A serious spinal cord injury in the 90s left Dean bound to his bed. His functions declining over the years, the 51-year-old spent his days eating, sleeping, having a bed bath, changing his urinary bag and watching television. Better Rehab Occupational Therapists Emily and Danielle have been working diligently alongside Dean’s support coordinators and equipment suppliers from AusTech medical to improve his quality of life. They conducted research to explore his options for a power wheelchair (PWC), eventually coordinating a date to trial a chair from Permobil. “The trial took over 3 hours to script the chair to Dean’s anthropometrics, get him on the power wheelchair, check the chair fit within his home, and explore switch options to ensure he could drive the chair,” Emily said.

After an application to the NDIS, funding approval and training, Dean was given his Permobil Power Wheelchair, which he could independently control using ergonomic switches. With his right arm positioned at his chest, he can navigate the PWC forwards and backwards, while head switches facilitate side-to-side movement. A final switch, behind his elbow, allows him to adjust modes, including wheelchair speed and position.

In June, for the first time in 20 years, Dean was able to get out of bed.

“I felt independent and like I was 17 again – driving a car for the first time,” he said. “I felt freedom - like I could go anywhere at any time.”

Emily said Dean has redefined possible and the progress he has made is remarkable.

“When we first met Dean, he was bedbound, only leaving his bed in the ambulance plinth to go to the hospital,” she said. “Dean’s wheelchair is brand new - he has now been able to use it on three occasions in which he was able to spend time in the sun, visit neighbours down his street, see a rainbow, see his backyard for the first time in twenty years and have a tea party on his back patio.” Click here to meet Dean

Better Rehab is an NDIS- registered allied health provider with branches across Australia. For more information on the services they provide, visit www.betterrehab.com.au.

Better Rehab

1300 0 REHAB

www.betterrehab.com.au

As I write my President’s report for the final issue of ASSBI’s Newsletter for the year, I am sure that you will agree with me that we look forward to putting 2020 behind us. Who would have thought that, just 12 months ago, we would experience the worst wildfires in Australia's history burning more than 12.6 million hectares, which would be eclipsed by the COVID-19 pandemic with, at current count, 60.7 million confirmed cases worldwide and 1.4 million deaths.  Australia and New Zealand have continued to be model countries in dealing with the pandemic and, at year’s end, we welcome the reopening of our inter-state and territory borders, and look forward to soon being able to travel within the “Australia-New Zealand bubble”.  Particular mention is made of our Melburnian colleagues, who have recently emerged victorious from a crippling second wave of the virus.  Tough lockdown measures were enforced for more than 110 days, with good community adherence, and a supportive and highly visible Premier who gave lengthy and candid press conferences for 120 consecutive days. We hope that the sky-rocketing rates of infections and deaths in other countries will be contained soon, particularly as the northern hemisphere enters its winter season.

                    Like many other businesses, the pandemic has had adverse consequences upon ASSBI’s financial position.  The annual conference, scheduled for Perth in May, had to be cancelled.  This was a severe financial blow to the Society, given that the conference is our main source of revenue.  But it could have been a lot worse.  Thanks to our remarkable Executive Officer, Margaret Eagers, our Continuing Education Officer, Barbara Zupan, and ASSBI Resources Manager, Skye McDonald, an excellent series of diverse and well-attended webinars was scheduled throughout the remainder of the year.  This was marketed as ASSBI Conference Bite Size, thus allowing ASSBI to continue offering its (always highly acclaimed) professional development programme.  Particular thanks are also due to the webinar speakers, not only for the high standard of their presentations, but also for foregoing payment for the webinars.

                    The ASSBI Committee has been extra busy this year planning for a review of the Society. An important first step in the process was a survey of the membership (see the September 2020 Newsletter for a summary of the survey results).  We have had various working parties to advance this process, and I thank Jacinta Douglas, Olivier Piguet and Dana Wong for working with me to develop the survey items; and also Olivier, Jacinta, Dana, Nicci Grace and Clare Ramsden for their subsequent input into synthesising the results into a detailed report.  This report has been discussed at length by the entire Committee. The next step has been the formation of another Working Party, with Jacinta, Olivier, Jennie Ponsford, Tamara Ownsworth, Janet Wagland, Margaret Eagers and myself, which will take the report and Committee discussions and develop goals for a review for consideration by the Committee.  These activities will carry over into next year and I will keep you updated via the Newsletter.

                    Other activities have included instating a new social media team specifically formed to promote our journal, Brain Impairment (see this Newsletter for details), and student activity, coordinated by Jonathan Reyes.  ASSBI’s encouragement and support of students and early career clinicians and researchers were identified in our membership survey as being worthwhile areas to expand, as is ASSBI’s role in greater inclusion of people with lived experience with brain impairment.  So you can expect to see further development of ASSBI’s role in these areas.

                    As I mentioned in the September Newsletter, one of the most encouraging outcomes of the review was the positive endorsement of ASSBI being a welcoming community that is friendly, approachable, generous, inclusive, supportive, and collegiate; a society where members feel a sense of belonging.  This sets ASSBI aside from many other professional organisations and makes us especially proud of our Society.  I thank both the Committee and the wider membership who make ASSBI what it is.  On that note, I take this opportunity to send you season’s greetings and let us all welcome in 2021 in a big way.

My very best wishes to you all,

Robyn Tate

President 

As the COVID-19 pandemic continues its path of devastation my thoughts go out especially to any ASSBI member who has been personally affected by the pandemic.  The world continues to live with restrictions on everyday living - within Australia our state borders remain closed and international travel is banned.  The second wave has severely affected residents of metropolitan Melbourne who, as I write, are still under lockdown with Stage 4 restrictions, as is regional Victoria with Stage 3 restrictions.  May the situation be vastly improved come my next newsletter later this year.

In the December 2019 Newsletter, I heralded that ASSBI was planning to conduct an external review of the Society – its first review in 43 years of operation.  In preparation for the review, ASSBI conducted an online survey of the membership in May 2020, and here I thank our working party (Jacinta Douglas, Olivier Piguet, and Dana Wong) who worked with me to draw up the survey items, feedback from the Committee, and the suggestions of those who piloted the survey for us.  In this Newsletter, I am highlighting some results from the survey.

The 31-item survey was completed by 100 members (representing 25% of the membership). The overall satisfaction with ASSBI was high (8.45/10, SD=1.41, range 4-10; higher scores reflect higher satisfaction).  Respondents were asked to rate the importance of 16 areas of ASSBI activity, together with their satisfaction.  The table below summarises the findings - the first percentage represents ‘importance’, and the second percentage denotes ‘satisfaction’.  Significant proportions of respondents endorsed the ‘don’t know’ response, especially for ‘satisfaction’ ratings which affect interpretation, and so those percentages are also included.

Survey respondents also provided helpful perspectives on a range of issues, including suggestions about raising ASSBI’s profile and visibility, and ASSBI’s relevance for people with lived experience of brain impairment.  One question regarding the ideal geographical coverage received a wide variety of responses.  Five possible configurations were presented: (i) Australia, New Zealand, neighbouring Pacific Islands and Asia was endorsed by the largest proportion of respondents (41.6%), followed by (ii) Australia, New Zealand, and neighbouring Pacific Islands (28.6%), (iii) Australia and New Zealand (20.8%), (iv) Australia only (6.5%), and (v) other configurations (2.6%).  This information needs to be considered further (including at an AGM) before any recommendation could be made about changing ASSBI coverage.  At present, ASSBI’s geographical coverage applies to Australasia (Australia, New Zealand and neighbouring Pacific islands).

It was gratifying to see that many respondents regard ASSBI as being a welcoming community that was friendly, approachable, generous, inclusive, supportive, and collegiate; a society where members felt a sense of belonging.  ASSBI’s multidisciplinary focus was seen as one of its most attractive features. Overall, the membership survey results suggest that ASSBI is on the right track, but there are areas where we can improve service to our members and the broader community.   Results from the survey have yielded very rich data which the Committee will be considering further and will use not only to inform the external review, but also its forward planning.  I welcome your responses to this brief summary, so please send me your comments.  I will keep you informed, via this Newsletter and the ASSBI website, about next steps regarding the external review.

Table referred to in Robyn's report

Importance / satisfaction of ASSBI activity	Not at all / a little	Somewhat	Quite a lot / very much	Don’t know
Professional development -      Conference -      Webinars -      Workshops	3.7% / 2.8% 2.5% / 0 1.3% / 0	7.4% / 0 7.5% / 8.7% 7.5% / 9.9%	85.2% / 76.1% 87.5% / 65.2% 90.0% / 71.8%	3.7% / 21.1% 2.5% / 26.1% 1.3% / 18.3%
Journal -    Brain Impairment	3.8% / 1.4%	7.5% / 5.6%	87.5% / 81.7%	1.3% / 11.3%
Clinical resources -      ASSBI Resources -      BRAINSPaN -      NeuroBITE	0 / 1.4% 5.1% / 5.6% 6.3% / 4.2%	6.3% / 5.6% 11.4% / 5.6% 10.1% / 4.2%	89.8% / 64.8% 68.4% / 67.6% 60.8% / 52.1%	3.8% / 28.2% 15.2% / 21.1% 22.8% / 39.4%
Communication with members -      Website -      Social media -      Newsletters	5.2% / 7.0% 18.0% / 7.0% 1.4% / 7.6%	15.4% / 8.5% 29.5% / 12.7% 19.9% / 7.0%	79.5% / 71.9% 44.9% / 26.7% 73.4% / 81.7%	0 / 12.7% 7.7% / 53.5% 0       / 9.9%
Professional networking/identity -      Networking opportunity -      Professional identity	2.6% / 4.3% 6.3% / 1.4%	12.8% / 14.3% 10.1% / 14.3%	80.8% / 58.6% 73.4% / 61.4%	3.9% / 22.9% 10.1% / 22.9%
Students -      Student teams/activity -      Prizes and awards	9.1% / 7.0% 19.5% / 1.4%	16.9% / 9.9% 26.0% / 8.6%	57.2% / 31.0% 45.5% / 42.9%	16.9% / 52.1% 9.1% / 47.1%
People with lived experience -      Involvement in ASSBI -      Advocacy	3.9% / 9.9% 7.7% / 5.8%	6.4% / 25.4% 10.3% / 20.3%	83.3% / 38.0% 77.0% / 39.1%	6.4% / 26.8% 5.1% / 34.8%

Housing for people with high and complex support needs

Since 2006, the Summer Foundation has been working to solve the issue of younger people with disabilities being forced to live in aged care because there is nowhere else for them to live. 

The Summer Foundation’s work includes research into outcomes for people with high and complex support needs – including people with neuro-degenerative conditions and acquired brain injuries – as well as building the capacity of the health and disability sectors to better support people in these cohorts.

Appropriate housing is central to achieving good outcomes for people with high and complex support needs, so in 2017 the Summer Foundation piloted the Housing Hub –www.housinghub.org.au – a website that advertises properties for people with disability.

From small beginnings, the Housing Hub is fast becoming the way for people with disability to find suitable housing. To date, almost 2,300 places to live have been listed on the Hub and around 147,000 people have visited the site. A recently-added feature is the ability for housing seekers to create a Housing Hub profile that details their environmental needs, as well as their preferences around location and property features. If a property is subsequently listed on the Hub that matches a person’s profile, the Housing Hub will notify them directly!

The Summer Foundation’s Housing Hub team also provides a service that supports people with high or complex disability support needs to access appropriate funding from the National Disability Insurance Scheme (NDIS) and connect with suitable housing opportunities.

The Housing Hub team is able to offer support to you with advice, housing resources and connection to appropriate sector professionals at no cost.

For more information phone Melody Carbans on 0499 111 848 or email info@housinghub.org.au

Clinical translation of Cognitive Behavioural Therapy for anxiety and depression - Adapted for Brain Injury (CBT-ABI): How do we train competent clinicians?

Dana Wong, Adam McKay, Nikolaos Kazantzis & Jennie Ponsford
International Journal of Cognitive Therapy
https://link.springer.com/article/10.1007/s41811-020-00079-2

What the study is about
Depression and anxiety are common following acquired brain injury (ABI) and can be effectively treated using cognitive behaviour therapy (CBT) that has been adapted to compensate for cognitive difficulties (CBT-ABI– as outlined in the CBT-ABI manual available from ASSBI Resources!) However, effective delivery of CBT-ABI requires a specialised skill set. Training clinicians to deliver CBT-ABI is therefore a crucial step in effective translation of this intervention into widespread clinical practice.

What we did
This study evaluated the outcome of didactic (instruction-based) and experiential (skill-based) training on competencies in delivering CBT-ABI.  Participants were 39 registered psychologists who attended a day-long ASSBI workshop on using CBT-ABI to treat anxiety and depression after brain injury, which included knowledge-building, observational learning (i.e., videos of CBT-ABI) and skill-based (e.g., role play) content. Fourteen participants completed three additional supervision sessions reviewing audio recordings of their use of CBT-ABI with clients they saw in their workplaces. Training outcomes were measured using surveys rating the usefulness of the various workshop components; a checklist of competencies in CBT-ABI on which participants rated themselves pre- and post-workshop and post-supervision; and the Cognitive Therapy Scale (CTS), used by supervisors and a blinded expert to evaluate supervisees’ skills.

What we found
Participant-rated confidence and competence in delivering CBT-ABI significantly improved following workshop training. Examples of CBT modifications for ABI, case descriptions and videos of CBT-ABI in action were consistently rated as the most helpful elements of the workshop.

Self-rated competencies did not show further change after supervision. CTS ratings of the supervisor, but not the blinded expert, showed significant improvement after short-term supervision. The authors surmised that a longer period of supervision may have been necessary for greater impact on competencies. Nevertheless, at 16-month follow up, self-rated competency gains were maintained; and encouragingly, therapist confidence and competence were no longer major barriers to using CBT-ABI in the workplace. These findings suggest targeted training that includes opportunities for observational and experiential learning is important for clinical translation of this evidence-based intervention.

Acknowledgements
The authors would like to acknowledge and thank the psychologists who participated in the study and the individuals with brain impairment who consented to have their therapy sessions recorded for supervision. We would like to thank Dr Kerrie Haines, who provided supervision for some of the study participants, and Dr Lillian Nejad, who was our expert CTS rater. This research was supported by the Moving Ahead NHMRC Centre of Research Excellence in Brain Recovery.

Brain Impairment is proud to announce its new 2019 impact factor of 1.356. Thank you to our special issue editors, authors, reviewers and readers!

On behalf of the organising committee, you are warmly invited to Melbourne, VIC, Australia, to participate in the 6th Pacific Rim conference. This is the first joint conference of three outstanding organisations: the International Neuropsychological Society (INS), the Australasian Society for the Study of Brain Impairment (ASSBI), and the Australian Psychological Society’s College of Clinical Neuropsychologists (CCN). To reflect the difference we can make when we join together, our theme is “Putting our heads together to change lives”. You are warmly invited to the vibrant metropolitan city of Melbourne to participate in an exciting, multidisciplinary, practically grounded, innovative program of presentations and events, including international and national speakers who will undoubtedly inspire us to reflect on our professions and how we can maximise our impact for people living with brain conditions.

Six half-day workshops will take place on Wednesday 30^th June. A broad range of papers will be presented from renowned international and national speakers on Thursday 1^st, Friday 2^nd and Saturday 3^rd July. There will also be the INS Presidential Address by Professor Skye McDonald, the ASSBI Presidential Address by Professor Olivier Piguet, and a professionally focused address by CCN Chair Dr Amy Scholes. In addition to platform presentations there will be “how-to” sessions, datablitz presentations and posters, together with a select number of invited symposia.
Dr Kerryn Pike, Dr Travis Wearne and Dr Dana Wong (co-convenors)

Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

Kate Rachel Gould, Jennie Louise Ponsford, Amelia J. Hicks, Malcolm Hopwood, Belinda Renison and Timothy J. Feeney

Neuropsychological Rehabilitation

https://doi.org/10.1080/09602011.2019.1656647

What the study is about

Challenging behaviours, such as aggression, inappropriate social behaviours and lack of initiation are common following acquired brain injury (ABI). These behaviours may place the person and others at risk of harm, interfere with community participation and cause distress to family members. There are no evidence-based guidelines for managing challenging behaviours after ABI, leaving clinicians with few resources to guide practice. Over the last few decades, findings from case studies and single subject experimental designs have supported the use of positive behaviour support (PBS) interventions for challenging behaviour post-ABI. The key approach of PBS, which evolved from applied behaviour analysis, is that by proactively preventing challenging behaviours –

making them inefficient and ineffective – and systematically facilitating desired behaviours, challenging behaviours become unnecessary (Carr et al., 2002).

What we did

This paper introduces PBS + PLUS: a multi-component and flexible PBS intervention using a person-driven collaborative approach to build a meaningful life and self-regulate behaviour after ABI. This approach reflects  on the body of knowledge developed by Mark Ylvisaker and Tim Feeney. The efficaciousness of PBS + PLUS is currently being examined in a randomised controlled trial (RCT) conducted by our team, which will help to strengthen evidence-based practice. In the meantime, we have prepared three detailed pilot case studies from our trial to illustrate the highly individualised implementation of the program, delivered to the individuals with ABI and carers over 12 months by a transdisciplinary team including neuropsychologists, occupational therapists, and psychiatrists. These case studies will assist clinicians and service providers to implement PBS + PLUS in anticipation of the results of the RCT. Objective behavioural outcomes are reported for participants using the Overt Behaviour Scale (OBS) at baseline and four-monthly intervals for two years. Goal attainment scaling was used to measure personally meaningful goals.

What we found

The three participants presented with diverse behaviours, living situations, cognitive profiles, functioning levels, support networks and desired outcomes. Reese, Ethan and Ollie, along with their support networks, received 12 months of individualised intervention from transdisciplinary PBS + PLUS therapists. Through these varied cases, we demonstrate different aspects of the flexible and individualised PBS + PLUS approach. Visual analysis of the primary outcome measure, the OBS, indicated that whilst Ethan and Ollie made substantial improvements

in self-regulation of behaviour, which were maintained over time, Reese’s improvements in behaviour were not sustained beyond 8 months. The qualitative appraisals of the intervention by participants, families and carers, and 12-month follow-up outcomes are described in the article along with a discussion of the advantages and challenges of program delivery. The detailed description of the intervention and expansive case studies should assist clinicians in understanding how the PBS + PLUS principles, framework and strategies may be applied.

Acknowledgements

The authors would like to acknowledge and gratefully thank the generosity, time and effort of the participants, therapists (Dr Kate Gould, Dr Belinda Renison, Dr Kim Trezise, Dr Diane Parcell, Nadine Holgate, Cathy Bucolo, Sally Peterson, and Dr Clare Kempnich), research staff at the Monash-Epworth Rehabilitation Research Centre; our independent expert for integrity monitoring Melissa Capo, Albany, NY, USA; and Kat Orgallo, Teaching Resource Support Unit. This research was funded by the Transport Accident Commission (through the Institute for Safety Compensation and Recovery Research).

How our world has been turned up-side down this year with the COVID-19 pandemic!  Such public health devastation has not been seen in our lifetime.  As ASSBI members, we are lucky to be living in Australia and New Zealand, where our governments listened to expert advice and responded with timely and definitive action; where our communities adhered to government directives regarding lockdowns, social distancing and hand hygiene. The outstanding success of these strategies and the community’s adherence to them is on record: by the end of May 2020, Australia and New Zealand had respectively recorded 282 and 301 confirmed cases per million population, each country having 4 deaths per million population.  Both countries are well below the world average of 774 confirmed cases and 47 deaths per million population.  The pandemic is not only affecting personal health, well-being and social relations, but is causing widespread disruption in education, work and economically.  Again, we are fortunate that our governments, labour and liberal alike, have stepped up to the mark, putting policies and economic packages in place to support our communities. 

I had looked forward to writing this editorial, which traditionally would report on the annual conference.  This was to be held in May in Perth, co-convened by Janet Wagland and Michelle Kelly.  Regrettably, it, along with so many other conferences world-wide, had to be cancelled due to the pandemic.  So, did that leave me with nothing to write about for this Newsletter?  Not at all!  I have to say that, as ASSBI’s President, I have been so very proud of ASSBI’s responsiveness during the pandemic.  Barbra Zupan and Skye McDonald from ASSBI’s Professional Development Committee, converted the annual conference into a series of “ASSBI 2020 Conference Bite Size” webinars, being presented on a monthly basis from May to November via Zoom (see programme displayed in the Newsletter, or go to the website).   BRAINSPaN was quick off the mark in the early stages of the pandemic, providing a vital conduit for communication and sharing resources, including fact sheets from peak bodies.  Our speech pathology colleagues have been especially proactive in developing resources for people with communication impairments.  Lizzie Beadle and Travis Wearne are active on social media, promoting ASSBI and its offerings via Twitter.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

And speaking of Twitter - you know, one day I guess I will look back on this pandemic and ponder what I did during all that time of enforced staying at home.  One of the projects that engaged me during this time, has been teaching myself to use Twitter.  Being a latecomer to this medium, I had some degree of trepidation (needing yet another work task to do, like I need a hole in the head!), but the reason was to help advance the cause of raising the profile of ASSBI (and NeuroBITE).  I have to say how amazed I am at this medium, how engaging it is, discovering who is doing what, and its potential reach – and I take my hat off to all those active twitterers – what stamina you have!  In reading the tweets, I am so very proud of our ASSBI members and other Australian colleagues who are at the vanguard of developing telehealth and digital platforms for both assessment and interventions. Clinicians the world over are grabbing at such resources in these lockdown and social distancing times.  ASSBI Resources, of course, has a number of telehealth manuals available addressing different neurological conditions and presenting problems.  The ASSBI 2020 Conference Bite Size programme also features several webinars addressing telehealth.  So, well done, everyone!

But the pandemic is not over yet, in spite of the easing of restrictions in various countries. The consequences are likely to continue for some time. Moreover, it is now recognised that the coronavirus infection can cause secondary neurological sequelae. The implications for neurorehabilitation are obvious and are of vital concern to ASSBI, our brain impairment clinical and research society.

My very best wishes to you all,
Robyn Tate
President