addressing Sexuality following TBI - Ongoing

Overview: Sexuality problems are common following TBI but are rarely addressed.

Aim: The first aim is to identify the nature and frequency of changes in sexual behaviour, affect, self-esteem and relationship quality, their interrelationships and changes over time and the causes of these changes. The second aim is to better understand clinician attitudes and barriers to addressing sexuality after ABI and the experience of clients with brain injury. The third aim is to develop interventions to address sexuality, including a team-based intervention, information resources and a cognitive behaviour therapy intervention to be evaluated in a pilot trial.

Evaluating the efficacy of Olanzapine in reducing agitation during post-traumatic amnesia after TBI - Ongoing

Overview: Agitation is common during PTA and is frequently treated with antipsychotic medication such as olanzapine. However, there is no evidence to support its effectiveness and it may exacerbate confusion.

Aim: This pilot RCT aims to evaluate the efficacy of Olanzapine in reducing agitation during PTA after TBI.

Memory Rehabilitation following TBI and Stroke - Ongoing

Overview: Memory is the most common cognitive impairment after TBI and stroke and stroke patients receive little support with these problems.

Aim: This series of studies has evaluated the relative efficacy of compensatory versus restorative therapy to alleviate memory problems in individuals with stroke and TBI,  the former delivered in a group setting, and the effectiveness of telehealth delivery and of assistive technologies to maintain gains. Two further studies have examined the relative effectiveness systematic instruction and retrieval-based practice, to enhance memory function following stroke.

Translating Positive Behaviour Support into clinical practice - Ongoing

Overview: Our recently completed randomised controlled trial indicated positive behaviour support is an effective means of reducing challenging behaviours in adults with brain injury.

Aim: To establish and evaluate a multicomponent community co-designed translation program for clinicians including the establishment of a new training clinic, the Positive Behaviour Service.

Understanding and increasing cybersafety for adults with brain injury - Ongoing

Overview: People with brain injury may be at greater risk of being scammed when online. There are no tailored prevention or treatment resources for people with brain injury.

Aim: To qualitative explore lived experiences of scams after brain injury and co-design evidence-based tailored skill building and self-assessment tools, which maximise safe online participation, their ‘CYBERABILITY’ and to evaluate interventions to address the consequences of Cybercrime.

Light therapy for sleepiness and fatigue following TBI and stroke - Ongoing

Overview: Fatigue and daytime sleepiness are common and persistent problems following brain injury. This novel study is the first RCT of a non-pharmacological treatment (light-therapy) for sleepiness and fatigue after TBI or stroke.

Aim: To evaluate the effect of blue light therapy, versus yellow light therapy (placebo) and ‘treatment as usual’ on subjective daytime sleepiness and fatigue following TBI. A current clinical trial is evaluating the impact of exposure to short-wavelength light in-home on daily fatigue, sleepiness, sleep and activity levels following TBI or stroke.

Development and Evaluation of a Multidisciplinary Intervention for Persistent Post-Concussion Symptoms - Ongoing

Overview: Whilst most individuals who sustain concussion recover, about a quarter experience debilitating persistent symptoms. Single modality treatments for persistent post-concussion symptoms have not shown lasting gains.

Aim: To develop and evaluate a multidisciplinary intervention for Persistent Post-Concussion Symptoms, termed the iRecover Trial.

The return of memory following TBI - Ongoing

Overview: Post Traumatic Amnesia (PTA) is a hallmark period following TBI that is characterised by profound memory impairment. The length of time individuals remain in PTA has emerged as one of the strongest predictors of acute as well as long-term functional outcome.

Aim: To identify the brain regions and networks implicated in impaired memory in patients with TBI during PTA using fMRI and to examine changes in BOLD activation in specific brain structures or networks that may modulate the recovery of memory following PTA.

Developing guidelines for Pharmacological management of neurobehavioural problems after TBI - Ongoing

Overview: Despite the frequent use of medications to treat neurobehavioural problems after TBI evidence is sparse, and there are no established guidelines.

Aim: To conduct a series of systematic reviews of studies trialling pharmacological treatment for neurobehavioural disorders after TBI including agitation, aggression, depression, anxiety, apathy and pseudobulbar palsy to inform the development of guidelines.

Using Telehealth to provide Neuropsychological Assessment and Rehabilitation to Rural Stroke Patients - Ongoing

Overview: In Australia, only 6% of rural and remote patients with stroke have access to psychological services.

Aim: Initially a pilot study to examine the potential for telehealth to improve patient access to psychology by developing, implementing and evaluating a pilot teleneuropsychology service, the Monash TeleNeuropsychology Service is now established and provides services to numerous rural Victorian hospitals. This is in turn being evaluated.

Understanding and Improving Return to Work Outcome following a TBI - Ongoing

Overview: For patients with a TBI, the injury-related cognitive, physical and emotional changes can have a significant impact on an individuals’ ability to return to work (RTW). A number of factors have been shown to be associated with short- and long-term employment outcome, including age, education, previous employment status and income, and severity of injury.

Aim: to analyse factors associated with successful employment outcome following a TBI, using data from the Return to Work Service provided by Epworth Rehabilitation, to conduct interviews with individuals with TBI who have received this vocational rehabilitation and their employers, to better understand the lived experience of RTW and the vocational rehabilitation process from their perspectives. A final aim is to develop an APP to support individuals with TBI in the RTW process.

Improving Rehabilitation Services in Rural and Remote Regions - Ongoing

Overview: Little is known about the how the rehabilitation needs of trauma patients residing in rural Victoria are met.

Aim:  This study is investigating rehabilitation service needs and access in rural and remote Victoria, from perspectives of clinicians, trauma patients and TAC co-ordinators, and scoping models of clinical service delivery to remote regions.

Psychological Interventions for Stroke Survivors with Aphasia – Ongoing

Overview: Despite the high frequency of depression after stroke, the majority of stroke survivors with depression do not access treatment. This access is particularly challenging for those with aphasia.

Aim: To utilise stroke clinical registry linked data to explore what demographic, clinical and structural factors act as either facilitators or barriers to psychological treatment access for survivors of stroke. This project also aims to develop and pilot a novel psychological therapy, tailored specifically for people with aphasia and cognitive impairment, to treat depression following stroke.

Optimising Detection and Management of Post-Stroke Cognitive Dysfunction – Ongoing

Overview: National audit data indicate that despite high prevalence and negative impacts of cognitive impairment on outcome, most Australian stroke survivors do not receive assessment or rehabilitation of their cognition.

Aim: In collaboration with Oxford University and multiple health services across NSW, VIC and SA, we aim to investigate current barriers and facilitators to cognitive assessment in clinical practice. We are also currently adapting and validating an Australian version of the Oxford Cognitive Screen - a stroke-specific cognitive assessment screening tool. This research will improve early detection of post-stroke cognitive impairment, facilitating consistent and timely access to rehabilitation.

Reducing Behaviours of Concern following TBI - Completed

Overview: Behaviours of concern following TBI (e.g. aggression, sexual inappropriateness and lack of initiation) present significant challenges for the person with TBI, the people who care for and support them, service organisations and wider society. These behaviours often result in social isolation, relationship breakdown and dislocation from accommodation, and create a significant burden for the person living with TBI, families or other carers.

Aim: To evaluate the efficacy of a 12-month Positive Behaviour Support intervention in alleviating behaviour problems following acquired brain injury.

Agitation during the period of PTA after TBI - Completed

Overview: Agitation occurs commonly in patients in post-traumatic amnesia following TBI. Its causes and optimal methods of management are poorly understood. This study has examined the evolution of agitation in patients in PTA and its relationship with orientation and memory, as well as injury-related factors and medications.

Aim: To assess the associations of PTA with agitation, memory and attention and other behaviours using the Confusion Assessment Protocol; to investigate the association of agitation with fatigue and therapy participation; and to investigate the experiences of nursing staff in working with agitated patients.

Efficacy of Motivational Interviewing and CBT for Anxiety and depression following TBI - Completed

Overview: Agitation occurs commonly in patients in post-traumatic amnesia following TBI. Its causes and optimal methods of management are poorly understood. This study has examined the evolution of agitation in patients in PTA and its relationship with orientation and memory, as well as injury-related factors and medications.

Aim: To assess the associations of PTA with agitation, memory and attention and other behaviours using the Confusion Assessment Protocol; to investigate the association of agitation with fatigue and therapy participation; and to investigate the experiences of nursing staff in working with agitated patients.

The efficacy of early rehabilitation after TBI - Completed

Overview: Patients in PTA often do not receive active therapy (owing to disorientation, amnesia, cognitive disturbances, delirium, and agitation), so there has been limited research assessing rehabilitation interventions for people in PTA.

Aim: To complete a RCT evaluating the impact of therapy to retrain activities of daily living (ADL) during PTA, and comparing this with the impact of ADL training commencing after the patient has emerged from PTA as is current practice.

Towards better detection and management of Sports Concussion in Australia - Completed

Overview: This project is one of the first ever to investigate the frequency and magnitude of head impacts in elite and amateur Australian football, and to elucidate the cognitive and physical symptoms associated with such head impacts.

Aim: to improve processes for the measurement and management of concussion in sport, and the AFL to deliver outcomes that will be readily translatable into player management on game day, and over a career in reducing the risk of long-term potential ramifications of multiple head impacts.

Padded headgear in youth football: what is the evidence? - Completed

Overview: There is an ongoing debate as to whether protective headgear is an effective injury prevention measure in Australian football. The same debate extends to junior AFL, and whether our Australian youth really benefit from wearing padded headgear when playing the game.

Aim: To compare baseline head, orofacial, and other injury rates across junior clubs which do/do not currently mandate headgear, and investigate the relationship between player attitudes towards headgear and on field behaviour.

Research collaborations