Research

Longitudinal head injury outcome study.  J. Ponsford, J. Olver, M. Ponsford,  M.Acher, R.,  Carty, M. Downing, G. Spitz, D. McKenzie


Traumatic brain injury (TBI) is the leading cause of acquired disability in young people, resulting in a complex range of physical, cognitive, behavioural and emotional changes. The elucidation of the long-term problems experienced by those who sustain TBI owes much to the Longitudinal Head Injury Outcome Study, which has been conducted at Epworth HealthCare (formerly Bethesda) since 1995, supported by TAC.

This study, which is following up a large cohort of individuals who have sustained moderate to severe TBI, over a 30-year period, aims to provide a comprehensive picture of the post-injury changes experienced, the impact, over time, of these changes on the individuals who sustain these injuries and their families, in terms of cognition and behaviour, mobility, living skills, study, employment, recreation, social and personal relationships, factors predicting outcomes in each of these domains, including factors of a demographic, cultural, genetic and  injury-related nature, as well as post-injury factors. It also aims to elucidate the evolution of these changes across the lifespan, their emotional consequences and the impact on families. Findings are being used as a basis for formulation and evaluation of intervention strategies to improve quality of life in those who sustain these injuries and their families and to translate findings to improve outcomes for TAC clients.

After recruitment as inpatients, all patients admitted to Epworth HealthCare with traumatic brain injuries are routinely invited to complete follow-up at 1, 2, 3, 5, 10, 20 and 30 years post-injury. They are interviewed by a rehabilitation physician or research psychologist and complete questionnaires documenting their level of mobility, functional independence, living situation, relationship status, vocational activities, neurological, cognitive, behavioural and emotional problems experienced, coping style, fatigue levels, drug and alcohol use and sexuality. With 3000 patients in the database, this is one of the largest and most comprehensive databases worldwide.. The study has provided comprehensive information regarding the difficulties experienced by these individuals and their families over long periods of time after injury. Findings have been published in more than 80 international peer-reviewed journal articles, and in over 120 national and international conference presentations. The information has influenced service provision models employed by the TAC, by rehabilitation centres in Australia and worldwide over the past two decades.

Recent Publication:

Ponsford, J. L., Downing, M. G.,Olver, J., Ponsford, M., Acher, R., Carty, M., Spitz, G. (2013). Longitudinal follow-up of patients with traumatic brain injury: Outcome at 2, 5, and 10-years post-injury.  Journal of Neurotrauma, 31, 64-77.

Outcome patterns following TBI – a US collaborative study. J. Ponsford, M. Sherer, A. Sander, A. Hicks

With funding from the US Department of Education, 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. MERRC is collecting comprehensive outcome data which has been used to cross-validate the models developed based on US TBI patients, showing that they apply in an Australian population. A paper documenting this cross-validation was published in 2017. The ultimate aim of this project is 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.

Recent Publication:

Sherer, M., Ponsford, J., Hicks, A., Leon-Novelo, L., Ngan, E., Sander, A. (2017). Cross-cultural Validation of a Classification System for Persons with Traumatic Brain Injury in the Post-Hospital Period. Journal of Head Trauma Rehabilitation, 32(5), E17-E25.

Sexuality following TBI. J. Ponsford, R. Stolwyk, M. Downing.

Despite extensive documentation of relationship problems following TBIs, there have been relative few studies examining sexuality in this group. As part of the longitudinal head injury outcome study we have surveyed patients at 1,2,3,5, 10, 20 and 30 years post-injury, aiming to identify the nature and frequency of changes in sexual behaviour, affect, self-esteem and relationship quality, and their interrelationships and changes over time. We have validated a scale to assess these aspects of sexuality in individuals with TBI, the Brain Injury Questionnaire on Sexuality (BIQS). Factors predicting these problems have been identified, as a basis for the development of interventions. In 2013-14, three papers were published in the Journal of Head Trauma Rehabilitation, and made several presentations of the work were given at national and international conferences.

Recent Publications:

Stolwyk, R.J., Downing, M.G., Taffe, J., Kreutzer, J.S., Zasler, N.D.., & Ponsford, J.L. (2013). Assessment of sexuality following traumatic brain injury: Validation of the Brain Injury Questionnaire of Sexuality. Journal of Head Trauma Rehabilitation, 28(3), 164-170.

Downing, M.G., Stolwyk, R., & Ponsford, J.L. (2013). Sexual changes in individuals with traumatic brain injury: A control comparison. Journal of Head Trauma Rehabilitation, 28(3),171-178.

Ponsford, J.L., Downing, M.G., & Stolwyk, R. (2013). Factors associated with sexuality following traumatic brain injury. Journal of Head Trauma Rehabilitation, 28(3), 195-201.

Investigation of substance use following TBI.  J. Ponsford, G. Spitz, M. Carty, Bryce, S., Tweedly, L.

Studies have found that a significant number of individuals with TBI report a history of substance abuse, and alcohol and drugs are implicated as causal factors in 36-51% of TBI cases. The deleterious effects of substance abuse on medical, neurological, neurobehavioural, and functional outcomes have been demonstrated. Despite this, many of the alcohol and drug use problems remain unidentified, and are consequently neglected during the rehabilitation process. Although there appears to be an initial decline in substance use following TBI, a recent review indicated that a subpopulation of patients continue, or even begin to abuse substances post-injury. The aims of this study are to examine pre-injury drug and alcohol use compared with the normal population, and to investigate the development of alcohol and drug use over time. This includes the identification of variables that predict drug and alcohol use. The sensitivity and specificity of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test for use in the TBI population has been investigated and published in the Journal of Head Trauma Rehabilitation 30(5) in 2015.  With doctoral student Laura Tweedly, the group has also previously evaluated the efficacy of an intervention in the form of an information booklet, with or without a single session of Motivational Interviewing to reduce alcohol use after TBI.

Publications:

Ponsford, J., Whelan-Goodinson, R., & Bahar-Fuchs, A. (2007). Alcohol and drug use following traumatic brain injury: A prospective study. Brain Injury, 21(13-14), 1385-1392. DOI: 10.1080/02699050701796960.

Bryce, S, Spitz, G. & Ponsford, J. (2015). Screening for substance use disorders following traumatic brain injury: Examining the validity of the AUDIT and DAST. Journal of Head Trauma Rehabilitation, 30(5), E40-E48. . DOI: 10.1097/HTR.0000000000000091.

Tweedly, L., Ponsford, J., &  Lee, N. (2012). Investigation of the effectiveness of brief interventions to reduce alcohol consumption following traumatic brain injury. Journal of Head Trauma Rehabilitation, 27(5), 331-341. DOI: 10.1097/HTR.0b013e318262200a.

Ponsford, J., Tweedly, L., Lee, N., & Taffe, J. (2012). Who responds better? Factors influencing a positive response to brief alcohol interventions for individuals with traumatically brain injury. Journal of Head Trauma Rehabilitation, 27(5) 342-348. DOI: 10.1097/HTR.0b013e318265a576.

Ponsford, J., Tweedly, L., & Taffe, J. (2013). The relationship between alcohol and cognitive functioning following traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 35(1), 103-112. DOI: 10.1080/13803395.2012.752437.

Psychiatric disorders following TBI. J. Ponsford, K. Gould, L. Johnston, Y. Alway, C. Pais.

Psychiatric disorders are common TBI, and exacerbate disability and impede psychosocial and vocational reintegration. The aim of this project  has been to prospectively examine the frequency, course, and predictors of psychiatric disorders over the first ten years following TBI. Specifically, the pre-injury, injury-related and post-injury factors associated with the development, course and remittance of psychiatric disorders are examined. Further, as the impact of a TBI extends beyond the injured individual, a secondary aim has been to examine the influence of family dynamics on both patient and family psychosocial adjustment following TBI.

Recent publications:

Alway, Y., Gould, K. R., McKay, A., Johnston, L., & Ponsford. J. (2016). The evolution of post-traumatic stress disorder following moderate-to-severe traumatic brain injury. Journal of Neurotrauma, 33(9), 825-831.

Alway, Y., McKay, A., Gould, K.R., Johnston, L., & Ponsford, J. (2016) Factors associated with posttraumatic stress disorder following moderate to severe traumatic brain injury: A prospective study. Depression and Anxiety, 33(1), 19-26.

Alway, Y., Gould, K. R., Johnston, L., McKenzie, D., & Ponsford, J. (2016). A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. Psychological Medicine, 46(6), 1331-1341.

Alway, Y., Ponsford, J., & McKay, A. (2016). The relationship between family expressed emotion, perceived criticism and criticism sensitivity and psychiatric outcomes following traumatic brain injury. Psychiatry Research, 246, 827-832.

McKenzie, D.P., Downing, M.G., & Ponsford, J.L. (2018). Key Hospital Anxiety and Depression Scale (HADS) items associated with DSM-IV depressive and anxiety disorder 12-months post traumatic brain injury. Journal of Affective Disorders, 236, 164-171.

A recent study by doctoral student Celia Pais has examined factors influencing Positive Growth following TBI. Recent publications: Pais, C., Ponsford, J. Gould, K., Wong, D. (2017). Role of Valued Living and Associations with Functional Outcome following Traumatic Brain Injury. Neuropsychological Rehabilitation, Published online 19 April 2017

The influence of genetic factors, specifically the Apolipoprotein and COMT genes, and age at injury on outcome following head injury. J. Ponsford, R. Burke, C. Willmott, T. Withiel.

TBI can result in significant disability, but outcome is variable. The impact of known predictors accounts for a limited proportion of the variance in outcomes. Apolipoprotein E genotype has been investigated as an additional source of variability in injury severity and outcome, with mixed findings reflecting variable methodology and generally limited sample sizes. This study examines whether possession of the Apolipoprotein E e4 allele is associated with greater acute injury severity and poorer long-term outcome in patients referred for rehabilitation following TBI and published in Ponsford, J., McLaren, A., Schönberger, M., Burke, R., Rudzki, D., Olver, J., & Ponsford, M.  (2011) Journal of Neurotrauma, 28(9), 1683-1692.

The impact of catechol-O-methyltransferase (COMT Val158Met) allele status on cognitive and functional recovery following TBI has also been investigated:  Willmott, C., Withiel, T., Ponsford, J., & Burke, R. (2014). Journal of Neurotrauma, 31(17): 1507-1514; Willmott, C., Ponsford, J., McAllister, T.W., & Burke, R. (2013 ). Brain Injury. 27(11), 1281-1286.

The influence of cultural background on rehabilitation and outcome following TBI. J. Ponsford, M Downing, A. Hicks.

Most TBI outcome studies focus on white, Anglo-Saxon English speaking patients who identify with the dominant health care system. Relatively little is known of the experience of TBI individuals from culturally and linguistic diverse (CALD) backgrounds and potential influences of cultural factors upon attitudes and responses to rehabilitation. This study is examining the influence of linguistic cultural background, and beliefs about injury and recovery on participation in rehabilitation and subsequent outcomes in two groups with mild-severe TBI: those from non-CALD compared to those from CALD backgrounds. .As the cohort grows in size, we also aim to differentially compare groups from different countries/regions.

Publications:

Saltapidas, H. & Ponsford, J. (2007). The influence of cultural background on motivation for and participation in rehabilitation and outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation, 22(2), 132-139. DOI: 10.1097/01.HTR.0000265101.75177

Saltapidas, H. & Ponsford, J. (2008). The influence of cultural background on experiences and beliefs about traumatic brain injury and their association with outcome. Brain Impairment, 9(1), 1-13. DOI: 10.1375/brim.9.1.1.

Ponsford, J., Downing, M., & Pechlivanidas, H. (in press). The impact of cultural background on outcome following traumatic brain injury. Neuropsychological Rehabilitation, Accepted 13 March 2018.

Fatigue and Sleep Disturbance Following Traumatic Brain Injury. J. Ponsford, S. Rajaratnam, Carlo Ziino, Diane Parcell, J Shekleton, M Roper, J Redman, J. Phipps Nelson.

Although fatigue and sleep changes are commonly reported following TBI understanding of their nature and treatment remains limited. With funding from an NHMRC grant, we have conducted a series of investigations of the nature and causes of fatigue and sleep disturbance following TBI. A large cohort of community-based TBI patients with TBI recruited from a TBI rehabilitation program completed measures of subjective fatigue and sleep disturbances, as well as attentional measures. A subgroup completed polysomnography and assessment of Dim Light Melatonin Onset. Results showed that fatigue and sleep disturbance are common following TBI, affecting more than 50 percent of cases. Both are associated with anxiety, depression and pain. However fatigue is also associated with slowed information processing and the need for increased effort in performing tasks. Sleep disturbances contribute to fatigue. Objective sleep studies show reduced sleep efficiency, increased sleep onset latency and increased time awake after sleep onset. Depression and pain exacerbate but cannot entirely account for these problems. There is increased slow wave sleep. Individuals with TBI show lower levels of evening melatonin production, associated with less REM sleep. These findings suggest potential treatments including cognitive behaviour therapy supporting lifestyle modifications, pharmacological treatments with modafinil and melatonin, and light therapy to enhance alertness, vigilance and mood.

Publications:

Ziino, C. & Ponsford, J. (2005). Measurement and prediction of subjective fatigue following traumatic brain injury. Journal of the International Neuropsychological Society, 11(4), 416-425. DOI: 10.1017/S1355617705050472.

Ziino, C. & Ponsford, J. (2005). Measurement and prediction of subjective fatigue following traumatic brain injury. Journal of the International Neuropsychological Society, 11(4), 416-425. DOI: 10.1017/S1355617705050472.

Ziino, C. & Ponsford, J. (2006). Vigilance and fatigue following traumatic brain injury. Journal of the International Neuropsychological Society, 12(1), 100-110. DOI: 10.1017/S1355617706060139.

Ziino, C. & Ponsford, J. (2006). Selective attention deficits and subjective fatigue following traumatic brain injury. Neuropsychology, 20(3), 383-390. DOI: 10.1037/0894-4105.20.3.383. Impact factor 3.176

Steele, D.L., Rajaratnam, S.M.W., Redman, J.R., & Ponsford, J.L. (2005). The effect of traumatic brain injury on the timing of sleep. Chronobiology International, 22(1), 89-105. DOI: 10.1081/CBI-200042428

Parcell, D.L., Ponsford, J.L., Rajaratnam, S.M., & Redman, J.R. (2006). Self-reported changes to nighttime sleep after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 87(2), 278-285. DOI: 10.1016/j.apmr.2005.10.024

Parcell, D.L., Ponsford, J.L., Redman, J.R., & Rajaratnam, S.W.M. (2008). Poor sleep quality and changes in objectively recorded sleep after traumatic brain injury: A preliminary study. Archives of Physical Medicine and Rehabilitation, 89(5), 843-850. DOI: 10.1016/j.apmr.2007.09.057.

Shekleton, J.A., Parcell, D.L., Redman, J.R., Phipps-Nelson, J., Ponsford, J.L., & Rajaratnam, S.M.W. (2010). Sleep disturbance and melatonin levels following traumatic brain injury. Neurology, 2010; 74(21), 1732-1738. DOI: 10.1212/WNL.0b013e3181e0438b.

Ponsford, J.L., Ziino, C., Parcell, D.L., Shekleton, J.A., Roper, M., Redman, J. R., Phipps-Nelson, J., & Rajaratnam, S.M.W. (2012). Fatigue and sleep disturbance following traumatic brain injury – Their nature, causes and potential treatments. Journal of Head Trauma Rehabilitation, 27(3), 224-233. DOI: 10.1097/HTR.0b013e31824ee1a8.

Ponsford, J.L., Parcell, D.L., Sinclair, K.L., Roper, M., & Rajaratnam, S.M.W. (2013). Changes in sleep patterns following traumatic brain injury: A controlled study. NeuroRehabilitaiton and Neural Repair, 27(7), 613-621. DOI:10.1177/1545968313481283.

Schönberger, M., Herrberg, M., & Ponsford, J. (2014). Fatigue as a cause, not a consequence of depression and daytime sleepiness: A cross-lagged analysis. Journal of Head Trauma Rehabilitation, 29(5), 427-431. DOI: 10.1097/HTR.0b013e31829ddd08.

Ponsford, J.L. & Sinclair, K.L. (2014). Sleep and fatigue following traumatic brain injury (Review). Psychiatric Clinics of North America, 37(1), 77-89. DOI: 10.1016/j.psc.2013.10.001.

Ponsford, J., Schönberger, M., & Rajaratnam, S.M.W. (2015). A model of fatigue following traumatic brain injury. Journal of Head Trauma Rehabilitation, 30(4), 277-282. DOI: 10.1097/HTR.0000000000000049.

Schönberger, M., Reutens, D., Beare, R., O’Sullivan, R., Rajaratnam, S. M. W., & Ponsford, J. (2017). Brain lesion correlates of fatigue in individuals with traumatic brain injury. Neuropsychological Rehabilitation, 27(7), 1056-1070 . DOI:10.1080/09602011.2016.1154875.

The return of memory following TBI: The critical role of the medial temporal lobe, prefrontal cortex, and associated brain areas. C Roberts, G. Spitz, M. Mundy, J. Ponsford, A. Taing

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. This study has two parts. The first part, conducted by DPsych student Caroline Roberts,  examined patterns of recovery of memory during and after emergence from PTA, prospective versus retrospective assessment of PTA duration, as well as the relationship between anterograde and retrograde amnesia in individuals with TBI in PTA and post PTA emergence.

No study has examined the correspondence between impaired memory processes present during this period and the disruption to underlying brain regions and networks. The frontal and temporal lobes are most frequently affected following TBI. Anatomical structures within these regions are essential for memory processing. The prefrontal cortex is critical for processing information in working memory, whereas the medial temporal lobe comprises a system of structures critical for transferring information from working to long-term memory. It is not known, however, to what extent changes to these brain structures reflect the memory impairment exhibited in PTA. The second part of this study, led by Gershon Spitz and Matthew Mundy, and being conducted by DPsych student Abbie Taing, aims 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.

Recent Publications:

Roberts, C. M., Spitz, G., & Ponsford, J.L. (2016). Comparing prospectively recorded posttraumatic amnesia duration with retrospective accounts. Journal of Head Trauma Rehabilitation, 31(2), E71-E77.

Roberts, C., Spitz, G., Mundy. M., Ponsford, J. (in press). Retrograde Autobiographical Memory from PTA Emergence to Six-Month Follow-up in Moderate to Severe Traumatic Brain Injury. Journal of Neuropsychiatry and Clinical Neuroscience, Accepted 13 May 2018.

Roberts, C., Spitz, G., Mundy. M., Ponsford, J. (in press) Retrograde Personal Semantic Memory in and out of Post-Traumatic Amnesia. Journal of the International Neuropsychological Society. Accepted 4 June 2018.

Roberts, C., Spitz, G., Mundy. M., Ponsford, J. (in press).  Prospective evaluation of first and last memory reports following moderate to severe traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, Accepted 9 June 2018.

Agitation during the period of Post Traumatic Amnesia after Traumatic Brain Injury. A.McKay, C. Baxter, J. Ponsford

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. Following form this, DPsych student Courtney Baxter is further assessing the associations of PTA with agitation, memory and attention and other behaviours using the Confusion Assessment Protocol. She is also investigating the association of agitation with fatigue and therapy participation. In a third qualitative study she is investigating the experiences of nursing staff in working with agitated patients.

Recent Publication:

McKay, A., Love, J., Trevena-Peters, J. Gracey, J., & Ponsford, J. (in press).  The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury. Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2018.1479276. Published online 3 June 2018.

Ageing and dementia in TBI. Hicks, A., Ponsford, J., Rowe, C., McCrory, P. Hopwood, M., O’Donnell, M.

In the context of the aging population, there are 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). This NHMRC funded study is examining the potential for development of dementia in three groups – Ageing military with and without PTSD, AFL footballers, and at MERRC, in individuals with severe TBI. This last-mentioned study, which is the doctoral project of research fellow Amelia Hicks, aims to examine outcomes in 75 individuals who have sustained a TBI at least 10 years prior, by asking them to complete a battery of cognitive tests, an MRI, PET scans and a blood test to review genetic risk factors. This study is funded by the NHMRC and is conducted in collaboration with the Florey Institute of Neuroscience & Mental Health.

Factors involved in Return to Work Outcome following a Traumatic Brain Injury. L. Libeson,J. Ponsford, M. Downing, P. Ross

Return to work (RTW) outcomes are regarded as important benchmarks for successful rehabilitation. For patients with a traumatic brain injury (TBI), the injury-related cognitive, physical and emotional changes can have a significant impact on an individuals’ ability to return to work. 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. In order to better understand the challenges of returning to employment following TBI, it is important to understand both quantitative factors as well as the clients’ individual experience. Therefore, the aims of this study are to analyse the factors associated with successful employment outcome following a TBI, using data from the Return to Work Service provided by Epworth Rehabilitation and to conduct interviews with individuals with TBI who have received this unique model of comprehensive, fully funded vocational rehabilitation, to better understand the lived experience of RTW and the vocational rehabilitation process.

Recent Publication:

Libeson, L., Downing, M., Ross, P., & Ponsford, J. (2018). The experience of return to work in individuals with traumatic brain injury. Neuropsychological Rehabilitation. Published online May 2018.

Factors Influencing Physical Activity Levels Following Severe TBI. P. Analytis, M. Hamilton, G. Williams, A. McKay, J. Ponsford

Physical activity has a number of benefits to health and well-being. Whilst there is evidence that people with TBI have lower activity levels than the healthy population, it is not known what factors influence this. Most previous studies have examined physical activity levels in the early period after injury and relatively little is known of activity level over the longer term. This study extended a previous six week post-injury follow-up study by Megan Hamilton, aiming to (a) assess physical activity levels for people with severe TBI living in the community several years post-injury; and (b) explore factors which influence physical activity for people with severe TBI using a qualitative methodology. Findings suggested that lifelong physical activity habits and current life priorities impacted on physical activity engagement post-TBI and influenced whether TBI-associated impairments were seen as a barrier to physical activity. Therefore interventions need to address lifetime physical activity habits and offer ways to adapt physical activity to account for current life priorities within the context of TBI-associated impairments.

Recent Publication:

Analytis, P., McKay, A., Hamilton, M., Williams, G., Warren, N., Ponsford, J. (2018). Physical activity: perceptions of people with severe traumatic brain injury living in the community. Brain Injury, 32(2), 209-217.

Family Function and Sibling Relationships Following Paediatric ABI. P. Analytis, N. Warren, J. Ponsford

This research project aims to better understand the factors which contribute to family wellbeing in families with a child with an ABI. Working with the not-for-profit organisation Heads Together, doctoral student Penny Analytis is investigating the relationship between parental wellbeing, coping and family function. She is also conducting qualitative studies exploring the sibling relationship when one sibling has an ABI and young people’s perspectives of a camp for families with a child with ABI. A qualitative study exploring parental perspectives of the camp was undertaken in 2016 in collaboration with student Katrina Luzinat.

Publication:

Luzinat, K. J., Analytis, P., Hicks, A. J., Warren, N., & Ponsford, J. L. (2018). The experience of a recreational camp for families with a child or young person with acquired brain injury. Neuropsychological Rehabilitation, 1-16. https://doi.org/10.1080/09602011.2018.1461657

The Experience of TBI in Botswana. L. Mbakile, J. Ponsford, L. Manderson

Whilst there has been substantial documentation of outcomes following TBI in Western countries such as Australia, the US and Europe, there has been relatively little documentation of the experience of individuals with TBI in less developed countries such as Africa. Lingani Mbakile-Mahlanza (from Botswana) completed this study and is the first clinical neuropsychologist in Botswana taking up an appointment in the Department of Psychology at the University of Botswana in January 2016. Together with her supervisors Professors Jennie Ponsford and Lenore Manderson, and with some support from an Intercultural grant from the Australian Psychological Society, she conducted a mixed methods study investigating the experiences of individuals with traumatic brain injury, their caregivers and health professionals in Botswana. Through a series of qualitative interviews she documented the symptoms experienced, lack of information and access to rehabilitation services as well as the impact of cultural beliefs on response to injury. This study, which has produced three publications, will form the basis of further work developing information booklets for people with TBI in Botswana and their families.

Recent Publications:

Mbakile-Mahlanza, L., Manderson. L., & Ponsford, J. (2015). The experience of traumatic brain injury in Botswana. Neuropsychological Rehabilitation, 25(6), 936-958.

Mbakile-Mahlanza, L., Manderson, L., & Ponsford, J. (2017). Cultural beliefs about TBI in Botswana. Neuropsychological Rehabilitation, 27(1), 38-59.

Mbakile-Mahlanza, L., Manderson, L., Downing, M., & Ponsford, J. (2017). Family caregiving of individuals with traumatic brain injury in Botswana. Disability and Rehabilitation, 39(6), 559-567.

Treatment Trials

Efficacy of Motivational Interviewing and Cognitive Behaviour Therapy for Anxiety and depression following TBI. J. Ponsford, M. O’Donnell, N. Lee., A. McKay, D. Wong, Y. Alway, M. Hsieh, M Downing.

There is a high incidence of psychiatric disorders following TBI, most commonly anxiety and depression. Consequently, there is a need for effective psychological treatments to enhance psychosocial outcomes for this group. This NHMRC –funded randomised controlled trial has examined the efficacy of a cognitive behaviour therapy (CBT)-based treatment program adapted for a community sample with moderate-severe TBI. Motivational Interviewing (MI) was also evaluated as a preparatory intervention to increase motivation to change and engagement in treatment. Adult participants were randomly assigned to one of three treatment conditions, (1) MI+CBT, (2) CBT only and (3) treatment as usual (control). Assessment included a semi-structured clinical interview to determine psychiatric diagnoses; and measures of anxiety, depression, psychosocial functioning, coping style and cognitive functioning. The interventions were guided by manuals adapted for participants with TBI, with an emphasis on flexibility to tailor therapy to individual needs and cognitive difficulties. Both groups receiving CBT achieved a significantly greater reduction in anxiety and depression symptoms than the treatment as usual group. Motivational Interviewing did not impact significantly on the benefits of CBT alone. Following pilot studies led by Ming-Yun Hsieh, the final RCT has been published: Ponsford, J., Lee, N. McKay, A., Wong, D., Haines, K., Alway, Y., Downing, M., Furtado, C., & O’Donnell, M. (2016) Psychological Medicine, 46(5), 1079-1090.

The development and distribution of the manualised CBT-ABI intervention was also supported by the NHMRC Centre of Excellence in TBI Rehabilitation and will soon be published by ASSBI Resources. Dana Wong and Adam McKay led the translation of study findings, running workshops and providing ongoing supervision to clinicians implementing the CBT intervention. Doctoral student Leah Zelencich is examining CBT adaptations, working alliance and homework compliance and factors associated with them in this study cohort.

Efficacy of Melatonin for sleep disturbance following TBI. N. Grima, J. Ponsford, S. Rajaratnam, D Mansfield, T. Sletten

Sleep disturbance is a common problem in individuals who have sustained a TBI, with over half of those with moderate to serve TBI still experiencing difficulty with sleep 10 years post injury.  Presently, there is no evidence-based treatment for these complaints, despite their high prevalence. Recently published research, suggests that reduced concentrations of Melatonin may explain the reported sleep disturbance in this population.  Melatonin is involved in the circadian control of the sleep-wake cycle.  Numerous studies have demonstrated efficacy and safety of exogenous Melatonin treatment of sleep complaints.  This randomised controlled trial, funded by an NHMRC Project grant and led by doctoral student Natalie Grima, examined the efficacy of Melatonin relative to placebo in individuals with TBI and post-injury sleep disturbance Results showed significant improvement in subjective sleep quality on the Pittsburgh Sleep Quality Index, increased sleep efficiency, measured using actigraphy, reduced fatigue, reduced anxiety symptoms and improved Vitality and Mental Health on the  SF-36. There was no reduction in latency to sleep onset or daytime sleepiness. The intervention was well-tolerated without significant side-effects. This world-first trial, published in BMC Medicine in 2018, suggests Melatonin therapy may improve sleep quality in  individuals with TBI and sleep disturbance.

Publication:

Grima, N.A. Rajaratnam, S.W., Mansfield, D., Sletten, T.L., Spitz, G., Ponsford, J.L (2018). Efficacy of melatonin for sleep disturbance following traumatic brain injury: A randomized controlled trial. BMC Medicine201816:8.

Managing fatigue and sleep disturbance following TBI. J. Ponsford, S. Nguyen, L. Ymer J. A. McKay, D. Wong, S. Rajaratnam, S. Drummond, G Williams.

TBI frequently results in fatigue, daytime sleepiness and/or sleep problems which can interfere with the person’s lifestyle, sometimes over many years. Evidence shows that Cognitive Behaviour Therapy (CBT) is more effective than medication in treating Chronic Fatigue Syndrome and Insomnia in the general population. There is also increasing evidence of CBT being successful in reducing fatigue related to cancer, stroke and Multiple Sclerosis. The current study aims is evaluating the efficacy of Cognitive Behaviour Therapy for Sleep and Fatigue (CBT-SF) in reducing fatigue, daytime sleepiness and/or sleep disturbance following TBI and stroke. Pilot studies led by Sylvia Nguyen have shown CBT-SF to be superior to treatment as usual in alleviating sleep disturbance and fatigue following both TBI and stroke. The intervention is now being evaluated by Lucy Ymer against an active healthy lifestyle intervention control condition. The delivery of CBT-SF via telehealth is also being evaluated. The study has been funded by a grant from Epworth Research Institute and the NHMRC Centre of Excellence in TBI Psychosocial Rehabilitation.

Recent Publications:

Nguyen, S., McKay, A., Wong, D., Spitz, G., Mansfield, D., Williams, G., Rajaratnam, S., & Ponsford, J. (2017). Cognitive Behavior Therapy to treat Sleep Disturbance and Fatigue following Traumatic Brain Injury: A Pilot Randomized Study. Archives of Physical Medicine and Rehabilitation, 98(8), 1508-1517.e2

Nguyen, S., McKay, A., Wong, D., Spitz, G., Mansfield, D., Rajaratnam, S., Williams, G., & Ponsford, J. (2017). Cognitive behavioural therapy for post-stroke fatigue and sleep disturbance: a pilot randomised controlled trial with blind assessment. Neuropsychological Rehabilitation. Published online 19 May 2017.

Nguyen, S., McKenzie, D., McKay, A., Wong, D., Rajaratnam, S., Spitz, G., Williams, G., Mansfield, D.  & Ponsford, J. (2017). Exploring Predictors of Treatment Outcome in Cognitive Behaviour Therapy for Sleep Disturbance following Brain Injury. Disability and Rehabilitation, Published online 19 April 2017

Light therapy for sleepiness and fatigue following TBI. K. Sinclair, J. Ponsford, S. Rajaratnam, S. Lockley, L. Connolly

Fatigue and daytime sleepiness are common and persistent problems following brain injury. They are associated with depression and slowed information processing.  This novel study was the first randomised controlled trial of a non-pharmacological treatment for post-TBI sleepiness and fatigue. It builds on our existing work investigating the prevalence and nature of fatigue and sleepiness post-TBI, and demonstrating the efficacy of light to improve alertness in healthy volunteers. The primary aim of this world-first study in individuals with TBI, funded by the Victorian Neurotrauma Initiative and ISCRR, was to evaluate, in a randomized controlled trial, the effect of blue light therapy (Philips Home Healthcare Solutions-Apollo) versus yellow light therapy (placebo) and ‘treatment as usual’ on subjective daytime sleepiness and fatigue following TBI. The pilot study, led by doctoral student Kelly Sinclair and published in the Journal of NeuroRehabilitation and Neural Repair in 2014, showed that exposure to short wavelength or blue light resulted in a significant reduction in subjective fatigue and daytime sleepiness and a trend towards improved mood. Doctoral student Laura Connolly is continuing work on this study, investigating the impact of exposure to short-wavelength light in-home on daily fatigue, sleepiness, sleep and activity levels.  She is supported by a scholarship form the Summer Foundation and a grant from the Epworth Research Institute.

Recent Publication:

Sinclair, K.L., Ponsford, J.L., Taffe, J., Lockley, S.W., & Rajaratnam, S.M.W. (2014).  Randomized controlled trial of light therapy for fatigue following traumatic brain injury.  Neurorehabilitation and Neural Repair, 28(4), 303-313.

The efficacy of early rehabilitation after TBI. J. Trevena-Peters, J. Ponsford, A. McKay, R. Suda,  B. Renison.

Posttraumatic Amnesia (PTA) is a feature of traumatic brain injury (TBI) that commonly follows after the patient has emerged from a coma and represents the time from injury to the time patients can continuously remember their day-to-day activities. During PTA, patients can experience disorientation, amnesia, cognitive disturbances and delirium and often become agitated.  Because of these issues, patients in PTA often do not receive active therapy so there has been limited research assessing rehabilitation interventions for people in PTA. MERRC therefore conducted a world-first, randomised controlled trial 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.

Findings of this study indicated more improvements in the group receiving the ADL retraining during PTA at the time the patient emerges from PTA and at discharge from hospital. Ther3 was a trend towards shorter length of inpatient hospital stay and shorter PTA duration. The intervention did not increase agitated behaviour during PTA in the treatment group when compared to agitation ratings in the treatment as usual condition. Within the treatment condition, approximately 90% of all goals set were attained when the patients emerged from PTA. Treating occupational therapists who provided the intervention were also interviewed. They noted that delivering the therapy enhanced their working relationship with the participant therapeutic alliance and noted that delivering a manualised therapy was novel and challenging but they found the retraining approach provided helpful structure to skill development.

The research findings have been presented at The International Brain Injury Association's World Congress on Brain Injury (March 2017, New Orleans) and The 40th Brain Impairment Conference, Australasian Society for the Study of Brain Impairment (June 2017, Melbourne). The study findings have been published.

Recent Publications:

Trevena-Peters, J., McKay, A., Spitz, G., Suda, R., Renison, B., Ponsford, J. (2017).  Efficacy of activities of daily living retraining during posttraumatic amnesia: A randomised controlled trial. Archives of Physical Medicine and Rehabilitation, Published online 22 September 2017. DOI: 10.1016/j.apmr.2017.08.486

Trevena-Peters, J., Ponsford, J., McKay, A. (2017). Agitated behaviour and activities of daily living retraining during posttraumatic amnesia. Journal of Head Trauma Rehabilitation Published online 29 November 2017. DOI: 10.1097/HTR.0000000000000363.

Trevena-Peters, J., McKay, A., Ponsford, J.  (2018) Activities of daily living retraining and goal attainment during posttraumatic amnesia. Neuropsychological Rehabilitation, Published online: 08 Mar 2018: https://doi.org/10.1080/09602011.2018.1441033

Reducing Behaviours of Concern following TBI Program. J. Ponsford, M. Hopwood, T. Feeney, K. Gould, A. Hicks.

Behaviours of concern following TBI – including aggression, agitation, 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. There is concern within the TAC that a group of clients with behaviours of concern is excessively reliant on attendant care support and that this reliance is increasing over time in some cases. A recent analysis of these clients conducted as Phase 1 of this study, established that a significant percentage of these cases exhibited problematic behaviours of concern on the Overt Behaviour Scale. The second three-year phase of this waitlist-controlled trial, which is still underway, is evaluating the efficacy of a 12-month Positive Behaviour Support intervention in alleviating behaviour problems following acquired brain injury. The intervention is being supervised by Dr Tim Feeney, a world expert in this approach. The clinical intervention team of neuropsychologists, occupational therapists and speech pathologists is being led by Kate Gould. The research data collection is led by Amelia Hicks, who completes measures at four-monthly intervals during and for a year after completion of interventions. Study recruitment has been completed and participants waitlisted to receive therapy in the second year of the trial are commencing therapy. Qualitative studies are being conducted to evaluated the experience of the intervention by participants with ABI, their close others and the therapists delivering the intervention. A survey is also assessing attitudes and needs of clinicians working with this population.  The studies are being funded by ISCRR and the TAC.

Recent Publications:

Hicks, A. J., Gould, K. R., Hopwood, M., Kennardy, J., Krivinos, I., & Ponsford, J.L. (2017). Behaviours of Concern Following Moderate to Severe Traumatic Brain Injury in Individuals Living in the Community. Brain Injury, 31(10), 1-8.

Gould, K. R., Hicks, A. J., Ponsford, J. L., Hopwood, M., Kenardy, J., & Krivonos, I. (2017). The Lived Experience of Behaviours of Concern: A Qualitative Study of Men with Traumatic Brain Injury. Neurospsychological Rehabiliation, 1-19. Published online 10 April 2017.

Pharmacological treatment guidelines for neurobehavioural symptoms following TBI. Hopwood, M., Ponsford, J., Jayaram, M., Hicks, A., Clay, F., Batty, R.

Neurobehavioural symptoms (NBS) are common following traumatic brain injury (TBI) and contribute heavily to impaired quality of life, cost of care and carer burden. Pharmacotherapeutic management of NBS is inconsistent and frequently inadequate. The aim of this guideline development, funded by ISCRR, was to better inform the use of medications for the treatment and ongoing management of NBS post-TBI. A comprehensive systematic review of the literature was completed in 2017 to inform the content of the guidelines, and input was sought from a group of consumers and carers, and a team of experts from across Australian & New Zealand. Overall, there was a lack of high level evidence from well conducted randomized controlled trials and many studies did not report on safety. For the guideline, the majority of recommendations made were consensus based. Research based recommendations were made for amantadine in the treatment of agitation and aggression.

Recent Publications:

Hicks, A. J., Clay, F., Hopwood, M., Jayaram, M., Batty, R., & Ponsford, J. (2017). The Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post Traumatic Amnesia after Traumatic Brain Injury – Systematic Review and Meta-Analysis Protocol. JBI Database of Systematic Review and Implementation Reports. 15(12), 2890-2912. DOI: 10.11124/JBISRIR-2017-003430

Clay, F. Perry, L., Hicks, A., Oliver, R., Tufanaru, C., Jayaram, M., Ponsford, J., Hopwood M. (2017).  Pharmacotherapy for depression in adults who have sustained a traumatic brain injury: a systematic review protocol. Joanna Briggs Database of Systematic Reviews and Implementation Reports, 15(9), 2270-2286. DOI: 10.11124/JBISRIR-2016-003326.

Clay, F., Hicks, A.J. (co first author), Perry, L.J., Ponsford, J.L., Jayaram, M., Hopwood, M. Pharmacotherapy for the pseudobulbar affect in individuals who have sustained a traumatic brain injury: a systematic review protocol. The Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports. In Press, 2018. Accepted 13 April 2018.

Hicks, A.J., Clay, F.J., Hopwood, M., James, A.C., Jayaram, M., Batty, R., Perry, L.J., Ponsford, J.L. (in press). Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post Traumatic Amnesia after Traumatic Brain Injury – A Systematic Review. Journal of Neurotrauma. Accepted 15 June 2018.

Clay, F. Perry, L., Hicks, A., Oliver, R., Tufanaru, C., Jayaram, M., Ponsford, J., Hopwood M.   Kluver-Bucy syndrome following traumatic brain injury: A systematic synthesis of cases and review of pharmacological management from case reports in adolescents and adults. Journal of Neuropsychiatry and Clinical Neuroscience, May 2018.Accpeted pending minor revisions, 14 June 2018.

Safer Roads to Recovery: Assessing Readiness for Driving after TBI. R. Stolwyk, J. Charlton, J. Ponsford, M. Bedard, S.  Marshall, P. Ross.

More than two-thirds of TBI survivors return to driving. Despite this, limited research investigating driving performance following TBI has been conducted. Dr Pam Ross completed a retrospective analysis of factors predicting return to driving in a cohort of patients from Epworth’s driver rehabilitation program for her PhD. A further collaborative study was conducted in collaboration with the Monash University Accident Research Centre (MUARC) and researchers from the University of Ottawa and Lakehead University, Canada, and funded by the Victorian Neurotrauma Initiative and Ontario Neurotrauma Foundation. This study examined, objectively, the nature and causes of driving difficulties following TBI as a basis for developing more reliable and valid assessment procedures for readiness to return to driving and thereby improving the safety of drivers with TBI. DPsych student James Gooden also conducted a sub-study within this research program examining reduced self-awareness of driving performance following TBI. Key findings and achievement of this research program include:

  • Demonstrated an adapted version of the Driver Observation Scale (DOS) is a feasible and sensitive standardised driver assessment tool for use in TBI populations.
  • Identified common areas of driver performance strengths and weaknesses following TBI. We have shown that the far majority of TBI survivors successfully return to driving following driver assessment and rehabilitation.
  • Development and validation of the Brain Injury Driver Self Awareness Measure (BIDSAM). This is now being utilised within both clinical and research domains and has been translated into different languages. We have demonstrated that reduced self-awareness contributed to poor driving performance following TBI
  • Developed innovative methods to examine everyday driving behaviour of people with TBI using in-car recording devices.

Findings from this study will significantly contribute to a currently limited evidence-base available for rehabilitation clinicians assessing driver readiness. This research will guide the development of more sensitive driving evaluation procedures and more effective driving retraining programs. Following on from this, doctoral student Bleydy Dimech-Betancourt is conducting a pilot randomised controlled trial evaluating the efficacy of simulator driver re-training prior to on-road driver assessment, in improving driver self-efficacy and on-road assessment pass rates and reducing need for driving lessons.

Recent Publications:

Ross, P.E,, Ponsford, J.L., Di Stefano, M., & Spitz, G. (2015). Predictors of on-road driver performance following traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 96(3), 440-446.

Ross, P., Ponsford, J. L., Di Stefano, M., Charlton, J., & Spitz, G. (2016). On the road again after traumatic brain injury: Driver safety and behaviour following on-road assessment and rehabilitation. Disability and Rehabilitation, 38(10), 994-1005.

Ross, P., Di Stefano, M., Charlton, J., Spitz, G., & Ponsford, J., (2017).  Interventions for resuming driving after traumatic brain injury. Disability and Rehabilitation, Published online 27 January 2017.

Gooden, J.R., Ponsford, J., Charlton, J.L., Ross, P., Marshall, S., Gagnon, S., Bedard, M., & Stolwyk, R. Self-regulation upon return to driving after traumatic brain injury (2016). Neuropsychological Rehabilitation, 1-15. Accepted 9 November 2016.

Gooden, J.R., Ponsford, J., Charlton, J.L., Ross, P., Marshall, S., Gagnon, S., Bedard, M., & Stolwyk, R. (2017). Self-awareness and self-ratings of on-road driving performance after traumatic brain injury. Journal of Head Trauma Rehabilitation, published ahead of print, vol. 32, issue 1, p. E50-E59

Gooden, J.R., Ponsford, J., Charlton, J.L., Bedard, M., Marshall, S., Ross, P., Gagnon, S., & Stolwyk, R..(2017). The Development and Initial Validation of a New Tool to Measure Self-Awareness of Driving Ability, Australian Occupational Therapy Journal. 64(1), 33-40.

Stolwyk, R., Charlton, J.L., Ross, P., Bédard, M., Marshall, S., Gagnon, S., Gooden, J.R., &  Ponsford, J.L. (2018) Characterising On-Road Driving Performance Following Traumatic Brain Injury. Disability and Rehabilitation, Published online: 15 Jan 2018

Hua, P., Charlton, J.L., Ponsford, J.L. Gooden, J.R., Ross, P., Bedard, M. Marshall, S., Gagnon, S., Stolwyk, J.R.  (2018). Using Naturalistic Methods to Examine Real-world Driving Behaviour in Individuals with TBI upon Return to Driving: a Pilot Study. Journal of Head Trauma Rehabilitation.

A Comparison of Restorative and Compensatory Approaches to Memory Rehabilitation and Evaluation of the Use of TeleRehabilitation to Deliver Memory Strategy Training Following Stroke. R. Stolwyk, D. Wong, T. Withiel, D. Lawson, D. Cadilhac, J. Ponsford

Approximately half of all stroke survivors experience memory impairment, which significantly compromises functional independence and quality of life. Both restorative and compensatory approaches have been used to remediate memory difficulties post-stroke. However, evidence to support the effectiveness or cost efficiency of these approaches is limited. This study conducted by DPsych student, Toni Withiel in the Neurrehabilitation Clinic at the Monash Psychology Centre, with additional funding support from an internal Monash SPP seeding grant, was a randomized, controlled, phase II trial comparing the efficacy and efficiency of (a) restorative memory rehabilitation (LumosityTM computer program), (b) compensatory memory rehabilitation (memory skills group; Radford et al., 2010), and (c) waitlist control on functional memory goal attainment, neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use. Participants were 65 survivors of stroke. Outcome measures were completed at three time points: baseline, post intervention and at a six week follow up. Findings revealed that participants allocated to the MSG reported significantly greater attainment of memory goals and internal strategy use at a six week follow up relative to participants in CCT and WC conditions. Subjective accounts of each respective intervention were explored using a qualitative approach. A number of key barriers and facilitators to the success of memory rehabilitation were identified. Specifically, participants in the MSG highlighted the importance of the group experience in fostering a supported learning environment and described functional benefits associated with compensation training. By contrast, participants allocated to the CCT intervention described enjoyment of its game-like nature, yet reported frustration associated with game-specific characteristics and did not report everyday memory improvements. Finding from this study have inspired an expanding research program investigating memory rehabilitation following stroke:

  • With a grant from the Victorian Stroke Clinical Network, Dana Wong and Rene Stolwyk have collaborated with clinicians from Austin Health and Monash Health to implement memory rehabilitation groups within their networks. An evaluation of this implementation was shown to be both effective and cost-efficient, with the groups now successfully integrated into standard clinical practice. Based on this evidence, roll out of these memory rehabilitation groups throughout Victoria is ongoing.
  • DPsych student David Lawson is comparing the outcomes of memory strategy training delivered in person, with that delivered using telehealth techniques. This project is funded by the Stroke Foundation.
  • DPsych student Diana is currently running a randomised controlled trial investigating the whether training methods, such as Error-Based Learning are effective to train stroke survivors how to learn smartphone apps.
  • DPsych Felicity Evans is currently running a number of research trials investigating whether training strategies, including retrieval-based practice and wakeful rest, are effective at enhance learning and memory for stroke survivors with memory impairments.

Recent Publications:

Withiel, T.D., Sharp, V.L., Wong, D., Ponsford, J.L., Warren, N., Stolwyk, R.J. (in press). Understanding the Experience of Compensatory and Restorative Memory Rehabilitation: a Qualitative Study of Stroke Survivors. Neuropsychological Rehabilitation, Accepted 16 May, 2018.

Withiel, T., Stolwyk, R.J., Ponsford, J., Cadilhac, D., Wong, D. Effectiveness of a manualised group training intervention for memory impairment following stroke: A single case series. Paper submitted to Disability and Rehabilitation, May 2018.

Withiel, T., Wong, D., Ponsford, J., Cadilhac, D., Stolwyk, R. (in press). Feasibility and effectiveness of computerised cognitive training intervention for memory impairment following stroke: A single case series. Neuropsychological Rehabilitation. Accepted June 2018.

Withiel, T., Wong, D., Ponsford, J., Cadilhac, D., New, P., Mihaljcic, T., Stolwyk, R. A Comparison of Compensatory and Restorative Approaches to Memory Rehabilitation Following Stroke: A Phase II Randomised Controlled Trial. Paper submitted to Journal of Rehabilitation Medicine April 2017.

TeleNeuropsychology in Stroke Rehabilitation (TNSR). R. Stolwyk, J. Chapman, L. Arthurson, J. Kim, K. Bagot, J. Ponsford, B. Gardner., D. Cadilhac

In Australia, only 6% of rural and remote patients with stroke have access to psychological services. The aim of this project, funded by the Victorian Stroke Clinical Network, was to examine the potential for telehealth to improve patient access to psychology by developing, implementing and evaluating a pilot teleneuropsychology service delivered to Echuca Regional Health (ERH) from Monash University (MU). A range of patient neuropsychological assessment and rehabilitation services were adapted and developed for telehealth delivery. These included comprehensive neuropsychological assessments to assess patient cognition, and a secondary consultation process was developed whereby ERH medical, allied health and nursing clinicians could receive expert advice on how to manage patients with cognitive, mood or behavioural disturbance on the ward and/or in therapy sessions. Furthermore, an 8-session education program was delivered to ERH rehabilitation clinicians to build knowledge and confidence on how to manage patient psychological dysfunction. In addition, processes were developed to facilitate clinical neuropsychology attendance at team and family meetings using telehealth. The following are some key achievement and findings. Compared to a pre-implementation control period, during TNSR:

  • Cognitive and mood screening rates rose from 40 to 90% for cognition and 20 to 90%, improving ERH performance above national standards
  • The percentage of patients receiving comprehensive psychology input rose from 0% to 71%
  • Setting of goals for cognition rose from 20% to 40% and goals for mood rose from 10 to over 50%.
  • 89% of patients and 95% of clinicians reported being satisfied with their neuropsychology consultations.
  • From an economic evaluation perspective, preliminary simulations indicate neuropsychology services are more efficiently delivered via telehealth compared to a face-to-face, with teleneuropsychology costs approximately half of that compared to a face-to-face model of service provision. Preliminary analyses supported TNSR as potentially cost-effective compared to existing ERH services.

In recognition of the success of this pilot project Safer Care Victoria are providing further funding during 2018-2020 to examine scaling up of TNSR to 3 further rural Victorian stroke services. Furthermore, doctoral student Jodie Chapman is completing a study investigated the reliability and validity of conducting neuropsychological assessment via telehealth.

Alleviating Attentional Disturbances Following TBI. A. Dymowski, C. Willmott, J. Owens, J., J. Ponsford J. Olver

This study, led by Cathy Willmott and Alicia Dymowski, has investigated attentional deficits following TBI and identified slowed information processing speed as a core factor contributing to attentional problems after TBI. In an attempt to rehabilitate these difficulties, a randomised controlled trial of methylphenidate and a single-case series examining the effects of individualised strategy training beyond the effects of computerised training were conducted, with funding from the Epworth Research Institute. Recruitment into the RCT of methylphenidate, which continued over four years, proved highly problematic. Results of the study, published in Clinical Rehabilitation revealed no evidence in support of a significant impact of methylphenidate on attention and longer term outcome, but this may have reflected a lack of power in the study. Results of the single case intervention studies supported an individualised approach to rehabilitation to improve real world outcomes after brain injury. Jacquie Owens has studied the association between injury to white matter tracts and attentional disturbance following TBI in this cohort.

Recent Publications:

Dymowski, A.R., Owens, J.A., Ponsford, J.L., & Willmott, C. (2015). Speed of processing and strategic control of attention after traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 37(10), 1024-1035. DOI: 10.1080/13803395.2015.1074663.

Dymowski, A.R., Ponsford, J.L., Owens, J., Olver, J.H., Ponsford, M., & Willmott, C. (2017). The efficacy and safety of extended-release methylphenidate following traumatic brain injury: A randomised controlled pilot study. Clinical Rehabilitation, 31(6), 733-741. DOI: 10.1177/0269215516655590.

Dymowski, A.R., Ponsford, J.L., & Willmott, C. (2016). Cognitive training approaches to remediate attention and executive dysfunction after traumatic brain injury: A single case series. Neuropsychological Rehabilitation. 26(5-6), 866-894. DOI: 10.1080/09602011.2015.1102746.

Owens, J.A., Spitz, G., Ponsford, J.L., Dymowski, A.R., Ferris, N. Willmott, C. (2016). White matter integrity of the medial forebrain bundle and attention and working memory deficits following traumatic brain injury. Brain & Behavior, 7, e00608. doi: 10.1002/brb3.608

INCOG Guidelines for Cognitive Rehabilitation following Traumatic Brain Injury. P. Bragge, M. Bayley, M., J. Ponsford, Downing, R. Tate, L. Togher, D. Velikonja,

Ascognitive impairments represent the greatest impediment to participation following moderate-severe TBI, cognitive rehabilitation is vital. Jennie Ponsford was part of a group led by Mark Bayley and Peter Bragge, who developed guidelines for cognitive rehabilitation, entitled INCOG, published in the Journal of Head Trauma Rehabilitation in 2014. Little is known about current practice by therapists working with individuals with TBI.This study has continued under leadership of Marina Downing with two aims: (1) development of an audit tool to characterise the use of cognitive rehabilitation strategies during subacute rehabilitation from TBI; and (2) characterising current cognitive rehabilitation practices via an online survey of therapists engaged in rehabilitation in individuals with TBI.

Recent Publications:

Bragge, P., Pattuwage, L., Marshall, S., Pitt, V., Piccenna, L., Stergiou-Kita, M., Tate, R.L., Teasell, R., Wiseman-Hakes, C., Kua, A., Ponsford, J., Velikonja, D., & Bayley, M. (2014). Quality of guidelines for cognitive rehabilitation following traumatic brain injury. Journal of Head Trauma Rehabilitation, 29(4), 277-289. DOI: 10.1097/HTR.0000000000000066.

Bayley, M.T., Tate, R.,  Douglas, J.M., Turkstra, L.S., Ponsford, J., Stergiou-Kita, M., Kua, A., & Bragge, P. (2014). INCOG guidelines for cognitive rehabilitation following traumatic brain injury: Methods and overview.  Journal of Head Trauma Rehabilitation, 29(4), 290-306. DOI: 10.1097/HTR.0000000000000070.

Ponsford, J., Janzen, S., MacIntyre, A., Bayley, M., Velikonja, D., & Tate, R. (2014). INCOG Recommendations for management of cognition following TBI Part I: Posttraumatic amnesia/delirium. Journal of Head Trauma Rehabilitation, 29(4), 307-320. DOI: 10.1097/HTR.0000000000000074.

Ponsford, J., Bayley, M., Wiseman-Hakes, C., Togher, L., Velikonja, D., McIntyre, A., Janzen, S., & Tate, R. (2014) INCOG Recommendations for management of cognition following TBI Part II: Attention and information processing speed. Journal of Head Trauma Rehabilitation, 29(4), 321-337. DOI: 10.1097/HTR.0000000000000072.

Tate, R., Kennedy, M., Ponsford, J., Douglas, J., Velikonja, D.,  Bayley,M., & Stergiou-Kita, M. (2014). INCOG Recommendations for management of cognition following traumatic brain injury: Part III: Executive function and self-awareness. Journal of Head Trauma Rehabilitation, 29(4), 338-352. DOI: 10.1097/HTR.0000000000000068.

Togher, L., Wiseman-Hakes, C., Douglas, J., Stergiou-Kita, M., Ponsford, J., Teasell, R., Bayley, M., & Turkstra, L.S. (2014). INCOG Recommendations for management of cognition following traumatic brain injury: Part IV. Cognitive communication. Journal of Head Trauma Rehabilitation, 29(4), 353-368. DOI: 10.1097/HTR.0000000000000071.

Velikonja, D., Tate, R., Ponsford, J.,McIntyre, A., Janzen, S., & Bayley, M. (2014). INCOG Recommendations for management of cognition following traumatic brain injury, Part V: Memory. Journal of Head Trauma Rehabilitation, 29(4), 369-386. DOI: 10.1097/HTR.0000000000000069.

Downing, M., Bragge, P., Ponsford, J., Cognitive rehabilitation following traumatic brain injury: A survey of current practice in Australia. Paper submitted to Brain Impairment, December 2017. Revised and resubmitted May 2018.

Singing my story: Negotiating identities through therapeutic songwriting for people with acquired neurological injuries. F. Baker, J. Tamplin, N. Rickard, J Ponsford, R. MacDonald.

This study funded for 2015-17 by an ARC Discovery grant has investigated the efficacy of therapeutic songwriting interventions in enhancing self-efficacy, the reconstruction of a meaningful identity, and psychological well-being for individuals with neurological injury, specifically stroke and spinal cord injury. Data are in the process of being analysed and findings will be submitted for publication.

Recent Publications:

Baker, FA, Tamplin, J., MacDonald, R., Ponsford, J., Roddy, C., & Rickard, N. (2017). Exploring the past, present, and future self through narrative songwriting: A lyric analysis of songs composed by people with acquired neurodisability in an inpatient rehabilitation program. Journal of Music Therapy, 54(1), 35-54.

Baker, F. Tamplin, J. New, P., Ponsford, J., Rickard, N. Meaning making process and recovery journeys explored through songwriting in early neurorehabilitation: Exploring the perspectives of participants of their self-composed songs through the interpretative phenomenological analysis. Paper submitted to Frontiers in Psychology, March 2018.

Cognitive Rehabilitation in Individuals with Schizophrenia. S. Bryce, J. Ponsford, S. Lee, S. Rossell

Cognitive impairments are marked in the majority of individuals diagnosed with schizophrenia. These impairments are one of the primary determinants of poor psychosocial outcomes, including work or social engagement and quality of life. Pharmacological interventions are relatively ineffective in improving cognitive symptoms. In recent years cognitive remediation training has been applied to improve cognition in people with schizophrenia. Meta-analytic reviews have concluded that cognitive remedial training produces small-to-moderate improvements in neurocognition and functional outcomes, with some evidence of small improvements in symptoms. However generalisation to real-world outcomes is limited in the absence of adjunctive therapies and is frequently not measured. Moreover variation among cognitive remediation models and programs is too great to allow identification of key elements. Some programs focus on separate cognitive functions, whilst others remediate core functions underpinning higher cognitive functions, the latter being termed the neuroscience-based approach The current project, led by doctoral student Shayden Bryce, aimed to: 1) examine the impact of 10-week computer-assisted, drill-and-strategy CR on cognition, everyday and social self-efficacy, and independent living skills relative to a computer game (CG) control; 2) explore the impact of task-specific intrinsic motivation on session attendance and training outcomes; and 3) qualitatively compare the lived experience of CR and CG in an assessor-blinded, randomized-controlled trial. CR completers demonstrated more improved greater global cognitive test performances at end-treatment than controls, which was sustained at three-months follow up. Both CR and CG showed improved self-efficacy. No changes in independent living skills were observed in either group. Over 60% of study completers demonstrated a reliable improvement in at least one cognitive domain at end-intervention. Only early perceptions of task value predicted session attendance when considered alongside baseline cognitive and psychiatric symptomatology. Positive changes in interest and value during the intervention increased the odds of reliable cognitive improvement. Qualitatively, study completers described CR and CG positively with similar rates reporting at least one perceived improvement. CR completers were, however, more likely to describe greater memory and community function, having learned new skills, and opportunities to overcome challenge.

Recent Publications:

Bryce, S., Sloan, E., Lee, S., Ponsford, J., & Rossell, S. (2016). Cognitive remediation in schizophrenia: A methodological appraisal of systematic reviews and meta-analyses. Journal of Psychiatric Research, 75, 91-106.

Bryce, S., Rossell, S, Lee, S, Lawrence, R, Tan, E., Carruthers, S.,& Ponsford, J. (2018). Neurocognitive and self-efficacy benefits of cognitive remediation in schizophrenia: A randomized controlled trial. Journal of the International Neuropsychological Society, 23, 1–14, doi:10.1017/S1355617717001369.

Bryce, S., Warren, N., Ponsford, J., Rossell, S. & Lee, S. (in press). Understanding the lived experience of cognitive remediation in schizophrenia: A qualitative comparison with an active control. Psychiatric Rehabilitation Journal. Accepted 12 April 2018.

Bryce, S.D., Lee, S.J., Ponsford, J.L, Lawrence, R.J., Tan, E.J., Rossell, S.L.(in press).  The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia. Schizophrenia Research, Accepted 11 June 2018.

Headstrong: Multi-family groups for traumatic brain injury. G Couchman, J Ponsford, A.Kelly, G. McMahon

This clinical research program, funded by the Institute for Safety Compensation Recovery Research, studied the impact of multi-family group intervention on the social and psychological functioning of people with traumatic brain injury and their care givers. The study found gains in social integration and family functioning, as rated by caregivers. Qualitatively, individuals with brain injury and their family members reported gaining valuable knowledge, but mostly valued the opportunity to make a connection with others with similar experiences and feel a sense of acceptance that they did not feel in the broader community.

Recent Publications:

Kelly, A., Ponsford, J., & Couchman, G. (2013). Impact of a family-focused intervention on self concept after traumatic brain injury. Neuropsychological Rehabilitation, 23(4): 563-579. DOI: 10.1080/09602011.2013.795903.

Ponsford, J., Kelly, A., & Couchman, G. (2014). Self-concept and self-esteem after acquired brain injury: A control group comparison. Brain Injury, 28(2):146-154. DOI: 10.3109/02699052.2013.859733.

Couchman, G., McMahon, G., Kelly, A., & Ponsford, J. (2014) A new kind of normal: Qualitative accounts of Multifamily Group Therapy for acquired brain injury. Neuropsychological Rehabilitation, 24(6): 809-832. DOI:10.1080/09602011.2014.912957.

Mild TBI/Concussion

Outcomes Following Mild TBI in Young Children. C. Bernard, J. Ponsford, A. McKinlay, R. Testa, & D. Krieser

Mild traumatic brain injury (mTBI), or concussion, is extremely common during childhood with notable peaks of incidence in pre-school children. Despite this, few studies have examined the nature and frequency of post-concussive symptoms (PCS) in children younger than eight. There are additional challenges of PCS assessment in younger children which are yet to be fully considered. In order to address these gaps, this study adopted a semi-structured interview approach to PCS assessment with the aims of  1) identifying which PCS differentiated children with mTBI from trauma controls in the acute stages of recovery, and whether these differed among pre-school and school-aged children, 2) examining the frequency and nature of PCS and behavioural outcomes, across a three month post-injury period; and 3) investigating the relative influence of child, family, and injury factors on both acute and persistent PCS. Participants were 101 parents of children aged 2 – 12 who presented to a hospital Emergency Department between November 2012 and February 2015, with either mTBI (n = 46) or superficial injury to the body (trauma control (TC), n = 55)).

Adopting a prospective longitudinal design, PCS were assessed in the acute stage post-injury (<72 hours) and re-assessed at one week, one month, two months, and three months post-injury. Children’s behaviour, sleep, and levels of parental stress were also examined at baseline and re-assessed across the post-injury period.  PCS burden peaked in the acute stages post-injury, where children presented with a different profile of PCS following mTBI from that evident in children with superficial bodily injuries. In most children, PCS reduced significantly from 1 week to 1 month post-injury, but persisted in a greater percentage of children with mTBI (18%) than trauma controls (5%) up to 3 months post-injury. These were characterised mostly by behavioural and sleep-related symptoms. Injury characteristics remained the strongest predictors of PCS across the post-injury period, but their association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Early intervention which addresses family stress, in addition to providing education and recommendations for cognitive/physical rest, may minimise longer-term complications in this population.

Recent Publications:

Bernard, C., McKinlay, A., Krieser, D., Testa, R., & Ponsford, J. (2017) Acute post-concussive symptoms in young children, Brain Injury, 31:11, 1414-1421, DOI: 10.1080/02699052.2017.1350999.

Bernard, C., Ponsford, J., McKinlay, A., Krieser, D., & McKenzie, D. (2016).  Predictors of post-concussive symptoms in young children: Injury versus non-injury related factors Journal of the International Neuropsychological Society, 22(8):793-803. doi: 10.1017/S1355617716000709

Bernard, C., McKinlay, A., Krieser, D., Testa, R., & Ponsford, J. (2017). Do concussive symptoms really resolve in young children? Journal of Head Trauma Rehabilitation, 32(6), 413-424. DOI: 10.1097/HTR.0000000000000298.

Towards better detection and management of Sports Concussion in Australia. C Willmott, D Mitra, A. McIntosh, T. Howard

Dr Cathy Willmott is a Chief Investigator on this 2017-2019 $200,000 NHMRC Partnership Grant, in partnership with funding from the Australian Football League and experts including Professor Biswadev Mitra from the National Trauma Research Institute (NTRI) and A/Prof Andrew McIntosh. 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. This alliance brings together an outstanding multi-disciplinary team of brain injury researchers in neuropsychology, neurosurgery, biomechanics, and trauma systems, the Australian Football League (AFL) to improve processes for the measurement and management of concussion in sport, and the AFL aims 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. This program of research has the following students:

In 2018 Psychology Honours student Olivia Rossi, is studying the relationship between baseline mood symptomatology and SCAT3 symptom report and cognitive performance.

In 2017, Mr Jack Nguyen, Psychology Honours student studied metrics of head impacts in the Australian Football League compared to other contact sports.

Jonathan Reyes, Doctor of Psychology (Clin Neuro). Is working under cathy Willmott’s supervision on a project entitled “Towards better detection and management of sports concussion in Australia. “

In 2016 Psychology Honours student Ashley Paxton examined the effects of exercise and practice on the SCAT-3 in non-contact sport athletes.

Padded headgear in youth football: what is the evidence? C Willmott, D. Mitra

Dr Catherine Wilmott, in conjunction with experts including Professor Biswadev Mitra from the National Trauma Research Institute (NTRI), a Department of Alfred Health and Monash University, and with support from the AFL, has been awarded a $141,000 grant from The Walter Thomas Cottman Charitable Trust. The support is to evaluate attitudes towards the use of headgear, and the efficacy of headgear in the prevention of sports concussion across levels of junior Australian football.

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. Over the next three years, the proposed research program will 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. The program has the following student:

Jennifer Makovec-Knight is a Doctor of Psychology (Clin Neuro) student.  Since 2017 she has been working on a thesis entitled “Padded headgear in youth football: what is the evidence?”

Recent Publications:

Willmott, C., McIntosh, A.S., Howard, T.,  Mitra, B., Dimech-Betancourt, B.,  Donovan, J. & Rosenfeld, J.V. Head impact biomechanics in amateur Australian football players and association with SCAT3. (2017). Journal of Science & Medicine in Sport. https://doi.org/10.1016/j.jsams.2017.09.591.

Brennan, J. H., Mitra, B., Synnot, A., McKenzie, J., Willmott, C., McIntosh, A. S., Maller, J. J., & Rosenfeld, J. V. (2016). Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Medicine, 1-10. doi: 0.1007/s40279-016-0582-1.

Media:

2016 NFL Fantasy 'n Insight with The Aussie Guys. Ep 157: Concussion - An interview with Dr Catherine Willmott.  Available at: https://audioboom.com/posts/4293046-ep-157-concussion-an-interview-with-dr-catherine-willmott

Link to ABC Radio National podcast 2017: http://mpegmedia.abc.net.au/rn/podcast/2017/04/sra_20170423_0905.mp3

Link to Channel 7 News program re: sports concussion study 22 May 2017: https://au.news.yahoo.com/video/watch/35596583/major-concussion-study-could-change-footy-forever-thanks-to-melbourne-scientists/

Our work was mentioned in a Herald Sun article on 3rd February 2017 and Sydney Morning Herald & The Age 10th February 2018: “Greater risk of concussion for women, experts warn as codes beckon women to contact sports”

Net Trial-Evaluating Intervention Delivery and Outcome Following Mild Traumatic Brain Injury. S.Green, M. Bosch, J. Ponsford, S. Nguyen, M. Downing, R. Gruen,

The aim of this knowledge translation project conducted in collaboration with Prof. Russell Gruen and Prof. Sally Green from the NTRI, as part of a program grant funded by the VNI, was to evaluate the implementation of procedures to enhance screening of patients with mild TBI in a cluster randomised trial involving 30 hospital emergency departments around Australia. Specifically, the trial evaluated implementation of use of the Abbreviated Westmead PTA scale to screen patients, use of guidelines to guide decisions regarding CT scanning and provision of an information booklet to patients, which was originally developed and evaluated by Prof Jennie Ponsford. As an additional component of this study, the MERRC team has conducted a telephone follow-up study involving 400 patients who have presented to an ED with mild TBI to investigate whether they have continuing symptoms or other difficulties and whether and how they found the information booklet useful. 17 emergency departments were randomised to the control group and 14 to the implementation intervention. 1943 patients were included in the chart audit. Patients from EDs randomised to the intervention group compared to those in the control group were more likely to have been appropriately assessed for PTA and to have had at least one administration of the validated PTA tool or an assessment for memory where the physician used clinical questions. The odds of compliance with recommendations for CT scanning and provision of written patient discharge information were not statistically significantly different between groups. When outcomes were combined, patients from EDs that were randomised to the intervention compared to the control group were more likely to have had ‘appropriate management’, both based on PTA and provision of written patient.

Recent Publications:

Bosch, M., McKenzie, J.E., Ponsford, J.,  Turner, S., Chau, M.,  Tavender, E.J.., Knott, J.C., Gruen, R.L., Francis, J.J., Brennan, S.E., Pearce, A., O’Connor, D.A., Mortimer, D., Grimshaw, J.M., Rosenfeld, J.V., Meares, S., Smyth, T., Michie, S., & Green, S.E.  Evaluation of a Targeted, Theory-Informed Implementation Intervention Designed to Increase Uptake of Emergency Management Recommendations Regarding Adult Patients with Mild Traumatic Brain Injury: Results of the NET Cluster Randomised Trial. Paper submitted to Implementation Science June 2018.

Mortimer, D., Bosch, M., McKenzie, J.E., Turner, S., Chau, M., Knott, J., Ponsford, J. Gruen, R.L., Green, S.E.  Economic evaluation of the NET intervention for management of mild head injury in hospital emergency departments. Paper submitted to Implementation Science, June 2018.

Ponsford, J., Nguyen, S., Downing, M., Bosch, M., McKenzie, J.E., Turner, S. Chau,M., Mortimer, D., Gruen, R.L., Knott, J., &  Green, S.   Factors associated with persistent post-concussion symptoms following mild traumatic brain injury in adults.  Paper submitted to Journal of Rehabilitation Medicine, April 2018

Trauma Studies

Comparison of long-term outcomes following traumatic injury: What is the unique experience for individuals with brain injury compared with orthopaedic injury?  J. Dahm, J. Ponsford.

The aim of this study was to seek greater understanding of the subjective experience following TBI compared with traumatic orthopaedic injury (TOI), and hence identify aspects unique to individuals with TBI. This prospective study examined and compared the evolution of functional outcome, employment status and psychological adjustment and its predictors in a group of TBI compared to TOI over ten years after injury.

Recent Publications:

Dahm, J. & Ponsford, J. (2015). Comparison of long-term outcomes following traumatic injury: What is the unique experience for those with brain injury compared with orthopaedic injury? Injury, 46(1), 142-149.

Dahm, J. & Ponsford, J. (2015). Long-term employment outcomes following traumatic brain injury and orthopaedic trauma: A ten-year prospective study. Journal of Rehabilitation Medicine, 47(10), 932-940.

Dahm, J. & Ponsford, J. (2015). Predictors of global functioning and employment 10 years following traumatic brain injury compared with orthopaedic injury. Brain Injury, 29(13-14), 1539-1546.

The relationship between compensation, recovery and chronic pain following a motor vehicle accident. M. Giummarra, S. Gibson, J. Ponsford, P. Cameron, J. Fielding, P. Jennings, L. Ioannou, N. Georgiou-Karistianis

This ARC-funded study conducted in collaboration with TAC completed a systematic review of the impact of compensation status on recovery from trauma, and recruited trauma survivors form the Victorian State Trauma Registry to complete measures with the aim of examining predictors of chronic pain and poor recovery following trauma, with a focus on the potential role of compensation status and fault attribution. Numerous publications have been produced.

Recent Publications:

Giummarra, M.J., Ioannou, L., Ponsford, J., Cameron, P., Jennings, P.A., .Gibson, S.J., & Georgiou-Karistianis, N. (2016). Chronic pain following motor vehicle collision: A systematic review of outcomes associated with seeking or receiving compensation. Clinical Journal of Pain, 32(9):817-27. DOI: 10.1097/AJP.0000000000000342.

Ioannou, L., Braaf, S., Cameron, P., Gibson,S.J., Ponsford, J., Jennings, P.A., Arnold, C.A., Georgiou-Karistianis, N., & Giummarra, M.J.  (2016). Compensation system experience in the first 12-months after road and workplace injury in Victoria, Australia. Psychological Injury and Law, 9(4), 376–389. DOI 10.1007/s12207-016-9275-1

Giummarra, M. J., Baker, K. S., Ioannou, L., Gwini, S. M., Gibson, S. J., Arnold, C. A., ... & Cameron, P. (2017). Associations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study. BMJ open, 7(10), e017350. DOI: 10.1136/bmjopen-2017-017350.

Ioannou, L. J., Cameron, P. A., Gibson, S. J., Gabbe, B. J., Ponsford, J., Jennings, P. A., ... & Giummarra, M. J. (2017). Traumatic injury and perceived injustice: Fault attributions matter in a “no-fault” compensation state. PloS One, 12(6), e0178894. DOI: 10.1371/journal.pone.0178894

Giummarra, M. J., Casey, S. L., Devlin, A., Ioannou, L. J., Gibson, S. J., Georgiou-Karistianis, N., ... & Ponsford, J. (2017). Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic injury. Pain Reports, 2(5), e622. DOI: 10.1097/PR9.0000000000000622

Ioannou, L., Cameron, P., Gibson, S.J., Ponsford, J., Jennings, P.A., Georgiou-Karistianis, N., Giumarra, M.J. (in press). Financial and recovery worry one year after traumatic injury: A prognostic, registry-based cohort study. Injury. Accepted 14 March 2018.

Giummarra, M.J., Baker, K., Ioannou, L., Hassani-Mahmooei, B., Gibson, S.J., Collie, A., Ponsford, J., Cameron, P., Georgiou-Karistianis, N., Gabbe, B.  Prognostic role of demographic, injury and claim factors in the persistence of disabling pain and clinically elevated anxiety, depression or PTSD 12-months after compensable injury. Paper submitted to Pain, May 2017

Outcomes after serious injury: What is the trajectory of recovery and how do priorities for treatment and disability services change over time? B. Gabbe, P. Cameron, J. Harrison, R. Lyons, J. Ponsford, A. Collie, S. Ameritunga.

This population-based project, funded by an NHMRC Project grant, describes the long term consequences of injury and recovery experiences of more than 2500 seriously injured patients recruited into the Victorian State Trauma Registry. The study has used quantitative and qualitative methods to provide a comprehensive overview of patient outcomes and experiences in the first 5-years after traumatic injury. The results of this study are providing unique insights into patient experiences with recovery, including barriers and facilitators to recovery, and patient perceptions of the care provided, thereby identifying unmet needs and potential improvements in the delivery and care of services to survivors of serious injury.

Recent Publications:

Gabbe, B.J., Simpson, P.M., Harrison, J.E., Lyons, R.A., Ameritunga, S., Ponsford, J., Fitzgerald, M., Judson, R., Collie, A., & Cameron, P.A. (2016).  Return to work and functional outcomes after major trauma: Who recovers, when and how well? Annals of Surgery, 263(4), 623-632. DOI: 10.1097/SLA.0000000000001564

Gabbe, B.J., Cameron, P.A., Ponsford, J., Lyons, R.A., Fitzgerald, M., Judson, R.,Teague, W.,  Braaf, S., Nunn, A., Ameratunga, S., Harrison, J.E. (2017). Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study. PLoS Med, 2017. 14(7): p. e1002322.

Collie, A., Simpson, P.M., Cameron, P.A., Ameritunga, S., Ponsford, J., Lyons, R.A., Fitzgerald, M., Judson, R., Teague, W., Braaf, S., Nunn, A., Harrison, J.E, Gabbe, B. (2018). Patterns and predictors of return to work after major trauma: A prospective population based registry study. Annals of Surgery, 2018 Jan 16. doi: 10.1097/SLA.0000000000002666. [Epub ahead of print].

Braaf, S., Beck, B., Callaway, L., Ponsford, J., & Gabbe, B. (2018) The residential status of working age adults following severe Traumatic Brain Injury. Brain Impairment, https://doi.org/10.1017/BrImp.2018.3 Accepted 9 March 2018.

Braaf, S., Ameritunga, S., Christie, N., Teague, W., Ponsford, J., Cameron, P.A., Gabbe, B.  Care coordination: experiences of people with traumatic brain injury and their family members in the 4-years after injury. Paper submitted to Brain Injury September, 2017. Revised and resubmitted June 2018.

ICU Recovery Study

This study, conducted in collaboration with the Alfred trauma ICU team examined outcome six months after admission to intensive care. It identified significant levels of continuing disability.

Hodgson, C, Udy, A., Bailey, M.., Barrett, J.,Bellomo, R.,   Bucknall, T., Gabbe, B., Higgins, A., Hunt-Smith, J., Murray, L.J., Myles, P.S., Pilcher, D.V., Ponsford, J., , Walker, CS., Young, M.E., Iwashyna, T.J., Cooper, D.J., (2017). The impact of disability in survivors of critical illness.  Intensive Care Medicine, 43(7), 992–1001.

Research Collaborations

Transport Accident Commission

Our most long-standing and productive industry partnership in research has been with the Transport Accident Commission, which has funded MERRC’s Longitudinal Head Injury Outcome Study since 1995. MERRC researchers meet with the TAC Steering Committee, for the project, chaired by David Attwood, several times a year, presenting findings and applying them to enhance TAC’s services, whilst taking direction for future studies and analyses. The research has thereby contributed to TAC policy and practice over many years.

NHMRC Centre for Excellence in TBI Psychosocial Rehabilitation

Jennie Ponsford is part of a team of chief investigators who have been the recipients of an NHMRC Centre of research Excellence in in Traumatic Brain Injury Rehabilitation grant, entitled the CRE in Traumatic Brain Injury Psychosocial rehabilitation: Breaking down barriers for social reintegration has an overarching aim to break down the barriers that currently prevent people with TBI returning to the community. It has embraced basic research into remediation for emotional, social and communication disorders through to evaluation of clinical techniques to improve participation, focusing on self-competency, i.e., fatigue, mood, self-awareness and self-regulation and social competency, i.e. speech, social cognition, social skills and communication. Each member of the team is expert in different facets of remediation research. Professor Skye McDonald, who leads the team, is a neuropsychologist and world leader in the assessment and remediation of social cognition and communication disorders following TBI. Professor Vicki Anderson is a pediatric neuropsychologist with internationally recognised expertise in models of social function and interventions post child TBI. Professor Jennie Ponsford is a world renowned clinical neuropsychologist for research into evidence-based management of mild and moderate-severe TBI, longitudinal outcomes and predictors. Professor Robyn Tate is a clinical neuropsychologist with an international profile in rehabilitation and outcome evaluation following TBI. Professor Leanne Togher is a world renowned speech pathologist for her work in communication and adult TBI. Dr Angela Morgan is a speech pathologist whose internationally acclaimed research is focused on new discoveries in genes, brain and behaviour associated with childhood communication disorders. Dr Jennifer Fleming is an occupational therapist with expertise in the assessment and rehabilitation of awareness and metacognitive skills. Dr Tamara Ownsworth is a clinical neuropsychologist internationally recognised for work on the rehabilitation of metacognitive impairments after TBI. Jacinta Douglas has combined skills in speech pathology and clinical neuropsychology research, underpinned by 30 years of clinical experience in TBI.

This CRE has provided a platform to tackle psychosocial deficits on a number of coordinated fronts addressing psychosocial deficits from basic impairment through to participation, focusing on self competency, i.e., fatigue, mood, self-awareness and self-regulation and social competency, i.e. speech, social cognition, social skills and communication. All CRE researchers are engaged in translational clinical research that has a multi-disciplinary focus in contrast to the way in which (discipline specific) training of clinicians occurs. The CRE has been a pivotal interface to translate research to clinical practice. It has provided the structure and support for research training for clinicians from allied health professions via scholarships, postdocs, websites, meetings, mentoring and across-site training. The CRE has capitalised on the internationally recognised expertise and funding of its members, enhancing Australia’s profile in improving TBI outcomes.

Monash Alfred Injury Network

MERRC is affiliated with the Monash Alfred Injury Network (MAIN), which is a collaborative partnership between Monash University and Alfred Health. MAIN focuses on injury prevention, injury management and recovery from injury and trauma. It is chaired by Professor Peter Cameron.

Australian Football League

Catherine Willmott has forged a successful partnership with the Australian Football League for studies of concussion in footballers.

Victorian Stroke Clinical Network

Rene Stolwyk and Dana Wong have forged a relationship with the Victorian Stroke Clinical Network to deliver memory strategy interventions in the Monash and Austin Health Networks, in collaboration with Dr Sandy Grayson

Department of Health

Rene Stolwyk is working with the Department of Health to deliver psychology services to regional areas in Victoria, including Echuca, via telehealth.

Other collaborations:

An NHMRC-funded grant is funding a collaborative project headed by Prof Chris Rowe and Dr Paul McCrory from The Florey, Dr Malcolm Hopwood and Dr Meaghan O’Donnell from the University of Melbourne in a study examining the association of traumatic brain injury with dementia.

Jennie Ponsford and Marina Downing have collaborated with A/Prof Peter Bragge from Monash University and Dr Mark Bayley from Toronto, as well as Prof Robyn Tate, Prof Leanne Togher, Dr Diana Velikonja and Prof Jacinta Douglas in the development of guidelines  in Cognitive Rehabilitation following TBI.

Collaboration has also been developed with A/Professor Meaghan O’Donnell from the Australian Centre for Post-Traumatic Mental Health and Dr Nicole Lee towards the development of interventions studies for psychological disorders in individuals with traumatic brain injury.

The Centre also has a close collaborative relationship with Dr Richard O’Sullivan the Director of Magnetic Resonance Imaging (MRI) at Epworth Hospital, who contributes to research on imaging following traumatic brain injury. Collaborations have been forged with Professor Erin Bigler of Brigham Young University in Utah, USA, and with A/Prof Matthew Mundy from the School of Psychological Sciences on studies of the neurobiology of cognitive impairments following traumatic brain injury.

Research on sleep disorders and  their treatment is carried out in collaboration with Professor Shantha Rajaratnam in the School of Psychological Sciences at Monash University, Associate Professor Steven Lockley of Harvard and Brigham Young University in Boston and with members of staff from the Monash Sleep and Circadian Rhythm Centre

A collaboration with the Dr Judith Charlton from the Monash University Accident Research Centre and Drs Michel Bedard and Shawn Marshall from the University of Ottawa has resulted in a collaborative project entitled:  Safer Roads to Recovery: Assessing Readiness for Driving after Traumatic Brain Injury, funded by the Victorian Neurotrauma Foundation and Ontario Neurotrauma Foundation.

A collaboration has been forged with Professor Mark Sherer and A/Prof Angelle Sander from the University of Houston, USA, to conduct a study identifying patterns of outcome following TBI. This study was funded in part by the US Department of Education and our work on this is now funded by TAC.

The centre is working with US TBI researchers from Craig Hospital in Denver, Dr Cynthia Harrison-Felix, Dr Jessica Ketchum and well as Dr John Corrigan and to conduct a comparison of outcomes from the MERRC database with those from the Model Systems project in the USA.

Another comparative predictive study is underway in collaboration with Dr William Walker and Dr Jennifer Marwitz as part of an NIH funded study.

MERRC is also actively collaborating with Prof Carolyn Van Heugten and her students from the University of Maastricht on studies of fatigue and sleep disturbance and fear avoidance in mild TBI.

Jennie Ponsford is collaborating with researchers from Suunaas Rehabilitation Hospital in Norway, Professors Marianne Lovestad and Nada Andelic on studies of fatigue and return to employment following traumatic brain injury.