Novita Research Report January 1999 - Novita Children's Services

Research Report 

January 1999 – June 2004

table of contents 

Foreword 1 

Summary of research reports 2 

Overview of research at Novita 4 

Our research partners 5 

Selecting research projects 6 

Research teams 8 

Projects 12 

Publications 64 

Conference presentations 65

foreword 

Novita Children’s Services Inc (formerly The Crippled Children’s Association of South 

Australia Inc) has demonstrated a commitment to research for many years, as an 

essential part of providing quality services to people with disabilities. We are very 

pleased to endorse the first Novita Research Report, which showcases research activities 

undertaken during the past five years. 

Research at Novita Children’s Services (Novita) is conducted within two streams. The 

Research and Development Department of NovitaTech has a history of over 8 years of 

leading-edge research in the Rehabilitation Engineering field. The Clinical Research 

Department was established five years ago, as the first clinical research department within 

a disability organisation in Australia. Both areas have achieved outstanding results in 

research and the dissemination of research findings. 

As a service delivery organisation, Novita is ideally placed to undertake research that makes 

a difference to clients and has direct benefits to service provision. A particularly important 

part of this report is the implications section which identifies the client and service delivery 

outcomes achieved from each research project. 

1 

Novita research activities are possible because of generous community support, effective 

fundraising by the Marketing and Public Relations Division and through specific research 

grant funding. Research activities are also supported by partnerships with many community 

agencies, including universities and other disability and health organisations. 

Novita is committed to the importance of research as an investment into the current and 

future quality of services in the disability sector. 

Jane Hyde 

President 

Glenn Rappensberg 

Chief Executive 

Novita Children’s Services Incorporated • Research Report January 1999 – June 2004

summary of research reports 

The following pages contain the summaries of Research Projects undertaken by or in collaboration 

with Novita Children’s Services Inc (formerly The Crippled Children’s Association of SA Inc). These Projects 

are reported in greater detail later in this Research Report. Projects are arranged alphabetically by the title 

of the project and with the primary investigator named. 

PRIMARY 

INVESTIGATOR PROJECT TITLE PG 

Children’s Physical Functioning 

Opperman K Paediatric dysphagia and physical disability: the evidence base 13 

Russo R 

Pilot study into the use of Botulinum-A Toxin in the management of spasticity 

in the upper limb of children who have spasticity of central origin 

13 

Bostock S Serial casting after Botulinum Toxin: A retrospective study of outcomes for dynamic equinus 14 

Children’s Activity and Participation 

Manson P Can typically developing preschool children learn the meaning of graphic symbols through play 15 

Durand S Early Intervention: when is it too late A case study of a 6 year old boy with mild cerebral palsy 15 

Murchland S 

DuBois L 

Evidence based practice review of occupational therapy interventions to assist pre-school children with physical 

disabilities to become spontaneous and independent players, and guidelines for clinical practice 

Handwriting of children who have hemiplegia: a profile of abilities in children aged 8 – 13 years from a parent 

and teacher survey 

16 

17 

2 

Bricher G ‘If you wanted to know about it just ask!’ Exploring disabled young people’s experiences of health and health care 18 

Ising M 

Now I can eat too: the impact of an intensive community based feeding program on a four year old with severe 

feeding difficulties 

19 

Guidera A Participation of Augmentative and Alternative Communication (AAC) users in school settings: research evidence 19 

Leane J 

Reading and phonological awareness in children with complex communication needs: 

literacy outcomes of internet-based assessment and intervention 

20 

Grace E School vocabulary in typically developing 6 year old Australian children 21 

Centre for Allied 

Health Evidence 

Systematic review of strategies used by therapists to work effectively with teachers and aides to implement 

programs which address client goals 

22 

Murchland S 

Unravelling handwriting: an investigation into the factors that influence handwriting ability in primary school aged 

children with hemiplegia 

23 

Equipment 

Communication Equipment 

Raghavendra P Clinical pathway for voice output communication aid recommendation and training for adults with disabilities 24 

Symonds B Convergence of AAC and portable computers 25 

Symonds B Effective mounting solutions 26 

Bebb M Predictors of device abandonment: transitioning from school to the community 27 

Garrett R Vocabulary Organiser – development of the program 28 

Garrett R Vocabulary Organiser – enhancement and commercialisation 29 

Bradley M Vocabulary Organiser – marketing 30 

Hobbs D Vocabulary Organiser – the addition of the merge function 31 

Environmental Control Equipment 

Ingram R The design and development of a range of cordless switches 32 

Hobbs D Movement-to-music therapy 33 


PRIMARY 

INVESTIGATOR PROJECT TITLE PG 

Mobility and Transferring Equipment 

Sanders D Computer aided customisation of walker designs 34 

Symonds B Integrated control of wheelchairs and communication devices 35 

Shepherd A 

Introduction of a hoist into the family home – a qualitative study into the perspectives of three mothers who care 

for a child who has a severe physical disability 

Svistounov A Remote monitoring of the testing laboratory 36 

Telecommunication Equipment 

Nguyen T Focus group to assess home and mobile phone needs 37 

Hobbs D Making the home phone accessible for people with a disability 38 

Nguyen T Mobile phone access via an augmentative and alternative communication device 39 

Nguyen T Survey of accessible mobile communication for people with disabilities 40 

Nguyen T Technological options for people with physical disabilities through use of telecommunications equipment 41 

Website Accessibility 

Ziersch T Development of accessible websites 42 

Garrett R Using product features to select appropriate AT products 43 

Spizzo M 

Assessment Tools 

Intra-rater and inter-rater reliability of the Tardieu Scale to quantify spasticity in biceps brachii 

in children with cerebral palsy 

Lyons T Use of the Canadian Occupational Performance Measure: therapists’ and parents’ views – a pilot study 45 

36 

44 

Gibson S 

What is the evidence for the use of the gross motor function measure (GMFM-88) 

as a functional outcome measure for children with cerebral palsy 

46 

Parent Support 

Ward N The prevalence of low back pain in parents of children with a physical disability aged 5 years or below 47 

Service Evaluation 

Raghavendra P Childhood therapy experiences of adults with cerebral palsy: implications for today’s children with cerebral palsy 48 

Morris R Comparison of feedback conditions in spelling instruction for a child using AAC 49 

Crettenden A Evaluation of behaviour management advice 50 

Bentley M Evaluation of family centred practice using the measure of process of care 51 

Jones J How occupational therapists at Novita train clients in the scanning access technique 51 

3 

Gibson S 

“Is more therapy better” A comparison of two models of intensive physiotherapy 

and “conventional” intensive physiotherapy for children with cerebral palsy 

52 

Durand S 

Motor and functional outcomes of children with physical and /or multiple disabilities living 

in rural and remote areas compared with their metropolitan counterparts – a pilot study 

Dryden L Single event multilevel surgery: a description of stakeholder experiences 54 

Service and Policy Development 

Walker L Australian representation on ISO TC173 SC1 55 

Hobbs D Churchill Fellowship research, experiences and outcomes 56 

Seeger B Development and delivery of an undergraduate subject in Rehabilitation Engineering at Flinders University 57 

Walker L Development of collaborative links with University of Pittsburgh 58 

Garrett R Disability Standards Working Group (DSWG) 59 

Svistounov A Enhancing innovation and development of new products in the Australian rehabilitation equipment sector 60 

Walker L Evaluation and scoping of a movement analysis facility in Adelaide 61 

Garrett R Phone accessibility information working committee 62 

Murchland S Resource allocation project 63 

53 


overview of research at novita 

Research, development and evaluation have been a vital part of high quality services provided by Novita Children’s Services 

Inc, (formerly The Crippled Children’s Association of SA Inc). Novita provides therapy, equipment and family support services to 

over 1000 South Australian children and young people with physical and/or severe multiple disabilities. Children have cerebral 

palsy (approximately 65%), muscular dystrophy, spina bifida or other conditions that result in a permanent physical disability. 

4 

Novita employs occupational therapists, orthotists, 

physiotherapists, psychologists, rehabilitation engineers, 

speech pathologists, and social workers, totalling over 

150 staff. Services are delivered by multi-disciplinary teams 

of therapists in clients’ homes, kindergartens, and schools or 

other community settings. There are five regional offices in 

the Adelaide metropolitan area, with staff from each office also 

visiting one or more country areas to support country families 

and local service providers. In addition, Novita provides 

equipment services to children and adults through NovitaTech 

(formerly Regency Park Rehabilitation Engineering). 

Historically, research was undertaken by individuals or 

by key departments within Novita. A research culture was 

established by Dr Leon Stern, Medical Director, Dr Barry Seeger, 

Director of Regency Park Rehabilitation Engineering, and former 

Chief Executive, Dr David Caudrey. This was strengthened in 

1996 by the creation of a new Research and Development 

(R&D) Department within the Regency Park Rehabilitation 

Engineering division of Novita, now called NovitaTech, and 

then later in January 1999 with the establishment of the 

Clinical Research Department. 

NovitaTech’s new Research and Development 

Department was formed using staff from the Electronics 

Department, providing a much clearer focus for R&D efforts. 

The team aimed to maximise the usefulness and relevance 

of technology to the lives of people with disabilities by 

conducting meaningful research and product development. 

As a result of the history and experience of the team, there 

was a clear emphasis on projects and products related to 

electronics and computers. 

Since then, the R&D Department has continued to refine 

and improve its internal processes while making a significant 

contribution to research and development in the field of 

rehabilitation engineering. In recent years there has been a 

move to the employment of Rehabilitation Engineers as they 

graduate from the Flinders University School of Informatics 

and Engineering. Since its inception, the Department has 

seen an increase in the level of collaboration with academic 

institutions, an increase in the use of sub-contractors to 

ensure that professional standards are applied to all areas, 

and an increased requirement for marketing skills. 

The Clinical Research Department was established to enable 

a systematic research focus in the Therapy Division that ensured 

effective assessments, interventions and support were provided 

to clients and families. The Department aims to conduct 

research; facilitate a spirit of enquiry amongst therapists within 

Novita; and to reduce the research-practice gap with therapists. 

The Department encourages therapists to pose clinical questions 

and provides the support required to answer these questions in a 

systematic way. It also facilitates the implementation of outcomes, 

as well as evaluating the effectiveness. 

The Clinical Research Department manages research 

projects in a number of ways: 

1) Supporting and educating Novita therapists involved in 

providing direct services to clients who initiate research 

ideas and are often involved in doing the research; 

2) Conducting joint projects internally and with other agencies 

and academic institutions such as the Women’s and 

Children’s Hospital, the University of South Australia and 

Flinders University; 

3) Providing an interface and liaison between the external 

groups and students who initiate projects and the Novita 

staff and families who may be involved in the study. 

Research projects are presented at bimonthly research 

seminars and biennial research days conducted by Novita; at 

state, national and international conferences; and published in 

newsletters and journals so that clients, their families, other staff 

and professional colleagues can benefit from the findings. 

Evaluating the evidence 

Evidence-Based Practice (EBP) is defined as “integrating 

best research evidence together with clinical knowledge and 

reasoning in providing assessments and interventions that 

are effective and efficient for particular clients”. To enhance 

evidence-based practice, Novita has focussed on: 

1) Staff Training in EBP • In July 2000, the Clinical 

Research Manager, the three research seniors and several 

physiotherapists from Novita attended a three-day course 

on EBP conducted by the School of Physiotherapy, 

University of SA. Over the subsequent four years, using a 

‘Train-the-Trainer’ model, most Novita therapists have been 

trained in EBP. 

2) Developing Novita Children’s Services Appraisal 

Forms to critically appraise research • The Research 

Department found that the hierarchy of evidence model 

used in Evidence-Based Medicine, and the tools used to 

evaluate research, were not suitable to appraise research 

in disability. Via a process of evaluating existing tools, the 

Clinical Research department used an adapted appraisal 

form and the McMaster forms for all allied health discipline 


esearch evaluations (http://bluewirecs.tzo.com/canchild/ 

patches/qualform.pdf and http://bluewirecs.tzo.com/ 

canchild/patches/quantform). 

3) Gathering and synthesising evidence for clinically 

relevant questions • Between 2001–2003, each therapy 

discipline investigated the evidence relating to one question 

of clinical relevance. All therapy staff were involved in the 

process of reviewing and critically appraising the literature, 

coordinated by research seniors. The outcomes of these are 

summarised on pages 13, 16, 19 and 46. 

4) Collaborating with the Centre for Allied Health 

Evidence (CAHE) (University of South Australia) – 

A collaborating Centre of Joanna Briggs Institute 

for Evidence Based Nursing • This has included 

contracting the CAHE to undertake a systematic review of a 

multi-disciplinary intervention question (page 22). 

our research partners 

Clinical Research (CR) and Research and Development 

(R&D) have strong links with university departments, hospitals 

and other external agencies within South Australia, nationally and 

some internationally. Our collaborative partners have provided an 

enriching relationship that has been of mutual benefit. 

Our Partners 

• Better Software 

• Colsoft (Computer Systems Management 

and Support Services) Pty Ltd 

• Flinders University of South Australia 

– School of Medicine, 

Department of Speech Pathology 

• Dr Ingrid Scholten PhD 

– School of Medicine, 

Department of Rehabilitation and Aged Care 

– Psychology 

– School of Informatics and Engineering 

• Prof Trevor Hearne B Sc (Hons) PhD 

• Assoc Prof Karen Reynolds MA M Sc PhD 

• Independent Living Centre 

– Adult Therapy Services 

• Michael Bebb, Speech Pathologist 

• South Australian Department of Education 

and Children’s Services 

– Regency Park School 

• Telstra Disability Services 

• The Defence Science and Technology Organisation 

• Therapy Focus, Western Australia 

• University of Pittsburgh, Pennsylvania USA 

– School of Health and Rehabilitation Sciences 

• Prof Rory Cooper BS MEng PhD ATD 

• University of South Australia 

– School of Health Sciences 

• Prof Esther May PhD 

• Dr Paul Grimshaw PhD 

– Division of Physiotherapy 

• Assoc Prof Marie Williams PhD 

• Dr Susan Hillier PhD 

• Dr Andrea Warden Flood PhD 

– Division of Occupational Therapy 

• Hugh Stewart Cert Tech (Electronic Engineering) 

B App Sc (OT) M App Sc (OT) 

– Joanna Briggs Institute, Center for Allied Health Evidence 

• Assoc Prof Karen Grimmer PhD 

– Louis Laybourne-Smith School of Architecture and Design 

• Women’s and Children’s Hospital 

– Department of Orthopaedic Surgery 

• Mr Philip Brook MBBS FRACS (Orth) 

– Department of Paediatric Rehabilitation 

Partnerships with some individuals have also been extremely 

productive, resulting in joint grant submissions, conference 

presentations, book chapters, journal articles and improved 

research processes. These include: 

• Jeff Clayton 

Director of Clayton Management Pty Ltd, 

Management Consultants 

• Prof Philip Darbyshire PhD 

Head of Nursing & Midwifery Research 

Women’s and Children’s Hospital, SA 

• Prof Andrew Downing 

Foundation Professor, Biomedical Endineering 

School of Informatics and Engineering 

Flinders University, Adelaide SA 

• Dr Peter Flett 

Director of Paediatric Rehabilitation, 


• Jeff Groves 

Director of Innovation, 

Centre for Innovation, Business and Manufacturing 

• Dr Teresa Iacono PhD 

Senior Research Fellow, Centre for Developmental 

Disability Health Victoria, Monash University, 

Communication Resource Centre, Scope Victoria. 

• Dr Ralf Schlosser PhD 

Associate Professor, 

Dept. of Speech Pathology, NE University, Boston, USA 

• Peter Wilkinson 

Software Programmer 

5 


selecting research projects 

The Clinical Research and Research & Development 

Departments have different committees 

and criteria for the approval of research ideas. 

6 

Research & Development Project 

Selection Process 

The Research & Development (R&D) Department has 

refined its project selection process since the creation of 

the Department, to establish and maintain ISO9001 Quality 

Accreditation and as a result of annual reviews of the 

Department. The essential criteria for project selection have 

not changed significantly over the past few years, however the 

process of evaluation against the following criteria has been 

modified. The criteria for project approval are as follows: 

• The idea must have the potential to enhance the lives of, 

or provide benefit to more than one individual; 

• Ideas should promote a collaborative relationship between 

R&D research staff and clinical staff, caregivers and 

end users; 

• The idea must provide an opportunity for the NovitaTech 

R&D Department to create an innovative, technological 

solution that meets the needs of people with disabilities 

in South Australia; 

• Where possible, the need for the idea should have arisen 

due to a lack of other existing, suitable or alternative solutions 

in the market. The idea should contribute to developing and 

piloting of a new product or service alternative; 

• The idea or problem solution must be in keeping with 

Novita Children’s Services’ Strategic Plan; 

• There must be a ‘project champion’ (ideally the person 

who submits the idea) who is willing to be involved with the 

project through to completion; 

• The idea should potentially demonstrate one or more of 

the following measurable benefits, to justify the allocation 

of Novita resources: 

− enhance the lives of Novita clients; 

− provide a marketable/profitable end product; 

− provide a significant time or cost saving outcome 

(this could be to staff, clients, carers, etc.); 

− strive to enhance client satisfaction with the services 

of Novita; 

− clinical-based ideas should strive to increase the 

efficiency of Novita staff, and in doing so, benefit 

Novita clients. 

In the first instance, all project ideas that are submitted to 

R&D are filtered against these criteria. If an idea passes this 

initial filtering process, the idea is further developed into a 

strong business case before it is undertaken as a project. 

The secondary process (referred to as ‘Phase Zero’) 

is a more exhaustive evaluation that aims to identify and 

investigate any weaknesses or ‘areas of concern’ surrounding 

the submitted idea, to ensure that the project is feasible and is 

likely to produce a significant benefit. These concerns typically 

involve work to evaluate items such as the technical feasibility; 

an estimate of the significance to the lives of the people with a 

disability; an estimate of the number of Novita and other clients 

impacted upon; similar work occurring elsewhere in the world; 

alternative existing products; resolution of legal and ethical 

issues; and consideration of marketing issues. 

The output of ‘Phase Zero’ is a business and project plan 

that is tabled before an R&D Project Review Panel. This panel 

has skills in the assessment and review of business cases 

and has the authority to approve or reject project proposals or 

recommend additional work on particular parts of the business 

case. The panel may also rank or prioritise projects. 

The successful business case forms the basis of a request 

for project funding which may be sought from internal budget 

resources, the Novita Executive Reference Group or external 

funding bodies. Proposals where the scope extends beyond 

children’s services alone may require external funding, and their 

commencement is dependant upon the success of applications 

for such funding. 

If a project is approved through the selection process it will 

then be entered into the R&D project database and project plan. 

All projects are then required to be clearly defined, with sign-off 

by appropriate personnel at the end of each of the following 

stages throughout the life of the project: 

• design documents and production; 

• design document verification; 

• prototype construction or project implementation; 

• project internal validation; 

• project external validation; 

• project completion. 

If any of the above stages cannot be met then the project 

objectives are revised and re-evaluated at one of the earlier 

stages, or the project is cancelled because it is not feasible. 

Up until 2004, a group known as the ‘R&D Reference Group’ 

was used to assist the selection of projects and the allocation 

of resources. Members of the group came from the other 

Departments within NovitaTech, the former Communication and 

Therapy Services division, the occupational therapy and speech 

pathology departments of Novita, and also included the parents 

of two Novita clients. 


Clinical Research 

Selection Process 

The Clinical Research Sub Committee (CRC) was established 

in June 2000 to ensure that Novita Children’s Services has 

a cohesive clinical research program that aligns to the 

Association’s strategic directions and results in best practice 

outcomes for clients and families. Specifically, the committee 

ensures that equitable, objective project selection/acceptance 

is undertaken and that proposals gain appropriate ethics 

approval from relevant agencies prior to commencement; 

monitors all projects on a regular basis; and contributes to 

future directions of Novita’s research program. Criteria for 

project approval: 

• the project idea should reflect Novita’s research direction, 

mission, strategic and/or business plan objectives; 

• projects should be of benefit to clients, families, therapists, 

and the community; 

• the same clients and families should not be requested to 

take part in more than one research project. (Consideration 

given to avoiding excessive use of same clients); 

• there should be a balance of projects from various 

disciplines; 

• scientific merit; and 

• ethics approval from the appropriate Human Research 

Ethics Committee. 

In 2003 a process of identifying the priority directions for 

Clinical Research at Novita commenced and was ratified by 

the Board in 2004. The priority areas for Clinical Research in 

2004–2007 are: 

1. projects that examine ways to enhance participation of our 

children and families in the community and measuring the 

effectiveness of those intervention methods; 

2. life span issues – research that investigates issues acrosss 

0–18 years, promoting personal autonomy and client and 

family centredness; and 

3. evaluations of interventions and aspects of service delivery 

reflecting outcomes at client Impairment, Activity and 

Participation levels. 

The Clinical Research Committee members are: 

Greg de Cure B A (Int Studies) Hons 

Parent & Project Officer (Curriculum Design) 

Office of Planning & Quality, University of Adelaide 

2002 – current 

Dr Peter Flett M B, B S, FRACP, FRACM, FAFRM (RACP), MRACMA 

Director of Paediatric Rehabilitation 



Dr Tim Connell B A, Dip Soc Sc (Psychology), PhD 

Chief Psychologist, Novita Children’s Services Inc 


Terry Lyons Dip Tech (Occupational Therapy) 

Chief Occupational Therapist, Novita Children’s Services Inc 


Louise McCarthy B App Sc (OT) 

Manager, North Western Regional Office 

Novita Children’s Services Inc 

March 2004 – current 

Catherine Olsson B App Sc (Speech Pathology) 

Chief Speech Pathologist, Novita Children’s Services Inc 


Dr Parimala Raghavendra B Sc, M Sc, PhD 

Chairperson 

Manager, Clinical Research, Novita Children’s Services Inc 


Judy Sprod B App Sc (Physiotherapy) 

Chief Physiotherapist, Novita Children’s Services Inc 


Wendy Wake-Dyster Dip Tech (Physio) Grad Dip (Physio) 

Grad Dip (Mmt), AFAIM, CPMger 

Director, Client Programs, Novita Children’s Services Inc 


Past Members: 

Tori Wilckens B App Sc (Physiotherapy) 

Senior Physiotherapist, Communication & Therapy Services 

2001 – 2002 

Pam Donnelly B Soc Sc (Community Services) 

Manager, Northern Regional Office, 

Novita Children’s Services Inc 

2001 – 2003 

7 


esearch teams 

The two research teams within Novita are 

Clinical Research, Therapy Division and 

Research and Development, NovitaTech. 

8 

Clinical Research Team 

Manager, Clinical Research 


1999 – present 

Adjunct Lecturer, Department of Speech Pathology 

& Audiology, Flinders University of SA 

The Manager is responsible for the development and implementation 

of an innovative and meaningful research and evaluation 

program. This is achieved by developing and maintaining a strong 

multidisciplinary research focus across Novita therapy services; 

identifying, formulating and conducting relevant research projects 

within the context of Novita’s policies and priorities; and working 

with Novita therapy staff, university schools and external agencies. 

Research Seniors 

Research Senior Occupational Therapist 

Sonya Murchland B App Sc (OT), M H Sc (OT) 

1999 – present 

Research Senior Physiotherapist 

Sue Gibson B App Sc (Physiotherapy), 

G Dip Physiotherapy (Paediatrics), M App Sc Physiotherapy (Paediatrics) 

1999 – 2002, 2003 – present 

Dr Trish Bate B App Sc (Physiotherapy), M App Sc, PhD 

2002 – 2003 

Research Senior Speech Pathologist 

Sandra Stewart B App Sc (Speech Pathology) 

April 2004 – present 

Kylie Opperman B App Sc (Speech Pathology) 

2003 – April 2004 

Angela Guidera B App Sc (Speech Pathology) 

1999 – 2002 

The Research Seniors are the key link between therapists and the Research 

Department by providing clinical services to clients and also working in 

the Research Department. They contribute to the development of research 

direction of their discipline and client programs; undertake and facilitate 

research projects within their discipline and disseminate research 

outcomes at conferences; promote evidence-based activities; and liaise 

with university departments and other agencies to promote research. 

Other staff 

Project Officer 

Julie Smith B A (Adelaide) 

1999 – 2002 

Research Assistant Occupational Therapist 

Jocelyn Kernot B App Sc (OT) Hons 

2002 – 2003 

Research and Development Team 

Manager 

Rob Garrett B Tech, Grad Dip Maths, C P Eng, ATP 

Group Leader, Research & Development, 

Engineering & Support 

1985 – present 

The Group Leader is responsible for the development and 

implementation of innovative technological solutions that will 

enhance the lives of people with a disability. 

This is achieved by actively soliciting new ideas and projects, 

appropriate analysis of the potential benefits and costs, the 

creation of a business plan, the involvement of key stakeholders 

and review of the project at the end of critical development stages. 

Senior Rehabilitation Engineer 

David Hobbs B Sc (Physics), B Sc / B Eng (Biomed) (Hons) 

May 2001 – present 

Marketing Specialist 

Melissa Bradley B Des (Int Des), B Mgt (Intl Mktg) 

April 2000 – present 

Rehabilitation Engineers 

Ben Symonds B Sc / B Eng (Biomed) (Hons) 

March 2003 – present 

Toan Nguyen B Sc / B Eng (Biomed) (Hons) 

Masters Candidate, 2001 – present; 

Research Assistant 2003 

Rebecca Gallio B Sc, B Eng (Biomed) (Hons) 

January 2002 – January 2003 

Electronics Engineers 

Paul Davies B Eng (Electronics) (Hons), Grad Dip (Disability Studies), ATP 

May 1997 – Aug 2000 

Duane Stapleton B Eng (Computer Systems) (Hons) 

December 1994 – April 1999 

The Research and Development staff are assigned to one or 

more projects as a project co-ordinator, responsible for ensuring 

the involvement of stakeholders, collaboration with partners, 

development of business cases, liaison with sub-contractors, 

reporting on progress, publishing results and disseminating 

outcomes at conferences. They also contribute to the strategic 

direction of the department. 

Other staff 

Undergraduate students gain work experience and contribute 

to projects from time to time. 


Researcher Profiles 

Susan Bostock B App Sc Physiotherapy 

Sue graduated from the Lincoln Institute of Health Sciences, Victoria 

in 1978 and has had over 20 years experience in paediatric 

disability and recent research experience. She is currently Senior 

Clinical Physiotherapist and is based in the Northern Regional Office 

of Novita Children’s Services. 

Melissa Bradley B Des (Int Des), B Mgt (Intl Mktg) 

Melissa graduated from the University of South Australia with 

a design degree (majoring in Interior Design) in 1994 and a 

Management degree (majoring in International Marketing) in 1998. 

As part of her final year studies, Melissa travelled to Malaysia and 

the Philippines to investigate the business opportunities for Adelaidebased 

company, Sabco Australia. Since starting as Marketing 

Specialist with NovitaTech in April 2000, Melissa has worked with 

the Research and Development Department in investigating several 

market opportunities for various products in the small, unique and 

highly specialised disability field. A key element of her work has been 

the establishment of systems to project manage research and input 

from clients, families and staff. Melissa has also worked on 

the commercialisation of the Vocabulary Organiser program. 

She has been highly involved in the graphical representation of 

material produced by the Division, with a distinct goal to strengthen 

its profile. Melissa has also worked in a Marketing role for Novita 

Children’s Services, NovitaTech’s parent organisation. 

Louise DuBois B App Sc (Occupational Therapy) 

Louise graduated from the University of South Australia in 1992 with a 

Bachelor of Applied Science in Occupational Therapy. Her first job was 

in Aged Care in Grafton, where she worked for one year before moving 

to Grafton Base Hospital where her case load included some paediatrics. 

After 2 years, Louise headed overseas and worked in a Children’s 

Development Centre in Basildon, Essex, UK. She returned to Adelaide 

and gained employment with Novita Children’s Services in 1997 and 

was appointed Senior Therapist later that year. Louise currently works 

as a Regional Senior in the Northern Regional Office of Novita. 

Sue Durand C Cert (Physiotherapy) 

Sue graduated from the Bristol School of Physiotherapy in 1971. 

She has many years of experience in paediatrics working, in 

England and different states of Australia. Sue began her employment 

in South Australia with the Spastic Centres of SA, Inc in 1989 and later 

transitioned to Novita Children’s Services. Sue finished working with 

Novita in June 2004, at which time she held the position of Regional 

Senior Physiotherapist in the South Eastern Regional Office. For many 

years Sue was on the Australian Physiotherapy Association’s South 

Australian Paediatric Group Committee. Sue always had an interest in 

hydrotherapy and is now working in a private paediatric physiotherapy 

practice and is a consultant for specialised walking equipment. 

Dr Peter Flett MBBS, FRACP, FACRM, FAFRM (RACP), MRACMA 

Dr Peter Flett is a Consultant Physician in Paediatric Rehabilitation 

Medicine, and is currently the Director of Paediatric Rehabilitation, 

Women’s and Children’s Hospital, Adelaide, a strategic alliance 

position with Novita Children’s Services. Following the conferring of 

his FRACP in 1981, he became the first paediatrician in Australia to 

become fully qualified as a specialist in rehabilitation medicine by 

examination and has been an examiner since 1986 for the Faculty 

of Rehabilitation Medicine. Dr Flett was also a member of the original 

Research and Development Sub-Committee of the Board of CCA, 

chaired by Dr Barry Seeger. Dr Flett has an interest in children with 

cerebral palsy, publishing widely in this area, and contributing to the 

establishment of the South Australian Cerebral Palsy Register. 

Rob Garrett B Tech (Electronics), Grad Dip Maths, MIEAust, CPEng, ATP 

Rob graduated from the University of Adelaide with a Bachelor 

Technology in Electronic Engineering in 1971 and completed a 

Graduate Diploma in Mathematics at the South Australian Institute 

of Technology in 1976. 

After working at the Defence Science and Technology Organisation at 

Salisbury South Australia for 22 years, in 1985 Rob became the first 

Electronics Engineer in Australia to work in the field of Rehabilitation 

Engineering at NovitaTech. 

Rob was awarded a Churchill Fellowship in 1990 to study the “Use 

of Computers to Enhance the Lives of People with Disabilities” for a 

period of 9 weeks in USA, Canada, UK and Sweden. Rob is also a 

certified Assistive Technology Practitioner. 

Rob has been a member of: the Australian Rehabilitation and 

Assistive Technology Association (ARATA) Board (1999–current); 

Modbury Hospital Board (2002 –2004); chair Modbury Hospital 

Community Consultative Committee; member Disability Advisory 

Body of the Australian Communications Industry Forum since 

inception in 1999; Telstra Regional Consumer Council in SA (1996– 

2000); Telecommunications Consumer’s Group, SA since inception in 

2000; Technical Aid to the Disabled (past member of executive) and is 

a corresponding member of Engineers Australia’s National Committee 

on Rehabilitation Engineering. 

His interests include the application of Universal Design principles to 

the development of products and processes to enhance the lives of all 

people and especially those who have a disability with a particular 

interest in ensuring telecommunications products are accessible to all. 

Susan Gibson 

B App Sc (Physiotherapy), Grad Dip Physio (Paeds), M App Sc Physio (Paeds) 

Susan graduated from the South Australian Institute of Technology 

with a Bachelor of Applied Science (Physiotherapy) in 1978, a 

Graduate Diploma in Physiotherapy (Paediatrics) from the South 

Australian Institute of Technology in 1989, and completed a Masters 

of Applied Science in Physiotherapy (Paediatrics) at the University 

of South Australia in 1993. She has worked at several organisations, 

both in Australia and the UK, that provide therapy services for 

children and adults with disabilities. Susan commenced work at 

Novita Children’s Services in 1985. Her areas of interest include 

the promotion, and use of, research in clinical practice. Susan is 

currently employed as the Senior Research Physiotherapist, and 

has a clinical caseload in the Southern Regional Office of Novita 

providing metropolitan and outreach services. 

Angela Guidera B App Sc (Speech Pathology), MSPAA, CPSP 

Angela graduated from the South Australian College of Advanced 

Education with a Bachelor of Applied Science (Speech Pathology) 

in 1989. She started working for Novita Children’s Services in 1993. 

She has worked in various roles, including providing communitybased 

therapy services, providing country outreach services and 

working in the organisation’s Clinical Research Department. Angela 

is currently a member of the NovitaTech Support Team. Her role 

provides a consultative service in the use of technology, primarily in 

relation to augmentative and alternative communication (AAC), 

for children with disabilities. She has presented at several national 

conferences. Angela has previously worked in rural areas in South 

Australia and Western Australia. 

9 


10 

David Hobbs B Sc (Physics), B Sc / B Eng (Biomed) (Hons), Exec Dip Bus Plan 

David graduated from Flinders University with a Physics degree in 

1994 and a double degree in Biomedical Engineering, with Honours, 

in 2000. He also has an Executive Diploma in Business Planning 

(2001) through the South Australian Enterprise Workshop. David 

started working at NovitaTech in May 2001, and is employed as a 

Senior Rehabilitation Engineer within the Research & Development 

Department and the Engineering (Testing Laboratory) Group. 

David is a member of the National Committee on Rehabilitation 

Engineering, through Engineers Australia, a Board member of 

ARATA, and was awarded a Churchill Fellowship in 2002. The 

aim of David’s Churchill research was to investigate how leading 

rehabilitation engineering centres around the world are using 

research and development, Universal Design, and the application 

of technology to assist people with a disability. David has 

recently been appointed as a ‘Flinders Ambassador in the 

Community’ by the Vice-Chancellor of Flinders University, and is 

a member of ‘Engineers Without Borders Australia’ at a state and 

national level. 

Merrin Ising B App Sc (Speech Pathology) 

Merrin graduated from Flinders University in 1996 with a Bachelor 

of Applied Science in Speech Pathology. Merrin began her career 

working with adults with acquired brain injury at Julia Farr Services. 

In January 2000 she accepted a position at Novita Children’s Services 

and has enjoyed working with children ever since. Merrin has an 

interest in working with children with complex communication 

needs and giving them a voice within our community. She has also 

maintained a particular interest in acquired brain injury and would 

one day like to pursue this further with children and adolescents. 

Merrin is currently the Senior Speech Pathologist at the Southern 

Regional Office of Novita Children’s Services. 

Sue van de Loo B App Sc (Occupational Therapy) 

Sue is currently a member of the NovitaTech Support Team. She 

graduated from the South Australian Institute of Technology in 1988 

and gained employment with the Crippled Children’s Association 

(now Novita Children’s Services) in the same year. She has worked in 

a broad range of therapy areas including Early Childhood Services 

Speech and Language units, country outreach and been a senior 

therapist in the North East Regional Office. During 1990–91, Sue 

worked in Paediatrics in the United Kingdom. In 1996, Sue played 

a key role in the establishment of an internal NovitaTech Assistive 

Technology Support Team. Technology for people with disabilities 

has always been an area of interest, and Sue has a special focus on 

alternative controls for powered mobility and access to alternative 

and augmentative communication systems. Sue has presented papers 

at a number of national and state conferences and has been involved 

in running technology workshops both intra and interstate. 

Terry Lyons Dip Tech (Occupational Therapy) 

Following a cadetship during her training, Terry began working for 

the then Crippled Children’s Association of South Australia, Inc., and 

completed her qualifications in occupational therapy in 1974. She 

has worked in the area of services for children and adolescents with 

physical and/or multiple disabilities throughout her career, with a 

short period of employment in country South Australia. In 1988–91 

she held a joint position with the University of South Australia and 

Spastic Centres of South Australia as Student Unit Supervisor. Terry 

has an interest in occupational performance in children, and 

intervention methods to support their independence. Since 1997, 

Terry has been the Chief Occupational Therapist at Novita Children’s 

Services, and is the OT Australia – SA representative for the Paediatric 

and Adolescent Action Group. Terry has worked in most regions of 

Novita, and is currently based in the Northern Regional Office. 

Paul Manson B Sp Thy 

Paul completed his Bachelor of Speech Therapy at the University of 

Queensland in 1983. He started his career working with children 

with a disability in 1984 at the Hartley St School for Physically 

Handicapped Children in Canberra. He moved from Canberra in 

1985, and joined Novita Children’s Services. Paul has maintained 

his interest in communication for people with a disability ever 

since, and is interested in the ways we can improve the quality of 

life for children with disabilities. Naturally, this has focused on 

augmentative and alternative communication. Paul has performed 

different roles within the organisation, including within the Head 

Injury Program and Technology Access Service and 3 different 

Regional Offices. Paul is currently the Senior Speech Pathologist at 

Novita’s North Western Regional Office. 

Sonya Murchland B App Sc (Occupational Therapy), MH Sc (Occupational Therapy) 

Sonya gained her occupational therapy qualifications in 1982 

graduating from the South Australian Institute of Technology, and then 

in 1995 she gained her Masters in Health Science from the University 

of South Australia. She commenced working with children who have 

disabilities in 1982 at the Spastic Centres of South Australia, and has 

gone on to work in a variety of children’s health settings in Adelaide 

and in Scotland. Sonya commenced work at Novita Children’s Services 

in 1998, following a secondment from the Women’s and Children’s 

Hospital. Her interests include the development of hand function in 

children, measuring outcomes of therapy, models of service delivery and 

resource allocation. Sonya has a commitment to the provision of services 

to children in rural and remote areas. She has worked in most regions 

of Adelaide and is currently acting as Manager of Clinical Research 

before returning to the position of Senior Research Occupational 

Therapist with a clinical load in one of the regions in early 2005. 

Toan Nguyen B Sc / B Eng (Biomed) (Hons), M Eng (Research) Candidate 

Toan graduated from Flinders University with a double degree in 

Biomedical Engineering, with Honours, in 2000. He is now completing 

his Master of Engineering (Research) thesis entitled, “Accessible Mobile 

Communication for People with Disabilities” at Flinders University, 

Adelaide. In 2003, Toan was employed as a Research Assistant at 

NovitaTech within the Research & Development Department to assist 

with a trial of “New Technological Options for people with physical 

disabilities, through the use of telecommunications equipment”. The 

objective of this research was to trial and evaluate new configurable 

“off-the-shelf” technological options that can improve the lifestyle, 

independence, security and social interaction of people with disabilities. 

At present, Toan is employed as a Rehabilitation Engineer to carry 

out further research into telecommunications options for people with 

disabilities, with a particular emphasis on mobile phone access for 

Augmentative and Alternative Communication (AAC) device users. 

Kylie Opperman B App Sc (Speech Pathology) 

Kylie has been working as a Speech Pathologist in the area of 

paediatrics and disabilities for over 10 years. She has a particular 

interest in dysphagia in children, early communication development 

and the use of assistive and augmentative communication (AAC). 

Kylie has been a senior therapist since 1996, first as a Regional 

Senior Speech Pathologist, then Clinical Senior within specialist 

speech and language programmes, then in the area of dysphagia, 

before being appointed Research Senior in 2003. 


Dr Raghavendra has a PhD in speech pathology from Purdue 

University, USA. She has clinical, teaching and research experience 

in augmentative and alternative communication through her 

work in India, Singapore, USA, and Sweden. She has published in 

high quality journals and has over 60 national and international 

conference presentations. She has been a consultant editor for the 

Journal of Augmentative & Alternative Communication, since 

1990 and was the Vice-President without Portfolio, International 


Society for Augmentative and Alternative Communication (ISAAC), 

1995–1996. In 2002 she was on the selection panel for a statewide 

Therapy Service for people with a disability who have complex 

communication needs, Department of Human Services, Victoria. 

Currently, her work focuses on making research become an integral 

part of high quality services and on answering important clinical 

questions through research in paediatric disability. 

Dr Ray Russo MBBS FRACP FAFRM (RACP) 

Dr Russo is a Paediatric Rehabilitation Specialist working at the 

Women’s and Children’s Hospital, Novita Children Services and the 

Flinders Medical Centre. He is currently undertaking a PhD thesis in 

the area of upper limb function in children with spastic hemiplegia. 

His clinical work includes the rehabilitation care of children with 

chronic physical disabilities, and cognitive impairments associated 

with these conditions and in children with acquired brain injury. 

He is actively involved in the teaching programs for both adult 

rehabilitation physician and paediatric physician trainees and is 

an examiner in Paediatric Rehabilitation for the Australasian 

Faculty of Rehabilitation Medicine. He is currently the Chairman 

of the SA Branch of the Australasian Faculty of Rehabilitation 

Medicine representing the local interests of both adult and 

paediatric rehabilitation at a state level. 

research investigating the use of mainstream laptop computers as 

communication devices and has investigated alternative controls 

for powered mobility. Most recently he has been working with the 

Mobility & Seating Department and has also developed an interest 

and involvement in wheelchair mounting systems for communication 

devices and alternative powered mobility controls. Ben’s other role at 

NovitaTech is in the Engineering Department (an independent N.A.T.A. 

Accredited mechanical testing facility) where he tests a range of 

rehabilitation engineering equipment. 

Alex Svistounov ME (Mech), MIE Aust 

Alex Svistounov graduated from the Bauman Moscow State Technical 

University in 1994 as an Electromechanical Engineer with specialisation 

in mechanical systems of underwater robotic complexes. After 

graduation he worked as a senior mechanical design engineer in one 

of the departments of the Russian Federal Marine Research and Project 

Centre. Alex migrated to Australia in 2000 and joined the NovitaTech 

team in 2002 as a senior testing engineer. Alex is currently undertaking 

his Masters studies by research with the Adelaide University. He is 

interested in advanced design, innovation, failure prediction and 

technical problem solving techniques and in the effects of legislation on 

innovation. Alex is a corresponding member of Engineers Australia’s 

National Committee on Rehabilitation Engineering and a member the 

ME67 Committee of Standards Australia. 

Dr Barry Seeger BE (Mech), PhD, FIE Aust, AM 

Dr Barry Seeger was Director of Rehabilitation Engineering for 

the Crippled Children’s Association of SA (now Novita Children’s 

Services) for 25 years until his retirement in 2002. He has a degree 

in Mechanical Engineering and a PhD in Biomedical Engineering 

from the University of NSW. He has obtained over 40 research grants 

and authored over 80 papers in scientific journals. He has been chair 

of Standards Australia’s Committees on wheelchairs, and access 

for children and adolescents with disabilities, and a member of 

international standards committees on wheelchairs. He is a Fellow of 

the Institution of Engineers, Australia. He is an advocate of Universal 

Design, and to that end continues to be a Board Member of the 

Coalition for Adaptable Housing SA, and is the SA representative to 

the Australian Network for Universal Housing Design. In 2002 he was 

made a Member of the Order of Australia for his work for people with 

a disability in the area of rehabilitation engineering and received the 

Cerebral Palsy Medal from the Australian Cerebral Palsy Association. 

Annabelle Tilbrook BA, B App Sc (Occupational Therapy) (Hons) 

Annabelle Tilbrook graduated from the University of Queensland 

in 1987 with a Bachelor of Arts (Economics, Modern History and 

Psychology) and in 1991 with a Bachelor of Occupational Therapy 

with Honours. Before joining Novita Children’s Services in 1998, she 

worked as a senior therapist in a range of children’s therapy services 

in both Australia and in the UK (Hobart 1992–93, 1996–97, Brisbane 

1993, London, 1994 and Inverness, 1995–96). Her current focus in 

her role in the NovitaTech Support Team is to support children with 

physical disabilities to access and efficiently use assistive technology 

in their home, educational and community settings. She was involved 

in developing an accessible website for Novita Children’s Services and 

also in making recommendations for Novita regarding Australian 

Standards for equipment design and organisational requirements. 

Annabelle has presented workshops and papers on a range of topics 

at conferences both in Australia and the UK and has had a paper 

published in a professional journal. 

11 

Sandra Stewart B App Sc (Speech Pathology) 

Sandra graduated from the South Australian College of Advanced 

Education with a Bachelor of Applied Science (Speech Pathology) in 

1984. She has worked in the area of physical disability ever since. 

She worked initially for the Spastic Centres of South Australia and 

commenced at Novita Children’s Services in 1987. She also worked for 

a similar organisation in Canada in 1990. She completed training 

in the Neuro-development Treatment of Cerebral Palsy in 1993, 

being one of the few Speech Pathologists to do so. She has undertaken 

many roles including Augmentative Communication Specialist in 

Rehabilitation Engineering, member of the Technology Consultative 

Team (TeCT), Augmentative and Alternative Communication Clinical 

Senior Speech Pathologist, Regional Senior Speech Pathologist, Acting 

Quality Manager and is currently the Research Clinical Senior Speech 

Pathologist and maintains an active caseload. She has presented at 

international and national conferences and conducted numerous 

training forums nationally and locally. 

Ben Symonds B Sc / B Eng (Biomed) (Hons) 

Ben graduated from Flinders University with a double degree 

in Biomedical Engineering, with Honours, in 2002. During his 

studies Ben undertook two major projects, including his Honours 

project, focussing on the research and development of robotic 

systems. In March 2003 he began working at NovitaTech and is 

employed as a Rehabilitation Engineer, primarily in the Research 

& Development Department. In this position Ben has undertaken 

Dr Lloyd Walker BE (Hons), PhD (Strath), MIEAust, CPEng, ATP 

Lloyd Walker completed his Mechanical Engineering degree at the 

University of Queensland with a rehabilitation-based honours project. 

He gained an international scholarship to study at the University 

of Strathclyde in the Bioengineering Unit and investigated the 

biomechanics of the foot and lower leg. On his return to Australia in 

1991, Lloyd established a rehabilitation engineering facility in North 

Queensland, taught at James Cook University and developed and 

coordinated the preparation of the world’s first multimedia-based 

postgraduate course in Assistive Technology. In 1998 he became the 

foundation deputy head of the Occupational Therapy program at 

James Cook University until he was appointed Director of Regency Park 

Rehabilitation Engineering in 2002. 

Lloyd has been a member of the National Committee on Rehabilitation 

Engineering since 1995 (chair from 1999–2003), the National 

Technology Committee of ACROD (1996–2001), the Uniting Care 

Queensland Board (1996–2002), and the CONROD Research Advisory 

Group (1997–2001). He is currently Chair of the ME67 Committee of 

Standards Australia and is Australia’s nominee on the ISO TC173 SC1 

working group that covers wheelchair-related standards. As a person 

with a disability, Lloyd has a strong focus on worthwhile outcomes 

from the use of technology and this is a key focus of his research 

and presentations recently. He is also particularly interested in the 

application of accident investigation and prevention research to 

avoiding adverse outcomes in assistive technology delivery. 


projects 

The following pages contain details of the projects undertaken over the past five years at Novita and NovitaTech. 

Early and external projects are listed below while detailed summaries are given for all other projects on subsequent pages. 

12 

1999 

1a. Expectations and Early Experiences of Parents with The 

Crippled Children’s Association of SA Inc. – Report 1. 

Parimala Raghavendra, Julie Smith with Members of 

“Working Together” Working Party 

1b. Current Work Practices and Expectations of Therapists of 

The Crippled Children’s Association of SA Inc. – Report 2, 

Therapists’ Work Practices and Expectations. Parimala 

Raghavendra, Julie Smith with Members of “Working 

Together” Working Party 

2. Telephone interviews regarding name of the association: 

Feedback from parents of CCA, Report for CCA Board. 

Julie Smith & Parimala Raghavendra 

3. The Quality of life of children with disability in inclusive 

educational settings – Master’s project, Flinders University 

of South Australia 

2000 

1. Perception of Community Based and Family-Centred Practice 

for physiotherapists – Masters in Public Health, Flinders 

University of South Australia, Rachel Lichfield. Lichfield, R & 

MacDougall, C (2002). Professional issues for physiotherapists 

in family-centred and community-based settings. Australian 

Journal of Physiotherapy, 48: p. 105–112 

2. The Role of Social Support in Psychological Adjustment 

of Children with a Disabled Sibling. Kylie Barnes, Masters 

Student, Dept. of Psychology, Flinders University of 

South Australia 

3. What are the factors and how do they influence the decision to 

abandon day splints for three adolescents with cerebral palsy 

– Occupational Therapy Honours Project, University of 

South Australia. Biancha Gerlach 

2001 

1. Does an Intensive Fitness and Skills Training Program for 

Young Adolescents with Physical Disabilities Enhance their 

Independence with Mobility and A.D.L. Tasks – A parent 

initiated project, SWRO, CCA. Judith McPharlin, Jennifer 

Gutschi, Sue Gibson, Sonya Murchland 

2. Factors associated with the social development of children 

with disabilities at school. Kellie Bennett, PhD project, 

Curtin University 

3. What is a useful checklist for the prescription of a laptop 

based VOCA for children with a communication disorder 

– Third year Group project, School of Occupational 

Therapy, University of South Australia 

2002 

1. A retrospective case study of effectiveness of a 

child receiving multiple physiotherapy and medical 

interventions. Margarita Benias 

2. Technological Promise and Technology Abandonment: 

Understanding the Human Aspect of Technologies for 

people with disabilities. Dr Wendy Seymour, School of 

Social Work and Social Policy, University of South Australia 

2003 

1. Customer Valued Information Dissemination Strategy – 

A survey of consumers, professionals and carers/families 

regarding accessibility of telecommunication information. 

Dr Janet Owens, Deakin University/Communication Aid 

Users Society, Victoria 

2. Assessment of the monitoring of growth and nutrition 

in children with cerebral palsy accessing the Crippled 

Children’s Association. Karina Butcher, Dietician, CCA/WCH 

3. Audit of the assessment, management and treatment 

outcomes for spastic equinus ankle deformity in children 

with an inherited encephalopathy Dr Ray Russo, 

Dr David Baulderstone, Dr J Fletcher, Women’s and 

Children’s Hospital, Adelaide (ongoing) 

4. Botulinum Toxin and the neglected upper limb in children 

with hemiplegic cerebral palsy. Dr Ray Russo, Prof. 

Maria Crotty, Flinders University of South Australia, 

Dr Eric Hahn, Dr Peter Flett, Women’s and Children’s 

Hospital, Sonya Murchland (ongoing) 

5. Cognitive Appraisal in Parents who have a young child 

with a physical disability. Melissa Zschorn, PhD project, 

Supervisor Assoc. Prof. Ros Shute, CCA supervisor 

Dr Tim Connell (ongoing) 

2004 

1. Duschenne Muscular Dystrophy Falls Project, CCA and 

Rocky Bay, WA 

2. Benchmarking seating prescription – Therapy Focus, WA 


Paediatric dysphagia and physical 

disability: the evidence base 

Kylie Opperman 

Senior Research 

Speech Pathologist 

Jenny Faulks 

Senior Clinical Speech 

Pathologist 

Objective 

To summarise the current evidence base in relation to a range of challenging aspects of paediatric dysphagia 

assessment and management, including aspiration and nutritional status related issues, relevant to children with 

severe physical disabilities. 

Method 

The question “What characteristics are highly correlated with dysphagia and children with physical disabilities 

and, what management strategies contribute to the improvement of oral eating and drinking” was systematically 

searched. 38 articles were identified. Eight speech pathologists, with training in evidence based practice, read and 

critically reviewed the articles. Five articles were randomly chosen by an independent reviewer to re-critique them. 

Inter-judge reliability was satisfactory. Reviewers were asked to rank the relevance of the articles to the EBP question. 

Results 

It is difficult to generalise the results to clinical practice without additional evidence from other studies. Particularly 

pertinent points highlighted in the articles are as follows: 

• Aspiration is common among this population before, during and after swallowing; 

• Aspiration was significantly associated with specific food textures; and 

• Malnutrition and growth failure were common in the children with quadriplegic cerebral palsy. 

Management strategies highly correlated to dysphagia include nutritional supplements, enteral feeding, small and 

frequent kilojoule dense meals, oral motor treatment, kilojoule dense food/ fluid, positioning, texture modifications, 

rate of presentation. 

Implications 

Information has been disseminated to staff through training and development days. Guidelines have been 

developed regarding dysphagia assessment and management. Information has been disseminated to clients and 

their families. Management of dysphagia requires a multi-disciplinary approach. A research grant has successfully 

been obtained to further investigate the area. 

Project completed in 2004 

13 

Pilot study into the use of Botulinum-A Toxin in the management of spasticity 

in the upper limb of children who have spasticity of central origin 

Ray Russo 1 

Paediatric 

Rehabilitation 

Specialist 

Sonya Murchland 


Occupational Therapist 

Peter Flett 1 

Paediatric 


Specialist 

Myriam Sandelance 

Senior Clinical 


Philip Brook 1 

Orthopaedic Surgeon 

1 

Women’s & 

Children’s Hospital 

Objective 

To examine the effects of injecting Botulinum-A toxin into the upper limb of children with spasticity of central origin, 

and monitor the responsiveness of a number of outcome measures to reflect change in hand skills and functional 

ability of the children. 

Method 

This pilot study was an open label study, where 14 children of ages from 2 – 17 years were injected with Botulinum- 

A toxin into their upper limb, and their progress was monitored at baseline, 1, 2, 3, and 6 months post injection. 

Injection of the toxin occurred under a general anaesthesia using muscle stimulation to locate site of injection. 

Assessments used varied dependant on the age of the child and included the Quality of Upper Extremity Skill 

Test, Assessment of Motor and Process Skills (AMPS), School Assessment of Motor and Process Skills, Canadian 

Occupational Performance Measure, Goal Attainment Scaling, Range of Motion, Modified Ashworth Scale, and 

classifications of hand posture and function. 

Results 

The final results are still being analysed. 10 children completed the follow-up assessments. All showed positive 

gains in function as measured on the GAS, and COPM. The AMPS appeared to be responsive to functional 

changes in the older participants. 

Implications 

Following the initial positive results that were attained, a larger randomised control study has been proposed, with 

the Assessment of Motor and Process Skills and the Goal Attainment Scale being the major outcome measures. 

Project ongoing 


Serial casting after Botulinum Toxin: 

A retrospective study of outcomes for dynamic equinus 

Susan Bostock 


Physiotherapist 

Objective 

A preliminary retrospective study was undertaken at Novita to (i) review the use of outcome measures currently 

in use at Novita, and (ii) review Novita’s current practice of serial casting post Botulinum Toxin Type A (BoNT-A). 

This study was initiated in response to the increasing costs of casting materials and budgetary demands, and the 

perceived notion that, for optimal results, serial casting routinely follows BoNT-A injections for children with cerebral 

palsy who present with dynamic equinus. 

Method 

A retrospective review of case notes of 29 children who had received BoNT- A injections between May 1998 and 

May 2002 was undertaken. The data collected included passive range of movement (R2), dynamic range of 

movement (Modified Tardieu: R1), descriptions of gait and goals set. There was adequate data for only 24 children 

with cerebral palsy: 12 children with diplegia (D), 10 with hemiplegia (H) and 2 with triplegia (T). BoNT-A had been 

injected into gastrocnemius only in 24 legs, and to both gastrocnemius and hamstrings in 26 legs (total 50 legs). 

BoNT-A injections were followed by serial casting to the gastrocnemius muscle in 41 legs. 

Results 

R1 scores, PROM and casting protocols were available for 27 legs (D=20, H=5, T=2). For this group, Tardieu 

scores improved significantly (Wilcoxon Signed Rank test, z = -4.39, p< .01) from a median value of R1 = -15º 

(Range: -45º to 0º) before casting to R1 = 0º (Range: -25º to 25º) after casting. PROM improved in all subjects; 

from a median of 5 degrees (Range: -15º to 20º) to 20º (5º to 30º) (Wilcoxon, z = -4.5, p< .01). Overall, there 

were no significant differences in clinical and functional outcomes for children with diplegia or hemiplegia who 

underwent individualised spasticity management. Eighty three percent of children with diplegia who had BoNT-A 

to gastrocnemius alone, and 85% of those with BoNT-A to both hamstrings and gastrocnemius, underwent serial 

casting post BoNT-A. Seventy five percent of children with hemiplegia who had BoNT-A to gastrocnemius alone 

also had serial casting. There was a significant difference in dynamic (R1) and passive (R2) dorsiflexion pre serial 

casting and post serial casting for those children requiring serial casting post BoNT-A. 

14 

Implications 

The retrospective study will be useful in helping to formulate a prospective study as this study had several inherent 

limitations. The most significant finding was the lack of uniform data collection. Some measures were taken for 

some children, while other measures were used for other children. This made it difficult to compare measures, 

such as the Observational Gait Scale, as not all children routinely had video data taken. A controlled prospective 

study, with larger numbers of participants who have complete data sets, may provide further information on the 

effects of serial casting after BoNT-A injections. 



Can typically developing preschool children 

learn the meaning of graphic symbols through play 

Paul Manson 

Regional Senior 


Angela Guidera 

Senior Speech 

Pathologist, NovitaTech 

Support Team 

Sandra Stewart 



Kylie Opperman 



Parimala 

Raghavendra 

Manager , 


Objective 

To investigate whether typically developing preschool children can learn the meaning of graphic symbols without 

structured teaching. Children with complex communication needs (CCN) are increasingly being integrated into 

regular educational settings. Communication intervention with children who have CCN often involves the use of 

graphic symbols. If peers are not familiar with a child’s communication method, communication breakdowns are 

likely to occur. 

Method 

Participants were typically developing preschool children aged between 4 years, 3 months and 5 years old. In the 

pre-test the participants were asked to label 16 symbols. During intervention they were left to play with a speechgenerating 

device that had an overlay comprised of the 16 symbols. Each time they pressed a symbol a label was 

spoken. In the post-test the same procedure as the pre-test was used. 18 children completed the three phases of 

pre-test, intervention and post-test. 12 children completed a retention test 3 weeks after the post-test. 

Results 

The mean number of symbols correctly recognised at pre-test was 3.4 and this increased to 7.9 symbols at 

post-test. There was more gain from pre- to post-test for symbols pressed more frequently (4 words with most key 

presses – average gain was 7.12) and less gain for those pressed less frequently (4 words with least key presses 

gained 1.75). 

Implications 

The study shows that typically developing children can learn to recognise symbols through play. The findings 

have implications for the way opportunities can be provided for peers to become familiar with aspects of a 

child’s communication system. Peers could benefit from a combination of structured teaching and unstructured 

opportunities. More structured teaching may need to focus particularly on symbols that are less transparent. 


15 

Early Intervention: when is it too late 

A case study of a 6 year old boy with mild cerebral palsy 

Sue Durand 1 






1 

Currently employed 

in private practice 

Objective 

Although Early intervention may refer to services for children aged 0 – 8 years it is generally considered to be for 

children in the 0 – 6 year age group prior to school entry. This case study reports on the outcomes of a consultative 

therapy programme for a 6 year old boy with mild cerebral palsy who lived in rural South Australia. 

Method 

Following parent consent, the participant was assessed by an occupational therapist and physiotherapist with 

the Peabody Motor Scales (PMS) to determine his current motor abilities. A home and school programme was 

provided by the therapists based on the results of the initial assessment, with activities that could be included in 

daily activities. Progress was re-assessed at 6 months using the PMS and the programme was updated to reflect 

changes in abilities and new priorities for development. The participant was then reassessed at 12 months. 

Results 

On initial assessment at age 6 years 10 months his gross motor performance scored an age equivalent of 25 

months, and fine motor age equivalent was 35 months, with gains over the year of approximately 18 months in 

all motor areas. Gross motor gains preceded fine motor development. 

Implications 

A consultative therapy approach was appropriate in providing the input to the participant suggesting that early 

intervention in the form of a targeted therapy programme, was not too late for this child over 6. He received his 

input within his regular environments, and with the co-operation of his family and carers. It is recognised that the 

motivation of these people to work with the participant in a positive manner that recognised his individuality, would 

have contributed to the success of this intervention. 



Evidence based practice review of occupational therapy interventions 

to assist pre-school children with physical disabilities to become spontaneous 

and independent players, and guidelines for clinical practice 




Occupational 

Therapy Staff 

Objective 

The emergence of occupational science over the past ten years within occupational therapy, has seen an 

emphasis being placed on play as an occupational behaviour and role of children, rather than a means to achieve 

other therapy goals. This review reflected this change in emphasis, and aimed to determine the interventions that 

occupational therapists use to promote the ability of children to be spontaneous and independent players. 

Method 

A systematic review was undertaken using Medline and CINAHL, with additional hand searching of the reference 

lists. Staff also forwarded any existing articles that they had located. Staff were then allocated two articles to 

appraise, following training in a consistent method of appraisal. A modified version of Crombie’s Appraisal Tool 

(adapted by the Clinical Research Department, Novita Children’s Services), was used with the initial appraisals, 

and then the McMaster Clinical Appraisal Forms were used later. All studies and papers were included. The review 

period was limited to an 18 month period. 

Results 

Of the 60 articles distributed, only 39 were returned (65%). 26 were review articles. Of the remaining 13 studies, four 

were cross-sectional, three were case control studies, and the others were a cohort study, a quasi-experimental, 

and a qualitative study. There was a great variability in the quality of the papers, reflecting in appraisal scores that 

varied widely. Most of the studies were a low level of scientific exploration, and those of higher level only received 

moderate appraisal ratings. 

16 

Implications 

This was the first EBP review undertaken by the occupational therapy discipline and as such, was a learning 

process for all those involved. 

Critical appraisal of the literature found that the evidence for occupational interventions to promote play was 

inconclusive. Key themes for promoting play in children with physical disabilities were identified and guidelines 

for practice developed. 



Handwriting of children who have hemiplegia: a profile of abilities 

in children aged 8 – 13 years from a parent and teacher survey 

Louise DuBois 



Anna Klemm 




Research Senior 


Ann Ozols 



Objective 

Handwriting is a major occupational task for children attending mainstream schools in Australia, and children 

who have cerebral palsy (CP) with hemiplegia are expected to learn to write along side their peers. It had been 

the experience of occupational therapists at Novita that these children were often referred to their services due 

to difficulties with handwriting. However there was limited information on the specific nature of the handwriting 

difficulties in children with CP to guide therapists’ interventions. This study aimed to identify the prevalence of 

handwriting difficulties in a sample of school-aged children with hemiplegia, and gain an indication of the extent 

and nature of these difficulties. 

Method 

A descriptive, explorative study was undertaken using a survey design. Questionnaires were mailed firstly to 

parents and then to teachers with parent permission gained. The questionnaires were adapted from one designed 

by Duff and Goyeen, and used a 7 point ordinal scale to rate the child’s abilities related to speed, neatness, ability 

to copy and complete handwriting tasks. A convenience sample of 42 clients of Novita were identified as meeting 

the selection criteria of registration with the organisation, having a diagnosis of hemiplegia (congenital or acquired), 

aged 8 – 13 years, and attending mainstream school. 

Results 

31 of the 42 parents returned the questionnaires giving a 77.5% response rate, and 26 of the 30 teachers returned 

theirs giving a 86.7% response rate. 

The majority of children were indicated to have difficulties with one or more areas of handwriting (Parents report 

75%, teachers report 69%). Difficulties were reported in all areas of functional handwriting, speed, neatness, and to 

a lesser extent, organisation of written work. Children with epilepsy, speech and language difficulties, and/or visual 

problems experienced more difficulties than those with no other coexisting conditions. Boys and children with right 

hemiplegia were also reported to have more difficulties with handwriting. The impact of fatigue on performance 

was suggested in responses to a child’s ability to perform consistently over long periods of time. The prevalence 

of handwriting difficulties was not consistent with spelling and reading difficulties as reported by parents and 

teachers. 

Implications 

This study showed a high prevalence of handwriting difficulties in children with hemiplegia. Further investigation 

is recommended to gain a more detailed understanding of the nature of abilities and specific areas of difficulty 

experienced, in this population of children. 

17 



‘If you wanted to know about it just ask!’ 

Exploring disabled young people’s experiences of health and health care 

Gillian Bricher 1 

Doctoral Candidate 

Supervisors 

Philip Darbyshire 1 

Chair of Nursing 

Peter Flett 2 

Director 

1 

School of Health Sciences 

– Nursing and Midwifery, 

University of South Australia 

2 

Dept of Rehabilitation 

and Child Development, 

Women’s and Children’s 

Hospital 

Objective 

This project undertook a qualitative study into the health and health care experiences of disabled children and 

young people, using a flexible and participatory approach to challenge the traditional relations of research 

production. This reflected new paradigms in childhood research and the social model of disability. This study 

aimed to give a voice to disabled children and young people, and to gain an understanding of their experiences, 

perceptions and feelings. 

Method 

Twenty young people aged 9 –18 years met with the researcher up to four times, with the choice after the initial 

meeting of an individual or group meetings. All had a physical disability, some also had communication or learning 

difficulties. Conversations with the young people covered a range of topics that included hospitals, appointments, 

splints, therapy, and what it is like to have a carer. 

Results 

The young people showed recognition of factors that contributed to their health and sense of well being. They 

spoke of experiences of empowerment and powerlessness within a triad of the parent: professional: young person. 

Concern was expressed that many treatments were an experiment and that outcomes were hard to balance with 

the pain and inconvenience. Common talk was about living in a world that considers them as different, and the 

effect that this has with little opportunity for contact with disabled adults or peers. School issues raised concerns 

such as equity in access, being different, having to prove oneself, limited school sport involvement and issues of 

friendship and teasing. 

18 

Implications 

This study raises a number of issues for the provision of services to children in a client centred service, where both 

the child and parent need to be considered as clients. How therapists communicate with children to make their 

interventions understood, and outcomes realistic for the child, needs to occur in a manner that is meaningful and 

understood by the child. How a child determines success may be different to that of the professional, and there 

is a need for the “success” of interventions to be discussed and set before undertaking the procedure. There is a 

need to link children with other children with disabilities for peer contact, and adults with disabilities for role models. 

Social isolation was a factor for young people who were the only one with a disability at their school. 



Now I can eat too: The impact of an intensive community based 

feeding program on a four year old with severe feeding difficulties 

Merrin Ising 



Melissa Zschorn 1 

B Sc (Hons) 

Psychologist 

Karen Sowton 

Speech Pathology 

Assistant 

Julie Grayston 

Psychology Assistant 

Marcelle Pappas 2 

Dietitian 

1 

currently a doctoral 

student, not on staff 

2 

Women’s and 

Children’s Hospital 

Objective 

A case study to describe the outcome of a community-based intensive feeding program for a four-year old child 

with Moebius Syndrome. This condition is characterised by muscle weakness that affects the face and some throat 

muscles that may impact on swallowing strength and coordination. The child had a history of gastro-esophageal 

reflux disease and poor oral intake. At the commencement of the study the child’s nutritional requirements were 

met primarily via nasogastric feeds with very limited oral intake. 

Method 

A reward-based, intensive feeding program, was implemented by a multi-disciplinary team over a 20-week period. 

During this period the speech pathology assistant provided one to one input and modelling at home, up to five 

days a week, for lunch and dinner. 

Results 

At the completion of the program the child was no longer receiving enteral feeding and was obtaining her energy 

and nutritional requirements orally, mostly via supplementary drinks and vitamin and mineral supplements. 

Improvements were noted in oro-motor function and swallowing of various food consistencies. Parents reported a 

reduction in their stress levels. 

Implications 

Home-based intensive feeding programs can be effective and behavioural approaches are appropriate for some 

feeding difficulties. However, the programs are highly resource intensive. In this situation a considerable amount of 

additional time was dedicated to documentation and professional consultation. In spite of this, the intensive home 

based program may be considered cost effective due to its success, generalisability and maintenance compared 

to the previous treatment provided or alternative options. The authors attribute the success of this program to the 

multi-disciplinary team approach. 


Participation of Augmentative and Alternative Communication (AAC) 

users in school settings: research evidence 

19 


Senior Speech 

Pathologist 

NovitaTech 

Support Team 

Parimala 

Raghavendra 

Manager, 


Cathy Olsson 

Chief Speech 

Pathologist 

Objective 

One key area for many Speech Pathologists working in the disability field is the provision of services for users 

of augmentative and alternative communication (AAC) in school settings. A project investigating the research 

evidence relating to the participation of these students at school was conducted. 

Method 

The project was implemented by a group of Speech Pathologists. It involved collaboration between Novita 

Children’s Services Speech Pathology Department and Clinical Research Department. Research articles relating 

to factors influencing AAC users’ participation at school were gathered. Each article was critically appraised by 

at least one Speech Pathologist using critical appraisal forms developed by the Clinical Research Department. 

The Manager of the Clinical Research Department completed reliability checking of the critical appraisals. The 

results of the appraisals were collated and synthesised and the implications identified. The appraisal results were 

converted to percentages. The strength of the evidence for each factor identified was determined based on the 

number of papers which achieved scores of 75% or higher. 

Results 

Forty-one articles were appraised in total. They included review papers, surveys, case studies, group and single 

subject experimental designs and qualitative studies. The findings indicated that a range of factors influenced AAC 

users’ participation in school settings. There was strong evidence to show that AAC users’ participation is affected 

by training of adult communication partners (e.g. teachers). The evidence was moderate with respect to the 

influences of communication partner attitudes, peer training and instruction of the AAC user. Limited evidence was 

found for communication partner behaviours. 

Implications 

This project demonstrates that the research evidence indicates that AAC users’ participation in school settings 

is influenced by a range of factors. Novita plans to use this evidence in the development of resources, training 

packages and clinical guidelines for AAC intervention with students in school settings. 



Reading and phonological awareness in children with complex communication needs: 

literacy outcomes of internet-based assessment and intervention 

Joanne Leane 1 

Honours Student 

Supervisors 

Parimala 

Raghavendra 

Manager, 


and Adjunct Lecturer 1 

Ingrid Scholten 1 

Senior Lecturer 

1 

Department of Speech 

Pathology and Audiology, 

Flinders University of SA 

Objective 

A high proportion of people who use augmentative and alternative communication (AAC) have poor literacy skills. 

The aim of the study was: 

1) To use Assessment of Phonological Awareness and Reading (APAR) 1 to investigate each participant’s strength 

and weaknesses in phonological awareness and word reading skills; 

2) To compare results from APAR with two other standardised assessments in order to investigate the accuracy of 

results gained from the APAR; and 

3) To observe improvements in the participants’ abilities to read single words by way of word analysis using 

Accessible Word Reading Intervention (AWRI) 2 . 

Method 

APAR assesses three areas: reading, phonological awareness and listening comprehension and can be 

administered via computer, or, as was the case in this project, printed and presented in hard copy. AWRI also has 

three areas of focus: compound words, onset and rime, and word endings that are downloaded and presented on 

computer. In this project, only the onset-rime component was used. 

A single subject experimental design utilising a multiple baseline across three participants (age: 11, 14 and 15 years) 

was employed in this project. Each participant had cerebral palsy, complex communication needs and used a 

Pathfinder TM or Liberator TM communication device. Assessment and intervention sessions were conducted intensively 

over a 2 month period. The children were assessed with the APAR in daily sessions before commencing intervention 

with AWRI. Passive tasks were used to facilitate recognition of onset and rime in monosyllabic words. Active tasks 

were used to promote participants’ skills in selection of an appropriate onset or rime to complete monosyllabic 

words and picture to word matching. All three participants accessed AWRI via a switch-adapted mouse. 

Once each participant had responded correctly to 90% of the trained probes or had completed fifteen sessions 

with the AWRI, intervention ceased. Finally, APAR was re-administered. 

20 

Results 

Improvements were evident in word reading tasks of APAR’s reading section in all 3 participants. Analysis of results 

indicated that AWRI was highly effective in promoting word-reading skills for one participant, fairly effective for the 

second and of very little effect for the third. 

Implications 

Further research is required to evaluate the effectiveness of AWRI and further explore the reliability and validity of APAR. 

These preliminary results show that APAR and AWRI can be used with people with complex communication needs. 

1,2 

Iacono, T. & Cupples (n.d.) APAR & AWRI, www.med.monash.edu.au/access 



School vocabulary in typically developing 6 year old Australian children 

Emma Grace 1 

Honours Student, 

currently working at 

Novita Children’s 

Services 

Supervisors 

Parimala 

Raghavendra 

Manager, 


and Adjunct Lecturer 1 

Ingrid Scholten 1 


1 

Department of Speech 

Pathology and Audiology, 

Flinders University of SA 

Objective 

Children who use Augmentative and Alternative Communication (AAC) systems are increasingly participating in 

integrated settings. Access to individualized and functional vocabulary in different environments such as school, 

home and community, has long been recognized as an important and critical feature of an effective AAC system. 

One strategy that has been used is to observe typically developing individuals and record common vocabulary 

patterns. 

Method 

Fifteen typically developing children from six different schools participated. The children were all aged between 

6 – 7 years. The children’s speech was recorded using a small voice activated tape recorder and microphone 

that was fitted to them in a bag on their waist. Each child was recorded throughout one to two school days until 

two hours of continuous speech was collected. All of the words that the children said were transcribed onto the 

computer and the information was analysed using custom designed word counter software. 

Results 

Eighty four percent of the total 76,963 words analysed consisted of 500 most frequently occurring words. 

Participants in this study engaged in language play behaviours including rhyming slang, making up words and 

singing. These types of communication represented a significant proportion of the total communication (13% 

of total utterances). 25 topics were identified in the data. The most common topics in the data collected were 

academic language (e.g. counting/ spelling), current events (e.g. book week, royal show, footy finals) and 

judgements about behaviour or grooming. Lists of the most common words (i.e. words that were used by several 

of the children) and frequent words (i.e. words that occurred several times) were collated to inform vocabulary 

selection decisions for children who use AAC at school. Structure words (words used to connect other words) were 

listed separately from content words (words that provide meaning and give the communication a topic). 

Implications 

The study provided a valuable database of communication samples for six-year-old Australians in the school 

environment. This information can be used to develop vocabulary for children who use Augmentative and 

Alternative Communication at school. 

The flexibility to provide rhyming words, colloquial expressions, self talk, singing and non-words should be 

considered in the design of AAC systems for children as they provide important opportunities for literacy 

development and for engaging in socially appropriate and colloquial uses of language, enabling children to 

identify with their peers. 

21 

Child wearing a tape recorder. 



Systematic review of strategies used by therapists to work effectively 

with teachers and aides to implement programs which address client goals 

22 

Karen Grimmer 1 

Director 

Debashish Das 1 


Saravana Kumar 1 


Novita 

Reference Group 

Bronwyn Timko 



Terry Lyons 

Chief Occupational 

Therapist 

Catherine Olsson 

Chief Speech 

Pathologist 

Parimala 

Raghavendra 

Manager, 


Judy Sprod 

Chief Physiotherapist 

1 

Centre for 

Allied Health Evidence 

Objective 

Novita therapy staff work in kindergartens and schools with educational staff to achieve client goals, and enhance 

participation of children into their class environments. It has been recognised that therapists often struggle with 

how to effectively achieve client and family goals when the main intervention input is via support staff from other 

organisations. As there are no standard approaches or best practice guidelines, this study aimed to undertake a 

systematic review to identify evidence for strategies in use or different collaborative approaches. 

Method 

The Centre for Allied Health Evidence (CAHE) was contracted to undertake a systematic review that considered 

the evidence for effective training methods for therapists and education staff to work together with the purpose of 

supporting children with disabilities in the classroom. The Novita Reference group has been working with CAHE 

staff in refining the question, identifying the key databases and providing regular input into the appropriateness of 

the information retrieved. 

The parameters of the study were: 

• Population – Education staff (teachers/assistants/aides/para-professional); 

• Intervention – Strategies/methods that therapists (occupational therapists, physiotherapists, speech 

pathologists, psychologists) use in training and working with education staff (modelling, written information, 

verbal feedback, etc.); 

• Comparison – Effectiveness of two different strategies; and 

• Outcome – Before and after measures indicating positive change, maintenance of change in behaviour, 

attitude, etc. 

Results 

A synthesised report will be provided at the conclusion of the study. 

Implications 

The review may provide evidence to strategies already being used or may suggest different approaches in 

collaborating with education staff. 

Project commenced in 2004 


Unravelling handwriting: an investigation into the factors that influence 

handwriting ability in primary school aged children with hemiplegia 




Jocelyn Kernot 

Research Assistant 


Parimala 

Raghavendra 

Manager, 


Funding 

Channel 7 Children’s 

Research Foundation 

$16 500 

Objective 

This study aimed to investigate the relationships between handwriting ability (speed and legibility), hand function, 

posture, and visual perceptual skills in children aged 8 – 13 years who have cerebral palsy with hemiplegia. 

Method 

A descriptive study was undertaken that examined the school performance, handwriting speed, legibility, hand 

function and visual perceptual skills. Children identified as having cerebral palsy with hemiplegia, aged between 

8 – 13 years, attending a mainstream class in metropolitan Adelaide and registered with Novita Children’s Services 

were selected as potential participants. Each child was assessed over two withdrawal sessions, and then they 

were observed during school completing handwriting activities. The following assessments were given: 

• Handwriting: Handwriting Speed Test, Evaluation Tool of Children’s Handwriting, Extended Handwriting Task; 

• School Performance: School AMPS; 

• Hand Function: Grip and pinch Strength, Melbourne Assessment of Unilateral Hand Function, Bruininks- 

Oseretsky Test of Motor Proficiency Subtest 8 Upper Limb Speed and Dexterity, VMI Motor Co-ordination 

Subtest, Observations of grasp and movement; 

• Visual Perception: Beery Test of Visual Motor Integration (VMI) 4th Edition, VMI Visual Perception Subtest; and 

• Posture: Observations of sitting posture and movement control. 

Results 

24 Children participated in the study, with 21 consenting to be observed within their class environment. Over 

half (54%) had mild involvement in their hemiplegic hand. Handwriting difficulties with speed, legibility or school 

performance were identified in 17 of the 24 children (71%). Difficulties in motor control (posture, arm movement 

across the page, visual motor control) were identified as having an impact on handwriting legibility and speed. 

Visual perceptual difficulties were not more prevalent in this population. However, if these were compromised, 

the child did have impaired handwriting abilities. The severity of the hemiplegia had no correlation with functional 

abilities in the schoolroom as measured on the School AMPS. 

Implications 

Children with hemiplegia are working less efficiently than their peers in mainstream classes. They often have 

impairments of motor control that are influencing their ability to maintain stable sitting postures, complete smooth 

arm movements, work at speed, and have refined visual-motor control. A smaller percentage also had visual 

perceptual difficulties. Future studies will focus on the impact of interventions to improve motor functioning on 

handwriting ability. 

23 



Clinical pathway for voice output communication aid recommendation 

and training for adults with disabilities 

Parimala 

Raghavendra 

Manager, 


Roslyn Ferris 

Senior Speech 

Pathologist 

Adriana Rapagna 1 


Michael Bebb 1 


Michelle Hardy 1 

Speech Pathology 

Assistant 

Fiona McDonald 1, 2 

Quality Assurance 

1 

Communication and 

Therapy Services, now part 

of Adult Therapy Services 

at the Independent Living 

Centre 

2 

Currently Quality 

Coordinator, Ashford 

Hospital 

Objective 

Clinical pathway is a plan of care, that reflects best clinical practice and the expressed needs of customers. 

Because an enormous amount of time, effort, money and on-going support is needed in voice output 

communication aid (VOCA) prescription and use, it was decided to streamline the process and develop a pathway 

for consumers and external agencies involved in the process to ensure maximum efficiency and effectiveness. 

Method 

Information for the pathway was collected from adults with severe physical/multiple disabilities (consumers 

of Communication and Therapy Services- CTS), their families, support workers, CTS staff, staff of Assistive 

Technology unit of Regency Park Rehabilitation Engineering and an Options Co-ordinator (community case 

manager) through questionnaires, interviews, and focus groups. The central theme that was addressed was the 

current practices and expectations of VOCA prescription, training, support, use and follow-up. Two consumers of 

CTS who use VOCA and access workers from various accommodation and day activity centres were invited to be 

part of the project steering committee. Information from the above methods was used to develop a pathway at a 

macro level, which presented the various steps in the process of device prescription and training. 

Results 

A booklet containing simple text, pictures, Picture Communication Symbols, (Johnson, 1994) was used to 

illustrate each step in the process, the time frame and the agencies or individuals who can be involved. An initial 

evaluation of the booklet showed that the response to referrals were within the current set time of 10 working days 

and assessment was completed for the majority within a month. The period required for trialling varied amongst 

consumers. Several consumers were waiting for funding to be organised. Some comments regarding the pathway: 

“I was impressed with the booklet. It would have helped me with difficulties I had with obtaining a previous device” 

(Client), “excellent idea, It will help in keeping track of the process and to train other staff” (support worker 1),“some 

of the time frames are questionable” (support worker 2). 

24 

Implications 

With the use of the booklet, 

1) that the process for VOCA prescription and support is clear to VOCA users, their support workers, 

staff at CTS and all other stakeholders; 

2) that there is reduction in communication breakdowns; and 

3) that issues which interfere with VOCA prescription and support are identified and addressed. 



Convergence of AAC and portable computers 

Ben Symonds 

Rehabilitation Engineer 

Rob Garrett 

Group Leader, R&D, 


Rebecca Gallio 


Objective 

As computers become smaller, more powerful, compact, portable, and enjoy longer battery life, the desire to 

explore their use as a communication device with appropriate software has become a topic of interest. It has been 

suggested that the cost of setting up a custom system using an ordinary laptop and Augmentative & Alternative 

Communication (AAC) software is cheaper then buying a specialised communication device. This project aimed 

to investigate the effectiveness of such a concept – can an ordinary laptop with specialised software substitute the 

need for a specialised communication device 

Method 

The research first identified existing AAC devices that are built on PC based systems. Therapists were then 

consulted to obtain their opinions of the critical features of a communication device and particularly those features 

that would be absent or insufficient in a standard laptop. It was then necessary to investigate the possibility 

of replicating these features with a standard laptop, identify suitable laptops and identify the required add-on 

hardware and software that would need to be added to a standard laptop to give features equivalent to those of 

the commercial devices. The laptop solutions were then compared with the specialised devices, discussing some 

of the critical features and the comparative costs of the different options. 

Results 

Commercial laptop based AAC devices were identified and the features and cost were summarised in a 

comparison table within the final report. Similar tables were created for a variety of laptop and tablet computers, 

however the standard laptop does not account for the needs of an AAC user. Features such as durability, 

speaker volume and the provision of alternative inputs (i.e. joystick, switch or touch-screen) were identified as key 

considerations along with the associated software. Laptops such as the Panasonic Toughbook were identified to 

meet extreme durability needs, however the high cost of these laptops makes them inappropriate for most cases. 

Another issue was that of compatibility and reliability of both software and hardware, which therapists highlighted as 

a point of concern and trouble in past experience. The implications and costs associated with any additions were 

also presented and a few example custom systems described. It was demonstrated that laptops could be used to 

build systems that are functionally equivalent to the dedicated systems at a significantly lower cost. However this 

apparent cost saving needs to be weighed carefully against the further time and cost involved with the set-up and 

on-going maintenance required to ensure the system is adequately durable, reliable and trouble-free. 

25 

Implications 

Ultimately the report intends to educate anyone who is considering using a standard laptop as an AAC device about 

the relevant complications and give recommendations to assist them in achieving a positive, cost effective, outcome. 

The final report is available from the “Downloads” section of the R&D website (http://www.novitatech.org.au/research). 



Effective mounting solutions 

Ben Symonds 


Paul Manson 

Senior Speech 

Pathologist 

Sandra Stewart 

Senior Speech 

Pathologist 

Rob Garrett 



Objective 

Therapists spend a significant amount of time attempting to set up effective wheelchair mounting systems for 

communication devices, switches and computers, and would like to improve the efficiency and effectiveness 

of the process. Many are also not familiar with the relevant safety standards or legal implications associated 

with the addition of mounting systems to wheelchairs. This project aimed to provide information and some 

recommendations that would assist and enhance the process of setting up mounting systems. 

Method 

NovitaTech Research & Development committed to investigating how other centres, both nationally and 

internationally, are dealing with mounting systems, and also collating some information on the relevant standards. 

The research investigated all relevant standards, the usefulness of these standards and how they might be 

applied to improve safe outcomes. The implications of the Therapeutic Goods Administration (TGA) legislation 

were investigated to clarify the legislation’s impact on the development, prescription and installation of mounting 

systems. Finally, other centres were approached, asking about the approaches they have adopted when tackling 

mounting systems and to gain their perspective regarding the effect, relevance and importance of standards 

and legislation. 

26 

Results 

In terms of the new TGA Medical Devices Regulations 2002, standards testing is not compulsory. However, having 

a product successfully tested to a recognised, published, peer reviewed Standard will prove conformity with the 

relevant 14 Essential Principles, and will greatly assist with the ‘Declaration of Conformity’. Many centres seem to 

use the approach of over engineering to ensure the implementation of safe and reliable solutions. The relevant 

standards present important design and performance considerations that should certainly be understood and at 

least considered in the design process and/or theoretically assessed to some measure, if not tested. The test for 

anchorage of additional devices is one case that whilst providing meaningful information, just isn’t feasible. In this 

case a theoretical risk analysis or simulated test would be most appropriate. Non-destructive stability testing (both 

static and dynamic) however can give very important results that probably should not be dismissed if the resources 

are available. The addition of a mounting system and device could alter a wheelchair’s stability, making it unstable 

in environments where the user has previously had no problems, which is clearly a potential risk. Thus the decision 

regarding the necessity for such testing may benefit from the input of a technician or engineer who is familiar 

with the standards’ requirements. Similarly the actual design or choice of an appropriate mounting system would 

benefit greatly from a broader multidisciplinary input. 

Most centres suggest that a multidisciplinary approach is adopted when tackling the issue of developing or 

implementing effective mounting solutions. It appears that some centres have dedicated teams for this purpose, 

whilst others draw on the expertise of various disciplines in a less formal manner. Either way the collaborative 

involvement of therapists, clients, technicians and engineers is certainly advocated throughout the process. This 

is believed to enhance the process for everyone involved, ensuring positive and safe outcomes for the end user. 

Implications 

A further implication was that this work has contributed towards the establishment of an “on call” team that 

would be available to assist with the prescription of solutions for individuals with complex technological needs. 

The concept is to gather a team of key players who have relevant expertise with respect to the development of 

mounting solutions. 



Predictors of device abandonment: transitioning from school to the community 

Michael Bebb 1 


Parimala 

Raghavendra 

Manager, 


1 

Adult Therapy Services, 

Independent Living Centre 

Objective 

Abandonment of voice output technology is an ongoing concern for people who use augmentative and alternative 

communication (AAC), their families, clinicians and support workers. This study examined what factors influenced 

the discarding of devices during the transition from school to the community. 

Method 

The participants were five individuals who used AAC, five of their parents and two of their teachers. A structured 

interview was conducted. The questions addressed the opinions of the individuals who use AAC with regard 

to attitude toward their AAC device, length of time and frequency of use of the device, their perception of their 

peers’ attitudes to the device and factors that would increase device usage. Parents of AAC users were asked 

their opinions with regard to level of knowledge/familiarity with the AAC device, factors influencing reduced 

use/abandonment of the AAC device and personal experience during the AAC prescription and training process. 

Teachers of AAC users were asked their opinions with regard to appropriateness of prescription of the AAC device, 

users’ level of proficiency with the AAC device, communicative efficiency of AAC users (high technology vs low 

technology) and services provided by educators and clinicians during the prescription and training process. 

Questionnaires were completed during the interview and utilised for data analysis. 

Results 

Users of AAC decided to discontinue device use after leaving the school environment and the reasons related to 

aesthetic and functional aspects of the device. Parents felt their child had benefited communicatively from using 

the device, but most felt that despite many years of having access to the device, their personal knowledge of its 

function was limited. Teachers suggested that the high tech device was appropriate, that semantic compaction 

was easily incorporated into the curriculum whilst still catering to individual needs, and that whilst support for AAC 

in secondary schools was minimal initially, it developed over time. 

Implications 

The information will provide clinicians/carers with an insight into reasons for device dissatisfaction, thus providing 

opportunities for preventative action. Ongoing training and education for families, leading to increased support 

for in-home device use is an essential part of the transition planning process These findings also have important 

implications for device manufacturers, professionals and others who support clients in transition. 

27 



Vocabulary Organiser – development of the program 

Rob Garrett 



Melissa Bradley 



Senior Speech 

Pathologist 

Bob Collinson 1 

Software programmer 

1 

Colsoft Pty. Ltd. 

Objective 

Vocabulary Organiser is an innovative software tool for designing, producing and storing vocabulary dictionaries 

and worksheets. The software was developed by the Research and Development Department in collaboration with 

the Novita Speech Pathology Department (in particular, Jenny Faulks, who was the idea originator), in response to 

a demand for vocabulary management and teaching resources. It was developed for anyone who is involved in 

supporting users of augmentative and alternative communication systems. The objective was to validate that the 

software met the needs of the users within the organisation. 

Method 

The original version of the software was trialed by key stakeholders. Extensive feedback was sought, collated and 

used to specify software changes needed. 

Results 

Version 2.3 of the Vocabulary Organiser software was created with the following new features included: 

• Support for multiple vocabulary files; 

• Enhanced backup facilities; 

• User authentication and data security. Specification and modification of the vocabulary stored in the dictionary 

can be protected by password; 

• Numerous enhancements to speed up the entry and editing of vocabulary dictionaries; 

• Enhancements to the options available in printed output mode to create more useable teaching and 

learning aids; 

• Increased flexibility in graphic size with the addition of “Very Large” graphics option; 

• Ability to specify and save page margins to a specific report; and 

• Ability to create printed headings relevant to the contents of the dictionary file. 

The Users Guide and Help screens were also updated. A final positive validation of the software was achieved in 

October 2000. 

28 

Implications 

All of the regional offices now have an effective and usable copy of this powerful tool to efficiently support the 

clients of the organisation who use communication devices. 



Vocabulary Organiser – enhancement and commercialisation 

Rob Garrett 





David Hobbs 

Senior Rehabilitation 

Engineer 

Peter Wilkinson 1 


Sorin Buzilla 2 

1 

Contract 

2 

Better Software Pty. Ltd. 

Objective 

The move to MSAccess 2000 from the older MSAccess 2.0 software version will provide many tangible benefits, 

which would directly translate into a better Vocabulary Organiser (VO) product. Reasons for the move include the 

fact that Microsoft was no longer supporting the older version, as well as version 2.0’s inability to work correctly on 

the later 32-bit operating systems, such as Windows 2000 and XP. Upgrading to Access 2000, will allow for longer 

file name conventions compared with the older system that had the old DOS limit of 8 characters. Another reason 

for the upgrade is that the newer version of MSAccess was known to be more reliable. 

Method 

For much of its history, two programmers developed VO. As it moved from internal use to external customers, it 

became critical to ensure the software was maintainable by other programmers and had adequate error reporting 

capability. To assess this risk, Sorin Buzila from Better Software Pty Ltd was commissioned to perform a software 

audit. Sorin spent 3 days reviewing the code and identified 25 actions that were prioritised as “Immediate”, “High”, 

“Medium”, or “Low” actions to improve the software. The R&D Department identified all “Immediate” and “High” 

recommendations as priority actions. 

Industrial programming standards were documented by Sorin Buzila and used to specify the software 

programming requirements. In addition, all software changes were independently reviewed to ensure compliance 

with the documented standard. 

Results 

The newer version of Vocabulary Organiser (3.2) is compatible with Windows 2000/XP and the Novita standard 

computer operating system. Software coding Standards have been established for all software written in 

Visual Basic and Visual Basic for Applications. All changes to the software are now independently reviewed 

for compliance. A central website to record feedback and report problems can be accessed directly from the 

Vocabulary Organiser program. This website is universally available to all users who have access to the web. There 

is now one central list of issues enabling easier monitoring of the state of the program such as reliability statistics 

and requests for product enhancements. The new version of software now has extensive error reporting capability 

that can be simultaneously logged on the user’s computer in a simple text file. The website supports upload of files 

that will enable the log file to accompany any errors logged on the web site. The submission of an issue at this web 

site results in an immediate notification to key staff. 

29 

Implications 

The software conforms to industrial standards, is easily maintained, has increased reliability, now has error logging 

and can be effectively and efficiently supported independent of the location of the user. 



30 



Rob Garrett 



Greg Mathews 1 

Mark English 1 

1 

Vanilla Interactive 

Objective 

Vocabulary Organiser – marketing 

In 1999, the Research and Development Department were commended on the Vocabulary Organiser (VO) 

program by its Annual Review panel, and asked to investigate the possibility of selling the software in order to 

recoup some of the money spent on its development. 

Method 

In 2000, the VO program was externally reviewed with a view to fixing known bugs and increasing the reliability of 

the software. Activities included: 

• Design of CD cover, CD label and User Manual Cover; 

• Development of first promotional flyer; 

• Establishment of copyright requirements; and 

• Generation of mail out database. 

During 2001, VO progressed from a resource tool within Novita Children’s Services to a viable, packaged product 

to be sold around Australia. Activities included: 

• Updating of User Manual, CD cover and brochure; 

• Pricing strategy and Kit Lists for VO packages created; 

• Development of posters for promotion at conferences; 

• A VO brochure was sent to those who had registered an interest in VO and other identified potential customers; 

• Creation of a ‘Unity’ vocabulary file; 

• Creation of resource/example folders for use at workshops; 

• 1 hour Workshop at AGOSCI 1 Conference in Adelaide; and 

• 2 hour Workshop at ARATA 2 Conference in Brisbane. 

2002 saw changes to the marketing approach for VO. These changes were driven by the completion of the Key 

Word Signing vocabulary file, which opened possibilities to target a broader audience. Activities included: 

• Development of Demonstration CD in conjunction with Vanilla Interactive; 

• Development of a new brochure to support the demo CD; 

• Development of a Key Word Signing vocabulary file and specific promotional resources to support it; 

• Collection of photographs for VO marketing activities; 

• The demonstration CD promoting the Key Word Signing, Unity and AusUnity files was mailed to identified 

potential customers; 

• 1 hour Presentation at Speech Pathology Conference in Alice Springs; and 

• 1 hour presentation at ISAAC 3 Conference in Denmark. 

Marketing activities for 2003 focused on increasing awareness for VO in the community. Activities included: 

• Key Wording Signing User Manual written and distributed; 

• Visit by Bruce Baker from Semantic Compaction Systems (author/creator of the icon-based language, Unity); 

• Signed agreement for the use of ‘AusUnity’ and Australian ‘Unity’; 

• Windows XP manuals written; and 

• Presentation at AGOSCI 1 Conference in Sydney. 

Results 

The VO program is now in the mature stage of development, and is well entrenched with the Novita Speech 

Pathology Department. There has been a significant increase in sales. The effectiveness and efficiency of 

Vocabulary Organiser has been promoted. 

Implications 

Vocabulary Organiser is available for sale throughout Australia and a free demonstration CD is available as an 

educational tool. 

1 

AGOSCI: Australian Group on Severe Communication Impairments 

2 

ARATA: Australian Rehabilitation & Assistive Technology Association 

3 

ISAAC: International Society for Augmentative & Alternative Communication 



Vocabulary Organiser – the addition of the merge function 

David Hobbs 


Engineer 

Rob Garrett 




Senior Speech 

Pathologist 

Ben Symonds 


Peter Wilkinson 1 


Sorin Buzila 2 

1 

Contract 

2 

Better Software Pty. Ltd. 

Objective 

There are now multiple copies of the master vocabulary files being used by support staff dealing with individual 

clients. As changes and additions to the master vocabulary are created, the changes need to be copied to 

other computers. 

To facilitate this process, the Merge function has been added to the Vocabulary Organiser software. 

Method 

Merge allows two unique vocabulary files to be integrated (in essence, one file is merged into the other). The 

resultant file contains all the original messages plus any new messages from the merging file that weren’t 

contained in the original. 

If “clashes” are detected (ie: two elements have the same message name or same symbol sequence) the user 

is prompted to take the appropriate action. This could be either adding the new message to the dictionary, 

overwriting the original message with the incoming entry, or rejecting the new message. Figure 1 shows a screen 

shot for this process. 

Results 

The Merge function has undergone, and passed, a lengthy internal testing and validation process. 

Merge is currently in the hands of the Speech Pathology Department for external validation. 

Implications 

The Merge function will now make it possible to distribute vocabulary file updates and additions easily via email or 

as downloads from a web page. It also enables a user’s vocabulary to follow a person to an alternate location or 

therapy support area. 

31 

Figure 1 – A screen shot showing when a clash of messages is detected during the Merge process. 



The design and development of a range of cordless switches 

Roger Ingram 

Electronics Technician 

Jeff Price 

Electronics Technician 

David Hobbs 


Engineer 

Objective 

Several switches with big buttons exist for people with physical impairments. A major disadvantage of these 

switches is the cord – it can be cumbersome and sometimes dangerous for people in wheelchairs to use a device 

with a cord. The cord not only limits the distance over which the switch can be operated, but the cord itself poses 

a risk of tangling or being ‘snagged’. A cordless switch eliminates these issues. 

Method 

The Research & Development Department was involved in the management, validation and user documentation 

of the range of cordless switches that the Assistive Technology Department developed. The range includes the 

Cordless BIG Switch, the Cordless ANY Switch, and the Cordless Jelly Bean Booster Switch. 

Results 

A range of radio frequency (RF) cordless switches have been designed for non-critical applications, i.e. 

applications not involving the control of medical or safety related issues. Useful applications include the remote 

control of battery-operated toys, communication devices, environmental control units, computer access switch 

interfaces, and others. 

In 2002, the transmitter-receiver chips for these switches were changed for component availability reasons. The 

new chips operate on the same 433 MHz frequency but have an improved range of operation – in excess of 50m. 

Another benefit of the new switch transmitter-receiver system is the decreased delay (or lag) between switch press 

and switch activation. 

Implications 

The range of cordless switches has now become a regular item in the Assistive Technology catalogue. Loan 

switches have also been placed in the Novita Toy and Resource Centre so parents and therapists can trial them. 

32 

Figure 1 – The Cordless Jelly Bean Booster Switch 



Movement-to-m usic therapy 

David Hobbs 


Engineer 

Tom Chau 1 

Canada Research 

Chair in Paediatric 


Engineering, 

1 

Bloorview MacMillan 

Children’s Centre, Toronto, 

Ontario, Canada 

Objective 

The “Movement-to-Music” (MTM) therapy system, or Virtual Music Instrument (VMI), is an innovative software 

program that allows simple movements to be translated into music. The MTM system provides an interface for 

children with a disability to be able to play music without having to hold or manipulate an instrument. One simply 

positions themselves in view of a webcam and moves to interact with pre-defined coloured shapes they can see 

on the screen, as shown in Figure 1. The system generates musical sounds from very small movements, such as 

finger movements, to very large ones, such as waving your arms around. 

Method 

The MTM system was identified by the investigator as the best use of technology within the field of rehabilitation 

engineering and assistive technology after completing his Churchill Fellowship research in 2003. The system is 

simple to use and only requires the specific MTM software, a computer (preferably a laptop), a webcam, and a 

means of interacting with the webcam (a large TV or data projector). 

Results 

The group that developed the system at Bloorview MacMillan Children’s Centre in Toronto, Canada, completed 

usability testing of a prototype version with 6 children with cerebral palsy or spinal muscular atrophy in May 2002. 

The group has also begun conducting Suzuki music lessons using the VMI with 6 children with cerebral palsy or 

spinal muscular atrophy, and the system has been installed on the home computers of participating families to 

provide an opportunity for the children to practice at home. 

MTM can be used in a number of ways: as a virtual musical instrument, as a tool for physical, occupational or 

music therapy, as a leisure activity, or to encourage exploration and emotional expression. Some ways that children 

can play with the system include games like “Simon Says” and “Memory”, or they can learn to play songs on their 

own, in a group, or with family members. Research has shown that MTM can help improve children’s reach, range 

of motion, endurance, motivation, sense of satisfaction, confidence and ability to explore and create 

music independently. 

Implications 

A copy of the MTM software was donated to NovitaTech to trial with Novita clients and the system was 

demonstrated to Novita’s Speech Pathology and Occupational Therapy staff during their July 2004 in-service. 

Both disciplines were excited about the possibility of incorporating music therapy into their existing programs, 

and were interested in conducting similar research to what was being done in Canada. 

33 

Figure 1 – Dr Tom Chau, MTM therapy program developer, demonstrates the system. By making movements in 

front of the TV he can produce music each time he interacts with the coloured squares. 

Project commenced in July 2004 


Computer aided customisation of walker designs 

David Sanders 1 

4th Year Biomedical 

Engineering Student 

Alex Svistounov 

Senior Testing Engineer 

Kevin Clements 

Manager, Mobility & 

Seating Department 

1 

School of Informatics 

and Engineering, Flinders 

University, Adelaide, 

Australia 

Objective 

The aim of this project was to automate the current manual process of designing a walker for an individual client by 

developing a system that automatically produced the necessary design plans for a given client’s measurements. 

Method 

Initial attempts were made to complete this project using a software package called Pro/DESKTOP by P.T.C. 

Although the models were completed successfully, the user interface (which was used to simplify the use of the 

software and drawing creation) failed due to limitations in the software package. 

Given this limitation, another drawing package called Solid Edge V9 by Unigraphics Solutions was investigated. An 

academic version of the software was obtained and the models were recreated in this package. Visual Basic was 

the language used to program the user interface and it provided a solid, easy to use platform for the job. 

Results 

The project again encountered problems when it was discovered that the version of Solid Edge being used had 

functional limitations, e.g. the Visual Basic interfacing libraries were disabled. This halted any further progress with 

this project, however the concept was adequately demonstrated. 

Implications 

An automated drawing or modelling package would allow for quick and easy designs to be created without the 

need for time-intensive hand drawings. It would also allow for quick adjustments or modifications to be made to 

the drawings, and would provide a way of storing and documenting future designs. Current fully functioning retail 

packages are being investigated to further the work of this project. 


34 


Integrated control of wheelchairs & communication devices 

Ben Symonds 


Sue van de Loo 

Senior Occupational 

Therapist 

David Hobbs 


Engineer 

Rob Garrett 





Colin Clayton 1 

1 

Great Ormond Street 

Hospital for Children, The 

Wolfson Centre 

Objective 

Individuals with limited movement may only have one functional ‘access site’ which they must use to drive a 

wheelchair, control their communication aid or control the environment around them (eg: TV’s, personal computer, 

radio, etc.). The aim of this project was to enhance an individual’s independence by enabling them to incorporate 

driving a powered wheelchair and their ability to interact with their environment through the same control 

mechanism and site. Ideally it was also hoped that the solution would remove an individual’s reliance upon others 

when alternating between driving and control of other technology. 

Method 

Preliminary research was undertaken to identify or develop a solution that would enable someone to access both 

their computer and wheelchair using the same controls – be it a joystick, switch or other alternative control. A 

comparison document of identified devices was collated. This document compared three major systems to each 

other in a comparison table format, enabling a feature-based comparison to be made. 

When a particular system was selected for trial a referral form was completed providing background information 

about each client. Using this information and video footage of the current access methods of the clients, the 

system was then configured to the clients’ specific abilities. Each client then spent a day trialing the system. 

Results 

Early research identified three potential integrated systems – the Dynamics IRIS, the wiseDX and the SRS100 

system. After assessing all three, the wiseDX system was chosen for a trial with two Novita clients in 2003. The 

wiseDX was preferred for its flexibility to meet the needs of different users and for the relative ease of use, set-up 

and configuration of the system. Investigators from engineering and therapy worked together to achieve extremely 

significant results for both these clients. The wiseDX system enabled the first client, a single switch user, to 

independently drive her wheelchair and switch to controlling her Pathfinder communication device. The second client 

was a joystick user, who was able to control his wheelchair and several other devices with his joystick, including a 

television, infrared phone, and the mouse on a laptop computer (wirelessly) with complete independence. 

Implications 

The project identified an effective, easy to use and versatile integrated system that was demonstrated to meet 

the initial project aims. Engineering, technical and therapy staff were accredited by the inventor of the wiseDX 

system and gained valuable experience setting up the system for clients. This expertise and experience has given 

Novita the confidence and credentials to prescribe and support this system, thus providing an exciting solution for 

individuals who require such technology. 

35 



Introduction of a hoist into the family home – a qualitative study into the perspectives 

of three mothers who care for a child who has a severe physical disability 

Angela Shepherd 1 


Supervisor 

Hugh Stewart 1 

Lecturer 

Novita Supervisor 




1 


– Occupational Therapy, 


Objective 

To identify the perspectives of three mothers who use a hoist to assist in the care of a child with a severe physical disability 

in the home. It sought to identify the effects of hoist introduction on the family as well as factors that influence hoist use. 

Method 

A descriptive qualitative methodology was used for naturalistic inquiry. Purposeful sampling was used to select 

three participants who were the primary caregivers of a child with a severe physical disability that limited their 

capacity to transfer independently. Mothers were interviewed individually in their own homes using in-depth, semistructured 

interviews. Analysis of the data used an inductive process of thematic analysis. 

Results 

Four major themes emerged: ‘get it ahead of time’; ‘represents loss of function’; ‘meeting family’s needs’, 

‘improves quality of life’. The findings highlight the overall positive impact of hoist introduction on the parent and 

child’s quality of life as a result of improved management of care, increased options for the child, and increased 

respite options for the parent. 

Implications 

These positive outcomes of hoist use were very important in terms of hoist acceptance and eventual use. A number 

of influences such as the consultation on acquisition of the hoist, early introduction of the hoist, appropriate fit in the 

home, sensitivity to grief and loss, and negotiations with parents about changes in care provision were all seen as 

important in the introduction of the hoist. The study also served to remind occupational therapists of the complexity 

of the introduction process, and the compromises associated with ongoing hoist use in the family home. 


36 



Janitha Jayaweera 1 

4th Year Computer 

Systems Engineering 

Student 

David Sanders 2 

4th Year Biomedical 

Engineering Student 

1 

The University of Adelaide 

2 


and Engineering, 

Flinders University, 

Adelaide, Australia 

Objective 

Remote monitoring of the testing laboratory 

The aim of this research was to develop, build and launch a hardware/software based data acquisition (DAQ) 

system for the Rehabilitation Equipment Testing Laboratory (Test Lab) that would allow remote (preferably real-time) 

monitoring of cyclic tests, remote (PC based) control, and monitoring of environmental conditions. 

Method 

Preliminary research was undertaken to explore possible solutions, by looking at the systems employed locally by 

similar organisations and contacting suppliers of DAQ systems. Additionally the pros and cons of custom versus 

‘off the shelf’ systems and stand-alone versus PC based systems were investigated. The research was then 

combined with the specific requirements of the test lab to develop a detailed specification for the DAQ system. 

Results 

Several options were identified including turnkey solutions, the use of commercial DAQ and signal conditioning 

cards combined with some basic programming, or the in-house development of hardware and software. Due 

to the cost of the commercial solutions the student developed an in-house hardware and software solution for 

PC based monitoring of basic cyclic tests. This resulted in a functional prototype that can be employed for basic 

logging and also provided a solid validation of the concept. 

Implications 

A complete DAQ system would allow tests to be remotely monitored and thus remove the need for staff to come 

and check on test progress over weekends and holidays. It would also enable more detailed failure analysis 

through revision of test conditions leading up to any failures. Currently the student solution is being utilised for 

basic cyclic testing and the test lab is evaluating the identified commercial DAQ systems to enable comprehensive 

monitoring and control of all tests. 



Toan Nguyen 1 

Master of Engineering 

(Research) candidate 

Andrew Downing 1 

Foundation 

Professor, Biomedical 

Engineering 

Barry Seeger 2 

Director, NovitaTech 

Rob Garrett 



Ruth Davy 3 

1 



University, Adelaide. 

2 

Retired 

3 

Co-ordinator, Quality 

Assurance and Evaluation, 

Barkuma Inc. 

Funding: 

A Strategic 

Partnerships with 

Industry Research 

and Training (SPIRT) 

scheme funded by the 

Australian Research 

Council/ Department of 

Education, Training and 

Youth Affairs (DETYA). 

Funding amount of 

$42,160. 

Objective 

Focus group to assess home and mobile phone needs 

To assist in the understanding of both the mobile and fixed telecommunication needs of Novita Children’s 

Services clients and from the identified needs, develop and pilot new service alternatives and product concepts in 

telecommunications to the wider Novita community. 

Method 

A focus group discussion was held at Novita, with four clients consenting to take part. An informal discussion ran 

for approximately 90 minutes to find answers to questions such as: 

• How are people currently using mobile and home phones 

• What difficulties or barriers are people having when using phones 

• What needs to be changed or improved 

Participants were also asked to respond to a list of mobile phone solutions and features that could provide better 

mobile phone access and whether or not they were of significant importance for these participants. 

Results 

All members participating in the focus group were current users of mobile phones. The purposes for which the 

phone were used by the participants included: 

• a method of keeping in contact with friends and family; 

• a means of ringing for a taxi and checking on the taxi’s location; 

• a safety device to enable them to telephone for an ambulance, or the police; and 

• the use of the phone to type and display a key word or idea to assist in a conversation. 

There were many problems associated with mobile phone use, features and design. These included lifting the 

phone from waist level to ear level during mobile phone use. For many people with severe weakness and reduced 

strength in their arms and hands, a dilemma was noted when choosing between smaller mobile phone models that 

are lighter to lift but harder to use in contrast to larger models which easier to use but harder to lift to the shoulder. 

Some participants found that calls were terminated before they were able to retrieve the phone from its storage 

position, answer the call and then raise the phone to ear level. 

The type of disability that the participants have often limits the way they can use the mobile phone. Some have 

adapted ways to overcome their shortcomings when using their mobile phone, while others preferred advanced 

technologies to solve their problems (although there are some trade-offs, such as privacy). All participants 

expressed an interest in hands-free operation of the phone through the use of the speakerphone function and/or 

voice recognition, since all the participants had reduced strength in their arms and hands. There were also 

participants who have no knowledge of current mobile phone technologies available (hardware and software) that 

can be used in conjunction with their mobile phone or AAC device to help improve their use and accessibility. 

Implications 

The outcomes of this research suggest that accessible mobile phones will become a necessity for people with 

a disability. Indeed, many existing solutions may solve the many problems faced by people with disabilities. 

Education and trials of these solutions will play a vital role in determining their appropriateness to individuals. 

37 



Making the home phone accessible for people with a disability 

David Hobbs 


Engineer 

Rob Garrett 



Objective 

As part of the review process of the MiPhone project, new research was conducted to identify the common 

obstacles that prevent people with a disability from using the home phone. 

The steps involved with getting to and using the home phone were identified and divided into 6 separate tasks. 

These included getting to the phone in time to answer an in-coming call, holding the phone to your ear for the 

duration of the call, dialling a number using the key pad, and replacing the phone handset after a call is finished. 

A document titled “The Home Phone Solutions Guide” was then produced, where the Guide identified existing 

commercial solutions for each of the 6 tasks. 

Method 

Common problems and obstacles were identified through focus group sessions and questionnaires sent to both 

child and adult clients of Novita (run in conjunction with the mobile phone research, see ‘Focus Group to Assess 

Home and Mobile Phone Needs’, page 37 and ‘Survey of Accessible Mobile Communication for People with 

Disabilities, page 40). The Guide was then developed to provide hints, tips, and suggested solutions to each of the 

obstacles the questionnaires and focus group sessions identified. 

Solutions and recommendations for overcoming these obstacles were collected from the SA Independent Living 

Centre (ILC), NovitaTech’s Environmental Control Specialist (Annabel Gregory), and Telstra, through their Disability 

Equipment Program (DEP). An online version of Telstra’s Disability Equipment Program can be found at the 

following location: http://www.telstra.com.au/disability/catalogue/. 

Having identified a host of existing solutions, it became apparent that this information was not widely known within 

the disability community. Few people were aware of Telstra’s Disability Equipment Program, and less knew how it 

functioned, what it provided, and how one could be registered. 

For example, existing Telstra customers who are eligible for the DEP may be entitled to a “Holdaphone” (see 

Figure 1) or a speakerphone (for hands-free operation) for the cost of a standard telephone handset rental. 

38 

Results 

The Research & Development Department has concentrated on disseminating the information within the Guide. 

Presentations have been given to Novita’s OT’s, and feature articles explaining some of the solutions and 

highlighting the DEP have been published in Novita’s Nexus Newsletter and the Australian Rehabilitation and 

Assistive Technology Association (ARATA) newsletter. 

Implications 

R&D plans to continue to promote Telstra’s DEP, which directly benefits Novita’s clients and their families, and the 

solutions provided within the Guide. On-going discussions are being held with the Manager of Disability Services 

within Telstra about extending the scope of the DEP to encompass infrared controlled phones. At present, these 

are not part of the Program. 

Figure 1 – The Holdaphone, an assistive device for using the home phone. 



Mobile phone access via an augmentative and alternative communication device 

Toan Nguyen 



Foundation 


Engineering 

Rob Garrett 



1 




Funding: 

A Strategic 










$42,160. 

Objective 

People with severe disabilities are both functionally and socially disadvantaged and often require an Augmentative 

and Alternative Communication (AAC) device, with expensive customised hardware and software interfaces, 

to support their educational, vocational, social and recreational activities. For many of these people, the lack 

of a mobile phone interface is a significant impediment. This research aims to generate economical, effective 

communication solutions, for people with disabilities who need or want to be mobile, by developing and integrating 

mobile technology to suit their needs. For example, the development of an interfacing system to enable a person 

with a disability who uses an AAC device such as the “Pathfinder” to independently answer, initiate and terminate a 

mobile phone voice and to create and send text. 

Method 

Most Global Systems for Mobile Communication (GSM 1 ) mobile phones include an internal hardware modem. 

This modem allows data, fax, text messaging (such as the “Short Messaging Service”, or SMS) and voice calls 

to be controlled by standardised GSM AT 2 commands. Most AAC devices such as the Pathfinder have a serial 

and/or infrared (IrDA 3 ) port, which readily outputs strings of ASCII 4 characters. Consequently, a Pathfinder can 

be programmed to send the required sequences of GSM AT commands to control the mobile phone to initiate 

a voice call, answer incoming calls, terminate calls and send and receive text messages. With the integration of 

a compatible mobile phone car kit, a complete system can be created which would allow an AAC device user to 

independently control a mobile phone for voice and text communications. 

Results 

A prototype interfacing system for mobile phone access via an AAC device has been developed through this 

research to enable people with disabilities who currently utilize electronic communication aids to use a mobile 

phone for voice calls and text messaging. A working model was successfully demonstrated at the Australian 

Rehabilitation & Assistive Technology Association (ARATA) 2004 Conference held in Melbourne 1–4 June 2004 

pre-conference workshop and through a paper presentation. Further refinement is required to develop the system 

into a solution readily useable by AAC users. 

Implications 

A fully developed and packaged system to connect a mobile phone and an AAC device will provide mobile phone 

access for many users of AAC devices that otherwise has not been possible. Trials and evaluation of the fully 

developed system with end users will be the next phase of the project. 

39 

1 

A standard for digital cellular phone service in over 85 countries, which operates at 900/1800/1900 MHz. 

2 

AT stands for ATtention and is the two-character abbreviation that is always used to start communication between two devices. 

3 

Infrared Data Association - which sets standards for using infrared transmission to transfer data between electronic devices (e.g. computers and 

other peripherals and devices) through the air, with no cables or wires. 

4 

American Standard Code for Information Exchange – world-wide standard for the code numbers used by computers to represent all the upper and 

lower-case Latin letters, numbers, punctuation, etc 



40 

Toan Nguyen 1 

Master of Engineering 

(Research) candidate 


Foundation 


Engineering 



Rob Garrett 



David Hobbs 


Engineer 

1 




2 

Retired. 

Funding: 

A Strategic 










$42,160. 

Survey of accessible mobile communication for people with disabilities 

Objective 

Different people have different needs when it comes to using mobile and home phones. For people with 

disabilities, these needs become increasingly important, as accessing standard phones can become an issue. 

More often, specialised or modified phones are needed to deal with these special circumstances. 

The purpose of this research was to identify issues relating to current and future mobile phone technology use, and 

the difficulties or barriers that people with disabilities face when using a mobile or standard home phone. In addition, 

establishing what needs to be developed to enhance/improve accessibility to phones is still an on-going challenge. 

Method 

A Mobile and Home Phone Needs Analysis survey questionnaire was created and distributed via mail to 342 clients 

receiving services from Novita. 

The survey was divided in two sections: 

1. The Mobile Phone Needs Analysis section that dealt with issues relating to mobile phone use; and 

2. The Home Phone Needs Analysis that dealt with accessibility issues relating to home phone use. 

The information obtained from each section of the survey was then used to: 

• develop practical solutions to overcome the difficulties or barriers that users are having when using a mobile or 

home phone; 

• develop alternative methods or approaches to using a mobile or home phone; and 

• model an integrated system that would provide easier access to both the mobile and home phones. 

Results 

The results of the survey questionnaires indicated that people with disabilities within the community are able to 

use, and want to have access to, mobile phone technology. It also highlighted that, apart from general difficulties in 

performing essential tasks on current phones efficiently, most people with a disability are not aware of the available 

technology, and if they are, do not use it to the fullest extent. There was a need to make access to mobile phones 

easier through the development of an interfacing system as well as to look more closely at existing solutions as 

alternative options. 

Implications 

The findings from this research prompted the consideration of trials to investigate and evaluate viable and 

alternative solutions to improve awareness and telecommunications experience for people with disabilities. This 

work was carried out in 2003 through a government-funded project entitled “New technological options for people 

with disabilities through the use of telecommunications equipment” described on p41. 



Technological options for people with physical disabilities 

through the use of telecommunications equipment 

Toan Nguyen 



Foundation 


Engineering 

Rob Garrett 



David Hobbs 


Engineer 

Lloyd Walker 

Director, NovitaTech. 

1 




Funding: 

Telecommunications 

Research Grant 

Program, Department 

of Communications, 

Information Technology 

and the Arts. Funding 

amount of $24,705. 

Telstra’s Disability 

Services. Funding 

amount of $8,000. 

Objective 

Accessing telecommunication technology and the broad range of services behind it has been an ongoing 

challenge for people with disabilities. With technology continually changing and mobile phones shrinking in 

size, the gap between people with disabilities and telecommunication technology has grown. The results of the 

focus group (see page 37) and survey (see page 40) indicated that new mobile phone features and accessories 

could be significant in overcoming this gap. The aim of this research was to trial and evaluate new configurable 

‘off-the-shelf’ telecommunication options such as car kits, voice recognition and hands-free technology (e.g. 

speakerphone), and network features such as voice mail that can improve the lifestyle, independence, security 

and social interaction of people with physical disabilities. 

Method 

The trials involved ten participants, drawn from the 1300 children and adults receiving services from Novita. The 

trial group included people with mild, moderate and severe physical disabilities affecting movement and speech. 

The trials tested the ability of the participants to make and receive calls using a mobile phone, and for those 

participants that can use the Short Message Service (SMS), to create and send text messages efficiently. Various 

assessment methods including the Canadian Occupational Performance Measure (COPM) tool were used to 

measure the performance, frustration, and satisfaction as well as the time responses of participants when carrying 

out these activities: 

• before intervention – with the participant using their existing technology (prior to the trial); 

• during intervention – with the telecommunications equipment provided for approximately 3 weeks (end the trial); and 

• after intervention – when the trial equipment was withdrawn from the participant for approximately 2 weeks. 

Results 

Based on the outcomes of the trials it was found that: 

• there is no insurmountable barrier to the use of phone technology by people with a physical disability. Features of 

the existing technologies offer affordable solutions to problems of accessibility previously considered unsolvable; 

• nine out of ten participants showed high to very high results in terms of their overall performance and 

satisfaction with the use of the telecommunication equipment provided. (A technical difficulty prevented an 

effective evaluation for one of the participants); 

• participants who had an inadequate solution, now can have an adequate solution (or alternative solution) to 

access telecommunication equipment and services; and 

• participants who had no independent access to telecommunication equipment can now independently access 

the network successfully. 

Implications 

Through this research it was found that people with a range of physical disabilities can use and should have equal 

access to telecommunications equipment and services. With the right policies, processes and support (equipment 

matching, education, training and delivery) in place, current off-the-shelf solutions can help alleviate problems and 

improve the lifestyle, social interaction, security and independence of many people with physical disabilities. 

Acknowledgements: 

This research was supported by the Commonwealth Telecommunications Research Grant Program of the Department of 

Communications, Information, Technology and the Arts. This project proudly supported by Telstra. 

41 



Development of accessible websites 

Tim Ziersch 

Manager, Special 

Projects 

Annabel Gregory 

Assistive Technology, 

Computer Access 

Specialist 

Rob Garrett 



Annabelle Tilbrook 


Therapist 

Christian Russell 1 

David Morell 2 

1 

Fusion Design 

Consultants 

2 

Disability Action 

Objective 

To build a suite of four websites for Novita Children’s Services having the highest possible level of accessibility for 

people with a range of disabilities. 

Results 

A comprehensive range of accessibility features were incorporated into the 4 planned websites to meet the highest 

level of compliance for all 14 W3C Web Content Guidelines. The sites were built and tested with a high level of 

satisfaction being reported by testers using a range of assistive technology. Some minor enhancements were 

undertaken based on tester feedback. The sites achieved the AAA W3C compliance rating of the W3C and were 

also awarded the silver medal in the HESTA Web Awards Competition (2004), for which one of the criteria was 

accessibility for people with disability. 

The web sites can be found at: 

http://www.novita.org.au/ 

http://kids.novita.org.au/ 

http://teens.novita.org.au/ 

http://www.novitatech.org.au/ 

Implications 

This work is important in reinforcing the need for all websites to be built so that all people, regardless of whether 

they have a disability or not, can easily and fully access them. 

42 



Using product features to select appropriate AT products 

Rob Garrett 





Computer Access 

Specialist 

Libby Price 


Augmentative 

Communication 

Specialist 



Objective 

When assistive technology products are categorised by the desirable features required by the end users, it is 

possible to filter all the products for features required by a particular user. For example, a user who can only use 

1 switch and requires a device to produce speech can specify these features and then see a list of devices that 

have just these attributes. 

Earlier pioneering feature based selection work resulted in the stand-alone software “VOCAselect” 1 and “Computer 

Access Selector” 2 . With the addition of web pages containing product information, these innovative computer 

programs required product information to be entered into two different locations. With limited resources, it was 

difficult to maintain the software programs. 

The objective was to integrate the feature-based product selection system into the Assistive Technology product 

web pages on the new web site. 

Method 

A comprehensive comparison of feature-based selection systems was conducted and a specification included in 

the web site contract. 

The addition of a product to the online catalogue now requires the features to be identified and tagged within the 

web database system. 

Results 

The Product Selector system has been implemented for the Communication Devices, Computer Access and 

Environmental Control sections of NovitaTech’s online catalogue. The software items will also be included in 

the future. 

The Product Selection Web page can be found at: 

http://www.novitatech.org.au/selector.aspp=249 

Implications 

This new product selector enables people searching for assistive technology products to specify the feature or 

features needed and to quickly isolate a range of products most closely matched to the end user’s requirements. 

Purchasers are more likely to consider the full range of products that match the required features, resulting in a 

final purchase that is a better match to the user’s needs. 

43 

1 Stapleton D, Garrett RE. VOCAselect Version 1.0: An AAC Device Selection Tool. Proceedings of 2nd Australian Conference on Technology for 

People with Disabilities, Adelaide, 1995, p 114–116. 

2 Garrett RE, Stapleton D and Seeger BR. Computer Access Selector: A Windows-based Tool for Choosing Keyboard & Mouse Alternatives. 

Proceedings of EPSM 95, Queenstown NZ, 1995, p 148. 



Intra-rater and inter-rater reliability of the Tardieu Scale to quantify spasticity 

in biceps brachii in children with cerebral palsy. 

Marianne Spizzo 1 

Honours student 

Supervisors 

Andrea 

Warden Flood 1 


Paula Harris 2 



Susan Gibson 



1 


– Physiotherapy, University 


2 

Lyell McEwin Hospital, 

Adelaide, South Australia 

Objective 

The Tardieu scale is a commonly used test of spasticity that involves determining the difference between full 

passive range of motion at slow speed and then the angle of catch at fast speed in single joints such as the elbow. 

The aim of this study was to establish both intra-rater and inter-rater reliability of the Tardieu scale in biceps brachii 

of children with cerebral palsy. 

Method 

In this randomised single-blind design study, five participants with cerebral palsy (aged 4 – 16 years) were 

randomly assigned to one of two groups. Both right and left arms were tested on one subject, resulting in a sample 

of six limbs. Each subject was tested in supine on two consecutive days and at the same time of day. On each day, 

the Tardieu scale was assessed twice with a 5-minute inter-test interval during which the participant moved into 

sitting and was repositioned in supine prior to the second test. On day 1, one Rater (A) performed both tests. On 

day 2, Rater A was followed by Rater B for Group 1, and Rater B was followed by Rater A for Group 2. To blind the 

raters, an independent investigator measured all angles with a goniometer and recorded the results. 

Results 

Intra-rater reliability was acceptable (ICC(1,1) = 0.80) whereas inter-rater reliability was low (ICC(1,1) = 0.51) 

suggesting that the Tardieu score is not reproducible between the raters and that one rater may be required to 

conduct all tests to ensure agreement between repeated measures. These findings were supported by standard 

errors of measurement (intra-rater SEM = 6.65º and inter-rater SEM = 12.28º). Further, the minimal detectable 

change needed to demonstrate treatment effectiveness was 19º for one therapist and 35º for two therapists when 

using the Tardieu score as the outcome measure. 

44 

Implications 

The findings of this study suggest that the use of the Tardieu scale is justified when used by only one therapist for 

the measurement of biceps brachii spasticity in a child with cerebral palsy. If different therapists use the Tardieu 

scale, a change in score may be due to a difference in measurement technique and not a treatment effect. Further 

studies are needed to determine the intra- and inter- rater reliability of this scale with a larger sample and in other 

muscle groups and starting positions. 



Use of the Canadian Occupational Performance Measure: 

therapists’ and parents’ views – a pilot study 

Terry Lyons 


Therapist 

Parimala 

Raghavendra 

Manager, 


Objective 

Canadian Occupational Performance Measure (COPM) (Law, et al., 1998) is designed to measure changes in 

self-perception of occupational performance among clients with a variety of disabilities, across all developmental 

stages and by individual disciplines. However it is not known whether a multi-disciplinary team working with the 

same group of clients can use COPM. 

Method 

A pilot project was undertaken to investigate, whether COPM would inform the goal setting process for an early 

intervention (EI) group run by a multi-disciplinary team, the training needs of therapists, and their and parents’ 

views on the usability of the tool. Four children between the ages of 3 years 11 months and 5 years with physical 

disabilities including Leigh’s Disease, muscular dystrophy and cerebral palsy and their 4 family members formed 

the EI group.; An occupational therapist, physiotherapist, speech pathologist and psychologist were trained in the 

use of COPM. Each therapist was allocated a client and completed the COPM with the parent/carer of that client. 

Semi-structured interviews were conducted with the therapists after goal setting with parents, and at the end of the 

intervention period. The COPM was re-administrated approximately three months after the first. Parents were asked 

to share their experiences in identifying problem areas and their perception of change for their child. 

Results 

The COPM informed the goal-setting process for the EI group. The team was able to work on areas identified by 

parents that were common across the group. The team found COPM to be a simple tool to use but thought that 

more practice was necessary in documenting behavioural issues. Parents were positive about the goal setting 

process and the opportunity it provided to look back on changes in their child. COPM had provided an opportunity 

for them to reflect on their child’s progress and to discuss future goals. 

Implications 

The pilot project with a multi-disciplinary team working with an EI team showed that COPM could be used across 

different therapy areas. Parents observed progress in their children. COPM facilitates client-centred practice and 

may be more useful in using it with older clients and in describing occupation-related goals. 

45 

References: Law M, Baptiste S, Carswell A, McColl M, Polatajko H, Pollock N (1998). Canadian Occupational Performance Measures. CAOT 

publications: Canada. 



What is the evidence for the use of the gross motor function measure (GMFM-88) 

as a functional outcome measure for children with cerebral palsy 

Susan Gibson 



Physiotherapy 

Staff 

Objective 

The purpose of this critical appraisal of the literature was to (1) establish whether the GMFM-88 a reliable and valid 

tool to detect change in the gross motor skills of children with CP, and (2) establish its clinical usefulness and its 

sensitivity to detect change 

Method 

A systematic search was conducted using multiple databases through South Australian Health Services Libraries 

Consortium database (SALUS). Databases searched: Medline, CINAHL, AMED, Current Contents, IDEAL, Science 

Direct, Cochrane Library and Sports Discus. Key words: cerebral palsy, Gross Motor Function Measure, GMFM, 

GMFM-88, Gross Motor Performance Measure, GMPM, Gross Motor Functional Classification Scale, GMFCS, 

GMFM-66. Crombie Appraisal Tools, modified by the Clinical Research Department at Novita, were used to 

critically appraise the literature. All studies and articles located were acceptable evidence. 

Results 

A total of 50 studies were included. 12 articles pertaining to Question 1 (reliability and validity) were appraised: 

3 reviews, 7 observational studied and 2 experimental studies. For Question 2 (clinical usefulness) 38 articles were 

appraised: 4 reviews, 4 case studies, 15 observational studies and 15 experimental studies. The outcomes of the 

critical appraisal of the literature was that: 

• The GMFM-88 is a reliable and valid measure used to evaluate change in motor function in children with CP, it is 

not a very sensitive tool for the higher functioning child with a mild motor impairment, and a ceiling effect can be 

reached making it difficult to measure improvements in these children; 

• The GMFM-88 has been validated for use with children with Downs Syndrome and Osteogenesis Imperfecta; and 

• The GMFM-88 has been used to establish baseline profiles and detect change in gross motor function after 

interventions such as Selective Dorsal Rhizotomies, Botulinum Toxin Type A injections, Hyperbaric Oxygen 

Therapy and to demonstrate a treatment effect in the research into efficacy of intensive physiotherapy 

intervention and muscle strengthening programs for children with CP. 

46 

Implications 

This critical appraisal of the literature supports the use of the GMFM-88 as a Functional Outcomes Measurement 

tool for children with cerebral palsy. The physiotherapy staff at Novita continues to use the GMFM-88 as a clinical 

outcome measurement. The Physiotherapy Department also now uses the Gross Motor Functional Classification 

System, and have recently embarked on a training program for all physiotherapists at Novita in the use of the 

GMFM-66 and the Gross Motor Ability Estimator. 



The prevalence of low back pain in parents of children 

with a physical disability aged 5 years or below 

Nathan Ward 1 


Supervisor 

Marie Williams 1 

Associate Professor 


Trish Bate 



1 


– Physiotherapy, University 


Objective 

Low back pain (LBP) is a significant issue within the general population. Numerous risk factors have been linked to 

the development of LBP, with many of these presumed to be present in parents of young children. To date, there is 

little information concerning the prevalence of LBP in adults caring for young physically disabled children. The aim 

of this study was to conduct a survey to investigate the incidence of LBP in parents of children aged five years or 

below that have a physical disability. 

Method 

This study used a survey design where a postal questionnaire was undertaken to determine the prevalence of 

LBP in the study population. The questionnaire was administered to parents who had a child who was registered 

with Novita and was 5 years of age or younger. The Nordic Low Back Questionnaire and the Oswestry Disability 

Questionnaire were used in the study. A purpose-designed questionnaire to provide demographics was also 

mailed to each subject. Two hundred and seventy five packages were mailed out. 

Results 

This study achieved a final response rate of 36.7% (n=101). For this sample, there was a lifetime prevalence of 

90.1%, 12-month prevalence of 87.1% and a seven-day prevalence of 54.5%. On the day they completed the 

survey, 59% of parents said they had low back pain. Most parents reported only a small amount of inconvenience 

caused by the low back pain. There was no link between the time spent caring, washing/dressing, feeding, playing 

with and lifting/carrying the child and the level of disability. In the past year, 37% of the parents had sought help 

from a doctor, physiotherapist, chiropractor or another person due to low back pain. Low back pain had affected 

the normal work activities of 36% of the parents, with 41% having to limit their leisure activity due to low back pain 

in the last year. There also appeared to be no link between receiving assistance from a paid carer and having 

low back pain in either the last 7 days or 12 months. This means that having a paid carer did not help reduce or 

increase the incidence of low back pain in our study group. 

Implications 

The findings of the study suggest that LBP may be a significant issue for some parents with a young disabled 

child. However, due to the low response rate, prevalence figures cannot be considered significant of the entire 

population group. The Physiotherapy Discipline at Novita is considering whether back care information sessions 

and classes for parents should be offered on an ongoing basis. 

47 



48 

Parimala 

Raghavendra 

Manager 


Julie Smith 

Senior Psychologist 

Trevor Harrison 1 

Pam Donnelly 

Regional Manager 

Glenda Noble 2 


Therapist 

Heather Slattery 3 

Actress 

1 

Harrison Consultants 

2 

Communication and 

Therapy Services, now part 

of Adult Therapy Services 

at the Independent Living 

Centre 

3 

Deceased 

Childhood therapy experiences of adults with cerebral palsy: 

implications for today’s children with cerebral palsy 

Objective 

The aim of the project was to investigate how an agency providing long term support for children with cerebral 

palsy can best prepare them for adulthood. Adults who had received services from Novita Children’s Services 

(formerly Crippled Children’s Association of SA Inc.) as children, were asked how physiotherapy, occupational 

therapy, speech pathology and social work/psychology services had assisted them during their years at Novita. 

They were also asked what they thought of the services they had received, what else they might have needed, 

and what suggestions they would like to make regarding Novita’s services for the future. 

Method 

A qualitative research methodology involving focus groups and individual interviews was employed with a 

participatory research paradigm in which people with disabilities and researchers worked together at each stage 

of the project. 

Fifteen people with cerebral palsy between the ages of 20 and 35 years who had received services from Novita 

as children, participated in the study. Ten of them were individually interviewed and 5 participated in focus groups. 

All data was transcribed verbatim and cross-checked with the participants. Inductive analysis of the data included 

displaying the data in tables, developing codes, and identifying patterns, themes, and categories of responses. 

The report was provided to the participants in written and audio format and their feedback obtained and 

incorporated in the final report. 

Results 

Of all the services, participants remembered physiotherapy in greatest detail and depth. They spoke very highly of 

the quality of physiotherapy service they had received, in particular the amount of therapy. Of the nine participants 

who had received speech pathology services, most were satisfied. In looking back at occupational therapy 

services, they identified a need to have more input on practical living issues, e.g. getting about in the community, 

finding employment, managing a team of attendants. The majority of participants were satisfied with friendship 

experiences, but reported dissatisfaction with aspects of their school experiences. 

Some of the recommendations made by the participants: 

• Ensure mobility is presented as a range of options; 

• Provide more independence training; 

• Provide more training across a range of communication skills: directing personal attendants & conversing 

with peers; 

• Give greater emphasis to teaching literacy skills, especially the ability to read; and 

• Advocate more for disability awareness in the community, better access, better understanding and support. 

Implications 

A retrospective evaluation of its services provides Novita with some clear recommendations for future service 

delivery. A “Research into Services“ sub-committee studied the report and proposed two distinct areas of 

recommendations: 

1. Philosophical basis for Novita to reflect a focus on the development of autonomy in the young person; and 

2. Content and focus of services particularly for adolescents. 

For more information visit www.novita.org.au 



Comparison of feedback conditions in spelling instruction for a child using AAC 

Rebecca Morris 1 


Parimala 

Raghavendra 

Manager 


1 

Currently R Oaten at 

Intellectual Disability 

Services Council, Inc. 

Objective 

To investigate the effectiveness of three feedback conditions (PRINT – looking at the spelt word on the Liquid 

Crystal display only, SPEECH – listening to the synthesised word only, SPEECH-PRINT – listening and looking) on 

learning to spell 24 words for an 11-year-old boy with cerebral palsy and complex communication needs (CCN) 

who used a speech generating device (SGD) The child had a mild intellectual impairment and normal 

hearing and vision. 

Method 

A pre-assessment phase determined words that the child comprehended but could not spell. In study 1 an 

adapted alternating treatments design was used to evaluate the effects of the above 3 feedback conditions on 

spelling acquisition of 12 x 3 letter words. The sessions were conducted weekly. The spelling instruction employed 

the copy-write-compare method under the three different feedback conditions. The order of the feedback 

conditions within each session was counterbalanced to avoid any condition being favoured. In study 2 an intrasubject 

direct replication of study 1 was conducted with a different set of 12 x 3 letter words. These sessions were 

daily rather than weekly and generalisation and maintenance phases were added. 

Results 

The child learnt to spell all 24 words under the three feedback conditions. However, the PRINT condition 

consistently reached criterion (all words spelt correctly on two consecutive sessions) before the other two 

conditions. The intra-subject replication strengthened this finding. The sequence of criterion attainment was PRINT 

(session 21) followed by SPEECH and SPEECH-PRINT conditions simultaneously (session 33) in Study 1 and 

PRINT (session 10), SPEECH (session 18) and SPEECH-PRINT (session 29) in Study 2. 

Implications 

Children with CCN using SGD may learn to spell using visual feedback and may have the potential to develop 

some literacy skills if training is provided over a lengthy period. 


49 


Evaluation of behaviour management advice 

Angela 

Crettenden 1 

Clinical Psychologist 

Tim Connell 

Chief Clinical 

Psychologist 

1 

Currently a Doctoral 

Student at The University 

of Adelaide 

Objective 

Children with physical disabilities and their families experience significant psychological issues which are several 

fold. Significant numbers of parents experience stress due to grief and having to deal with diverse child needs. 

Some children experience difficulties learning basic skills, coping with school, getting on with others and living with 

limitations and others’ reactions. 

Analysis of the 270 referrals received by the Novita psychologists from June to December, 2000 found the most 

frequent referral (36% of the total) was for behaviour management. To evaluate the effectiveness of services 

provided for these referrals, and explore how our service could be improved, parents of children meeting specific 

criteria were invited to participate in an evaluation study. 

Method 

Parents of children referred to Novita psychologists were invited to participate in the study if the children presented 

with overt, acting-out behavioural issues (e.g. aggression and noncompliance), were between 2 and 10 years of 

age and did not attend a special school. This resulted in 17 families participating. The children included 12 boys, 

5 girls, average age of 6 years, 0 months (SD: 3 years, 4 months). The ages ranged between 18 months and 

13 years, 5 months. As part of study participation, parents completed the Parenting Scale (O’Leary et al, 1993), 

Child Behaviour Questionnaire (Eyberg & Pincus, 1999) before and after two terms (Average pre-post interval: 

18.1 weeks; SD: 8 weeks). At the post-test they were also asked to complete the Client Satisfaction Questionnaire 

(Larsen et al, 1979), and the treating psychologist completed the Therapist Satisfaction Questionnaire 

(Crettenden, 2001). 

Results 

After intervention, 70% of families reported that problems were now less severe and 67% reported a fewer number 

of behaviour problems. 75% reported an improvement in their overall parenting style (p

Evaluation of family centred practice using the measure of process of care 

South Australian 

Community Health 

Research Unit (SACHRU) 

Michael Bentley 


Officer 

Novita 

Reference Group 

Sarah Anderson 

Orthotist, NovitaTech 

Jane Loveday 

Senior Options 

Coordinator, Family 

Support Services 

Terry Lyons 


Therapist 

Pauline McGregor 


Parimala 

Raghavendra 

Manager, 



Acting Manager, 


Objective 

The aim of the project is to evaluate “how family-centred” is Novita in providing therapy, rehabilitation engineering, 

and family support services to clients and families of Novita. The South Australian Community Health Research 

Unit (SACHRU) has been contracted to conduct the evaluation as part of Novita’s ongoing commitment to service 

quality. SACHRU will work closely with the Novita Reference Group. 

Method 

The evaluation will use two survey instruments developed by CanChild, Canada. 

The Measure of Processes of Care (MPOC) is a self-administered questionnaire that measures parents’/caregivers’ 

perceptions of the extent to which specific behaviours of Novita staff occur. A sample of 285 families stratified by 

three age groups of clients (> 6 years, 6 – 12 and 13 – 18 years) and metropolitan/country places of residence will 

be sent the MPOC–20 questionnaire. 

The Measure of Processes of Care for Service Providers (MPOC-SP) is a 27 item self-assessment questionnaire for 

staff working in paediatrics, designed to measure their reported implementation of family-centred practice. All staff 

of Novita Children’s Services who have direct contact with clients and their families (approximately 170 staff) will be 

sent the MPOC-SP questionnaire. 

Implications 

The outcomes will inform Novita of parents’ perception of Novita’s family centred practice behaviours and also 

staff’s perception of their behaviours towards families. It may highlight strengths and needs in implementation of 

family centred practice. The results from MPOC-SP may also be useful in professional development activities. 


51 

How occupational therapists at Novita train clients in the scanning access technique 

Jennifer Jones 1 


Supervisor 

Hugh Stewart 1 

Lecturer 

Novita Supervisors: 

Sue van der Loo 


Therapist, NovitaTech 

Support Team 


Senior Speech 

Pathologist, NovitaTech 

Support Team 

1 


– Occupational Therapy, 


Objective 

This study explored the role of occupational therapists at Novita in training children in scanning access techniques. 

It then went on to investigate how this role was carried out by three experienced occupational therapists. 

Method 

The first part of the study employed a survey methodology where all Novita occupational therapists, speech 

pathologists, and their assistants completed a questionnaire. The second part involved qualitative methodology 

using in-depth, semi-structured interviews with three experienced occupational therapists. 

Results 

The survey found that the most common clinical diagnoses of clients who were taught scanning were cerebral 

palsy (CP) with spastic quadriplegia, and athetoid CP. Scanning was most commonly introduced between 

3–5 years of age. Occupational therapists were heavily involved in training in all phases, and speech pathologists 

were more involved in the middle to later phases. The training process was identified as consisting of a sequence 

of steps. From the in-depth interviews, four themes relating to the scanning process were found. These were that 

the process of scanning training is progressive and parallel; clients must be considered on an individual basis; 

scanning training is very closely linked with functional goals; and a collaborative approach in teaching the child 

and primary caregivers is important. 

Implications 

There is a significant role for occupational therapists in teaching a child to scan, despite the relatively small 

population of scanning users. The training of scanning is a dynamic process that uses a number of different 

approaches and is collaborative with the family and health professionals. Successful scanning enables enhanced 

quality of life. 

Project completed in November 2001 


“Is more therapy better” A comparison of two models of intensive physiotherapy 

and “conventional” intensive physiotherapy for children with cerebral palsy 

Susan Gibson 



Parimala 

Raghavendra 

Manager, 


Philip Darbyshire 1 

Chair of Nursing 

1 

Midwifery and Research 

and Practice Development, 

Women’s and Children’s 

Hospital, Adelaide 

Funding 

Channel 7 

Children’s Research 

Foundation ($35,000): 

2000 – 2002. 

Objective 

The aim of the study was to investigate if the rate of motor skill achievement and muscle strength increased 

following intensive physiotherapy intervention for children with cerebral palsy (CP). The models of intensive 

physiotherapy investigated were: Model 1: Conventional Intensive Physiotherapy Intervention (10 hours over 10 

weeks); Model 2: Intensive Holiday Physiotherapy Program (21 hours over 2 weeks); and Model 3: Intensive After 

School Block of Physiotherapy (21 hours over 4 weeks). The children, their parents, and physiotherapists were also 

asked their opinions and perceptions of the models of intensive intervention. 

Method 

Sixteen children with CP, classified at Level II or III on the Gross Motor Function Classification System (GMFCS), 

and aged between 4 and 7 years, were matched on GMFCS levels and then randomly assigned to two groups: 

Group A received Model 1 and Model 3 and a 6-week period of “no intervention”. Group B received Model 1 and 

Model 2 and an 8-week period of “no intervention”. Each group had a 2-week washout period between models. 

Muscle strength (Hand Held Myometer) and gross motor function (Gross Motor Function Measure) were recorded 

on 6 occasions. The Canadian Occupational Performance Measure (COPM) was administered to parents on 5 of 

these occasions. Views and opinions were gathered from parents, children and physiotherapists through focus 

groups and individual interviews. 

Results 

There was no significant difference in rate of motor skill acquisition or muscle strength between Model 1 and Model 

2 for Group B, and Model 1 and Model 3 for Group A. Although changes in muscle strength and gross motor 

function were unremarkable, parents perceived positive changes in their child’s functional skills as measured by 

COPM scores. Results from the interviews suggested that Group A children preferred weekly physiotherapy to after 

school intensive. Group B children preferred the school holiday intensive block to weekly physiotherapy. Parents 

were positive about both intensive models of intervention, but had specific issues and concerns relating to the 

models. The physiotherapists’ responses to the intensive models were variable. 

52 

Implications 

The lack of significant difference between intensive models of intervention may indicate issues regarding lack of 

sensitivity to change of tools used, and the use of small groups of children with high variability. The study highlights 

the importance of goal setting with parents as changes in gross motor function were related to the goals set, 

rather than the intensity of intervention. In addition to measuring functional changes using measurement tools, it is 

important to gather the views and perceptions of the people involved in studies as it assists in building meaningful 

partnerships resulting in a better family-centred service. 



Motor and functional outcomes of children with physical and /or multiple disabilities 

living in rural and remote areas compared with their metropolitan counterparts – a pilot study 

Sue Durand 1 

Senior Physiotherapist 

Pauline McGregor 





1 

Currently employed 

in private practice 

Objective 

In early 1999 an evaluation of the rural outreach service was carried out by means of a parent, caregiver and other 

local personnel questionnaire. The results indicated that there was a great deal of satisfaction with the service but 

the question remained as to whether the motor and functional gains of the children in remote and rural areas were 

equivalent to their metropolitan contemporaries. This study attempted to determine whether there were differences 

in the motor and functional outcomes of children with physical and/or multiple disabilities living in rural and remote 

areas compared with their metropolitan counterparts. 

Method 

A convenience sample of four matched pairs of children, who were clients of Novita was selected for this study, 

with parental permission gained for their inclusion. All of the children were aged under 6 at the end of the study. 

Each pair was matched as near as possible for age (ideally within 6 months), gender and disability. Pre and 

Post testing by the same Occupational Therapist and Physiotherapist occurred 12 months apart. No blinding of 

assessors occurred. The matched pairs were to be assessed within one month interval of each other. The children 

were assessed with the Peabody Motor Scales, Wee FIM, and parent survey of satisfaction. 

Results 

All children made fine and / or gross motor progress over the 12-month period. However, all children progressed at 

a slower rate, making developmental gains that were equivalent to less than 12 months. 

The developmental ratio of mean motor age/chronological age was consistent for all clients on pre and post 

testing. The Wee-FIM results appeared to be related to the parent’s understanding of their child’s abilities and how 

this understanding changed over time. 

Implications 

This pilot study suggested that children who lived in the country and have access to specialist paediatric therapy 

input quarterly made comparable progress to their city peers. They have an expectation of participation by family 

and local services to provide regular input that is guided by the specialist services. Parents residing in the country 

may be reassured that their children are not disadvantaged due to the location of their home. 

53 



Single event multilevel surgery: a description of stakeholder experiences 

Lauren Dryden 1 


Supervisor 

Karen Grimmer 2 

Director 


Susan Bostock 



1 


– Physiotherapy University 


2 

Centre for Allied Health 

Research, University of 


Objective 

Single event multilevel surgery is performed on a small number of children with cerebral palsy each year. It consists 

of multiple procedures being undertaken in one operation and occurs when conservative management success 

is decreasing. Following orthopaedic surgery, research has shown children with cerebral palsy experience a 

regression in motor function and a temporary loss of functional activities. 

An effective physiotherapy/ rehabilitation program is considered crucial to the success of multilevel interventions. 

The program must be intensive, and requires compliance and motivation from all stakeholders. Research states 

the need for parents to set expectations and desires around which a multidisciplinary team can create goals which 

are individualised, explicit and prudent; and treatment must take into account the family’s support and available 

resources. Despite this acknowledgement, information about what parents and children hope to achieve by 

undergoing surgery, the preparation of children and their parents for the operation, and the families’ perceptions 

of the outcomes of surgery are limited. 

The aim of this study was to report, from the perspective of all stakeholders, their experience from pre-operative 

planning to postoperative rehabilitation to identify barriers and facilitators for successful rehabilitation and to 

enhance preparation of future children and their families for surgery. 

Method 

This study used a qualitative approach and consisted of interviews with six physiotherapists, four families, one 

paediatric rehabilitation specialist and an orthopaedic surgeon. Transcripts were analysed and coded to extract 

key themes. 

54 

Results 

Themes which emerged from the data included recommendations for surgery, outcomes from surgery, information 

to families, complications, emotional factors and areas to improve from all stakeholder groups; as well as 

postoperative services from the family and medical personnel interviews; rehabilitation experience from the family 

interviews; and role of the physiotherapist and rehabilitation from the physiotherapist interviews. The findings 

suggested there is potential to improve service delivery in the areas of preoperative preparation, postoperative pain 

management, and postoperative family assistance. 

Implications 

It is anticipated this research will facilitate the development of a more comprehensive education tool aiming to 

improve management of children having SEMLS in areas including formalised pre-surgery goal setting, preparing 

the house and family members for when the child requires increased assistance, and rehabilitation requirements. 



Australian representation on ISO TC173 SC1 

Lloyd Walker 


Funding: 

Attendance allowance 

from Standards 

Australia 

2003 – NZ – $2,400 

2004 – USA – $3,500 

Objective 

Ensure that Australian needs and expertise are recognised in the development of new international standards that 

relate to wheeled mobility devices. 

Method 

NovitaTech staff have participated in Standards development over the years, but this involvement almost 

completely ceased around 2000. Dr Walker joined all five relevant ISO working groups listed below in mid 2003. 

Since that time he has monitored discussions on the various electronic lists that the groups have used and 

also participated in voting on Australia’s behalf through the ISO Server. He (or if available a suitable nominee) 

will be attending a face-to-face meeting (usually 5 days) of the five Working Groups at least once per year, and 

maintaining contact at other times through email. 

Results 

The group responsible for international standards relating to wheelchairs is Technical Committee 173 (TC173). 

TC173 has a Standing Committee 1 that oversees the activities of five Working Groups (WG): 

WG1 – Test Methods 

WG6 – Transportation Safety 

WG8 – Electronic and power systems 

WG10 – Stair climbing wheelchairs 

WG11 – Seating and related systems 

In November 2003 (Christchurch, NZ) and May 2004 (Estes Park, USA) Dr Walker participated in the face-toface 

meetings of the Working Groups over a full working week. In January 2004, Dr Walker participated by 

teleconference in discussions of WG6 as it met in Pittsburgh, and a delegate with relevant experience (Kevin 

Clements – Manager Mobility & Seating) attended the WG11 meeting in March 2004 in Vancouver, Canada. 

Implications 

There are currently a number of International Standards under review or being developed. Our contribution has 

been highly valued by our international colleagues, and this work has facilitated an approach that will make it 

simpler for Australia to adopt ISO standards rather than create our own requirements. Input into the development 

of these key documents has also helped to ensure that pragmatic testing and user requirements are being 

considered early, and that our personnel, and the Australian sector generally, are aware of changes being planned 

at an International level. 

55 

Project recommenced in 2003 


Churchill Fellowship research, experiences and outcomes 

David Hobbs 


Engineer 

Funding: 

The Winston Churchill 

Memorial Trust, 2003, 

$16,600 

Objective 

The purpose of this Churchill Fellowship research was to investigate how leading Rehabilitation 

Engineering (RE) Centres around the world are using research and development and the application 

of technology to assist people with a disability. Inherent to this research was understanding the 

structure and set-up of each facility in an effort to determine how their research was conducted, how it 

was funded, how research priorities were determined, to what extent each centre collaborated with industry or 

other centres, and the range of current project work. A secondary focus was to investigate how the concept and 

process of “Universal Design” was being taught and implemented within the field of RE. 

Method 

This research was conducted over a period of 8 weeks with 12 centres in England, Toronto, and the United States 

being visited and researched. A variety of centres and settings were chosen, including specialist Rehabilitation 

Centres, departments within hospitals, and tertiary research facilities. Initial contact was made with key 

stakeholders at each of the centres after the scholarship was awarded, and an individual program was developed 

that allowed the investigator to conduct his research and meet with key staff. At each centre the investigator was 

given an opportunity to give a presentation to interested staff about Novita and NovitaTech and the range of work 

that is conducted. The Fellowship concluded with the annual Rehabilitation Engineering Society of North America 

(RESNA) Conference in Atlanta, Georgia, the USA – one of the largest conferences focussing on technology 

and disability. 

56 

Results 

A number of novel, user-driven, innovative products and programs were investigated and researched at the 

different centres. These came from areas such as seating, mobility, home health care, telecommunications, and 

the general area of ‘assistive technology’. Many of these products, particularly those from Canada and the United 

States, are commercially available but have not reached Australian shores or are unknown to Australian healthcare 

professionals. Examples of such novel products include a talking mobile phone, the Movement-to-Music therapy 

system, a novel seating system called the Flip2sit booster seat, and Solesensor (an innovative shoe insole that 

improves balance in the elderly). 

Common themes that were identified were an emphasis on – technology transfer; information dissemination; end 

user involvement; research into ageing, falls, and balance; and a focus on developing collaborative links with 

industry and other institutions. Notably, every centre was either fully affiliated with a tertiary institution or operated 

as a department within a tertiary institution. This link strengthened their research program and was a common 

successful trait. 

Two successful research and development models were identified and investigated: namely the Canadian 

provincial Ontario Rehabilitation Technology Consortium (ORTC) model and the United States federal National 

Institute on Disability and Rehabilitation Research (NIDRR) model. A critical ingredient of both of these models was 

that of government support. Without government initiation and support, neither model would exist. 

Implications 

A number of benefits have resulted from this research. The investigator identified a centre in Atlanta (Georgia, 

USA) that is conducting similar mobile phone technology research and initial collaborative links have since been 

established. The investigator has also been successful in introducing the concept of music therapy at Novita, by 

bringing the Movement-to-Music therapy program to Australia. Formal links have also since been established with 

a major distributor of assistive technology equipment in Canada. Future plans include hosting a forum on how 

rehabilitation engineering and assistive technology centres can work closer with industry and academia to replicate 

the ORTC model of product innovation and development. 



Development and delivery of an undergraduate subject in 

rehabilitation engineering at Flinders University 



Lloyd Walker 


Rob Garrett 


Engineering & Support. 

David Hobbs 

Research & 

Development Dept. 

Kevin Clements 

Mobility & Seating 

Dept. 


Assistive Technology 

Dept. 

Libby Price 

Assistive Technology 

Dept. 

Leigh Taylor 

Group Leader, Mobility, 

Orthotics and Seating 

1 

Retired 

Objective 

In 1997 the Division, in conjunction with the School of Engineering (now the School of Informatics and Engineering) 

at Flinders University, initiated and began teaching an elective subject in Rehabilitation Engineering (course code 

ENGR 5122). The aim was to expose undergraduate Biomedical Engineering students to the career path and 

challenges of the field of Rehabilitation Engineering. 

Method 

The semester long 13-week course is typically taught to 5th (final) year Biomedical Engineering students at the 

university. It is structured so that each 3-hour lecture focuses on a different topic and the students are exposed to 

a number of different environments outside of the classroom. Approximately a third of the classes are taught on 

the university campus, the remainder involve site visits to NovitaTech, the Independent Living Centre, the Disability 

Information Resource Centre, and the Royal Society for the Blind. 

The topics that are addressed over the 13 weeks are: 

• An introduction and overview of assistive technology; 

• Universal Design; 

• Delivering assistive technology services to the customer; 

• Assessing access to the built environment; 

• Computer interfaces and computers as extrinsic enablers; 

• Augmentative and Alternative Communication systems; 

• Mobility and seating; 

• Environmental control; 

• Prosthetics and orthotics; and 

• Sensory aids for visual and auditory impairments. 

As well as the lecturers listed alongside, a number of guest lecturers assist with the course, providing 

specialist input. 

Results 

Students taking the course submit 3 problem-based assignments throughout the semester and sit a 2-hour exam 

during the normal exam period. Recently the exam format has shifted from being a 100% multiple-choice exam to 

including a number of short answer questions. Three of NovitaTech’s current engineers are graduates of the course. 

57 

Implications 

The course has been instrumental in terms of exposing undergraduate Biomedical Engineering students to the 

field of Rehabilitation Engineering. It continues to be a popular elective course for final year students. Interest 

in the topics and style of delivery is now being shown by other universities in Adelaide. This will potentially lead 

to a multidisciplinary class group who are interested in being exposed to the field of Assistive Technology and 

Rehabilitation Engineering. 



Development of collaborative links with University of Pittsburgh 

Lloyd Walker 


Rory Cooper 1 

1 

School of Rehabilitation 

and Health Sciences, 

University of Pittsburgh, 

Pittsburgh, USA 

Funding: 

Undertaken as 

part of other visits. 

Joint funding being 

explored. 

Objective 

This work seeks to establish a link into related research that will offer the opportunity of multi-centred research and 

collaborative funding proposals between NovitaTech and United States and European colleagues. 

Method 

The University of Pittsburgh is a world-leading centre in rehabilitation engineering research. It has hosted the 

Rehabilitation Engineering Research Centres in Wheeled Mobility and Wheelchair Transportation Safety. It is also 

a Veteran’s Administration (VA) specialist research centre – the Human Engineering Research Laboratories. 

It is expected that following the agreement between the two groups on joint research proposals, competitive 

funding submissions will be developed to support both the site based research and the collaboration. An aim 

of this work is to also permit the exchange of personnel between the centres as a means of strengthening the 

research and expertise exchange. 

Results 

There have been loose links between individuals at both centres over a number of years, but following various 

meetings during 2003 and 2004, the two groups are now negotiating on two potential collaborative research 

proposals: Real use characteristics of wheelchairs; and upper limb function and overuse biomechanics. Both of 

these projects have developed from established research programs in Pittsburgh and Australia’s contribution 

would be to extend the research to include children with disabilities. There is very little empirical evidence in this 

area. Currently project proposals are being reviewed for use in the Australian context including the ethical needs 

and changes that may be required for the different subject group. 

58 

Implications 

Potentially significant insight into how young people use and are affected by their wheeled mobility. This work 

would also permit strong international links that strengthen the power of research techniques by increasing the 

population base under study. As a result more definitive conclusions can be drawn on improving the health, 

wellbeing and social inclusion of people with disabilities. 



Rob Garrett 



Rob Burns 1 

(chair) 

Fiona Kieni-Judd 1 

(Telecommunications. 

Standards) 

Mike Johns 2 

Hank Wylie 3 

Teresa Corbin 4 

Bryan Porter 4 

Andrew Stewart 5 

Paul Robinson 6 

Rolf Regel 7 

Gunela Astbrink 8 

Merv Sewell 9 

1 

Australian 

Communications Authority 

2 

Australian 

Communications Industry 

Forum 

3 

Communications Aid 

Users Society 

4 

Consumers’ 


Network 

5 

Deafness Forum 

6 

IBM 

7 

Siemens 

8 

TEDICORE 

9 

Telstra 

Objective 

Disability Standards Working Group (DSWG) 

The Disability Standards Working Group (DSWG) was convened at the Australian Communications Authority’s 

(ACA) Communications Technical Regulation Advisory Committee (CTRAC) meeting on 23 May 2002. The 

Working Group was established as a result of the ACA’s dissatisfaction with the limited content of the current 

telecommunications disability standard. 

The DSWG was required to provide advice and make recommendations on what needs to be included in any 

future disability standards and appropriate compliance arrangements. 

The disability standard does not cover specialist equipment for people with disabilities, but does specify the 

requirements for features on the regular phone that will facilitate access to the standard telephone service for 

those with a disability. 

Method 

Representatives from the disability sector, telecommunications industry and Australian Communications Authority 

were sought. 

A total of 5 one-day meetings were held in Melbourne in 2002 to develop the required document. 

Results 

The final recommendations contain a list of features in two categories. The “A List” is a proposed list of features 

that are generally considered to be of benefit to all members of our community, and are to be considered as 

mandatory. This list includes features such as a standard key layout, adjustable ringer volume, a non-slip base, 

etc. The “B List” contains desirable features that can be phased in over time. A home phone will need to comply 

with at least 6 of the features on the “B List”. This approach will open the way for future standards to “raise the bar” 

and specify more than 6 features. These features include items such as enlarged keys, key feedback, high contrast 

display, microphone amplification, etc. 

The final report “Communications Technical Regulation Advisory Committee – Report on features for inclusion in 

future disability standards, 24 February 2003”, is now available from the Australian Communications Authority. 

Implications 

The final report has been submitted to the CTRAC meeting, and as a result, the ACA has requested that the 

Australian Communications Industry Forum develop: 

a) an Industry Code to specify obligations on customer equipment importers and manufacturers to provide 

product information on the functional characteristics of phones that would be beneficial to people with a 

disability; and 

b) an Industry Guideline to provide guidance for phone equipment importers and manufacturers on features 

of customer equipment used for telecommunication that will assist consumers with disabilities. 

See also page 62 (Phone Accessibility Information Working Committee). 

59 



Enhancing innovation and development of new products in the 

Australian rehabilitation equipment sector 



Objective 

To develop methods and strategies to maintain and enhance the process of innovation and the design of new products 

and technologies in the Australian Medical Devices Industry with specific reference to the Rehabilitation Equipment sector. 

Method 

This research is a part of a Masters of Engineering Degree through The University of Adelaide. The research will 

involve the evaluation of the suitability and the adaptation of advanced innovation, design and failure prediction 

methods and their combinations for the Rehabilitation Equipment sector. 

The research will also include an analysis of the effect of the new Therapeutic Goods Medical Device legislation on 

the Australian Rehabilitation Equipment sector, with respect to innovation. 

The design and innovation processes in the Australian Medical Device Industry and effects of the TGA regulations 

will be compared with analogous processes, regulations and effects in Europe. 

Implications 

This research will evaluate the effects of the new Therapeutic Goods (Medical Device) legislation on the Australian 

Rehabilitation Equipment sector with respect to the development of new products and harmonisation with 

international best practice. The quality systems used by manufacturers and the quality and safety of equipment will 

also be investigated. Instrumental techniques and tools for maintaining and enhancing innovation and the design 

of new quality products and technologies in the Rehabilitation Sector will be developed and verified. 

Project commenced in September 2004 

60 


Evaluation and scoping of a movement analysis facility in Adelaide 

Lloyd Walker 


David Hobbs 


Engineer 

Judy Sprod 


Susan Gibson 



Trish Bate 



Esther May 1 

Susan Hillier 1 

Paul Grimshaw 1 

Karen Reynolds 2 

Trevor Hearn 2 

1 

School of Health 

Sciences, University of 


2 



University, Adelaide, 

Australia 

Objective 

To offer the people of Adelaide a world-class movement analysis facility that will permit research, teaching but most 

importantly, a clinical evaluation tool. 

Method 

Novita Children’s Services has been utilising gait analysis in a two dimensional context for several years. A number 

of children have also been funded by the Variety Club to attend the Hugh Williamson Gait Laboratory at the Royal 

Children’s Hospital in Melbourne for more detailed 3D examinations as a precursor to surgical intervention. 

A visit by Prof Kit Vaughan drew together a number of potential partners to explore what further options could be 

introduced into Adelaide that would both maximise the usefulness of a full 3D facility but also provide access for 

the clinical cases currently being referred to Melbourne for assessment. 

Results 

To date discussions have been held with the University of South Australia, Flinders University, the Gerontology 

group at the Repatriation General Hospital and key individuals within Novita Children’s Services. As a result of 

negotiations, a proposal has been developed for a joint Post Doctoral position to be based at the University of 

South Australia to establish collaborative research projects, evaluate the potential systems and build the case 

for a dedicated facility (potentially with a satellite facility at Regency Park Centre) to serve a number of needs in 

South Australia. 

Implications 

This project, if approved in final form, may herald a range of joint research initiatives between clinical and university 

based researchers. It will also establish a facility that can offer the same level of movement analysis that is available 

in Melbourne and permit our involvement in several international biomechanics studies of direct relevance to 

wheelchair users. 


61 


62 

Rob Garrett 



Teresa Corbin 1 

Chair 

Gunela Astbrink 2 

Bert Ciavarra 3 

Deborah 

Goodman 4 

Malcolm Garnham 5 

Kim Yan 6 

Richard Robbins 7 

Cecily Yan 8 

Stacey Joyce 9 

1 

Consumers’ 


Network 

2 

TEDICORE 

3 

Telstra 

4 

Vodafone 

5 

Trillium Communications 

5 

Cisco systems 

7 

NEC Business Solutions 

8 

Australian Electrical & 

Electronic Manufacturers’ 

Association Ltd 

9 

Australian 

Communications Authority 

Objective 

Phone accessibility information working committee 

At the direction of the Australian Communications Authority, an Accessibility Information Working Committee has 

been established under the auspices of the Customer Equipment and Cable Reference Panel (CECRP) of the 

Australian Communications Industry Forum (ACIF). This Committee is to develop: 

a) An Industry Code to specify obligations on customer equipment importers and manufacturers to 

provide product information on the functional characteristics of home and mobile phones that would be 

beneficial to people with a disability. This information is to be provided to phone companies that provide 

telecommunication services. Consideration will also be given to the provision of information to other parts of the 

telecommunications market. 

b) An Industry Guideline to provide guidance for phone equipment importers and manufacturers on features of 

customer equipment used for telecommunications that will assist consumers with disabilities. 

Method 

In developing both the Code and Guideline, the Working Committee is to: 

• take account of international work and align the documents with relevant standards and guidelines developed 

by recognised international bodies; 

• recognise that both the Code and Guideline be developed in relation to the standard telephone service, and 

consider if the scope of the work should be further confined, for example, by confining the Code to consumer 

equipment for use primarily by the residential/small business market; and 

• consider whether there should be a phase in period required to fully implement the Code. 

The Working Committee has been established with three consumer representatives, six industry representatives 

and a non-voting representative from the Australian Communications Authority. The Committee has been meeting 

approximately once every three weeks since April 2004. 

Results 

A comprehensive list of 61 features have been named within the categories: Mobility/Dexterity, Vision, Hearing and 

Speech. The Committee is close to completing a checklist to be completed by the industry that will specify the 

features on each phone made available to Australians. A genuine attempt has been made to make this checklist as 

simple as possible. 

Implications 

This work is an important first step to ensure that people with disabilities can select phones suitable to meet their 

needs. It will name the features that are important to those with a disability. This process will raise manufacturer and 

importer awareness of these needs and promote the application of Universal Design principles. 



Resource allocation project 


Research Officer 

Wendy 

Wake-Dyster 

Director, 

Client Programs 

Objective 

This study has aimed to develop, implement and evaluate a model that identifies priorities for therapy resources in 

accordance with Novita’s principles of family centred, community based therapy service delivery that allows: 

• equity and planning in resource distribution; 

• prediction of resource usage; and 

• advocacy for new resources rather than the constant stretching of those available. 

It has recognised that initially the model needs to address existing resources, while enabling a model for future 

changes in resources to be accommodated. 

Method 

An action research methodology was employed, with the following data collected through the process of the study 

and contributed to the model formation: 

• Discipline and Regional Profiles of Services (Feb-March 2002); 

• Qualitative data from regional and discipline management teams on factors influencing service delivery 

(March – June 2002); 

• Client Numbers – from regions for seasonal board reports (October 2002) and Annual Reports (1996–2003); 

• Caseload Numbers – from therapists as a part of survey of Client Profiles (December 2002); 

• Client Profile – from therapists indicating intensity of service provision, and features indicating need for services 

(December 2002); and 

• Travel Time – snapshot data of two weeks (October–December 2002). 

Results 

A model for allocating resources across the organisation was developed and is now being trialled. As client 

numbers change on a daily basis throughout the organisation, percentages of clients in the different service types 

are reported upon and used for comparison and model development. The WHO International Classification of 

Functioning was used to describe the range and type of therapy services provided by Novita Children’s Services. 

Implications 

Trial and review of this method of resource allocation needs to occur as calculations were based on estimations 

rather than actual recording of therapists activities. This has commenced with a review of support activities that aim 

to develop the social environment of individuals with disabilities. 

63 

Ongoing implementation and review 


publications 

All journal articles, book chapters, research symposium papers, 

conference papers published in proceedings or accepted for 

publication between January 1999 – June 2004 are listed below. 

64 

Journal Articles (peer reviewed) 

Croser R, Garrett R, Seeger B, Davies P (2001) Effectiveness of 

electronic aids to daily living: Increased independence and decreased 

frustration. Australian Occupational Therapy Journal, 48: p. 35–44. 

DuBois L, Klemm A, Murchland S & Ozols A (2004) Handwriting 

of children who have hemiplegia: A profile of abilities in children 

aged 8–3 years from a parent and teacher survey. Australian 

Occupational Therapy Journal, 51: p. 89–98. 

Flett P, Stern LM, Waddy H, Connell T & Gibson S (1999) 

Botulinum toxin A versus fixed cast stretching for dynamic calf 

tightness in cerebral palsy. J Paediatric Child Health, 35: p. 71–77. 

Raghavendra P, Murchland S, Gibson S & Guidera A (2004) 

Producing and evaluating research evidence in a multi-disciplinary 

community setting: An organisational approach. Australian 

Epidemiologist, 11.2: p. 33–35. 

Raghavendra P, Rosengren E & Hunnicutt S (2001) An 

investigation of different degrees of dysarthric speech as input to 

speaker-adaptive and speaker-dependent recognition systems. 

Augmentative and Alternative Communication, 17: p. 265–275. 

Schlosser R & Raghavendra P (2004) Evidence based-practice in 

AAC. Augmentative and Alternative Communication, 20: p. 1–21. 

Journal Correspondence 

Flett P, Gibson S & Murchland S (2004) Lycra Pressure Orthoses. 

International Journal of Therapy and Rehabilitation, 11(7): p. 340. 

Book Chapters 

Balandin S & Raghavendra P (1999) Challenging Oppression: 

Augmentative Communicators’ Involvement in AAC Research. In 

Loncker F, Clibbens J, Arvidson H & Lloyd LL (Eds) Augmentative 

and Alternative Communication: new directions in research and 

practice: p. 262–277, Whurr Publishing Ltd, London, UK. 

Schlosser R, & Raghavendra P (2003) Using evidence to guide 

clinical/educational decision-making. In Schlosser RW (ed). The 

Efficacy of Augmentative Communication: Towards evidencebased 

practice: p. 259–297. Academic Press, New York, USA. 

Other Publications 

Chip Karmatz et. al. (2001) “Willing and able” Assistive 

Technology, Accessibility for people with disabilities: p. 36–40, 

Microsoft Communiqué, December 2001 (R Garrett and A Gregory 

were quoted and contributed to this article). 

Garrett R (1999) “Exciting Award Winning Phone Improves Quality of 

Life for Children with Disabilities.” CCA Newsletter, December 1999. 

Garrett R (2003) Telecommunications and Physical Disability: A Journey. 

ARATA News, No 29, Autumn 2003: p. 1–2, also in Accord SCI, The 

Journal of Spinal Cord Injuries Australia, No 2, Spring 2003: p. 14–15. 

Hobbs D (2002). “Home Phone Solutions Guide: Making the Home 

Phone more Accessible“. ARATA News, No 28, Summer 2002: p. 3. 

Hobbs D (2002) A Report on my Trip to the UK. ARATA Newsletter, 

April 2002 

Hobbs D (2004) Churchill Fellowship Experiences – Researching 

Rehabilitation Engineering Overseas. Accord SCI, the Journal of 

Spinal Cord Injuries Australia, No 4, Autumn 2004: p. 17–18. 

Nguyen T (2002) Accessible Mobile Phone Project. ARATA News, 

No 28, Summer 2002: p. 1–2. 

Nguyen T (2002) Accessible Mobile and Home Phone Project. CCA 

Nexus Newsletter, September 2002 and also the CAUS Newsletter, 

Winter 2002: p. 6, 7, 9. 

Nguyen T & Garrett R (2003) New technological options for people 

with physical disabilities, through the use of telecommunications 

equipment. Final Report submitted to the Department of Information 

Technology, Communications and the Arts, December 2003. 

Nguyen T & Garrett R (2004) New technological options for people 

with physical disabilities, through the use of telecommunications 

equipment trials’ results. ARATA news, No 33, Autumn 2004. 

Nguyen T, Garrett R, Downing A, Walker L & Hobbs D (2004) 

“Research into Telecommunications Options for People with Physical 

Disabilities” in Zhang D & Mokhtari M (Eds) Towards a Human Friendly 

Assistive Environment: p57-64. IOS Press, Amsterdam, The Netherlands. 

Olsson C (2003) The EBP experiences of an AAC Service Provider: 

Diving in Deep. Perspectives on Augmentative and Alternative 

Communication, Newsletter of Division 12 Special Interest Group of 

the American Speech-Language-Hearing Association: p. 15–19. 

Olsson C (in press) Experiences with EBP: Perspectives from the 

Clinical Coalface. Proceedings of Seventh Biennial ISAAC Research 

Symposium, Odense, Denmark. 

Raghavendra P (in press) New Mandate for AAC: How do we move 

towards evidence-based practice Proceedings of Seventh Biennial 

ISAAC Research Symposium, Odense, Denmark. 

Raghavendra P, Olsson C, Iacono T, & Schlosser R (in press) 

New mandate in AAC: How do we move towards EBP Summary 

and Recommendations. Proceedings of Seventh Biennial ISAAC 

Research Symposium, Odense, Denmark. 

Seeger BR & Garrett RE (2001) Universal access needs to 

encompass private as well as public buildings. Engineers Australia, 

July 2001, vol 73, No 7: p. 28–32. 

Timko B, Guidera A, Hutchinson R & Stewart S “Vocabulary 

Organiser” Software to Support Signing Users. Proceedings of the 2002 

Speech Pathology Australia National Conference. 


conference presentations 

Novita’s research profile continues to grow with increasing number of high quality presentations made at state, 

national and international conferences. We would like to congratulate and thank all the therapy staff for their hard work and 

enthusiasm in preparing and making the presentations. Unless stated otherwise, the presentations listed are free papers. 

1999 

Health Outcomes: 

Integrating the Elements (Canberra) 

Raghavendra P, Ferris R, Rapagna A, Hardy M & McDonald F 

A critical pathway for communication device prescription and use by 

adults with disabilities in the community: An instrument for 

outcome measurement. 

Australian Rehabilitation and Assistive Technology 

Association (Sydney) 

Davies P & Garrett R Environmental control client trials and 

demonstration site. 

Davies P, Garrett, R & Stapleton, D MiPhone: Accessible 

telephone solution for Australia. 

Garrett R & Stewart H Vocabulary Organiser 2.0 and the Internal 

Symbol Prediction Software. Pre-conference Workshop 

Garrett R, Davies P & Seeger B New on-line research needs register. 

Garrett R, Seeger B, Enders, A & Rowe, R. Telephones in 

Australia: How close to universal access Forum 

Raghavendra P, Stewart H, duCaine A, Collins M, Garrett R & 

Seeger B Technology for Work: Evaluation of Telecommuting for 

people with disabilities 

Raghavendra P, Ferris R, Rapagna A, Hardy M & McDonald F 

Critical pathway for VOCA prescription and training for adults with 

multiple disabilities: results from development and evaluation 

Stewart S, Symon J & Tilbrook A Using a Liberator with Dragon 

Naturally Speaking for Internet access. 

Australian Physiotherapy Association 

Paediatric Group (Sydney) 

Gibson S & Sprod J Use of Standing Frames in the Maintenance of 

Hamstring Muscle Length in Non-mobile Children with Cerebral Palsy 

Spasticity Conference (Adelaide) 

Frogley M & Gibson S Physiotherapy in children with spasticity 

Steer V & Murchland S Assessment and therapy of the upper limb 

International Society for Alternative and 

Augmentative Communication (Dublin, Eire) 

Stewart, S & Olssen C Comparison of Minspeak Teaching Methods 

OT Australia – National (Canberra) 

Ziersch, T & Murchland S Linking the country and the city: 

outreach services provided by CCA. 

2000 

International Society for Augmentative and 

Alternative Communication (Washington DC, USA) 

Raghavendra P Evidence-Based Practice: Where are we in AAC 

Raghavendra P, Ferris R, Rapagna A, Bebb, M & McDonald, 

F Clinical Pathway for VOCA Recommendation and Training for 

Adults with Disabilities. 

Balandin S, McNaughton D, Morgan J, Raghavendra P & 

Williams M Developing Inclusive Research Communities: Issues 

in promoting AAC user Participation. 

Speech Pathology Australia (Adelaide) 

Cootes C, & Hughes A The Rocky road to achieving inclusion at 

school for a child who is blind and has no speech: p. 73. 

Ferris R Progressive Neurological conditions – AAC intervention 

and functional outcomes: p. 72. 

Morris, R & Raghavendra P Comparison of feedback conditions 

in spelling instruction for a child using AAC: p. 73. 

Raghavendra P & Balandin S Augmented Communicators 

involvement in AAC: Facilitating inclusion and practical 

implications: p. 72. 

State OT Australia – SA (Adelaide) 

Brayley A Use of a dynamic triceps driven orthosis to assist 

feeding for a child with Arthrogryposis Multiplex Congenita. 

DuBois L, Klemm A, Ozols, A & Murchland S The handwriting 

of children who have hemiplegia – a profile in children aged 

8–13 years. 

Durand S, & Murchland S Early Intervention – When is it too late 

Durand S, McGregor, P & Murchland S Country Services 

Evaluated: a pilot study comparing the motor and functional 

progress of city and country clients of CCA. 

Farrall A Expanding horizons: Developing a Youth Group for 

teenagers with physical disabilities. 

Lian P & Lietzau R Paediatric OT equipment prescription 

within CCA. 

McPharlin J & Gutschi J Unlocking Imagination to build 

cognitive and physical skills – an exploratory study. Poster. 

Murchland S More than a Hunch. Keynote presentation. 

65 


66 

Rehabilitation Engineering and Assistive 

Technology Society of North America (RESNA) 

Conference (Orlando, USA) 

Garrett R, Davies P, Stapleton D Miphone: The Multiple Input 

Speaker Telephone. 

Cerebral Palsy Support National Network 

(Melbourne) 

Gibson S A A Comparison of three models of Intensive 

Physiotherapy for Children with Cerebral Palsy. 

Raghavendra P Evidence Based Practice: Where are we in 

Paediatric disability 

Australian Cerebral Palsy Association (Melbourne) 

Balandin S, Grant G, & Raghavendra P Working Together: 

A new dimension to research with people with disabilities. 

Bebb M & Raghavendra P Predictors of device 

abandonment: Transitioning from school to the community. 

Durand S & Murchland S Country outreach services evaluated. 

Manson P, Guidera A & Raghavendra P Can preschool 

children learn the meaning of picture symbols without 

structured teaching 

McPharlin J & Gutschi J Unlocking Imagination to build 

cognitive and physical skills – an exploratory study. Poster. 

Other Presentations 

Frogley M Rehabilitation Equipment Interest Group 

Seating Seminar 

Frogley M Manual Wheelchair prescription and Use Australian 

Physiotherapy Association Paediatric Special Interest Group Seminar. 

2001 

Australian Group on Severe Communication 

Impairments (Adelaide) 

Bebb M & Raghavendra P Predictors of device abandonment: 

Transitioning from school to the community. 

Iacono T & Raghavendra P What is the evidence base in AAC 

Manson P, Guidera, A & Raghavendra P Symbol Learning: 

Examining a technique for assisting typically developing preschool 

children to learn picture communication symbols. 

Morris, R & Raghavendra P Comparison of feedback conditions 

in spelling instruction for a child using AAC. 

Tilbrook A & Timko B Integrating education, communication and 

literacy: Inclusion of a 5 year old AAC user in the classroom. 

Australian Physiotherapy Association National 

Paediatric Group (Melbourne) 




Durand S & Murchland S Early Intervention: When is it too late 

Gibson S Can we deliver better Therapy A Comparison of Three 

Models of Intensive Physiotherapy Intervention for Children with 

Cerebral Palsy. Old issues: New Focus. 

Paediatric Occupational Therapy (Sydney) 

DuBois L, Klemm A, Ozols A & Murchland S The handwriting 

of children who have hemiplegia – a profile in children aged 

8–13 years. 




Durand S & Murchland S Early Intervention: When is it too late 

Engineers Australia’s Inaugural Rehabilitation 

Engineering Workshop (Brisbane) 

Hobbs D How to build a better wheelchair – workshop 

presentation. 

Australian Rehabilitation and Assistive 

Technology Association (Brisbane) 

Garrett R, Gregory A, Tilbrook A & Ziersch T Magic For 

Everyone: Accessible Website Design. 

Hobbs D Hey Presto – are we really getting bums on the right 

seats in Australia Interactive seating forum. 

Hobbs D Pulling the Bilby out of the Hat – a show and tell 

of seating systems designed for the client with complex 

multiplanar fixed deformity. 

Nguyen T, Garrett R & Downing A Accessible Mobile Phones. 

Frogley M Powered Wheelchair Trialling. Poster. 

Stewart S Vocabulary Organiser. Workshop. 

2002 

Speech Pathology Australia (Alice Springs) 

Timko B, Guidera A, Hutchinson R & Stewart S Strategies for 

Supporting Signing Users. 

International Society for Augmentative and 

Alternative Communication (Odense, Denmark) 

Morris R & Raghavendra P Comparison of feedback conditions 

for spelling instruction in AAC. 

Guidera A, Raghavendra P & Olsson C Participation of AAC 

users in school settings: Research Evidence. 

Olsson C, Guidera A, Stewart S & Garrett R Easily Managing & 

Producing Materials from Customised Vocabulary Sets. 

Olsson C, Stewart S Guidera A & Garrett R A tool for managing 

vocabulary and producing customised therapy materials. 

ISAAC Research Symposium (Odense, Denmark) 

Raghavendra P, Schlosser R, Iacono, T & Olsson C New Mandate 

in AAC: How do we move towards Evidence-based Practice 


Australian Cerebral Palsy Association Conference 

(Sydney) 

Bebb M & Hardy M A multipurpose board. Poster. 

Slack J & Opperman K Alice in Computerland: The 

challenges in integrated System. Poster. 

Gibson S, Guidera A, Murchland S & Raghavendra P 

Application of evidence based practice in a multi-disciplinary 

setting. Poster. 

Guidera A, Raghavendra P & Olsson C Participation of AAC 

users in school settings: Research Evidence. 

Raghavendra P, Smith J, Harrison T, Donnelly P, Noble, G 

& Slattery H CCA Evaluates its services: What are our former 

clients with cerebral palsy telling us about services that they 

received and what are their ideas for future services 

Sprod J & Olsson C CCA involvement in the personal care 

support planning in schools and pre-schools in SA. 

Australasian Academy of Cerebral Palsy and 

Developmental Medicine (Sydney) 

Gibson S & Raghavendra R Intensive physiotherapy 

intervention for children with cerebral palsy: parents ’ 

perceptions of outcomes using the Canadian Occupational 

Performance Measure. 

Raghavendra P, Smith J, Harrison T, Donnelly P, 

Noble G, & Slattery H The childhood therapy experiences 

of adults with cerebral palsy: What long term impact did it have 

and what does it mean for today’s children with cerebral palsy 



setting. Evidence into Practice. Poster. 

State OT Australia – SA (Adelaide) 

Jones, J & Stewart H How Occupational Therapists teach the 

scanning technique 

Lyons. T & Foley S School AMPS: An assessment tool that 

informs classroom strategies. 

Murchland S Evidence Based Practice and Play. 

Sandelance M Zooming in: Video education for staff & families. 

Slack J & Opperman K Alice in Computerland: The challenges 

in integrated System. Poster. 


Hobbs D “Rehabilitation Switches”, aired on the Channel 10 

children’s television program “Totally Wild” on Tuesday 19th 

November. 

Hobbs D “Universal Design (for Earthlings) – What’s it all about”, 

31st Annual CCA Auxiliaries Conference, (prior to the 2002 CCA 

AGM), 12th November. 

Frogley M Wheelchair and Seating Workshop, Novita/Independent 

Living Centre Workshop. 

2003 

National Allied Health (Adelaide) 


(equal authorship) Application of evidence based practice in 

a multi-disciplinary setting. Poster. 

Lyons T & Raghavendra P The use of Canadian 

Occupational Performance Measure by a multi-disciplinary 

team: therapists; and parents’ views from a pilot study. Poster. 

Murchland S What to count and what to cost: a resource 

allocation model for therapy services. 

Australian Group on Severe Communication 

Impairment (Sydney) 

Faulks J, Olsson C & Opperman K Paediatric Dysphagia 

and Physical Disability: A review of the literature... and then 

some. Workshop. 

Grace E, Raghavendra P & Scholten I Vocabulary Use at 

School: What do Six Year Olds Say 

Guidera A, Raghavendra P & Olsson C Participation of users 

in school setting Research Evidence. Poster. 

Leane J, Raghavendra P & Scholten I Reading Outcomes of 

Internet-based Assessment and Intervention. 

Raghavendra P, Iacono T, Guidera A, Olsson C Evidence 

Based Practice: What does it mean for AAC 1⁄2 day Workshop. 

International Conference on Cerebral Palsy 

(Quebec City, Canada) 



setting. Poster. 

Murchland S How far will the elastic stretch: Resource 

Allocation for Community Based Therapy Services. Poster. 

World Congress on Medical Physics and 

Biomedical Engineering (Sydney) 

Hobbs D An International Perspective on Rehabilitation Engineering 

Research & Development – Results from a Churchill Fellowship. 

Walker L Regulation versus Information in Australia’s Assistive 

Technology Sector. 

Australian Physiotherapy Association National 

Paediatric Group (Perth) 

Bostock S Serial casting after Botulinum toxin: A review of 

outcomes for dynamic equinus. 

Gibson S & Raghavendra P Intensive physiotherapy intervention 

for children with cerebral palsy: Functional outcomes and parents’ 

perceptions of outcomes. 

Raghavendra P, Darbyshire P & Gibson S Physiotherapists’, 

parents’ and children’s views on intensive physiotherapy 

intervention for children with cerebral palsy. 

67 


68 

Raghavendra P, Smith J, Harrison T, Donnelly, P & Noble G 

Childhood physiotherapy experiences of adults with Cerebral 

palsy: Implications for today’s children with cerebral palsy 

Awarded Best Paper under “Quality.” 

Ward N, Williams M & Bate T The prevalence of low back 

pain in parents of children with a physical disability aged 5 

years or below. 

Sprod J, Frogley, M, & Murchland S Changing paediatric 

practice increasing demands on the role of the community 

physiotherapist. 

Pediatric Occupational Therapy (Brisbane) 

Murchland S Evidence based practice and play. 

Murchland S & Kernot J Unravelling Handwriting: An 

investigation into the factors that influence handwriting ability 

in primary school children with hemiplegia. 

Smith J, Raghavendra P, Harrison T, Donnelly, P & Noble G 

Childhood Occupational Therapy experiences of adults with 

cerebral palsy: Implications for today’s children with 

cerebral palsy. 

Speech Pathology Australia (Sydney) 

Faulks J, Olsson C & Oppermann K A training package for 

staff assisting children with eating and drinking difficulties 


Hobbs D During his Churchill Fellowship (6th May – 24th 

June), David made 11 presentations about Novita, NovitaTech 

and rehabilitation engineering at different Centres in England, 

Toronto, and the United States. Two of these were specifically 

about Vocabulary Organiser to special groups. 

Lyons, T & Occupational Therapy Staff Play for All, SA 

Department of Education and Children’s Services Early 

Childhood Conference Workshop. 

2004 

Australasian Academy of Cerebral Palsy and 

Developmental Medicine (Melbourne) 

Crettenden A & Connell T Changing problem behaviour in 

children with physical disabilities. 

Gibson S, & Raghavendra R Intensive physiotherapy 

intervention for children with cerebral palsy: Functional 

outcomes and parents’ perceptions of outcomes. 

Murchland S & Kernot J Hand function, visual perception and 

handwriting in children with hemiplegia. 

Opperman K & Faulks J Paediatric dysphagia and physical 

disability: a review of the literature. Poster. 

Raghavendra P, Darbyshire P, & Gibson S Physiotherapists’ 

parents’ and children’s views on intensive physiotherapy 

intervention for children with cerebral palsy. 

Australian Rehabilitation and Assistive 

Technology Association (Melbourne) 

Gregory A New Software from Regency Park. 

Pre-conference workshop. 

Guidera A & Olsson C Why are speech generating 

devices returned 

Guidera A & Garrett R ‘Does your vocabulary need organising’ 

Guidera A & Garrett R The ‘Vocabulary Organiser’ Software. 


Hobbs D An International Perspective on Rehabilitation 

Engineering – Results from a Churchill Fellowship. 

Hobbs D, Nguyen, T & Ward T The Development and 

Teaching of a Biomechanics Module in Cambodia. 

van de Loo S & Symonds B One Control Everywhere 

for Everything. 

Nguyen T, Garrett R, Downing A Mobile Phone Access Via 

an Augmentative and Alternative Communication Device. 

Nguyen T, Garrett R, Downing A, Walker L & Hobbs D 

Research into Telecommunications Options for People 

with Disabilities. 

Nguyen T, Gregory, A & Garrett R Telephone Options for 

People with Physical Disabilities. Pre-conference workshop. 

Svistounov A & Hobbs D Introduction to Standards Testing 

of Rehabilitation Equipment. 

Walker L Wheeled Mobility – Today, Tomorrow, Everywhere. 

Invited plenary speaker. 

Walker L & Hobbs D Good Practice or Best Practice – 

Where Do Professional Standards Come In 

Walker L, Svistounov, A & Hobbs D NCRE/ARATA TGA 

Workshop (a workshop and open forum on the affect the new 

TGA regulations will have within the RE/AT industry). 


Ziersch T and Gregory A Building Accessible Websites 

for Everyone. 


The results of our “New technological options for people with 

physical disabilities, through the use of telecommunications 

equipment trials’ results” research has been presented by: 

Garrett R to Australian Communications Industry Forum, 

Disability Advisory Body, Sydney, 13 February 2004. 

Garrett R to a combined meeting of the Australian 

Communications Industry Forum, Disability Advisory Body and 

Working Committee 19 “Accessibility Information”, Sydney, 

18 May 2004. 

Garrett R & Nguyen T to Telstra Research Laboratories, 

Melbourne, 3 June 2004. 

Hobbs D to the funding body – Department of Information 

Technology, Communications and the Arts staff, Canberra, 3 

March 2004. 


DESIGN AND PRODUCTION CORPORATE PROFILE PTY LTD

Head Office 

Regency Park Centre 

171 Days Road 

Regency Park SA 5010 

PO Box 2438, Regency Park SA 5942 

Telephone (08) 8243 8243 

Facsimile (08) 8243 8238 

Email research@novita.org.au 

r&d@novita.org.au 

www.novita.org.au 

NovitaTech (formerly Regency Park 

Rehabilitation Engineering) 

171 Days Road 



Telephone 1300 855 585 

Facsimile (08) 8243 8208 

Email info@novitatech.org.au 

www.novitatech.org.au 

Family Support Services (formerly 

CCA Options Coordination) 

171 Days Road 



Telephone (08) 8243 8266 

Facsimile (08) 8243 8269 

Email family.support@novita.org.au 

www.novita.org.au/familysupport 

Northern Regional Office 

422 Salisbury Highway 

Parafield Gardens SA 5107 

Telephone (08) 8182 1000 

Facsimile (08) 8182 1010 

Email nro@novita.org.au 

www.novita.org.au/north 

Southern Regional Office 

111 Beach Road 

Christies Beach SA 5165 

Telephone (08) 8329 5600 

Facsimile (08) 8329 5607 

Email sro@novita.org.au 

www.novita.org.au/south 

North Eastern Regional Office 

5 Darley Road 

Paradise SA 5075 

Telephone (08) 8207 8940 

Facsimile (08) 8207 8941 

Email nero@novita.org.au 

www.novita.org.au/northeast 

South Eastern Regional Office 

151 Greenhill Road 

Parkside SA 5063 

Telephone (08) 8172 9200 

Facsimile (08) 8172 9201 

Email sero@novita.org.au 

www.novita.org.au/southeast 

Northern Western Regional Office 

171 Days Road 


Telephone (08) 8243 8311 

Facsimile (08) 8243 8377 

Email nwro@novita.org.au 

www.novita.org.au/northwest

Novita Research Report January 1999 - Novita Children's Services

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