Current Higer Degree Research (HDR) students associated with iCAHE are listed below, with links to the students home page. Details of their projects are provided, in order, below.
Felicity Braithwaite (PhD)
Sheena Davis (PhD)
Daniella Dougherty (PhD)
Erika Gosney (PhD)
Olivia Hill (PhD)
Debbie Howson (PhD)
Katrina Li (PhD)
Priya Martin (PhD)
Simon Mills (Masters by Research)
Carolyn Murray (PhD)
Donna Nitschke (PhD)
Sujatha Raj (PhD)
Paul Reid (PhD)
Ines Serrada (PhD)
Scott Weeks (PhD)
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This PhD aims to address the marked inconsistency in dry needling research methods, particularly in sham needling protocols. Conclusive benefit of dry needling over placebo has not been demonstrated. However, generally poor methodological quality (including underpowering) of empirical dry needling research could explain the equivocal evidence, with inconsistency in sham protocols preventing strong meta-analytic comparisons.
This research is still in the planning phase, but the central aim is to develop and validate a sham protocol for dry needling research that can effectively blind participants to treatment.
Four studies are planed:
1. A systematic review to describe the types of sham protocols that have been used to mimic the active intervention in dry needling research to date, with a focus on the pros and cons of each.
2. A Delphi consensus survey with a dry needling expert panel to see if any of the controversial issues surrounding dry needling prescription and sham protocol development can reach consensus. The results of this survey will be used to develop a draft sham protocol guideline.
3. A review conference to review the draft guideline, using experts who trade in deceptive techniques (magicians). This will aim to ensure that the whole simulation experience is addressed by the sham protocol.
4. An experimental trial to test the sham protocol for participant blinding effectiveness.
This research hopes to promote higher quality and more consistent research methods in future dry needling trials, so that effect beyond placebo (if it exists) can be more conclusively determined. This research also hopes to bring to light the ethical dilemma of the increasing clinical prescription of an unproven therapy.
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The Ergonomics of the Combat Helmet System (TECHS): Developing Task-Related Measures & Metrics for an Ergonomic Assessment Framework of Combat Helmets
There are multiple influencing factors and performance variables that affect the overall fit and function of a combat helmet which, in turn, can affect the soldier’s operational performance. There is a paucity of validated measures and metrics relating to the ergonomic evaluation of combat helmets, historically there has been a heavy reliance on collecting ‘acceptability’ data through subjective feedback and there are no standardised frameworks to guide the collection of validated, consistent data.
The aim of the research is to develop and collate measures and metrics that can be fostered into a framework to ensure systematic collection and analysis of ergonomic evaluation data on combat helmets. The objectives underlying this aim are:
1. Develop a systems model of the ergonomic aspects of the use of a combat helmet.
2. Identify current ergonomic measures and metrics for evaluating helmets and identify where specifics gaps exist in terms of lack of data, validity of data and applicability of data.
3. Develop a task analysis of key dismounted operations that would be conducted whilst wearing a helmet and have the potential to be impacted by the wearing of a helmet.
4. Develop & collate validated measures and metrics for the ergonomic evaluation of combat helmets into an assessment framework that provide a systems view and address relevant task demands.
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Cognitive reserve is a construct originating from the idea that there is not always a direct correlation between damage that has occurred to the brain and the associated deficit, whether it be cognitive or physical. It is proposed that the brain actively attempts to cope with brain damage, either by using pre-existing cognitive processing approaches or by enlisting compensatory methods. Cognitive reserve is influence by several factors, either independently or in conjunction with one another (physical activity, education, social interaction, intellectual pursuits and cognitive remediation) to promote improved cognitive reserve through facilitation of positive neuroplasticity or enhancing lifestyle behaviours that support the physiological function of neuroplasticity.
The aim of this PhD is to take the construct of cognitive reserve and apply it in the world of stroke research, establishing whether it has any influence on an individual’s stroke severity and initial functional impairment and then the recovery accomplished over a 12 month period. In addition, seeing if cognitive reserve has an influence on a stroke survivor’s self-efficacy which is the belief in ones capability to organise and execute the course of action required to produce a given attainment.
The research will employ an observational cohort study of individuals who have suffered a stroke. Participants will be recruited from the Royal Adelaide Hospital and the Lyell McEwin Hospital and followed up for 12 months post stroke. Participants will complete a cognitive reserve measure at baseline then a battery of questionnaires and functional measures at month 3, 6 and 12 to determine if cognitive reserve is correlated with functional improvement.
Mapping the normal reaction to acute exercise in the Achilles and Patellar tendons using ultrasound in athletes
Overuse injuries are a common occurrence amongst athletes of all ages that often result in pain, and disability to the athlete and in severe cases may lead to an inability to continue with their chosen sport activity. Patellar tendon injuries can be caused by activities that require running and jumping that exert a force on the knees of up to nine to 11 times of the bodies weight. Achilles tendon injuries can be seen in activities with sudden increases in training distance, hill running or sprint work which involve running, jumping and with sports characterised by sudden stops and starts. Achilles and patellar tendon injuries are common causes of injuries with the patellar tendon injuries have 0.5 injuries per club per season with 2.7 games missed per club per season, the Achilles tendon was 0.6 injuries per club per season with 2.5 games missed per club per season. Advancement of ultrasound, has significantly helped with the management of overuse injuries amongst athletes. Ultrasound imaging assists in diagnosing conditions by providing dynamic images during active and passive movements.
The aims of this research project are to understand the acute response of the Achilles and Patellar tendons to a bout of exercise, as measured by diagnostic ultrasound, and the relationship of these changes to the incidence of pain/injury to these tendons.
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The transition from primary to secondary school is a period of significant physical, psychological, social and environmental change for adolescents. While a large body of literature exists regarding the psychosocial impacts of this transitional period, there is a paucity of research exploring the physical risk factors and consequences of this period on adolescents. This is in spite of a high prevalence of musculoskeletal pain reported in adolescents in this transitional period, with an estimated 4-40% experiencing chronic and recurrent pain not associated with disease. A more thorough understanding of musculoskeletal pain in adolescents transitioning between primary and secondary school will be beneficial in informing interventions to reduce pain, and for understanding the antecedents and correlates of adult musculoskeletal chronic pain.
This PhD aims to increase the understanding of the potential role of factors in the development of musculoskeletal pain as a child/adolescent transitions between primary and secondary school. This information will be used to develop and pilot an intervention to reduce musculoskeletal pain in adolescents transitioning from primary to secondary school.
This research will employ a mixed-methods approach including three main phases; a literature review, an observational study and a pre-post cohort study. Through a review of the literature a conceptual framework will be developed for understanding the multifactorial nature of the risks that may influence adolescent musculoskeletal health; an observational study will be conducted to explore this framework in a real world cohort. Information from this will be used to inform and assist in the development of a targeted intervention to improve adolescent’s musculoskeletal health during this vulnerable period.
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Australian radiation therapist’s awareness and use of evidence-based guidelines
Awareness of guidelines was low (2 (IQR 1-4) of 9 guidelines presented) with 12.2% of radiation therapists were not aware of any of the 9 guidelines presented.
There was no correlation found between radiation therapists' awareness of guidelines and:
- Years of practice (Pearson correlation, p=0.372)
- Professional role (Chi-Square, p=0.059) or
- Location of work-place (Chi-Square, p=0.418).
However, 75% of radiation therapists who had read the guidelines found them useful or extremely useful in their daily practice and an average of 48.5% (SD 14.3%) of radiation therapists who were aware of a guideline said it had been used to develop departmental protocols for that topic.
Barriers to Guideline Use
The major barrier to guideline use is lack of awareness by Australian radiation therapists.Other perceived barriers include lack of senior peer and management support for their use and lack of time to access and read guidelines.
This project is exploring evidence-based guidelines for the radiation therapy profession.Key stages of the project are:
- Scoping studies of six broad topic areas of radiation therapist’s practice to identify the quantity and quality of research evidence that is available in each of these areas.
- Development of a framework to organise, review and assess the evidence in radiation therapy processes.
- Description of Australian radiation therapist’s awareness and use of evidence-based guidelines.
- Description of Australian radiation therapists perceptions on the barriers to evidence-based guideline use in their practice.
- Development of evidence-based recommendations for imaging for radiotherapy treatment verification, including a dissemination strategy.
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterised by inflammation and narrowing of airways. One in seven Australians over the age of 40 have some form of COPD, it is estimated that 65 million people are affected by COPD worldwide. The risk of developing COPD can be influenced by intergenerational influence and life course exposure. Maternal smoking, low birth weight, asthma, smoke/occupational exposure and cigarette smoking are some of the common risk factors for COPD. The inter-relationships between these risk factors are complex; they may have a separate or accumulated effect on an individual’s lung health. Limited research with offspring of people with COPD has been conducted, yet they not only have a family history of COPD but are also more likely to have been exposed to intergenerational and life course factors that predisposes them to respiratory impairment.
The overall aim of this research program is to explore intergenerational influences on respiratory impairment in offspring of people with COPD. It is hypothesised that offspring of people with COPD are exposed to intergenerational and life course factors that increase their susceptibility of developing COPD. This program will examine the COPD incidence and patterns of risk exposure in this at-risk group, in addition to the development of identification and intervention strategies.
A series of four studies will be conducted to achieve the overall aim. Study one will be a systematic review on the reported prevalence of COPD in offspring of people with COPD in the published literature. Study two will involve secondary analysis of longitudinal data collected from the “National Child Development Study”, this study will explore whether intergenerational and life course influences had any impact on the cohort member’s lung function. Study three will be a feasibility study conducted locally, where we will attempt to recruit offspring of people with COPD through their parents. Spirometry will be performed and life course information will be gathered from the participants to allow comparison between risk exposure throughout the life course in offspring who may or may not meet the spirometric criteria for COPD. Study four will aim at exploring the perspectives of offspring of people with COPD regarding intergenerational influence, early identification and intervention for lung health.
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What is the relationship between postural alignment and mobility for adults admitted to brain injury rehabilitation who have ongoing severe mobility impairment at 8 weeks post-injury?
Acquired brain injury (ABI) can result in severe physical impairments that restrict skills and independence. Limitations in mobility can have a huge effect on lifestyle, and quality of life. Some people never recover even basic skills and require life-long assistance.
Recovering walking skills is a priority for many people after ABI. Analysis of the mechanics of walking has been used to determine which aspects are changed and where treatment can be targeted after ABI. Analysis of body mechanics in most of these studies has focused on the hips, knees and ankles. The results have provided a lot of information about the lower body, however, a large gap in knowledge is left about how the body operates as a whole during mobility. This means there is very limited understanding of whether body alignment is altered during mobility after ABI, or if this affects mobility skills.
While walking has been widely investigated after ABI, there are relatively few studies that investigate mobility skills for people with more severe physical impairment, such as those who can't stand up or can't walk 8 weeks after ABI. This means that there is limited evidence identifying factors that influence progress in this severely impaired group, or what the impact of these restrictions is on quality of life. In the current study, measures of mobility and postural alignment will be taken with a healthy sample to develop a model for healthy postural alignment and its relationship with mobility. Mobility and postural alignment measures will then be taken for inpatients in brain injury rehabilitation at Hampstead Rehabilitation Centre who are not walking or are minimally ambulant at 8 weeks post-ABI. Measures will be repeated after 3 months and 6 months to allow analysis of change over time. Interview and survey data will also be collected at each time point to investigate the significance for an individual with severe mobility impairment of lacking or achieving these more basic skills. This will be used to evaluate quality of life.
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Data analysis to date has revealed eight categories about troublesome aspects of practice which include knowing OT theory, understanding OT concepts, knowing how to analyse a situation, explaining thinking and reasoning, being socialised into the profession, navigating the service delivery models and workplace culture, developing confidence, and managing the emotional and ethical issues. Strategies for overcoming these troublesome aspects of practice are organised into five categories including focusing on the foundations, being guided to engage in critical reflection, being positive and cognitively flexible, consolidating learning and knowledge, and being active and assertive contributors to OT. Further data collection and analysis will contribute to development and refinement of this provisional theory.
My research aims to explore troublesome aspects of practice for new graduate occupational therapists. The philosophical assumption that all knowledge is mediated by cultural and social influences has led me to assume that the intersection between knowledge and context may be troublesome for new graduates. This assumption is reflected in the decision to use an interpretive paradigm with a social constructivist grounded theory approach. This approach will enable development of a theory about how new graduate occupational therapists encounter and overcome troublesome aspects of practice. This theory will provide frameworks for supporting new graduates and for preparing students to be new graduates.
The research is guided by two research questions:
1. What is troublesome in OT practice for new graduates?
2. How do people resolve these troublesome aspects of OT practice?
Data collection will involve in-depth interviews with occupational therapists because they construct their interpretations of knowledge and the contexts in which they work through the cultural and social lens of the occupational therapy profession. Data will be analysed concurrently with collection and emerging findings will be constantly compared. As a result data will be collected over a series of four phases.The research is currently in the third phase.
The first phase involved a systematic review and meta-synthesis of qualitative research about challenges experienced by occupational therapists. The second phase involved in-depth interviews with eight occupational therapists from across Australia with over ten years’ of experience. The third phase will involve in-depth interviews with up to eight occupational therapists who recently graduated (between 2010 and 2013). The final phase will involve theoretical sampling which means participants will be purposively sought and selected for interview based on their ability to bring the emerging theory to saturation. This may include those involved in clinical education of new graduate occupational therapists and students.
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Grounded in current research from neuroscience and at the request of four north eastern metropolitan Adelaide schools, Donna Nitschke has developed a school-based program entitled, ‘Being the Best Learner You Can Be’ (to be referred to as the BBL Program) for children from preschool to Year 7 (ages 4 to 13 years). This program was created to improve the development of executive function skills in students and was shaped in direct response to specific needs of the participating schools. However, there appears potential to generalise the approach to other school settings.
The major aim of this project is to conduct and evaluate the BBL Program using a randomised and controlled study. In order to make the project viable, the targeted student population has been restricted to Year 4/5 students (ages 9-11 years). Twelve classes, across the range of socioeconomic levels, have opted to participate in the study.
It is broadly hypothesised that the BBL Program produces better outcomes (in the defined areas of measurement) compared with usual teaching practice. The defined areas of measure include computer-based tests of attention, impulsivity, vigilance and visual working memory, as well as, questionnaires regarding motivation, engagement, sleep, diet and physical activity.
The primary research question examined the development of executive function skills.
- Is the BBL Program more effective in increasing the specific executive function skills of auditory and visual working memory, attention (both directed and sustained) and self-regulation (particularly delayed gratification) as compared to a control group receiving usual classes?
Secondary questions consider attitude and physical patterns of behaviour.
- Is there a correlation between self-reported and teacher/parent-reported data regarding executive function skills compared to data obtained from objective testing?
- Does student attitude towards school and learning correlate to executive function skills as measured by the test battery?
- Is there any correlation between initial levels of executive function and an individual student’s sleep profile?
- Is there any correlation between initial executive function measures and socio-economic status (SES) as defined by a school’s Index of Educational Disadvantage rating?
- Do students from a lower SES background demonstrate more improvement on the designated outcome measures from the BBL Program intervention?
The principal significance of this proposal lies in the aim of translating current neuroscience research into a classroom environment – implementing the program and evaluating it in the real world. The BBL Program is both a novelty in the realm of Australian education and a unique South Australian attempt to embed current cognitive neuroscience and psychology into existing educational practice. However, the BBL Program was developed specifically in response to the four Neuroscience in the Classroom Cluster schools over a four year period. What this project proposes to assess is both the viability and portability of a shortened core version of the program. Further, this work has the potential to begin the dialogue about Australian-based neuro-educational research and practice.
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Title: Does home-based Occupational Therapy reduce carer burden and slow functional decline in adults with Down Syndrome and Alzheimer’s type dementia disease?
Adults with Down Syndrome (DS) have an increased risk of developing younger-onset of Alzheimer’s disease (AD) type of dementia, occurring before the age of 65 because the amyloid protein that causes AD is coded on the same gene as that which causes DS, thereby increasing the likelihood of getting AD. The clinical signs and symptoms of AD in DS are consistent with that of AD in the general population. They include changes in personality and behaviour, and cognitive deterioration such as memory loss, apraxia and agnosia which impacts the participation and performance level in everyday activities . However, the clinical manifestations in adults with DS are more complex as a result of pre-existing intellectual impairment, behavioural and psychiatric problems.
Currently, there is no specific service pathway to access occupational therapy for people with both DS and AD. The aim of this exploratory study is to determine whether home-based occupational therapy interventions will help to maintain the level of occupational performance in adults with both DS and AD type of dementia and reduce their caregivers’ burden.
My research study will consist of three phases. In Phase 1, two Systematic Reviews will be completed to assess the current evidence for the effectiveness of home-based occupational therapy interventions in (i) adults with Down Syndrome, and (ii) people with Alzheimer’s disease in the general population. In Phase 2, a cross-sectional survey design will explore the scope of current practice in occupational therapy for individuals with both DS and dementia. In Phase 3, a Single-Case Experimental Design will be conducted to determine the effectiveness of home-based occupational therapy intervention for adults with both DS and dementia on functional decline and carer’s burden.
Title: Experimental investigation of in-vitro cancer stem cell survival in head and neck cancer cell lines following X-ray irradiation.
There is evidence of a subpopulation among cancer cells that is analogous to stem cells in normal tissue. These cancer stem cells (CSCs) can proliferate indefinitely, creating all tumour cell types and self-renewing their own phenotype. CSCs are identified in most cancers including in head and neck cancer (HNC), and are considered responsible for treatment resistance and tumour recurrence, the principal cause of mortality in HNC. While radiotherapy is an intervention with intent to cure in HNC, it is also shown to stimulate CSCs in cancers. Identification of CSCs and understanding of their radiobiology is crucial to improve HNC treatment outcomes. As yet there is limited quantitative data on the amount and radiobiology of CSCs in HNCs
This in vitro experimental controlled study seeks to quantify relative changes in the CSC population in HNC cell lines after X-ray irradiation and to determine changes in the radiation response of HNC cell lines with subsequent irradiations.
Head and neck cancer cell lines will be cultured for irradiation using a 6 MV X-ray beam from a Varian linear accelerator (Varian® Medical System, Palo Alto, CA). At 24, 48 and 72 hours after irradiation, CSC populations are measured, against the control, by flow cytometry. CSCs are characterised by phenotypic expressions of proteins used as markers. In the selected cell lines, the cell surface protein CD44 and the metabolic enzyme, aldehyde dehydrogenase (ALDH), will be used to identify and count CSCs by flow cytometry.
Cell lines re-cultured after sequential irradiations will be exposed to an escalating scale of X-ray dose and plated for clonogenic assay to quantify changes in their radiosensitivity.
Arm use is considered critical to life engagement and our ability to perform everyday activities independently. The National Stroke Foundation has reported 48,000 Australians this year will experience impairment in these functions as a result of stroke.
Stroke rehabilitation studies in animal and human models have demonstrated a large amount of practice (AoP) based on hundreds of daily repetitions of arm practice may be required to facilitate optimal motor learning and function, accelerate the rate of recovery, and produce long-term changes in cortical and motor networks. However, the definitive number of repetitions for optimal human learning are unknown. There is a strong need to establish research on AoP repetitions, as this has widespread implications for clinical practice and the organisation of rehabilitation services. Therefore, this study aims to explore the optimal AoP required to improve arm recovery outcomes post-stroke.
Three studies will be completed. A prospective longitudinal cohort observational design to describe current practice and the amount of usual arm practice performed across acute, sub-acute and chronic rehabilitation settings. A multi-arm parallel randomised controlled trial design, nested in the observational study to determine if a high AoP compared to a low AoP or usual care improves motor recovery outcomes, including daily function, participation, self-efficacy and engagement; to determine if there is a minimum threshold AoP to improve arm recovery outcomes (AoP dose-response relationship); and an exploratory sub-study using an experimental design to determine if performing a higher AoP drives greater cortical reorganisation (and functional recovery) than usual care. A systematic review to evaluate current evidence regarding clinimetric properties of triaxial accelerometers in measuring arm use post-stroke.
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Occupational therapists frequently administer intervention to address the sensory needs of children with Autism Spectrum Disorder (ASD). However, current evidence for the effectiveness of these interventions remains inconclusive, which has resulted in appeals for more robust testing to be conducted.
The original intent of this PhD research was to conduct a large-scale intervention trial to test the effectiveness of sensory-based interventions, as they are administered by South Australian occupational therapists in community-based clinical practice. However, it became apparent whilst preparing this research that conducting a large-scale intervention trial was not possible at present because there are uncertainties regarding many criteria required for a robust community-based trial. These include, for instance, standard mechanisms of diagnosis, how to recruit children with ASD in a robust manner, agreed definitions of sensory-based interventions, including details of how these are administered, and measures of outcome. Consequently the proposed doctorial research was constructed to address and better understand these issues, in preparation for a randomised controlled trial as post-doctoral work. The aims of this health service delivery research is to unpack the current scenario of how children with autism are diagnosed for sensory difficulties, what occupational therapists classify as sensory-based assessment and intervention, the various ways in which they are administered, how treatment decisions are made, the frequency of intervention and compliance with prescribed guidelines of various types of interventions, as well as what measures of effectiveness are being used and recorded in South Australian clinical practice. This information is essential to underpin future intervention studies that have real-world applications for occupational therapists and children diagnosed with ASD, with more robust methodology than is currently available.