Tookit A

This project was undertaken by Rebecca Harris, Project Officer, GMTT Brain Injury Rehabilitation Directorate.

The members of the Paediatric Reference Group from the GMTT Brain Injury Rehabilitation Directorate are acknowledged for their expertise, advice and contributions to the project. The members included;

• Dr. Adeline Hodgkinson: Director, GMTT Brain Injury Rehabilitation Directorate
  
• Gaurav Tandon: Program Manager, GMTT Brain Injury Rehabilitation Directorate
  
• Dr. Stuart Browne: Staff Specialist, Brain Injury Rehabilitation Unit, Royal Rehabilitation Centre, Sydney
  
• Dr. Kath McCathy: Consultant in Rehabilitation Medicine, Outreach Team Leader, Brain Injury Rehabilitation Unit, Westmead Hospital
  
• Annabell Gibson: Manager, North Coast Head Injury Service • Helene Chew: Coordinator, Brain Injury Service, Children’s Hospital Westmead
  
• Miriam Poole: Case Manager, Brain Injury Rehabilitation Program, Sydney Children’s Hospital, Randwick
  
• Sian Routley: Case Manager, Brain Injury Rehabilitation Program, Sydney Children’s Hospital, Randwick.
  
• Karen Williams: Coordinator, Brain Injury Rehabilitation team, John Hunter Children’s Hospital, Newcastle
  
• Dianne Martin: Senior Case Manager, Brain Injury Rehabilitation Unit, Liverpool Hospital
  
• Thelma Osoteo: Community Team Coordinator, Brain Injury Rehabilitation Unit, Liverpool Hospital
  
• Dr Jenny Ault: Director, Brain Injury Service, Children’s Hospital Westmead
  
• Former member of the Paediatric Reference Group, Donna Carmichael: Co-ordinator, Brain Injury Rehabilitation Program, Sydney Children’s Hospital, Randwick.

Thanks are also given to other individuals who also work within Brain Injury Rehabilitation Services through out NSW.

These individuals have all contributed their knowledge to this project:

• Irena Gordon: Manager, Illawarra Brain Injury Service
  
• Margaret McPherson: Manager, New England Brain Injury Rehabilitation Service
  
• Robert van Dartel: Manager, Dubbo Brain Injury Rehabilitation Unit
  
• Lyndall Ross: Acting manager, Mid Western Brain Injury Rehabilitation Unit
  
• Val Tyler: Paediatric Co-ordinator, Southern Area Brain Injury Service
  
• Phillipa McRae, Head to Work Coordinator, Brain Injury Rehabilitation Unit, Liverpool Hospital

A special thank you is given to Wendy Moore from the South West Brain Injury Rehabilitation Service, Albury and Robert Parker, Outreach Worker, South West Brain Injury Rehabilitation Service, Albury for their contributions to the information sheets contained within the folder.

The professionals within the Brain Injury Services in NSW are acknowledged for their insight, knowledge and participation in providing valuable feedback into the transition process and where improvements are required.

Finally, grateful acknowledgement is given to the twelve young people and their parents who participated in the feedback survey.

Background

In 2004 the New South Wales Greater Metropolitan Transition Taskforce’s Brain Injury Rehabilitation Directorate initiated a project to explore the issues surrounding transition for young people with a brain injury moving from paediatric to adult services.

The Paediatric Reference Group, within the Brain Injury Rehabilitation Directorate, had identified that staff at the brain injury units across NSW recognised that transition could be improved for young people and their families.

The paediatric reference group wanted to examine how transition was undertaken in the different units throughout NSW, undertake a literature review and gain feedback from staff and young people and their families who had recently undertaken transition.

The outcome of this investigation and analysis was to develop a tool to help young people and their families navigate their way through gaining more independence and moving from school and paediatric services to adult services.

It was identified that for transition to be successful a young person needs the opportunity to talk through many areas of their life. Areas such as education, training and employment, living skills, recreation and leisure activities, friendships and relationships, living arrangements and financial issues need to be discussed.

The tool that was to be developed would have to encompass this wide variety of topics, if it were to assist in making transition more successful for young people with a brain injury.

It was considered necessary that the tool had to be youth friendly, easy to read, relevant to young people and also provide some guidance to the young person’s family. It needed to be able to help young people consider the individual areas within their life, work through their goals and gain skills in these areas throughout the transition process and in the years to follow. The tool had to be relevant to all young people throughout NSW, both those that live in the city and in rural areas.

An information folder for young people with a brain injury going through transition seemed to fit all these requirements. Hence, the information folder, ‘The Next Step – Transition from Children’s Services to the Adult World’ was developed. The Greater Metropolitan Transition Taskforce has been reconvened as The Greater Metropolitan Clinicians’ Taskforce

Toolkit B

The Kit was developed for the Brain Injury Rehabilitation Unit (SWSAHS) by Belinda Shepherd, Occupational Therapist and Barbara Strettles, Residential Services Manager, BIRU (SWSAHS).

Funding was provided by the Motor Accident Authority of New South Wales to the Brain Injury Rehabilitation Unit (BIRU) (SWSAHS) for the development of this Kit.

People with a brain injury, families and service providers were involved in the development and evaluation of the Kit. People involved in the Kit's development included:

• Cheree Martin-Roberts, Clinical Psychologist, BIRU (SWSAHS)
  
• Kim Ferry, Neuropsychologist, BIRU (SWSAHS)
  
• Rosie Meury, Diane Lamont & Daniel Daepoli, Occupational Therapists, BIRU (SWSAHS)
  
• Shannon Aitken, Speech Pathologist, BIRU (SWSAHS)
  
• Anne Mosely, Physiotherapist, BIRU (SWSAHS)
  
• Grahame Simpson, Social Worker, BIRU (SWSAHS)
  
• Sue Moffat, Wareemba Community Living, Ine.

A special thanks to people involved in the Kit's review, who included:

• Jenny, Gordon and Scott McVicar
  
• Helen Anderson
  
• Staff from Southern Cross Community Healthcare
  
• Staff from Wareemba Community Living, Inc.
  
• Residential Care Workers in the Transitional Living Unit and Camden Respite Service, BIRU (SWSAHS)

A special thanks to members of the Reference Group for their ongoing support, creativity and direction:

• Trevor Parmenter (Centre for Research and Disabilities),
  
• Sue Moffat (Wareemba Community Living),
  
• Barbara Merran (Southern Cross Community Healthcare) and
  
• Michelle Brennan (Occupational Therapist, Hunter Brain Injury Rehabilitation Program).

Toolkit C

The Project

The project Implementing and evaluating Smart Phone Applications technology across the NSW Brain Injury Rehabilitation Program aims to:

• Provide web-based resources for clinicians
• Evaluation the efficacy of Smart Phone Apps for people with brain injury

  1. Does Smart Phone technology facilitate the setting and acquisition of client centred goals following a non-progressive acquired brain injury?
  2. Is smart phone technology a more time efficient therapy tool for therapists in a brain injury rehabilitation setting, as opposed to traditional devices?

The Project Coordinator is: Emma Charters, Speech Pathologist, Liverpool Health Service.

Acknowledgements

 The important contribution of Liverpool Hospital to this project is acknowledged, for convening the Working Party and for funding the project co-ordinator role undertaken by Emma Charters (Speech Pathologist).

 Acknowledgement is also extended to Dr Adeline Hodgkinson (Director, Brain Injury Rehabilitation Directorate) for supporting the project.

 The members of the Implementing and evaluating Smart Phone Applications technology across the NSW Brain Injury Rehabilitation Program (BIRP) Working Party are acknowledged for their expertise, advice and contributions to the project.

The Working Party

The Project Working Party includes:

Barbara Strettles: Brain Injury Rehabilitation Directorate Network Manager, Agency for Clinical Innovation
Emma Charters: Speech Pathologist; Liverpool Hospital, Sydney
Lauren Gillett: Neuropsychologist, Liverpool Hospital, Sydney
Grahame Simpson: Research Team Leader/Social Worker – Clinical Specialist, Liverpool Hospital, Sydney
Emma Power: Speech Pathologist/Post Doctorate Research Fellow, University of Sydney
Nathan Haywood: Speech Pathologist, Hunter Brain Injury Service
Rosa Ali: Neuropsychologist, Concord and Sydney Children’s Hospital

Background

TBI

Between 2004 and 2005, the Australian Institute of Health and Welfare (AIHW) Research & Statistics Series reported that over 22 000 Australians were hospitalised after sustaining a traumatic brain injury (TBI). Of these, falls, motor vehicle accidents and assaults were the highest incidents leading to a hospital admission . Helps, Henley and Harrison (2008) identified that males who are aged between 15-24 and 80-85 were at a higher risk of sustaining a TBI. The AIHW also note that of these admissions, almost 12 000 required ongoing services specialising in TBI.

A TBI can lead to changes relating to a person’s physical, psychological, cognitive and communication abilities. These changes have implications for the person’s family, friends, caregivers and the community at large. Costly and lengthy hospital admissions, extensive post hospital care and difficulty carrying out their premorbid roles and responsibilities are examples of the economic and social implications following a TBI . In addition to these, individual impairments such as physical strength and coordination, cognitive, communication, memory and executive functioning difficulties can lead to difficulty initiating simple routines such as self care, taking medications, recalling their medical history or following through with recommendations made by health care professionals.

Smart phones

In recent years, the range of technological devices that are available to assist with everyday activities have expanded rapidly. In particular, the Smart Phone varieties provide a handheld device which functions as a telephone, internet service and has multiple applications available for download. Clinicians in health care settings have begun to use this technology to assist their clients with a range of individualised therapy tasks .

Recent literature (including studies carried out in 2008 by Schoenberg et al and Thorton et al) have shown that a Smart Phone has the ability to compensate for executive functioning and communication impairments where traditional devices have been unsuccessful. Participants have been trialled using a Smart Phone to replace traditionally recommended devices such as alarm clocks, calendars and verbal prompting from a caregiver. To date, functional improvements following the implementation of a Smart Phone into a client’s management plan have included improved recall, initiation of a target behaviour or goal, planning and organisation skills (Wright et al 2001, Blackstone et al, 2007 and Kennedy et al 2008).

Trials

In practice, clinicians specialising in brain injury rehabilitation across the Sydney Metropolitan Area have started trials with various types of Smart Phones and applications. These clinicians have reported that a Smart Phone can successfully prompt activities of daily living, record important details, provide a means of communication across a range of modalities and facilitates the storage of a large amount of information in a secure location. For many patients this tool has replaced their need for multiple tools which are not age or socially acceptable, with a single portable device able to be used in a range of environments.

Pilot study

A pilot study has been carried out in Liverpool Brain Injury Rehabilitation Unit (BIRU) at Liverpool Hospital. Five single study case trials were completed with patients admitted to Liverpool BIRU in 2010. In each of these cases, the Smart Phone facilitated the interdisciplinary and patient centred goal setting in order to attain effective therapeutic and compensatory outcomes. Outcomes included; improved communication, executive functioning skills, and completion of activities of daily living and increased compliance with physiotherapy recommendations.

The reasons behind the preliminary success of the smart phone as opposed to traditional devices are likely to vary significantly between individuals. They may include one or more of the following;

• Multi-purpose, socially acceptable and age acceptable
• Features which can compensate for motor and sensory impairment (e.g. vision, hearing, limb weakness or in-coordination)
• Large storage capacity which can be synchronised to an external hard-drive
• Easily update to address the changing needs of the individual
• Repetitive use giving opportunity for errorless learning of daily routine
• Cost effective.