Novita Research Report - 2004 to 2007 - Novita Children's Services

Research Report2004-2007Connecting kidswith their worlds

VisionBy 2010, Novita will be a recognised andcelebrated world leader in the research,development and provision of innovativechildren’s services.PurposeConnecting kids with their worldsStrategicDirections1. Opening our doors to new clients, newchallenges and new solutions2. Listening, learning and achieving3. Fostering creativity and productivityleading to sustainability4. Leading our industry through partnershipand sharing5. Connecting kids with their worldsContents3 Welcome to Research at Novita 10 Project summaries4 All about Novita 81 Publications and presentations5 Research at Novita 88 Grants and awards received6 Novita’s research team 91 Our research partners8 List of project summaries

Welcome to Research at NovitaWelcome to Novita Children’s Services’ secondResearch Report, showcasing the past three years’work of our innovative research team.At Novita, we are committed to providing thebest possible therapy services, support andequipment solutions to our clients and theirfamilies. Undertaking research and building abody of research evidence is vital to ensure theservices we provide are effective, high quality anddeliver what our clients and their families require.Research enables us to be more accountable to oursupporters, clients and the community, while alsoimpacting on the broader community by assistingpeople of all ages living with disability locally andaround the world.Since the release of our first Research Report in2004, our dedicated research team has continuedto work tirelessly alongside families, professionalstaff and other research partners to explore andidentify new and better ways to ‘connect kids withtheir worlds’ – both now and into the future.Over the past few years we have continuedto strengthen our relationships with universitydepartments across the nation and beyond, throughnumerous undergraduateand post-graduate studentresearch projects. Ourresearch team has alsoforged some exciting newinternational partnershipswith high-profile researchinstitutions includingBloorview Kids andthe Toronto RehabilitationInstitute (Canada), North EasternUniversity (USA) and the Universityof Newcastle (UK). This knowledgesharing on a global scale gives ourstaff, clients and partners first-handaccess to the latest research resultsand cutting-edge new technologiesfrom around the world.Novita’s research isincreasingly published in peerreviewedinternational researchjournals, further cementing our reputation as worldleaders in disability research and innovation.As always, underpinning Novita’s research successis the excellent financial support we receive from theAustralian and South Australian Governments, ourresearch partners, numerous funding bodies andthe broader community.We were also honored to receive extensive supportfrom the estate of the late Mrs Marjorie Edwards.This bequest will continue to support services toSouth Australian children and families living withdisabilities, by allowing us to undertake researchinto their experiences and the interventions,technology and supports that help them ‘connectwith their worlds’.We acknowledge the Channel 7 Children’s ResearchFoundation and the Australian Government’sDepartment of Communication, InformationTechnology and the Arts (DoCITA), whose ongoingsupport has enabled us to undertake a numberof crucial research projects that will help ensure abetter future for people living with disabilities.In looking to the future, Novita has reaffirmed theimportance of, and our commitment to, research.Through our new Strategic Plan (2007-2010), thenext stage of our researchdevelopment is theestablishment of a Divisionof Research and Innovationto bring all of our researchefforts together. Thisstructural change, beginningin 2008, will heighten theresearch profile and improvecollaboration with local,national and internationalorganisations.We encourage you to readon and discover more aboutNovita’s innovative andexciting research projects,many of which are alreadymaking a real and lastingdifference to hundreds of lives,both here in South Australiaand around the world.(pictured left to right)Andrew DowningVice-PresidentElizabeth RobinsonPresidentGlenn RappensbergChief Executive

All about NovitaWhere we’ve come from…Novita was originally established in1939 as the Crippled Children’sAssociation of South Australia,to care for children diagnosed with polio.When cases of polio in Australia declined,our services were widened to includechildren living with a range of physicaldisabilities.In 2004, we changed ourname to Novita Children’sServices, to reflect a morepositive and modernview of kids living withdisabilities. Novita isa combination of twoLatin words – ‘nova’(meaning new) and‘vita’ (meaning life).To find out more about Novita’s rich history, visitthe history page of our website atwww.novita.org.au.Novita todayAlmost 70 years sincewe were first formed,Novita Children’s Servicesis today one of SouthAustralia’s premierchildren’s charities. Weare also recognised as worldleaders in the provision oftherapy, equipment and familysupport services to morethan 1000 children and theirfamilies living with physicaldisabilities and acquired braininjuries.Connecting kids with their worldsNovita’s team of almost 300 expert staffprovide life-changing therapy and supportservices such as occupational therapy,physiotherapy, psychology, familysupport and speech pathology tofamilies at home, at school, at childHow do we pay for it all?care and across the community.We also provideessential equipmentsuch as wheelchairs, walkingframes and communicationdevices to help kids move,speak, grow, play and really‘connect with theirworlds’.Our services are provided free of chargeto our families – and in most cases, thevalue of this support adds up to hundredsof thousands of dollars. While we arefortunate to receive 55% of our annualfunding from the Government, wealso rely heavily on the generosityof our loyal supporters and theSouth Australian community to raisethe additional money we need tocontinue our essential work.To find out more aboutNovita and our life-changingwork with more than 1000local children and theirfamilies, visit ourwebsite atwww.novita.org.au.

List of project summariesProject titleEnhancing participation at home, school and communityInterventions to facilitate participation of children with disabilities in all life domains: A systematic review 10Participation profile of children with physical disabilities with and without complex communication needs:Association between social networks, communication, activity engagement and time useParticipation profiles of adolescents with and without complex communication needs: The relationship betweensocial networks, communication and activity engagementPatterns of engagement in young people with physical disabilities: Factors associated with the achievement ofmeaningful participation in life activitiesMeasurements/assessmentsEvaluation of measurements, interventions, programs and clinical practicePulse oximetry levels of children with cerebral palsy and dysphagia before, during and after eating and drinking: Apilot studyTest-retest reliability of the QUEST 2.1: Children’s version 16InterventionsAn exploratory study of effects of hydrotherapy for children with a disability: Views of parents and therapists 17Botulinum toxin and the neglected upper limb in children with hemiplegic cerebral palsy 18Modified constrained induced therapy and impact on upper limb function in children with hemiplegia who have hadupper limb Botox AThe effect of serial casting following Botulinum Toxin A (BoNT-A) treatment for dynamic equinus for children withcerebral palsy: A controlled clinical trialThe relationship between ankle-foot-orthosis shank vertical angle and optimal gait in children with cerebral palsy 22The role of intensive treadmill training in improving functional mobility in ambulant children with cerebral palsy: Apilot studyThe use of Theratogs – A pilot study 24Using the internet to increase physical activity in adolescents with cerebral palsy – are you kidding? 26ProgramFeasibility of It Takes Two To Talk® for families of children with motor impairments 27The MOVE program for special schools for students with severe and multiple disabilities: A pilot study 29Clinical practiceAn evaluation of psychological support for families of children with cerebral palsy 30A review of the factors that impact the success of goals and intervention strategies used with simple speechgenerating devices; single or sequenced messages (SSGD) within Novita Children’s ServicesAssistive Technology solutions for students with physical disabilities: An analysis of utility, cost and studentsatisfactionGaining knowledge for practice: A review of the practice of therapists at Novita in seeking the evidence to informpracticeInformation and communication technology solutions for students with special needs – an analysis of utility andsatisfaction: A pilot studyPostural management programs at school for children with cerebral palsy 34The assistive technology support and training needs of occupational therapy staff at Novita Children’s Services 35The Augmentative and Alternative Communication train: What brings parents onboard? 36Evaluation of service delivery models and methodsEmbedding wellness approaches into paediatric health and disability policies and practices of allied healthprovidersPage111314152020233132333338

Evaluation of service delivery models and methods (cont.)Evaluation of family-centred practice using the measures of process of care 39Evaluation of ‘The Programs Project’ – the restructuring of client services at Novita 40Planning for tomorrow: Service provision for children and adolescents with acquired brain injury 41Systematic review of strategies used by therapists to work effectively with teachers and aides to implementprograms which address client goalsLife span issues for children with disabilities and their familiesAn investigation of views of fathers with children with disabilities regarding their involvement and support needs 43Cognitive coping of parents who have a young child with a physical disability 44Physical and sedentary activity of adolescents with cerebral palsy – What’s the story? 45Relationship between caregiver time and mental health and wellbeing of mothers caring for children with chronicdisabilityWhat does it mean to have a friend? The friendships, or lack of, for adolescents with a physical disability 48The prevalence of low back pain in parents of children with a physical disability between five and 12 years of age 49Products and technology for personal use in daily livingIdentifying suitable accessible gaming controller solutions and options 50The development of a ZigBee-based universal remote control 51Products and technology for personal indoor and outdoor mobility and transportationWheelchair usage: tracking wheelchairs and their users – a pilot study using miniature data loggers (MDLs) toidentify wheelchair usage patternsDevelopment of a test instrument to determine the maximum speed, acceleration and deceleration of electricwheelchairsInvestigating the use of switches as inputs to powered wheelchair driving controls and the associated risks 55The design and development of a semi-autonomous wheelchair for obstacle avoidance 57Transporting kids and their wheelchairs – parents’ perceptions 59Products and technology for communicationThe NovitaTech Snowy Hydro Telecommunications Road Show: Promoting accessible telecommunications options 61Mobile phone interface system for communication device users 62Developing a ‘no-touch’ switch and interface for a computer and specialised communication device 64Investigating telecommunications needs and solutions for older people and people with a disability 65Large keypad for mobile phone access 66Provision of information on accessibility features for telephone equipment 67Telecommunications advisory service for people with physical limitations 69The IBM Web Adaptation Technology and accessibilityWorks software trial 70Vocabulary Organiser 71Products and technology for culture, recreation and sportThe Virtual Music Instrument: usability trials, program enhancements and commercialisation 72Products and technology, service and policy developmentAssistive technology in Australia: economic analyses from a user standpoint – methodological implications 74Developing an Australian rehabilitation engineering and assistive technology collaborative research anddevelopment centreDeveloping an environmental testing protocol for electronic assistive technology devices 77Innovative technology team 78Testing laboratory data logging and remote monitoring 794246535475

10Project summariesEnhancing participation at home, school and communityNovita staff contributors highlighted in boldProject titleContributorsFundingSummaryInterventions to facilitate participation of children with disabilities in all life domains:A systematic reviewDr Parimala Raghavendra, Professor Mats Granlund (Malardalen and JonkopingUniversities, Sweden), Professor Ralf Schlosser (Northeastern University, USA), Dr ShakilaDada (University of Pretoria, South Africa)• Swedish Council for Working Life and Social Research (fellowship to Dr ParimalaRaghavendra, August-December 2004)• Campbell Collaboration Education Coordinating GroupThe World Health Organisation International Classification of Functioning, Disability, andHealth defines participation as ‘involvement in life situation’. The ultimate goal of rehabilitationfor a child/adolescent with a disability is to participate in their life domains and be ameaningful contributor to the community. This is widely used as a vision statement by manyorganisations providing services to children with disabilities.To work towards the participation goal/outcome, we need to know which interventions assistparticipation and which are ineffective. A systematic review is needed to summarise therelevant literature and determine the effectiveness of interventions that facilitate participation,while also identifying gaps in the research for future work. Since this review will examineparticipation at home, school and community, the outcomes may influence policy andknowledge base.MethodParticipants: Studies will be included if the children with disabilities (physical, intellectual,multiple) who serve as participants are between three and 18 years of age.Types of interventions: Any type of intervention provided to the individual with disability and/orothers in their environment to promote/facilitate/increase participation of the person withdisability in school, home and community will be considered. Studies describing perceptionsof increases in participation by individuals with disability, parents, teachers and others willalso be considered.Types of outcome measures in primary studies: Standardised and/or non-standardisedoutcome measures used to demonstrate change in participation of children with disabilitiesin school, home and the community and also views\perceptions of the children, parents, andteachers regarding the intervention and outcome.Type of studies: Studies using experimental designs, descriptive and qualitative studieswhich investigate perceptions of interventions will be also be included.Search strategies for identification of studies: General purpose and other specialiseddatabases will be searched for articles published between 1990 and July 2007. Bookchapters, dissertations and hand searches will also be undertaken.Study Selection: All studies that potentially meet the inclusion criteria will be screenedindependently for the inclusion criteria by at least two investigators. A percentage of inter-rateragreement will be calculated. Data extraction and study quality evaluation will be undertakenfor all included studies.

11Results Two exhaustive database searches were undertaken in December 2005 and July 2006resulting in a small number of case studies, indicating limited research investigatinginterventions to facilitate participation. It seems the field of disability and rehabilitation isonly just beginning to understand the multi-dimensional construct and developing toolsto measure participation. Most of the research reported the barriers and facilitators toparticipation. Most studies did not use self-report measures, which are necessary forunderstanding and evaluating participation. The focus of the question will be narrowed andone context will be selected to investigate further.ImplicationsFor clients – knowing the most effective interventions to facilitate participation will be ofimmense benefit.For services – depending on the outcomes, the review may synthesise intervention strategiesthat are effective to facilitate participation.These results may have implications on practiceand policy. The results also identify gaps in research and highlight the urgent need toconduct more research.StatusOngoingProject titleContributorsFundingSummaryParticipation profile of children with physical disabilities with and without complexcommunication needs: Association between social networks, communication,activity engagement and time useDr Parimala Raghavendra, Dr Alison Lane (University of South Australia), CatherineOlsson, Dr Tim Connell, Rachael Virgo• Channel 7 Children’s Research FoundationParticipation in a variety of activities is important for physical and mental health and for achild’s overall development. For children and adolescents, this includes involvement in arange of activities at home, school and in the community. Research shows that a child’scognitive, communicative and physical ability is a major predictor of how they will participate.Children with disabilities are at risk of reduced participation in everyday activities. This risk isgreater for children with complex communication needs.This project will study the participation profiles of children with disabilities with and withoutcomplex communication needs, and children without disabilities. It will look at the types ofactivities children undertake and how much they enjoy them, how children spend their time,how children communicate and who they talk to and also their level of self-determination. Thiswill help us have a better understanding of the factors that influence participation.

12MethodThree groups of children aged between 10 and 15 years will participate in the study.Children with physical disabilities with and without complex communication needs willbe compared to children without disabilities. We aim to collect data from a total of 60participants.Participants will be administered a range of surveys and observational tools which willrequire self-report with or without the assistance of parents/caregivers. Students will also beobserved for four hours at school and a teacher or School Support Officer will be interviewedabout the student’s social networks and communication. Some of the tools are:• Social Networks: This tool provides detailed information on communication skills andabilities and circles of communication partners. Identification of communication partnersin five circles (life partners, friends, acquaintances, paid workers, unfamiliar partners)provides valuable information on environmental factors necessary for participation.• Children’s Assessment of Participation and Enjoyment (CAPE): This records the activitiesengaged in, intensity of participation, social and environmental context of activities, andenjoyment of non-school activities for children with complex physical disabilities.The data will be compared across the three groups to determine possible associationsbetween functional abilities and aspects of participation, and define typical profile/s for thegroups based on the proportions of time spent in each activity area.ResultsImplicationsEight children (four males, four females) between the ages of 11 and 15 years with complexcommunication needs are currently participating. These children use simple to highlycomplex communication devices, gestures, signing and word-boards for communication.Social network analysis shows they have higher numbers of paid communication partners(therapists, doctors, respite care workers) than friends and acquaintances. Data from theCAPE indicates that participants were involved in an average of 23 separate activities withmajority of activities being social (eg listening to music) and recreational (playing computergames). They participated in few physical, skill-based and self-improvement activities. Whileparticipation intensity was low for this group and there were restrictions in social context andlocation of participation, they indicated a high level of enjoyment in the activities in which theyparticipated.For clients – a better understanding of the factors that influence participation of children withphysical disabilities may lead to better interventions.For services – participation profile information is crucial to design effective interventions andcreate policies that increase opportunities and accessibility for all children to participate in avariety of activities.StatusOngoingNovita client using a communication device ina social network at school

13Project titleContributorsSummaryParticipation profiles of adolescents with and without complex communicationneeds: The relationship between social networks, communication and activityengagementSkye McGregor (Flinders University), Dr Parimala Raghavendra (University Supervisor),Kylie Opperman and Emma Colston (Novita Supervisors)For all children, social networks (relationships with peers, family and others in the context ofschool, home and the wider community) play an important role in community participationand life satisfaction. It is within this ‘peer culture’ that children develop their identity andvalues, and adolescence is a crucial period for forming identity and a time of rapid expansionof social circles – with a shift from parent-centered to peer-centred relationships. Ineffectivesocialisation can be a significant barrier to activity, participation and enjoyment.There have been no studies specifically targeting social networks, participation andpreference for leisure and recreation activities in adolescents with physical disability andcomplex communication needs (CCN). These adolescents are likely to face additionalbarriers to socialisation and participation than adolescents without disabilities, and thisstudy aims to develop profiles of social networks and activity and participation levels of bothgroups. The findings may provide guidelines for appropriate and effective interventions foradolescents with CCN.MethodResultsImplicationsTwo groups of adolescents aged between 16 and 18 years will participate in the study.Adolescents with physical disabilities with complex communication needs will be comparedto adolescents without physical disabilities. Participants will be administered threeassessment tools – Social Networks (a communication inventory for individuals with complexcommunication needs and their communication partners), the Children’s Assessment ofParticipation and Enjoyment and the Preferences for Activities of Children. The participantswill be interviewed individually using these tools which will require self-report with or withoutthe assistance of parents/caregivers. Speech pathologist of participants with CCN will alsobe interviewed using Social Networks. The data will be described to determine possibleassociations between communication abilities and participation and describe profiles for thegroups.Data has been collected from four adolescents with CCN and their speech pathologists.Further data collection and analysis is ongoing.For clients – patterns of participation, especially information on social networks ofadolescents with CCN, will provide a better understanding of the factors that influenceparticipation and also expectations of their participation.For services – this information is crucial is planning effective interventions and to createpolicies that increase opportunities and accessibility for all adolescents to participate in avariety of activities.StatusOngoing

14Project titleContributorsFundingSummaryMethodResultsImplicationsPatterns of engagement in young people with physical disabilities: Factorsassociated with the achievement of meaningful participation in life activitiesDr Alison Lane (University of South Australia) Professor Tim Olds (University of SouthAustralia), Sonya Murchland, A/Professor Jenny Ziviani (University of Queensland)• University of South Australia, Division of Health SciencesPrevious studies have shown there is a relationship between the ways young peoplespend their time and their likelihood of maintaining healthy living patterns into adulthood.Researchers have been able to collect self-recorded data about daily time use from youngpeople without disabilities using the Multimedia Activity Recall for Children and Adolescents(MARCA). This project adapted MARCA so young people with physical disabilities could alsorecord their daily activities.After initial evaluation of the usability and accessibility features of MARCA by NovitaTech,it was extensively reprogrammed to allow access to its graphics interface via the use ofa keyboard or assistive technology device. Twenty Novita clients who met the eligibilitycriteria were invited to participate in the trial and six responded – one declined the invitationto participate, two were unable to be contacted (one due to English language difficulties),one withdrew due to the exacerbation of their condition and two completed the trial of themodified MARCA.The modified MARCA was trialed by volunteers who experienced physical disability. Datacollected during the trial showed that no excessive ergonomic burden was placed on theparticipant, the time taken to complete a single day entry was 43 and 41 minutes respectivelyand participants reported that they found the physical and cognitive demands of MARCA tobe within their capacity. These results indicate that the modified MARCA could be completedby young people with physical disabilities as easily as young people without disabilities. Dueto the success of the initial modifications and the difficulty with recruiting participants to thestudy, no further user testing was conducted as planned in the original study outline.The modified MARCA will now be used in further studies with young people with disabilitiesto help understand how these young people choose and participate in activities.For clients – the modified MARCA can be used to record patterns of engagement in activitiesover a twenty-four hour period.For services – a broader study exploring patterns of engagement in activities with childrenwith physical disabilities can be undertaken to broaden therapists’ understanding of theimpact of disabilities on children’s lives.StatusCompleted

Project summaries15Evaluation of measurements, interventions, programs andclinical practice> Measurements/assessmentsNovita staff contributors highlighted in boldProject titleContributorsFundingSummaryPulse oximetry levels of children with cerebral palsy and dysphagia before, duringand after eating and drinking: A pilot studyEmma Colston, Kylie Opperman, Catherine Olsson, Dr Parimala Raghavendra,Sandra Stewart• Channel 7 Children’s Research FoundationFor many children with physical disabilities, eating and drinking requires significant effort.Respiratory distress during oral feeding has been observed in children with multipledisabilities and dysphagia. Pulse oximeters are small probes held against the finger or toethat measure pulse rate and calculate the amount of oxygen in the blood. It was thought thatchildren who have difficulty with swallowing may have changes in their breathing that couldbe seen through pulse oximetry monitoring.Research has shown that pulse oximetry monitoring is a safe, reliable, repeatable, noninvasiveand relatively inexpensive tool that adds value to the evaluation of dysphagia inadults with neurological difficulties. There is only limited research investigating the use ofpulse oximetry to monitor dysphagia in children with neurological disabilities, so this studyinvestigated its use as a clinical tool for assessment and management of dysphagia inchildren with cerebral palsy and dysphagia and provided exploratory data.MethodNine participants aged between five and 17 years were involved in the study. The participantswere clients of Novita Children’s Services who were:• Level IV or V on the Gross Motor Function Classification System for Cerebral Palsy• dependent on total assistance for eating and drinking• assessed by their Speech Pathologist as having pharyngeal or oesophageal stagedysphagia.Measurements of oxygen saturation levels and pulse rates were taken by the Nellcor 595pulse oximeter before, during and after three mealtimes at home for each participant.Observations were recorded and videotaped, including textures consumed, managementstrategies used, incidents of coughing and time taken for the meal.Providing assistance with eating

16ResultsThe lowest, highest and mean pulse rate and oxygen saturation measures before, duringand after mealtimes were compared across participants. The data revealed a significantdifference between mean pulse rate before and during mealtimes and lowest pulse ratebefore, during and after mealtimes, indicating that pulse rates were elevated during the mealand remained elevated after the meal.A desaturation event was defined as a drop in oxygen saturation of ≥4%. The frequency,duration and magnitude of desaturation events were compared before, during and aftermealtimes. There were no significant differences in drops in oxygen saturation beforemealtimes compared to during or after mealtimes.The study showed that oxygen saturation readings in children with cerebral palsy can beinconsistent across mealtimes and are highly variable. Movement was often present before,during and after mealtimes and could have contributed to the inconsistent results.ImplicationsFor clients – the data revealed a high variability and inconsistency in pulse oximetry measuresfor children with cerebral palsy and dysphagia. This research raises questions about theroutine use of pulse oximetry as an assessment measure for children with cerebral palsy anddysphagia.For services – future improvements in oximetry technology may lead to the development ofsettings that reduce error from movement. However this study shows that pulse oximterymay not be useful as a community-based clinical tool for children with cerebral palsy anddysphagia.StatusCompletedProject titleContributorsSummaryMethodTest-retest reliability of QUEST 2.1: Children’s versionErica Beakley (University of South Australia), Dr Alison Lane (University of South Australia),Sonya Murchland, Jocelyn KernotQUEST 2.1 has been developed for use in a larger Assistive Technology project to enablechildren to rate their levels of satisfaction with assistive technology items. The purpose of thisstudy was to examine the test-retest reliability of QUEST 2.1 with children aged seven to 17years.QUEST 2.1 is a pen and paper questionnaire consisting of 12 assistive technology-relatedsatisfaction items. The study utilised a non-experimental, repeated measures design. Twentythree children participated in the study in two groups – eight children with disabilities andfifteen children without disabilities. QUEST 2.1 was administered twice, with a two weekinterval between testing occasions. Test-retest reliability was examined using Mixed Modelsanalysis.

17ResultsImplicationsThe results indicated QUEST 2.1 scores were not significantly different between the twooccasions for the entire sample. QUEST 2.1 was therefore found to be reliable over a twoweek interval for children aged seven to 17 years. Closer examination of group effectsfrom the Mixed Models analysis revealed membership in the group with disabilities didnot significantly affect the reliability of QUEST 2.1 and there were no significant differencesbetween reliability for the entire sample and for the group with disabilities. These resultsindicate QUEST 2.1 is reliable over a two week interval for children aged seven to 17 yearswith physical disabilities.For clients – QUEST 2.1: children’s version can be used reliably by children to give feedbackon their levels of satisfaction with technology items they may use.For services – QUEST 2.1 is a new tool that can be used to gain reliable information fromchildren and their families.StatusCompletedEvaluation of measurements, interventions, programs andclinical practice> InterventionsNovita staff contributors highlighted in boldProject titleContributorsSummaryMethodAn exploratory study of effects of hydrotherapy for children with a disability: Views ofparents and therapistsMargarita Tsiros, Gisela van Kessel (University of South Australia), Susan Gibson,Dr Parimala RaghavendraHydrotherapy is a commonly used physiotherapy technique. There is some evidence thathydrotherapy is effective in the adult population, however there is a lack of quality researchamong the paediatric population. This project studied parents’ and therapists’ perceptionsof the benefits and disadvantages of hydrotherapy for children with physical and/or multipledisabilities. It also identified similarities and differences in the perceptions of these groups.Two focus groups were conducted:• Group 1: Three parents of Novita clients who were participating in an early interventionhydrotherapy group.• Group 2: Three therapists (two physiotherapists and a speech pathologist) at Novita whoparticipate in early intervention hydrotherapy groups.Parents and therapists were asked about the definition of hydrotherapy, what theyunderstood to be the benefits and disadvantages of hydrotherapy, potential barriers toaccess/attendance, structure of groups, and carryover effects. Completed transcripts weresent to each participant for verification. Three of the researchers independently analysedverbatim transcripts and extracted emergent themes. Researchers then concurred to confirmextraction of similar themes.

18ResultsImplicationsEmergent themes included perceptions of benefits of hydrotherapy, outcomes, barriers andpool accessibility issues.• Parents perceived greater benefits of hydrotherapy, and valued their and their child’sinvolvement more than therapists did.• Parents perceived the benefits to be ‘increase in muscle strength’ and ‘improvements inland-based gross motor skills’.• In contrast, therapists talked about the social benefits for the child and parent attendingthe group, particularly in relation to parent networking.• The barriers identified by therapists were location and temperature of the pool, difficultieswith travel and parents unable to fit it in the day.• Parents commented that fitting it in with other siblings, kindergarten/school and sleeptimes were more of an issue than travel.For clients – clients value hydrotherapy highly and consider it a fundamental and essentialcomponent of their child’s therapy.For services –this study has prompted a review of the hydrotherapy services provided atNovita, including how to best address the barriers identified by families and the role/need fortraining in multidisciplinary input in hydrotherapy services.There is a need for more rigorous clinical studies examining the effects of hydrotherapy forchildren with physical and/or multiple disabilities.StatusCompletedProject titleContributorsFundingSummaryBotulinum toxin and the neglected upper limb in children with hemiplegic cerebralpalsyDr Ray Russo (Children, Youth, and Women’s Health Service), Professor Maria Crotty(Flinders University), Dr Michelle Miller (Flinders University), Sonya Murchland, Dr PeterFlett (Calvary Health Care, Tasmania), Dr Eric Haan (Children, Youth, and Women’s HealthService), Belinda Van Zelst (Flinders University)• Allergan Pharmaceutical Company• Financial Markets Foundation for ChildrenThis project was a population-based study of children with hemiplegic cerebral palsyidentified from the South Australian Cerebral Palsy Register. The first phase of the studywas evaluating the children’s level of impairment, and functional abilities, while the secondphase was to assess the effect of botulinum toxin A (BoNT-A) and occupational therapy (OT)compared with occupational therapy alone on body structure, activities participation and selfperceptionin a sample of children recruited through the first phase of the study.

19MethodPhase 1: children were recruited and undertook baseline assessment of their neurologicalfunctioning, tone in upper limb, self-perception and activity participation in activities of dailyliving using the Assessment of Motor and Process Skills.Phase 2: Children from Phase 1 aged three to 16 years who met the criteria of a diagnosis ofhemiplegia, passive joint range of motion within defined limits, ability to initiate movement ofthe fingers, a Modified Ashworth Scale (MAS) of greater or equal to two on four at the elbowor wrist became the participants. They were ineligible if they had received BoNT-A in theupper limb less than one year previously, or the lower limb less than six months before thestudy.The children were randomly assigned in blocks of 10 to either OT only or OT and BoNT-Aintervention protocols. All children received a four week block of OT, which commencedwithin two weeks of injection for those children that received BoNT-A. All participants wereassessed at baseline, then at three and six months post-intervention. Measures included;neurological assessment, MAS, Tardieu Scale, subjective report on perception if they were‘worse’, ‘the same’ or ‘better’ since the intervention (in terms of cosmesis and function), PEDI,PedsQOL, Self-Perception Profile for Children, Pictorial Scale of Perceived Competence andSocial Acceptance, Assessment of Motor and Process Skills, Goal Attainment Scaling (GAS),and Pain via visual analogue scale.ResultsPhase 1: 54 of the 77 children with hemiplegia identified through the SACPR were recruitedand consented to the study. They had a mean age of seven years four months (SD 2year 5 m), 33 (61%) had right hemiplegia and 37 (69%) lived within 100km of Adelaide. Allparticipants were found to have significant difficulties with motor and process skills that wouldhave an impact on their ability in daily living tasks. More difficulty was found in motor skills inolder children (nine to 12 years) than younger children (three to eight years), and process skilldeficits may have more impact on development of independence than expected.Phase 2: 43 children (84%) were identified as being eligible and 51 (47%) of the 108 childrenassessed consented to participate and were randomly assigned to either group. At baselinethere were similarities in function, demographic and quality of life characteristics. Significantimprovement was found in the BoNT-A and OT group at three and six months in bodystructure, as well as improvements in activity participation, GAS, and Global Self-Worth atthree months. By six months there was no difference in the activity participation measuresbetween groups. The BoNT-A and OT group also experienced an increase in self-worth,which decreased in the OT only group.ImplicationsFor clients – BoNT-A can have a significant impact on children’s abilities across all levels ofperformance with improved self-worth.For services – OT is an important adjunct to BoNT-A injection to maximise outcomes forchildren with hemiplegia. OT input alone can also have a positive and lasting impact onchildren’s activity participation.StatusCompleted

20Project titleContributorsSummaryMethodModified constrained induced therapy and impact on upper limb function in childrenwith hemiplegia who have had upper limb Botox AMyriam Sandelance, Sonya MurchlandModified constraint induced therapy (MCIT) is a specific intervention for people withhemiplegia which focuses on motor training of the hemiplegic limb while restraining the useof the ‘unaffected’ hand. The aim of this pilot study is to explore two types of regimes (splintwith glove or holding) to be used in MCIT, and compare these with occupational therapyintervention of similar intensity with children aged up to 16 years.Metropolitan clients of Novita Children’s Services with hemiplegia or asymmetrical cerebralpalsy with upper limb involvement, aged up to 16 years and able to access regularoccupational therapy sessions were invited to participate in the study. The invitations weresent on the recommendation of their treating occupational therapist.Once parent consent was gained, the child was randomly assigned to one of two groups.Each child received one block of four weeks of MCIT, a four week rest phase, then four weeksof intensive occupational therapy. Blind assessing of hand function using the AHA occurredprior to and at the end of each intervention phase. Intervention phases were randomlyallocated.ResultsImplicationsTwo children consented to participate, which was a lower than expected take-up rate forparticipation in this intervention. Data is to be analysed as case studies.For clients – MCIT is an intense intervention method that may not always the mostappropriate for families or the child. The results will add to the greater body of knowledge onthis intervention with children with hemiplegic cerebral palsy.For services – MCIT is a new and emerging intervention that can be considered with families.StatusOngoingProject titleContributorsFundingThe effect of serial casting following Botulinum Toxin A (BoNT-A) treatment fordynamic equinus for children with cerebral palsy: a controlled clinical trialSusan Gibson, Dr Peter Flett (Calvary Health Care, Tasmania), Dr Ray Russo (Children,Youth, and Women’s Health Service), Susan Bostock• Channel 7 Children’s Research Foundation• Allergan Inc

21SummaryDynamic equinus (spasticity of the calf muscles) occurs commonly in children with cerebralpalsy and is the focus of numerous treatments including serial casting, orthoses, nightsplinting, injection with BoNT-A and physiotherapy. It is now common practice in SouthAustralia to use serial casting routinely as adjunctive treatment post-BoNT-A, on the premisethat it will enhance and increase the duration of the effects of BoNT-A treatment. Howeverthere is very little evidence available supporting the use of such combination interventions forchildren with cerebral palsy.This study aims to investigate the role of serial casting post-BoNT-A injections for childrenwith cerebral palsy and develop clinical and functional indicators for casting selection afterBoNT-A treatment.MethodNovita clients with hemiplegic or diplegic cerebral palsy aged between two and 16 years,who had planned to have BoNT-A treatment to their calf muscles, were invited to participate.Consenting participants had measures prior to BoNT-A treatment, then at four weeks, 12weeks and six months post-BoNT-A injection. Outcome measures included calf range ofmotion (goniometry), spasticity (Tardieu and Modified Ashworth Scale), Selective MotorControl, gait analysis (Observational Gait Scale), level of gross motor function (Gross MotorFunction Measure) and parental/child goals (Canadian Occupational Performance Measure).Ten days post-BoNT-A injection, participants were reviewed by the research team forconsideration for serial casting. Participants deemed as meeting Novita’s current castingcriteria were randomly assigned to either a casting or a control (no casting) group usingminimisation. This method allowed for the two groups to be matched for age range (two tofive, six to nine or 10-16 years), diagnosis (hemiplegia or diplegia) and GMFCS level (I, II orIII) while maintaining an element of randomisation. All participants received night splints,orthoses (where required), exercises and an exercise diary.Appropriate statistics will be used to determine if there are differences between the treatmentgroups for the outcome measures.ResultsImplicationsTwenty three participants (six hemiplegia, 17 diplegia) were recruited. GMFCS levels ofparticipants were level I (14), level II (six) and level III (three). Ages at BoNT-A injectionwere two to five years (13), six to nine years (nine) and 10-16 years (one). All data hasbeen completed for 20 participants, follow-up measures are being completed for threeparticipants, with the last participant due for measures in early November 2007.For clients – to ensure children with cerebral palsy and their families, receive the best practicemanagement for dynamic equines.For services – the findings of this study will ensure physiotherapists use resources suchas therapy time and splinting materials efficiently and in accordance with evidence-basedpractice.StatusOngoing

22Project titleContributorsFundingSummaryThe relationship between ankle-foot-orthosis (AFO) shank vertical angle and optimalgait in children with cerebral palsyEmily Graham, Susan Gibson, Tam Nguyen (Repatriation General Hospital, Adelaide), DrPaul Grimshaw (University of South Australia), Dr Lloyd Walker• Channel 7 Children’s Research FoundationMany children with cerebral palsy (CP) wear an ankle-foot-orthosis (AFO), sometimes calleda splint, to help control abnormal ankle movements. One type of AFO that may be requiredis the solid AFO, which are made individually for each child out of rigid thermoplastic. SolidAFOs can be made so that the calf section (or shank) is vertical or tilts either forward orbackward from vertical. Making small changes to this angle by placing wedges of materialbetween the heel of the AFO and the shoe is called ‘tuning’, and is described as changingthe shank vertical angle (SVA). Tuning affects how the child walks and is an important part ofprescribing and fitting a solid AFO – however very little research has considered how tuningsolid AFOs affects walking in children with CP and how it may affect their functional ability.Recent research based on clinical experience in the United Kingdom has suggested thattilting a solid AFO forward by approximately 10-15 degrees improves walking, balance andenergy efficiency and can help result in a more normal walking pattern. However this hasnot been quantified by measuring the kinematic and kinetic effects on the body or the effecton the child’s upright functional ability. Therefore this study aims to determine the effect ofdifferent AFO SVAs on the walking of children with CP. This study also aims to investigate theeffect of a permanent change to the tuned angle on the child’s functional ability.MethodChildren diagnosed with diplegic or hemiplegic spastic CP, who wear solid AFOs and who donot walk with any assistance, were invited to participate. After being fitted with new AFOs, thechildren underwent three functional tests to measure their walking endurance, walking speed,functional mobility and balance. Parents participated in a short interview to determine theirperception of their child’s performance in achieving set outcomes and goals.The children then undertook a gait analysis session at the Motion Analysis Laboratory at TheRepatriation General Hospital, walking barefoot and in their AFOs while they were set at threedifferent angles – five degrees, 10 degrees and 15 degrees forward tilt. The movement oftheir limbs and torso was recorded using three dimensional VICON motion capture. This datais analysed by the research team to determine which angle produced the most normalisedwalking pattern for that child before wedging the AFOs to this angle. After four months ofwear, the children will complete follow-up functional tests to detect whether there were anychanges after altering the tilt of the AFOs.ResultsImplicationsSix children have been recruited and undergone the first functional tests and gait analysissession. The final stages of data collection for this project will be completed in early 2008.For clients – if results from this study support our hypotheses, the ‘tuned’ AFOs will improvechildren’s walking pattern and also potentially their functional mobility, balance, enduranceand walking speed, compared with traditional AFOs.For services – this study will expand the AFO prescription options and help define the clientcharacteristics that indicate the use of ‘tuned’ AFOs.StatusOngoing

23Project titleContributorsSummaryThe role of intensive treadmill training in improving functional mobility in ambulantchildren with cerebral palsy: A pilot studySarah O’Brien (University of South Australia), Frances Hardy (University of South Australia),Susan GibsonChildren with cerebral palsy (CP) expend more energy at a given workload than childrenwithout CP, which may potentially lead to greater levels of fatigue and result in a higher levelof activity limitations and participation restrictions in daily life.While a number of studies have investigated the effect of aerobic exercise programs onchildren with CP, little research has been done to investigate the effect of treadmill trainingon walking speed and energy efficiency in ambulatory children with CP and in particular, thelink between a change in energy efficiency and the child’s ability to participate in everydayactivities such as school. This study aimed to investigate the effect of treadmill trainingon walking speed and energy efficiency, and the effect of a change in these on schoolparticipation in this population.MethodA single subject experimental design was used. Participants meeting the inclusion criteria(aged nine to 12 years, diagnosis with spastic diplegic CP, GMFCS levels I, II or III, livingin the Adelaide metropolitan area) were randomly selected from the Novita database andinvited to participate until three participants were confirmed.Participants undertook eight weeks of treadmill training, consisting of three 20-30 minutewalking sessions per week. Outcome measures included energy efficiency (PhysiologicalCost Index (PCI)), functional mobility at school (School Function Assessment (SFA)) andfunctional capacity (six minute walk test (6MWT). Measures were taken at baseline, one weekpost-completion of the intervention and eight weeks post-completion of the intervention.For each participant, changes in PCI and 6MWT distances were calculated and graphicallydisplayed. A decrease in a PCI value indicated improved energy efficiency and an increaserepresented decreased energy efficiency. Changes in the SFA were calculated in accordancewith the SFA manual.Treadmill use

24ResultsThree participants were recruited, and showed variable responses to the intervention.Participant 1 showed a 6.5% decline in PCI score from baseline to one week postintervention,whereas after eight weeks post-intervention compared to one week postintervention,showed 12.9% improvement in PCI score. 6MWT distance improved by 18.4%,which decreased by 4.4% following eight weeks of no training.Participant 2 showed a 12.3% improvement in PCI score from baseline to one week postintervention,whereas after eight weeks post-intervention compared to one week postintervention,showed 9.4% improvement in PCI score. 6MWT distance decreased by 6.2%following treadmill training, which improved by 5.7% eight weeks post-intervention.Participant 3 showed a 29.5% improvement in PCI score from baseline to one week postintervention,whereas after eight weeks post-intervention compared to one week postintervention,showed 10.1% decline in PCI score. 6MWT distance increased by 1.8% from preto post-intervention, which decreased by 2.8% following eight weeks of no training.No change in participants’ functional mobility was detected using the SFA. This study foundthat eight weeks of treadmill training resulted in minimal improvement in energy efficiency inthree participants with CP. No carry-over to functional mobility at school was detected. Allparticipants managed the treadmill training and assessment protocol safely, though reportedit was somewhat of a burden.ImplicationsFor clients – treadmill training leads to small gains in energy efficiency, however moreresearch is needed.For services – treadmill training leads to small gains in energy efficiency and offers an avenuefor cardiovascular training for ambulant clients, however more research is needed.StatusCompletedProject titleContributorsSummaryThe Use of Theratogs – a pilot studySusan Gibson, Susan Bostock, Susan Gilson, Nicki StewartTheraTogs are an orthotic undergarment designed to improve functional alignment andmovement in children with a variety of neuromuscular conditions. Consisting of velcro andelastic strapping that can be applied in a variety of ways, the garment is prescribed and fittedby a physiotherapist or occupational therapist.TheraTogs work by applying prolonged and gentle force to correct muscle imbalance.This is believed to provide the child with more effective movement or muscle activation whileworking to gradually change existing movement patterns through muscle and movementre-education. While material promoting TheraTogs sounds promising, there is very littlescientific evidence supporting their use. This study assessed the effects of six weeks oftherapy using TheraTogs in young children with moderate to severe cerebral palsy (CP).

25MethodTwo children with CP participated in the pilot study. Participant 1 was four years old withspastic quadriplegic CP and was classified as GMFCS (Gross Motor Functional ClassificationScale) Level V. Participant 2 was seven years old and classified as GMFCS Level III withdystonic CP. A Single Subject Experimental Design (SSED) was used with an ABA design,where Phase A comprised of six weeks TheraTogs off, and Phase B comprised six weeksTheraTogs on. Physiotherapy programs were individualised for each child as were theTheraTogs strapping techniques.As individual goals identified by the participants’ families were different for each child,different outcome measures were used. For Participant 1, outcome measures included theGross Motor Function Measure (GMFM) and Chailey Levels of Ability, while for Participant 2GMFM and functional abilities with Canadian Occupational Performance Measure (COPM)were used.ResultsFollowing the intervention phase, both participants demonstrated clinical improvements infunctional gross motor skills compared with baseline measures. These improvements weremaintained six weeks post-intervention, despite no longer using the TheraTogs. Morespecifically, Participant 1 made significant gains in their ability to sit independently on thefloor when positioned and showed improved abilities in prone lying while Participant 2 madegains in the ability to take steps independently and consistently. The COPM scores indicatedthat parents were very satisfied with the gains their child had made and both parentsindicated they would like to continue using TheraTogs.This study found that six weeks of therapy using TheraTogs lead to measurable functionalimprovements in the gross motor abilities of two children with moderate-to-severe CP.ImplicationsFor clients – the families involved reported that use of the TheraTogs was worthwhile. Thereis some care burden involved in using TheraTogs, however this is feasible for appropriatefamilies.For services – these findings provide beginning research evidence for the use of TheraTogs.Therapists could consider offering TheraTogs as an intervention strategy as part ofchildren’s therapy programs.StatusCompletedTheraTogs

26Project titleContributorsFundingSummaryUsing the internet to increase physical activity in adolescents with cerebral palsy– are you kidding?Carol Maher (University of South Australia and Novita Children’s Services), A/Prof MarieWilliams (University of South Australia), Prof Tim Olds (University of South Australia), Dr AlisonLane (University of South Australia)• Cerebral Palsy Foundation Doctoral Research GrantInteractive online computer-based programs are a relatively new medium for facilitatinghealth-related behaviour change. They offer numerous advantages over face-to-face delivery,including 24-hour availability, novelty, accessibility regardless of transport issues and onceestablished, low operating costs. This study tested the effectiveness of a purpose-designed,internet-based interactive intervention aimed at improving physical activity and relatedbehaviours in adolescents with cerebral palsy (CP). The program (named GetSet) is a ninemodule intervention program based on the Social Cognitive Theory, incorporating education,self-reflection, goal-setting and positive role-modeling.GetSet was tested using a randomised controlled trial, in which twenty adolescents with CPused the program and 21 adolescents with CP acted as controls. Assessments were carriedout at baseline, immediately post-intervention (12 weeks after baseline) and 10 weeks postintervention(22 weeks after baseline). The 22 week assessments are currently underway.Preliminary analyses based on the baseline and 12 week data suggest promising results,however it will be important to see if these trends are maintained longer-term.MethodNovita clients aged 11-17 with CP, mild-to-moderate levels of physical disability, consideredby their parent to have adequate reading and comprehension skills to use the website andwho lived near Adelaide were eligible for the study. Participants who agreed to be involvedwere randomly assigned to intervention or control groups. Intervention group participantsreceived a one-on-one introduction to the GetSet website and were encouraged to logonto the website at least weekly for eight weeks. Blinded assessments were carried out atbaseline, immediately post-intervention and 10 weeks post-intervention. The primary outcomemeasures were seven-day objective physical activity (NL-1000 pedometer/accelerometers)and four-day self-reported physical activity (measured using the Multimedia Activity Recallfor Children and Adolescents [MARCA]). Secondary outcomes were exercise knowledge(purpose-designed quiz), exercise attitudes, exercise intention, exercise self-efficacy (Leap IIscales), self-reported recreational screen time (MARCA) and functional capacity (six-minutewalk test).Results Of the 118 eligible Novita clients, 41 consented to participate (mean age 13 years, range 11-16years, males=26). Chi-squared analyses and t-tests revealed that prior to the interventionthere was no significant differences between the intervention (n=20) and the control (n=21)group participants for demographic characteristics or outcome measures, with the exceptionof screen time (p=0.05). All participants attended post-intervention assessments. At followup,both groups showed a reduction in weekly pedometer counts, self-reported dailymoderate-vigorous physical activity and an increase in self-reported daily recreational screentime, suggesting a seasonal effect of the timing of the intervention (autumn/winter). Mixedmodeling analyses found no statistically significant time-by-group interactions, howeverthe pattern of changes supported the intervention group relative to the control group withmoderate effect sizes (0.43, 0.5, 0.6 and -0.46 for weekly step counts [p=0.06], weekly activeminutes [p=0.06], exercise knowledge [p=0.08] and self-reported screen time [p=0.17]respectively). Final follow-up assessments are currently being completed.

27ImplicationsFor clients – it appears that the internet is an enjoyable, accessible and effective means ofaccessing services. Adolescent clients and their families were interested in, and engagedsuccessfully in, this self-management program.For services – this study has developed a new intervention which may be used to supplementmore traditional forms of therapy.There appears to be good potential to expand this program for a wider client population andto develop other types of self-management programs for adolescent clients.StatusOngoingEvaluation of measurements, interventions, programs andclinical practice> ProgramNovita staff contributors highlighted in boldProject titleContributorsFeasibility of It Takes Two To Talk® for families of children with motor impairmentsUK team: Dr Lindsay Pennington, Professor Senga Bond and Dr Thomas Klee (all fromUniversity of Newcastle, UK)Novita team: Dr Parimala Raghavendra, Catherine Olsson, Lynette Rule, EmmaColstonFundingSummary• Department of Health, National Health Service Research and Development Program, UK(fellowship to Dr Lindsay Pennigton)• Health Foundation, UKRecently, the Hanen Early Language Parent Program, It Takes Two to Talk®, has gainedpopularity and is offered to parents of children with a wide range of developmentaldisabilities in the UK and in Australia. Hanen aims to train parents to facilitate their child’searly communication development by watching and waiting for their child’s communicationsignals and responding to build conversation from these signals, which has been associatedwith changes in interaction patterns for parents and children. However the program wasdeveloped for children with developmental disabilities and has not been validated specificallyfor the subgroup of children with motor impairments who have distinct and complexcommunication disorders.The study investigated the following questions:1. Is It Takes Two to Talk® associated with positive communication changes for parents andtheir children who have motor disorders?2. Is It Takes Two to Talk® associated with changes in the complexity of mothers’ languageto their children with motor disorders?3. How acceptable and useful is the Hanen training to the families?

28MethodA quasi-experimental design was used. Data was collected at four months and two monthsprior to parents attending It Takes Two to Talk® training to estimate change in communicationpatterns without parent training, and at one month and four months after intervention toinvestigate the effects of the intervention. Participants were 25 families (four from Novita and21 from England) with children with non-progressive motor disorders affecting at least twolimbs and expressive communication. Children were aged between 18 months and 3.6 years,with a situational understanding and spoke English as a first language.Data was collected through a combination of assessment tools, behavioral observations,interviews and questionnaires. During each visit, mothers and children were videotapedplaying with a special box of toys. They completed Parenting Sense of Competence Scale(PSOC) to measure the value they place on parenting and their perceived skills as parents.Mothers were interviewed at the end of the program regarding their perceptions of usefulnessand suitability of the training program.Each mother–child pair dyad was transcribed and coded (using a scheme developed by DrPennigton in previous studies) to show the structure of conversation and pragmatic functionsexpressed. Modes of communication used by children were also coded. Hotelling one andtwo sample tests were used to test overall changes in communication patterns for mothersand children. Maternal language was coded using the Systematic Analysis of LanguageTranscripts, which were analysed alongside differences in PSOC data using repeatedmeasures tests. Data comparisons were undertaken at four different points of time.ResultsImplicationsThe study found that interaction patterns were stable before training. Mothers initiated lessand produced more responses after training, and produced fewer requests and moreprovisions of information, acknowledgements, confirmations and denials. Children producedmore initiations and fewer responses after training, and more requests and provisions ofinformation, fewer acknowledgements, yes-no answers and physical responses. Mothers’linguistic input to children reduced in complexity. Changes were maintained four months later.Mothers’ views of parenting did not change. The qualitative study suggested that familieswho attended found the training acceptable and useful.For clients – provides access to a program that provides beginning evidence of positivechanges in communication patterns in children with motor disorders following parentsundertaking the program.For services – this is the first study to examine the effectiveness of It Takes Two to Talk® withchildren with motor disorders, and begins to build an evidence-base.StatusCompleted

29Project titleContributorsSummaryThe MOVE program for special schools for students with severe and multipledisabilities: A pilot studyJudith Hodson (Elizabeth Special School), Kerry EvansThe Mobility Opportunities Via Education (MOVE) program was originally developed in thelate 1980s in the USA to meet the needs of school students with severe physical disabilities.Such students can tend to lose physical skills and develop deformities as they grow older.The program aims to counteract this pattern by encouraging families, teachers and therapiststo work together toward goals specific to the individual student’s needs. MOVE is activitybased,offering students various opportunities to improve sitting, standing and walking skillswhile participating in daily living activities.This project aims to implement a pilot MOVE program at the Elizabeth Special School toevaluate the effect on students’ gross motor skills, integration of positioning and mobilityopportunities into school curriculum/activities, generalisation of activities and new skills to allareas of students’ lives and team work between families, schools and therapists.MethodA pilot study of the MOVE program is currently underway with three students from ElizabethSpecial School’s Severe and Multiple Disabilities unit. These students are aged betweenseven and 10 years, are non-ambulatory (or mobile only with a mobility device) and areinvolved with their families’ consent.The students’ progress will be measured at baseline, six months and 12 months using theMOVE assessment form, gross motor function (Gross Motor Function Measure), functionalperformance (Canadian Occupational Performance Measure[COPM]), staff feedback (focusgroups) and family feedback (interviews and COPM).ResultsImplicationsTwelve month follow-up assessments are scheduled for October/November 2007. Resultswill be analyses to determine the impact of the MOVE program.For clients – if effective, the MOVE program will improve clients’ physical skills and minimisedevelopment of deformities.For services – The MOVE program will provide a collaborative and structured means ofproviding positioning and movement skills development for students within the schoolsetting.If found to be beneficial, the MOVE program could be implemented more widely withinNovita, in collaboration with other special schools across South Australia.StatusOngoing

30Evaluation of measurements, interventions, programs andclinical practice> Clinical PracticeNovita staff contributors highlighted in boldProject titleContributorsSummaryAn evaluation of psychological support for families of children with cerebral palsyDr Tim Connell, Violetta Hodges, Cassandra Harbutt-Nunerly, Liz Trubshaw.It is well recognised that mental health issues are more likely in a family that includes a childwith significant disabilities. Families of children with disabilities typically interact with a largenumber of support workers and health professionals. Some of these interactions help familiesconsiderably to deal with the psychological issues, others less so.Aims of the study were:• to identify practices, at a general level, of any service-provider personnel that parents felthelped them to deal with these psychological issues, and which practices were not helpful• to ask parents more specifically about the helpfulness of the practices of psychologyservice that they had experienced in the past and to indicate which of these psychologicalissues continued to be a concern and to what degree.MethodResultsImplicationsStatusThe study enabled us to identify those family/service interactions which were significant orimportant to families’ wellbeing. This information will be used to provide innovative directionsfor service development and more specifically, psychology services.The study was based on a single postal survey. 450 of the 1000 children with physicaldisabilities or acquired brain injury registered to receive therapy services from Novita in 2006were invited by letter to participate in the survey. Families who replied were sent the followuppostal survey that included open-ended questions, multiple choice questions and ratingscales. 70 families (15.5%) returned completed questionnaires.In relation to various types of health workers across different services, parents’ responsesindicated that key elements of helpful experiences for addressing psychological issuesincluded: positive worker qualities, tangible assistance, useful information and facilitationof connection with other families. Key elements of unhelpful experiences were: insufficientprovision of a specific service or information, negative effect of a prescribed process,perceived insensitivity of workers and interactions which unexpectedly re-activated theoriginal grief reaction to first news of their child having a disability.Parents reported most frequent and successful use of Novita’s psychology service forhelp with behavioural aspects of eating, sleeping, disability-related frustration, toileting andbedwetting. Psychological input was also most helpful for assisting children to make friends,children’s behaviour in public and school-related issues. Parental feelings/emotional stateand family/marital relationships were issues that remained of main concern.For clients – it is expected that the utilisation of the information from this study into servicedelivery will lead to improved worker-parent relationships and improved outcomes for childrenand families.For services – in addition to quality clinical services, the significance of quality of workerparentrelationships and facilitating connection between families is very important andneeds to be included in service development. The grief re-activation phenomenon suggestsmethods developed for helping people with post traumatic stress disorder may haveapplication with parents of children with disabilities. While still being beneficial, the areaswhere psychology support had room for development related to parental feelings/emotionalstate and family/marital relationships.Ongoing

31Project titleContributorsSummaryA review of the factors that impact the success of goals and intervention strategiesused with simple speech generating devices – single or sequenced messages(SSGD) within Novita Children’s ServicesJanelle Sampson, Liz Graetz (Flinders University), Nicola Crook (Flinders University),Kylie Opperman, Dr Parimala Raghavendra, Catherine OlssonThe development of communication skills for a child or young person with complexcommunication needs (CCN) is a challenging role for speech pathologists, familiesand carers. Early access to multiple forms of AAC is essential for early communicationdevelopment in young children at risk for expressive language impairments.Simple speech generating devices (SSGDs) represent one of the more recent additions tothe repertoire of AAC options in the last two decades. Unlike non-electronic communicationboards or typical word processors, SSGDs provide auditory stimuli via speech output as anadded component. Use of AAC methods including SSGDs has the potential to support aperson with CCNs to be an active participant in communication interactions.SSGDs with single and/or sequenced messages, such as BIGmacks, One-Step and Stepby-Steps(now known as Big Step and Little Step), are the most requested item by speechpathologists for equipment funding and it is estimated that around 150 Novita clients usethese devices. This study aimed to identify the most common goals set, factors that impactthe success of these goals, the intervention strategies used for the SSGDs and review theprescription procedure of SSGDs within Novita.MethodParticipants: Novita clients who use SSGDs and their speech pathologists.Data collection:1. File audits of 48 clients who met the selection criteria. Twenty eight of the clientparticipants were male and 20 were female, with an age range between two years fivemonths and 16 years one month.2. Interviews with 14 speech pathologists to describe current practice in prescription ofdevices, goal setting and methods used to achieve the goals.Data analysis: Pattern analysis of the use of SSGDs. Collation of information about whetherthe devices are supporting the communication development and participation of clients withcomplex communication needs in their environment.ResultsThe study found that the main goals set were increasing participation, developing causeand effect, developing pragmatic skills and increasing social closeness. There was a highlevel of partial or complete achievement of these goals. The main factor that had a positiveor negative impact on the achievement of the goals was the ability for the communicationpartners to integrate the use of the device in their environment, whether it was at home orschool/kindergarten/childcare. The results also indicated a high focus on parent and stafftraining in the use of the device, but goal achievement could be further increased withclient therapy. Therefore there was still need for further investigation on the specific factorsthat impact on the successful integration of the device and where the focus of speechpathologists’ intervention should be, particularly with outreach and country clients.The study also yielded some preliminary results on the effectiveness of the design of thelevels within these devices, showing that a high proportion of the clients did not use the levelsat all. Further investigation into the design of these levels is required.

32ImplicationsFor children and their families – from the results of this study, some changes may be made toservice delivery for children and families who use SSGD’s.For therapists and managers – these results will provide a resource to increase awarenessof strengths and limitations of the SSGD, as well as provide speech pathologists a point ofreference to guide their goal setting and intervention with the use of a SSGD’s.StatusCompletedProject titleContributorsFundingSummaryMethodAssistive Technology solutions for students with physical disabilities: An analysis ofutility, cost and student satisfactionSonya Murchland, Annabelle Tilbrook, Helen Dawkins, Prue Shiosaki, Dr Alison Lane(University of South Australia), Terry Lyons, Jocelyn Kernot• Channel 7 Children’s Research FoundationThe aim of this study is to explore how many school students of Novita aged between eightand 18 years are using assistive technology in one form or another, what items they areusing, their levels of satisfaction with these items, and estimate the costs for the technologyitems and therapist support.The study has a number of parts:1. Each child’s file is reviewed to compare what technology is in use with what wasrecommended for provision.2. Mailed survey of Novita clients aged eight years and over, asking about the types ofassistive technology solutions in use at school and/or home and satisfaction with thattechnology using the QUEST 2.1: Children’s Version and Technology Survey. A modifiedDillman methodology was utilised for the mailed survey.3. An interview by telephone or face-to face with child or parent, to gain a greater depth ofinformation on satisfaction with technology, whether it is assisting school performanceand therefore increasing student self-esteem, and desirable features of assistivetechnology.Results Part 1 – File audit to be completed October 2007.Part 2 – Survey undertaken in June 2007. 703 children were sent questionnaires withresponses gained from 152 (21%) and 133 (19%) completed questionnaires returned. Data iscurrently being analysed.Part 3 – To begin in 2008.ImplicationsFor clients – preferred range of effective technology items may be identified.For services – clearer understanding of documentation related to technology, costs andamount of support needed for children with technology items.StatusOngoing

33Project titleContributorsSummaryMethodResultsImplicationsGaining knowledge for practice: A review of the practice of therapists at Novita inseeking the evidence to inform practiceSonya Murchland, Dr Parimala RaghavendraThe aim of this study was to explore the patterns of seeking information used by therapists atNovita, along with their utilisation of evidence-based practice principles.All occupational therapists, speech pathologists, physiotherapists and psychologists atNovita were surveyed on the methods they use for gaining knowledge. Each discipline’sresponses were then analysed to explore the common patterns of seeking knowledge,preferences for staff development activities and utilisation of evidence-based practiceprinciples.Each discipline had a different profile on research utilisation practices. Analysis of the resultsis still in progress.For clients – skilled and knowledgable staff provide services to clients.For services – understanding of best methods to target professional development.StatusOngoingProject titleContributorsFundingSummaryMethodInformation and Communication Technology solutions for students with specialneeds – an analysis of utility and satisfaction: A pilot studySonya Murchland, Helen Dawkins, Ruth Motley (Department of Education and Children’sServices)• Channel 7 Children’s Research FoundationThe QUEST 2.1 and Technology Survey are two tools that have been developed for use inthe larger Assistive Technology Project, to identify what technology items are in use, and theirsatisfaction with technology. This pilot study trialed the use of the QUEST 2.1 and TechnologySurvey as a mailed survey to school students who had received technology items fromSpecial Education Resource Unit (SERU) to determine their satisfaction with technology itemsused to assist in completing school tasks.Mailed surveys (QUEST 2.1, Technology Survey) were sent to 20 students with languagedisorders, learning disabilities or autism spectrum disorders who had been identified bySERU as having received laptops to assist in school work. A modified Dilman methodologywas followed.

34ResultsFive students (25%) responded with completed questionnaires. This small pilot study hadyielded valuable preliminary data on the importance of assistive technology for students withspecial learning needs due to autism spectrum disorders or specific learning difficulties.The students were using laptops and software provided frequently and had high levels ofsatisfaction. As this was a small sample of five students, caution needs to be given wheninterpreting results and larger studies in the future will be needed. However the preliminaryfindings have identified the importance and need for training and support, adequate softwareoptions and lightweight laptops for ease of portability. The QUEST 2.1 provided a newmethod of determining the outcomes of technology provision for children to assist in futurerecommendations, service improvement, and identification of priorities when advocating forfunding and resources.ImplicationsStatusFor clients and services – the QUEST 2.1: Children’s Version appears to be promising tool ingaining feedback from children on their satisfaction with technology.CompletedProject titleContributorsSummaryMethodPostural management programs at school for children with cerebral palsyKerry Evans, Sue Bostock, Sue Gibson, Sue Gilson, Judy SprodPostural management encompasses the use of specialised seating, supported standing,regular positional changes, active exercises such as walking programs, use of orthoticsand individual therapy sessions. In the school setting, postural management aims to assistchildren with disabilities to access the curriculum and the school environment and improvetheir functional ability within the school environment. In general, therapists provide posturalmanagement advice and equipment for the children – however the postural management isundertaken on a day-to-day basis by school staff.At present, it appears likely that there is a lack of consistency in postural managementpractices across different educational settings, due to both variation in the advice providedby therapy staff and the implementation of postural management activities within schools.This project aims to determine:1. ‘best evidence practice’ for postural management2. current practice in the area of postural management at school for children aged five to 12years with cerebral palsy (CP), attending special schools or units within South Australia.This project is being completed in two stages:Stage 1: A review of the literature regarding postural management for children with CP. Thiswas undertaken to examine the evidence and guidelines for postural management programsfor children with CP. Twelve relevant studies were identified and appraised using the CriticalAppraisal Skills Programme (CASP). This stage has been completed.Stage 2: Postal survey to identify current practice of postural management at school forchildren with CP. Two survey tools (one teacher version and one therapist version) have beenadapted from an existing questionnaire. The survey will be mailed to all classroom teachersand therapists at (physiotherapists, occupational therapists and speech pathologists)involved in the management of Novita clients with CP, aged between five and 12 years,GMFCS levels 4-5 and attending a special school/unit.

35ResultsImplicationsThe review identified 12 eligible articles. In general the level of evidence was quite low,however the sources did support the use of positioning in school. Further high qualityresearch is needed to categorically prove the value of use of positioning in schools. It isplanned that surveys will be distributed in October 2007.The information regarding current practices will be incorporated with best evidence practicefrom the scientific literature, in order to develop standardised guidelines for the provision ofpositional equipment and programs for students with physical disabilities.For clients – positioning programs will optimise students’ ability to access the curriculum,their school environment and long-term, will help maintain/improve their functional abilities,which will impact on their educational and physical outcomes.For services – standardised guidelines will assist therapists to provide evidenced-based andconsistent care and equipment to their clients in a school setting.StatusThe guidelines will assist Novita to provide consistent, high-quality services, regardless of theindividual therapy staff or school-setting. There is a need for high-level research investigatingthe use of positioning programs and equipment in schools.OngoingProject titleContributorsSummaryMethodResultsThe assistive technology support and training needs of occupational therapy staff atNovita Children’s ServicesHelen Dawkins, Sonya MurchlandNovita’s Support Team provides assistive technology support and training to Novitatherapists. A survey of occupational therapy (OT) staff was conducted to answer thequestion: ‘What are the assistive technology support and training needs of currentoccupational therapy staff at Novita Children’s Services?’. The results have implications forthe method of delivery and topics for training.A 20 item paper questionnaire was administered in a group format during the OT in-serviceday in October 2006. All occupational therapists and occupational therapy assistants whowere present on the day and worked with Novita clients were invited to participate. 36 peoplemet this criteria and 23 surveys were returned (giving a response rate of 64%).OTs seek support with assistive technology from OT colleagues in the same regional officeand by referring to the Technology Support Team. Novita OTs are generally well skilled inthe area of assistive technology, however the inherent difficulties of learning in this area arerecognised. Self rating of skills and knowledge in assistive technology was related to years ofexperience working in the field. Respondents who rated their knowledge and skills higher usesupport less frequently. Key areas and delivery methods for further training were identified.Respondents reported that the most effective training is small group or one-on-one trainingthat is focused on application and the needs of a particular client.

36ImplicationsStatusFor consultants – better able to provide effective training based on expressed needs oftherapists. The following guidelines can now be used when planning training activities:• Timing of training – training activities should be conducted when the technology item isbeing used by a client, or when the training topic is clinically relevant for the therapist.• Method of delivery – regional small group and one-on-one training is the most effectivedelivery method. Training should be focused on the needs of clients. Workshops and inserviceday presentations are less effective.CompletedProject titleContributorsSummaryMethodThe Augmentative and Alternative Communication train: What brings parentsonboard?Catherine Olsson, Dr Parimala Raghavendra, Kylie Opperman, Emma Colston,Sandra StewartIntroduction of and ongoing support for Augmentative and Alternative communication (AAC)to children with complex communication needs (CCN) and their families is an important areaof work for Novita speech pathologists. While some families embrace the use of AAC fortheir children, a majority of others hold fears that AAC will negatively impact on their child’spotential to develop speech. Speech pathologists were interested to find out more about thethings that can help clients and their families in understanding and using AAC systems inorder to improve service delivery.A descriptive study using questionnaires and interviews was used to gather data from twogroups of participants and consisted of two phases:Phase 1: 19 speech pathologists were asked what characteristics (knowledge, skills,behaviour, attitude, awareness) they thought family members have, who were felt to be ‘onboard’with AAC, and also their comments regarding a definition of ‘successful use of AAC’.Phase 2: The speech pathologists identified families that met the ‘on-board’ characteristics.40 families were identified as being ‘on-board’, and 15 of these families were interviewed toexpress their initial reactions to AAC and the journey since then including any highlights andchallenges and any advice for other parents at an earlier point in their journey.

37ResultsPhase 1: 24 principle characteristics were identified as being important for families to be‘on-board’ with AAC. Some of these characteristics included use of AAC system (eg setup,modelling, different settings), willingness and open mind to AAC, positive attitude towardsAAC, communication, technology (‘belief’), willingness to try new strategies and take on newinformation, involvment in the development of the system, ability to ask questions (for moreinformation). The majority of speech pathologists agreed with the definition of ‘successful useof AAC’.Phase 2: Preliminary analysis of parents’ views and perceptions were summarised under thefollowing categories:1) initial thoughts about AAC2) highlights in child’s use of AAC3) challenges with AAC4) what families learned about their children who use AAC5) implications for families and advice for other parents6) implications for Novita and other service providers.ImplicationsStatusData analysis is ongoing.For clients – by responding to the results of this study some changes may be made toservice delivery for children and families who use AAC to improve the knowledge, skills andsupport given to children and their families and potentially improve communication outcomesfor children.For services – information provided from this study will increase understanding about thetypes of knowledge, skills and support and encouragement needed for parents and childrenwho are beginning, and later continuing, their journey with AAC.OngoingNovita client using an AACsystem

38Project summariesEvaluation of service delivery models and methodsNovita staff contributors highlighted in boldProject titleContributorsFundingSummaryMethodResultsImplicationsStatusEmbedding wellness approaches into paediatric health and disability policies andpractices of allied health providersSherry Saggers (Edith Cowan University), Helen Wildy (Murdoch University), Lauren Breen(Edith Cowan University), Vicki Larkins (Therapy Focus), Andrea Hurwood (QueenslandHealth), Dr Parimala Raghavendra, Sonya Murchland, Margaret Crowley (Association forthe Blind, WA), Marina Re (Association for the Blind, WA), Jeannine Millsteed (Edith CowanUniversity)• Edith Cowan University Industry Collaboration Grant• Cash and in-kind contributions from four industry partnersWellness approaches, based on the social model of disability, are increasingly preferredthroughout the health and disability service sectors. Despite this preference, most alliedhealth professionals continue to be trained and many services operate according to thebiomedical model of health indicating a clear misalignment between policy and practice.The aim of the project is to determine how wellness approaches to health and disability areconceptualised and embedded in the vision, policies, and practices of allied health providersin pediatric disability and health. The utilisation of wellness approaches may improve thedelivery of allied health services to people with disabilities.This unique national project is being undertaken by Edith Cowan University and MurdochUniversity in collaboration with Therapy Focus and Association for the Blind in WesternAustralia, Novita Children’s Services in South Australia and Queensland Health. A literaturereview was undertaken to examine the conceptualisation of wellness approaches in alliedhealth. The key indicators of wellness were searched for within the websites, annual reportsand strategic plans of 10 key paediatric health and disability organisations across Australia.The practice of wellness in the four partner organisations is being investigated through a casestudy approach involving interviews with key personnel within each organisation.The literature review highlighted that despite theoretical, empirical, social and politicalsupport for wellness approaches, the rhetoric remains largely misaligned with practices withinthe health and disability sectors. Embedding wellness approaches into health and disabilityservices requires action, not just a change in the terminology but a change process requiringstrategies at multiple levels. Allied health practitioners need to know what keeps people welland how to facilitate this, and they need to be encouraged to be life-long learners that canincorporate best practice and changes throughout their careers.The number of wellness indicators identified in the website pages, annual reports andstrategic plans of each service ranged from two to seven. The most common were holisticdefinitions of health, the use of multidisciplinary teams, the provision of support from acommunity-based setting and the shared control between client and practitioner. Overall,the website pages, annual reports and strategic plans of the non-government services weremore likely to include more of the key indicators of wellness than government services.For clients – the study findings may enhance the independence, empowerment and overallwellbeing of people requiring health and disability services by strengthening the capacity ofservice providers and allied health professionals to deliver services according to a wellnessapproach.For services – the study may stimulate the development of effective guidelines that enableservice providers to embed wellness approaches into their visions, policies and practices.Ongoing

39Project titleContributorsSummaryMethodResultsImplicationsStatusEvaluation of family-centred practice using the measures of process of careMichael Bentley (Flinders University)Novita reference group: Dr Pammi Raghavendra, Sonya Murchland, Sarah Anderson,Jane Loveday, Terry Lyons, Pauline McGregorFamily-centred practice recognises that parents are the ‘experts’ in their child’s care, areequal partners in the rehabilitation process and have the right to determine what is mostimportant for their child. This philosophy of service was formally adopted at Novita in the late1990s. As part of ongoing quality assurance activity and prior to undertaking organisationalchange, Novita undertook to evaluate how ‘family-centred’ it was in providing therapy,equipment and family support services, and to utilise this as a baseline measure for futurecomparisons. The second aim was to identify areas for improvement.The South Australian Community Health Research Unit was contracted to work closely withthe Novita Reference Group and conduct the study, to enable independent data collectionand evaluation. The evaluation used two survey instruments developed by CanChild,Canada. The Measure of Processes of Care (MPOC) is a self-administered questionnairethat measures parents’/caregivers’ perceptions of the extent to which specific behaviours ofNovita staff occur. A sample of 285 families stratified by three age groups of clients (youngerthan six years, six to 12 years and 13 to 18 years) and metropolitan/country places ofresidence were sent the MPOC-20 questionnaire.The Measure of Processes of Care for Service Providers (MPOC-SP) is a 27-item, selfassessmentquestionnaire for staff working in paediatrics, designed to measure theirreported implementation of family-centred practice. 176 Novita staff (including psychologists,occupational therapists, physiotherapists, speech pathologists, rehabilitation engineers,orthotists, managers, senior management, administrative staff and paediatric rehabilitationmedical specialists) who have direct contact with clients and families were sent thequestionnaire.189 parents/caregivers (66%) completed the MPOC-20 questionnaire. 145 service providers(82%) returned the MPOC-SP questionnaire.Parents generally rated the family-centred behaviours of staff as positive. Respectful andSupportive Care received the highest rating, while Providing General Information receivedthe lowest. There were significant differences in scores for all five scales of MPOC betweenmetropolitan and rural families and the age of the child. Service providers also generally ratedtheir family-centred behaviours as positive. There were significant differences amongst theprofessions in areas of Showing Interpersonal Sensitivity and Providing General Information.The areas highlighted in both surveys that might require specific attention (following furtherexploration) were continuity of care and the provision of written (both specific and general)information to families.For clients – providing general information to families about various aspects of disability maybe targeted for service developmentFor services – the outcomes highlight where families perceive Novita is doing well and alsostaff’s perception of their behaviours towards families. It highlights strengths and needs inimplementation of family-centred practice. The results from MPOC-SP may also be useful inprofessional development activities.Completed

40Project titleContributorsSummaryMethodResultsEvaluation of ‘The Programs Project’ – the restructuring of client services at NovitaDr Parimala Raghavendra, Margarita Tsiros, Wendy Wake-Dyster, Ivan Lawton, TerryLyonsIn 2004, Novita’s Client Services Division decided to review the current service delivery modeland structure in preference to the implementation of entry point waiting lists. The aim of thePrograms Project (PP) is to develop and implement a model of service delivery based on theLife Need’s Model (King et al, 2002). This model is a developmental, socio-ecological modelwith a community focus on service provision that incorporates a trans-disciplinary servicedelivery model (common goal and the way of viewing the service) that addresses transitionsand age-specific needs.Since the PP is a major undertaking for Novita, evaluation of such an undertaking is vitalto investigate whether the PP goals are achieved and examine the short-term impact of theimplementation of major changes in service delivery. The aim of the current project wasto conduct a ‘snapshot’ evaluation of Novita services to serve as a basis for comparisonfollowing the implementation of PP. Client demand management, transition from earlyintervention services to school and transition from Novita services into adult services werethe focus.Focus group and interview data was captured from Novita’s Therapy Services and FamilySupport Services staff, teachers, parents and staff from agencies that provide servicesto adults with disabilities. Novita staff were asked about their perceptions of client-relateddemand and the strategies they implement to manage demand for services. Novita staff,teachers, parents and staff from adult agencies were asked about their perceptions of twokey transition points (from early intervention to school, and from Novita to adult services),and to identify challenges, benefits and areas for improvement. Quantitative data includedsummary statistics relating to provision of client services, client satisfaction questionnaires(completed by parents) and auditing of written reference materials available to staff. Thebaseline information was collected from December 2006 until August 2007. The aim is tocollect similar information post-implementation of PP in two years time.Overall, parents, teachers and Novita staff felt that Novita provided a high quality service inrelation to supporting the transition of clients from kindergarten/early intervention to school.Both parents and teachers highlighted the change of therapists/team at the time the childcommenced school as an area for improvement.The feedback from parents and Novita staff indicated that the transition from Novita to adultservices was done poorly by Novita, and there was much inconsistency and confusion on thepart of the staff and families. Feedback from adult agencies was positive only when FamilySupport Staff had taken on a key role in the transition. Some of the recommendations wereto start transition process when the client is aged 15.5 or 16 years, a key worker to coordinatethe transition and steps to improve inter-agency communication.Therapy staff appreciated the autonomy and flexibility in managing their clients and theclient-centered team approach. However they thought that their workload was increasingand were frustrated with reduced time to plan ahead. Family Support Staff had better clientmanagement strategies in place which seemed to help them address the workload. Twoof the recommendations were strategies to reduce inefficiencies in work practices and thedevelopment of tools to assist workload prioritisation.The final report is being prepared and findings will be considered in the implementation ofPP.

41ImplicationsStatusReferencesFor clients and services – the baseline phase has given an opportunity to provide input intodevelopment and implementation of PP.OngoingKing GA, Tucker M, Baldwin P, Lowry K, La porta J and Martens L (2002), A Life Needs Model of Service Delivery:Services to Support Community Participation and Quality of Life for Children and Youth with Disabilities, Journal ofPhysical and Occupational Therapy in Pediatrics, 22, 58-77Project titleContributorsSummaryPlanning for tomorrow: Service provision for children and adolescents with acquiredbrain injuryAnita Smith, Lisa Quinn (Flinders University), June EyNovita has a newly established, specialised service for clients with a medical diagnosis ofacquired brain injury (ABI). Until recently, services to this population had been developedand delivered based on individual client requests or needs, by staff that linked themselves toexternal service providers when necessary.The purpose of this project is to identify a best practice approach to service provisionfor young people with ABI and their families. It is expected that current supports andinterventions that are effective and valued by participants will be highlighted, while anygaps, inconsistencies and areas of need will be brought to the fore. There is a need toevaluate services most important to young people with ABI to transition from adolescence toadulthood.The results are essential for future planning in the development and delivery of new servicemodels to this client group.MethodResultsImplicationsA 30 item paper questionnaire was mailed to participants aged 16 to 18 years who werecurrent clients of Novita’s Family Support Services division, with a medical diagnosis ofABI. The questionnaire sought information around employment, study/education, financialsupport, living arrangements, social activities and services accessed/required. With parentalconsent, a follow-up telephone interview was conducted, enabling expansion on responsesprovided in the paper questionnaire.Of the 27 questionnaires mailed out, 16 were completed and returned (59.26%). A further twoparticipants made contact to say that they would not be participating for individual reasons.The results are being analysed.For clients – the continuation of best practice service delivery.For services – the identification of gaps in services leading to improving service delivery tochildren with ABI and their families.StatusOngoing

42Project titleContributorsSummaryMethodResultsImplicationsStatusSystematic review of strategies used by therapists to work effectively with teachersand aides to implement programs which address client goalsDebashish Das, Dr Karen Grimmer, Saravana Kumar, Sonja Keller (all from University ofSouth Australia)Novita Reference Group: Bronwyn Timko, Dr Parimala Raghavendra, Sonya Murchland,Terry Lyons, Catherine Olsson, Judy SprodNovita staff work in kindergartens and schools with educational staff to achieve client goalsand enhance participation of children in class environments. Therapists find it challenging toeffectively achieve client goals when the main intervention input is via support staff from otherorganisations. As there are no standard approaches or best practice guidelines, this studyaimed to undertake a systematic review to identify evidence for strategies in use or differentcollaborative approaches.The review presents a systematic analysis of current literature on strategies used bytherapists to work effectively with teachers and aides to implement programs which addressclient goals. For this review, the term ‘client’ reflects children with physical and/or multipledisabilities.The University of South Australia’s Centre for Allied Health Evidence was contracted toundertake a systematic review that considered the evidence for effective training methodsfor therapists and education staff to work together to support children with disabilities in theclassroom. The Novita Reference group worked with CAHE staff in refining the question,identifying the key databases and providing regular input into the appropriateness of theinformation retrieved. Two independent systematic reviews of the literature were undertakenby two reviewers. The first review was undertaken during the winter of 2004 and the secondreview was undertaken in autumn of 2005.The majority of the literature was observational, descriptive and peer/expert opinion. Thelack of higher research designs (such as randomised controlled trials) might reflect theresearch question the review sought answers for. Additionally, while collaboration betweenprofessionals is not new, the recognition for practices to be based on evidence andeffectiveness is. Some of the findings were:1. Irrespective of the child’s disability, current evidence purports the need for collaborativestrategies between stakeholders (therapists, teachers, para-professionals and parents).2. The collaboration framework should be underpinned by regular meetings, setting up workgoals/plans and providing adequate training and support to non-health professionals.This can be successfully undertaken by coaching, observing and providing feedback.Ongoing consultation with fellow health professionals, teachers, para-professionals andimportantly parents also need to be incorporated.3. Literature evidence indicates that it is unlikely that any one service model will meet thecomplex and interacting requirements of all children.It was recommended that Novita develop and pilot a draft model of collaborative approachesbased on these findings. Based on the literature reviewed, there were core features whichwere considered by all stakeholders as acceptable and meeting the requirements of childrenwith disabilities.Novita has an opportunity to work with education sectors to develop a South Australianmodel of collaboration between teachers, aides and therapists.Completed

Project summaries43Life span issues for children with disabilities and their familiesNovita staff contributors highlighted in boldProject titleContributorsSummaryAn investigation of views of fathers with children with disabilities regarding theirinvolvement and support needsDr Tim Connell, Violetta HodgesTo date, the needs and challenges for fathers of children with disabilities have not beensystematically addressed by disability services. The research on fathers with children withdisabilities remains quite limited, however the consistent message is that fathers oftenlack the support they need and typically experience a wide range of obstacles to theirinvolvement.Novita has been supporting and working with fathers in the context of our family-centeredapproach, but more is required. Novita’s Psychology team devised a survey study,including a pilot version, as the first step in finding out more about issues related to fathers’involvement, and gaining information about how to improve service delivery in this area.MethodPilot study: 15 randomly selected Novita families were contacted to provide feedback on apilot survey questionnaire, in order to refine the questionnaires for the main study involving atleast 60 pairs of parents.For the main study, survey questionnaires will be sent to each of the parents (including thoseliving apart). Fathers will complete their questionnaire set and mothers will complete a shorterversion of the father’s questionnaire set. The questionnaires include open-ended questionsabout the importance of fathers’ involvement, rating of fathers’ involvement in a range ofchild-centered activities and satisfaction of this involvement by both parents separately.Fathers will also rate a range of strategies in terms of their helpfulness to them in theirinvolvement with raising their child with a disability.ResultsImplicationsPilot study: Three families completed the questionnaires. Feedback from parents regardingthe questionnaires and analysis is in progress. Preliminary pilot results indicated that mothersand fathers rated fathers’ involvement as essential. Fathers also placed most importanceon opportunity for direct communication with staff by phone, meetings and access toinformation by emails and websites. Attending father-child events (eg camps), after-hoursappointments, information sessions for fathers and for others about the importance ofsupport for fathers were also considered important.For clients – service development in response to the findings of this study is expectedto contribute to fathers experiencing greater support, satisfaction and opportunities forinvolvement in raising children with a disability. Associated benefits for the family as a wholemay also occur as a result of improved support for fathers.For services – information from the study will be used to develop services to improve supportfor fathers of children with disabilities in general and in relation to their involvement in thecare of their child. Evaluation of these services will assess the extent of the expected positiveoutcomes for children, their families, therapists, teachers and managers.StatusOngoing

44Project titleContributorsSummaryCognitive coping of parents who have a young child with a physical disabilityDr Melissa Zschorn, Professor Roslyn Shute (Flinders University)This doctoral degree project investigated the proposition that parents, as experts in the taskof raising children with disabilities, might have valuable insights to offer others, includingother parents (especially those with newly diagnosed children) and psychologists andother professionals working with this population. The focus of the research was on parents’thoughts and related emotions regarding having a young child with a physical disability.Drawing upon positive psychology and empowerment, and unlike the common portrayalof families in this situation as ‘victims’, this research revealed that parents’ cognitions arecomplex and multilayered, incorporating positivity alongside commonly recognised negativeaspects.This was a two-part study:1. To develop a new scale, Parental Appraisals of Disability Scale (PADS), for theassessment of positive and negative thoughts concerning parenting a child with aphysical disability. The scale was shown to be reliable and valid.2. To use the qualitative method of the ‘What, Who, Why, When’ framework that involved indepthinterviews to assess parental cognitions. This framework proved useful in revealingthe complexity of cognitions and that several cognitive patterns emerged across therange of families interviewed.MethodAll participants were parents of children registered with Novita. Items for the PADS weredevised from qualitative material yielded by 25 parents. The PADS was completed by 148randomly selected country and metropolitan parents.The framework of what (the problem is), who (is to blame), why (did this happen), when (theproblem is perceived to exist) was used to do in-depth interviews with 36 randomly selectedfamilies involving both mothers and fathers.ResultsFive main components emerged from the PADS reflecting the negative upheaval in theparents’ life, a positive evolution from the experience, a negative emotional reaction, beingworried about the future and unsupported and feeling understood as well as supportedprofessionally. Parental perceptions of the severity of the child’s condition were found to bemore closely related to parental cognitions as measured by the PADS than were objectiveindicators of the situation, such as the extent of the child’s use of technological aids.The framework proved useful in yielding multi-layered, complex cognitions featuring avariety of positive and negative appraisals with several cognitive patterns emerging. Severaldimensions and time frames were considered including thoughts and feelings prior to beingtold of their child’s disability, the impact of being told and strategies for thinking and dealingwith thoughts about the future.

45ImplicationsFor clients – parents’ coping needs and strategies (and related issues) for raising a child witha physical disability, which impact on themselves, the child with a disability and the family,may potentially be more effectively identified and addressed through the application of thefindings of this study.For services – positive strategies that parents used to handle their thoughts and fears asidentified in this study would be relevant for psychologists to incorporate in cognitive therapyused with parents experiencing difficulties, or showing signs of depression or anxiety. Arange of cognitive therapy strategies needs to be available and utilised, therefore staff trainingin these methods may be required.Following this study will be the development of materials to use with parents incorporatingguidelines for parents, psychologists and other allied health staff working with parents ofchildren with disabilities.StatusCompletedProject titleContributorsSummaryPhysical and sedentary activity of adolescents with cerebral palsy – what’s the story?Carol Maher (University of South Australia and Novita), Associate Professor Marie Williams(University of South Australia), Professor Tim Olds (University of South Australia), Dr AlisonLane (University of South Australia)Physical activity has many psychological and health benefits, such as improved wellbeingand reduced risk of diabetes, heart disease and colon cancer. Little is currently known aboutthe physical activity level of adolescents with cerebral palsy (CP). The little that is knownwould suggest that they are insufficiently physically active to achieve substantial healthbenefits – however, existing data is relatively outdated and based on overseas populations.This study aimed to determine current physical activity patterns amongst South Australianadolescents with CP. It also aimed to identify demographic characteristics related to physicalactivity levels in this population.MethodData collection was undertaken using a postal survey comprising two existing survey tools– The Health of Young Victorians Study Adolescent Questionnaire (which examines healthstatus and quality of life) and the Physical Activity Questionnaire for Adolescents (a wellrecognisedquestionnaire examining physical activity in the preceding seven days).Following piloting to confirm reliability and validity for the adolescent CP population, thesurvey was sent to all Novita clients aged 11 to 17 years with a principal diagnosis of CP.Participants were instructed that it was preferable for the young person with CP to completethe survey independently. If necessary, parents/guardians could assist the young person tocomplete the survey, or fill it out on their behalf in the case of severe intellectual disability.Results were compared with recent data from age and gender-matched South Australianadolescents without disabilities.

46Results The survey was sent to 229 potential participants and 118 responded (response rate 51.5%,age range 11 to 17 years, males n=76).Key findings were that:• physical activity level was associated with gross motor function ability (adolescents withless impairment were more physically active than those with greater level of impairment)• adolescents with CP were less physically active than their peers without disability• adolescents with CP participated in lower intensity and more solitary activities thanadolescents without disability• within the adolescent population with CP, there was a trend towards increased physicalactivity being associated with male gender, lower age and higher socioeconomic status.These are the same factors recognised as being associated with physical activity level inthe adolescent population without disability• the sedentary activity patterns (television viewing, recreational computer use, videogames) of adolescents with and without CP were very similar.ImplicationsFor clients – adolescents with CP are participating in a variety of physical activities, howeverthere is a tendency towards low-intensity, relatively solitary activities. It appears that the vastmajority of adolescents with CP are not undertaking physical activity of sufficient intensity toachieve psychological benefits.For services – therapists should aim to assist their adolescent clients to participate inphysical activity that will lead to both social and physiological benefits. Services are neededto assist adolescent clients to participate in physical activity.StatusCompletedProject titleContributorsFundingRelationship between caregiver time and mental health and wellbeing of motherscaring for children with chronic disabilityProfessor Michael Sawyer (Women’s and Children’s Hospital and University of Adelaide),(listed alphabetically) Peter Baghurst (Women’s and Children’s Hospital), Michael Bittman(University of New England), Angela Crettenden (University of Adelaide), Peter Flett (CalvaryHealth Care, Tasmania), Annette La Greca (University of Miami, USA), Jon Martin (AutismSA),Dr Parimala Raghavendra, Dr Ray Russo (Child, Youth and Women’s Health Services),Marie Iannos (Research Assistant, Women’s and Children’s Hospital)• National Health and Medical Research Council

47SummaryMethodResultsImplicationsStatusThe increased use of home-based care for children with chronic disabilities greatly increasesparental responsibilities for the care of these children. While the change has the potentialto benefit the psychological and social health of children and reduce health costs, greateruse of this approach to manage children’s disabilities places substantial financial and timedemands on children’s primary caregivers. These demands require mothers to substitutetime for caregiving which was previously available for other activities, including paidemployment, time with spouses, time with other children, hobbies, recreation or sleep. Thishas the potential to adversely affect the psychological adjustment and health-related qualityof life of mothers – a significant problem as the potential benefit of home-based care forchildren with chronic disabilities will only be realised if caregivers remain healthy.It seems unlikely that caregivers will be able to provide effective care for children if their ownhealth has been compromised by the children’s disabilities. The aims of this study are toaccurately describe the amount of time mothers of children with cerebral palsy (CP) or autismspend caring for their children, to investigate the relationship between the time required forcare giving and the mental health and wellbeing of mothers of children with CP or autism andto compare the time required by mothers to care for children with CP or autism with the timerequired to care for children without disability.This study is utilising a cross-sectional survey design. Participants will consist of 300 mothersof children with CP, 300 mothers of children with autism and 300 mothers of children withoutdisability. All children are aged three to 17 years.All mothers will complete a time diary specifically developed for the study which has beenmodeled on Australian Bureau of Statistics (ABS) time use diary. Activities during a 24hour time period are recorded in five minute intervals. The diary records main activitiesand whether the activities were performed for the purpose of caring/supervising the child,simultaneous activity and the intensity of effort or level of support provided for an activity withthe child. Mothers also complete standard questionnaires assessing maternal psychologicalfunctioning, health-related quality of life, maternal perceived time pressure and assessmentof social support.159 mothers of children with autism, 96 mothers of children with CP and 10 mothers ofchildren without disabilities are currently participating.A preliminary analysis of results from the time diaries of 12 mothers of children with autismand 20 mothers of children with CP showed that on average, mothers of both groups spentjust over six hours (or 43%) waking time caring for their children. Mothers of children withautism were waking up four nights in 12 (for between five and 100 minutes) and mothersof children with CP were waking up six nights out of 20 (for between five and 25 minutes)caring for their child. A comparison of 29 diaries of mothers of CP with 1997 ABS time usedata of mothers of children under the age of 15 showed that mothers of children with CPwere engaged in much larger amounts of child-care activities, reducing time for recreation,domestic activities and personal care.For clients – the outcomes of the project may lead to the development of effective supportto reduce the problems experienced by primary caregivers and ensure they can play aneffective ongoing role in the care of children with chronic disabilityFor services – a better understanding of the mechanisms by which environmental stressorsgive rise to mental health issues in mothers of children with autism, CP and children withoutdisabilities and the general population.Ongoing

48Project titleContributorsSummaryWhat does it mean to have a friend? The friendships, or lack of, for adolescents witha physical disabilityMichelle Alexander, Karen Heseltine (University of South Australia)Previous research has identified that young people with disabilities can often feel lonelyand isolated and may have difficulties establishing friendships. This can be due to physicalbarriers (such as the young person requiring adult assistance at all times, or the placeswhere friends gather being inaccessible for wheelchairs) as well as attitudinal barriers (suchas young people with disabilities feeling like they are seen as ‘only a kid in a chair’, and notsomeone that others would want to take the time to get to know).Most of the information about the friendships of young people with disabilities comes fromtheir parents or teachers, so the aim of this research is to ask the young people themselves.Using a one-on-one interview process, information obtained from these teenagers will beutilised to further the development of relevant programs delivered by Novita that address thesignificant issues raised by the young people.MethodResultsImplicationsNovita clients aged between 13 and 18 who are able to answer open-ended questions wereinvited to participate in this project. The method of collecting information was by face-to-faceinterviews between the researcher and the participant.A total of eight clients were interviewed. These in-depth interviews were recorded andtranscribed by the researcher. Results are currently being analysed. The qualitativemethodology of Glaser’s Grounded Theory is being applied in the analysis process.For clients – participants (as well as other Novita clients) will hopefully be able to see and feelthat they are not alone in feeling socially isolated or in experiencing barriers to developingfriendships. Families will also benefit in gaining a deeper understanding of their teenager’sexperiences and thus facilitate positive relationships within families.For services – therapists, teachers and managers will also benefit in gaining a deeperunderstanding of the friendship experiences of our teenage clients and will hopefully beable to use this information to devise practical strategies and create opportunities to bettersupport this client group.StatusOngoingNovita’s MD Mafia - asocial group for teenageboys with musculardystrophy.

49Project titleContributorsSummaryThe prevalence of low back pain in parents of children with a physical disabilitybetween five and 12 years of ageMathew Prior (University of South Australia), Professor Karen Grimmer (University of SouthAustralia), Susan GibsonLittle is known about the prevalence of low back pain (LBP) in parents of children with aphysical disability. A previous study of the prevalence of LBP in parents of young childrenwith a physical disability aged up to five years (Ward, 2003), undertaken by Novita and theUniversity of South Australia, identified that it was a common issue for parents of children inthis age group. Given that children become bigger and heavier as they grow, it seems likelythat LBP will be prevalent in parents of older children with physical disabilities.This project aimed to measure the prevalence of LBP in parents of children with a physicaldisability between five and 12 years of age. It also aimed to identify risk factors for LBP inthis population, such as whether or not parents had experienced LBP in the past, factorsrelated to their child (such as type of disability, and height and weight) as well as the types ofactivities parents might undertake when caring for their child.MethodResultsFollowing piloting, a survey tool (consisting of the Nordic Low Back Questionnaire, theOswestry Low Back Pain Disability Questionnaire and a purpose-designed DemographicQuestionnaire) was mailed to the parents of 300 Novita children aged between five and 12years of age. Repeated mail outs were used to enhance the response rate.A total of 78 participants responded to the surveys (26.1%). A key finding was that theprevalence of LBP reported by participants was considerably higher than that reported for thegeneral population. More specifically:• 48% reported experiencing LBP at the time of completing the survey• 48% reported experiencing LBP within the last seven days• 85.3% reported experiencing LBP within the last 12 months• 89.5% reported experiencing LBP at some point in their lives.In terms of risk factors for LBP, the child’s level of functional ability was most highly correlatedwith parental LBP (ie parents of children with more significant disabilities reported a higherincidence of back pain). Providing assistance for children’s functional activities, particularlymealtimes, was a significant risk factor for experiencing LBP.ImplicationsFor clients – LBP is a considerable problem among families of children with disabilities.For services – therapists need to work with clients to minimise the risk of, and developstrategies for dealing with, LBP. In the future, Novita will explore additional services to helpparents protect their backs. Such services may include back care and lifting classes andwritten information packages. Further research investigating the duration and nature oftasks undertaken by parents of children with a physical disability may help identify ways ofreducing the prevalence of LBP in this population.StatusCompleted

50Project summariesProducts and technology for personal use in daily livingNovita staff contributors highlighted in boldProject titleContributorsSummaryIdentifying Suitable Accessible Gaming Controller Solutions and OptionsDavid HobbsModern gaming systems capture the interest and excitement of the young and youngat heart. Not surprisingly, Novita clients also want to enjoy such video games with theirpeers – however, almost all gaming system use controllers (or consoles) that are veryinaccessible. Their buttons are small, too close together and difficult to get to for someonewith a physical limitation, and many gaming systems require two-handed control, whichfurther disadvantages people with a physical limitation. Consequently, the area of ‘accessiblegaming controllers’ developed as Novita therapists sought to identify appropriate solutionsthat provided greater access to gaming systems.Rather than re-invent the wheel and create a customised interface for accessible gaming,this project aims to identify a range of commercial, off-the-shelf solutions that satisfy therequirements for accessible gaming. The product can then be reviewed for suitability and, ifpossible, purchased/loaned from the manufacturer to enable Novita clients to trial the device.Where a device can be trialed, feedback is sought so the device can be rated, with the viewto determining its overall suitability for a given physical limitation.MethodA review of available gaming accessories, online gaming forums and websites and specialistadaptive technology centres and internet resources was conducted in an attempt to identifyexisting custom or commercial solutions. Surprisingly, the area of non-standard gamingaccessories is larger than first thought. Many of these products, which are pitched to highlevel(able-bodied) gamers as giving them an advantage, can be translated into the disabilitysector to provide greater gaming access.The range of potential solutions – including information on controllers, where they canbe purchased and cost in Australian dollars – has been captured in a document entitled:Alternative Gaming Controllers/Consoles. This document was circulated to interested Novitaoccupational therapists as a resource for future client referral, and given to families who makeenquiries about accessible gaming options.ResultsThe search undertaken revealed a number of potentially appropriate commercial solutions.One such product, the X-Arcade Controller, was purchased for Novita clients to trial asit offers larger, more accessible buttons and can interface with all three leading gamingsystems (PlayStation, X-Box and Nintendo) as well as a PC. In conjunction with Novitaoccupational therapists, a free two to three week trial of the controller can be arranged on thecondition that the client or their family provides constructive feedback on its suitability.To date, seven Novita clients have trialed the controller and feedback has ranged from ‘tooheavy to rest on my lap, too many buttons’ to ‘I could use a joystick and the buttons at thesame time’. In one instance it was the first time the child had played a game independently,and the trial worked so well the X-Arcade was bought for him for his birthday.

51ImplicationsStatusThe Alternative Gaming Controllers/Consoles document is currently in its third iteration andcontinues to be updated on a semi-regular basis when new devices enter the market orprices and availability change. The document acts as a reference and resource for enquiriesabout accessible gaming and has already enabled many Novita clients to find an appropriatesolution.OngoingProject titleContributorsSummaryThe Development of a ZigBee-based universal remote controlTravis Bessell (Flinders University), Matthew Randell (Flinders University), Paul Wator (FlindersUniversity), Tim Sierk (Flinders University), Professor Greg Knowles (Flinders University),David HobbsThe ability for a person with a disability to independently control appliances around the homeenvironment, such as a TV, DVD player and stereo, is satisfying and empowering. However,traditional commercial remote controls are usually inaccessible to someone with a physicaldisability, mainly due to the buttons being typically small and difficult to operate, the buttonlabels being difficult to read and the controls not being switch accessible. An opportunityexisted to develop an accessible remote control for home automation for the disability andageing markets.The aim of this project was to start from a Universal Design perspective and develop afully accessible remote control (termed a Universal Remote Control, or URC) that could becustomised to suit the person using the control and operated by people with a wide range ofabilities. The team was expected to produce a working prototype URC that took advantage ofthe latest wireless technology to communicate, hence eliminating the need for ‘line of sight’operation (a problem for traditional remote controls).MethodThe project was initiated and specified by staff at NovitaTech and submitted to FlindersUniversity’s School of Informatics and Engineering as a Final Year Honours Project forconsideration. Work on the project began in March 2005 (with Bessell and Randell, two FinalYear Engineering Students) who developed a working prototype URC under the supervisionof Professor Knowles. The students incorporated the design specifications and UniversalDesign methodology into their project with resounding success, having a working prototypecontroller available for the public to use with a TV, DVD player and a lamp at the 2005Engineering Expo Day held at Flinders University.Wator and Sierke (2006 Final Year Engineering Students) followed on from Bessell andRandell with the aim of simplifying the 2005 URC design, developing a more robust andcompact circuit board package, designing a single-chip solution and creating a moreintelligent controller in general.

52ResultsThe prototype URC that was developed was an accessible learning remote control for thehome environment. It used a new wireless method to communicate, removing the ‘line ofsight’ problems that hamper traditional remote controls. This new wireless technology (calledZigBee) was an ideal choice due to its specific relevance in a home automation setting, lowpower consumption (meaning longer battery life) and unique security features.The URC was based on a commercially available personal digital assistant (PDA) andfeatured switch scanning capability, direct ‘touch screen’ access, high contrast dynamic resizeablebuttons, flexible software to alter scan rates, colours and other functionality, audiblecues when scanning and selecting different options, voice output capability at the mainmenu screen and no ‘line of sight’ issues. Since few commercial products currently exist withZigBee capability, the URC operated a commercial TV, DVD and lamp through a ZigBee-toinfraredconverter, which provided the mechanism for control.ImplicationsStatusThe project demonstrated that developing a URC using a commercial product as aplatform, combined with a new and emerging technology (in ZigBee), was possible. Whileyet to undergo usability trials to collect feedback and general comments on design andperformance, the URC represents an important proof-of-concept model for accessiblecontrollers.CompletedThe prototype universal remote control, which is based on acommercially available personal digital assistant

Project summaries53Products and technology for personal indoor and outdoormobility and transportationNovita staff contributors highlighted in boldProject titleContributorsSummaryWheelchair usage: tracking wheelchairs and their users – a pilot study usingminiature data loggers (MDLs) to identify wheelchair usage patternsDavid Hobbs, Jillian Los (Queensland University of Technology), Dr Lloyd Walker, DrShirley Fitzgerald (University of Pittsburgh, USA), Dr Dan Ding (University of Pittsburgh, USA),Michelle Tolerico (University of Pittsburgh, USA), Robert Bingham (Royal Perth Hospital),Professor John Evans (Queensland University of Technology)There is little published research on how and how often wheelchairs are used in a communitysetting. The purpose of this study is to investigate usage patterns and communityparticipation of paediatric wheelchair users in Australia. The University of Pittsburgh’s HumanEngineering Research Laboratories have conducted a study by the same name with adultparticipants (see references below), however this study is the first to investigate wheelchairusage amongst children. The information that is collected will be combined with that fromPittsburgh to produce a broader and more comprehensive study relevant to wheelchair usersof all ages.Wheelchair activity is collected via a miniature data logger (MDL) that is attached to thespokes of a manual wheelchair’s wheels. It collects information on six variables – the distancetravelled forwards and backwards, the average speed travelled forwards and backwards andthe total number of times the chair stops during the day over a three month period. The dataobtained from this pilot study will be significant as it measures and records actual wheelchairactivity rather than perceived or estimated use. The data can then be analysed for trends andpatterns.MethodPotential participants are identified and referred by Novita therapists or respond directly toan advertisement in one of Novita’s publications. Once consent has been given, the MDLis attached to the child’s wheelchair and remains there for the duration of the trial. Parentsare asked to complete a questionnaire and the chief investigator interviews the wheelchairuser to gauge their feelings on certain aspects of their wheelchair (if they are capable ofanswering the questions posed). The questionnaire contains questions relating to the user’sdemographics, their wheelchair and their community participation. The inclusion criteria forparticipants is that they be manual wheelchair users (for greater than 20 hours per week) andbe under 18 years of age.The MDL collects information on all wheelchair movements from the moment it is attached,to an accuracy of one third of a wheel rotation. After the trial has been completed the MDLis removed, the raw data is downloaded and processed using a MATLAB program and theinformation is analysed.The MDLs are capable of reporting on wheelchair usage patterns by virtue of three internalsensors and a magnetic pendulum. Each time the pendulum passes a sensor, a time stamp(precise to a tenth of a second) and the sensor number is recorded. A motion is determinedas being clockwise or counter-clockwise according to the sensor sequence recorded, andforwards or backwards motion can be determined. A MATLAB program analyses the rawdata and reports on activity for all six quantities in hourly intervals (ie 1-2am, 2-3am etc) forevery day of the trial.

54ResultsImplicationsStatusReferencesInternal trials and testing of the MDLs identified inaccuracies in the data collection and theunits are currently being redesigned in the US. When the new MDLs have been received theywill be validated for accuracy and reliability prior to starting a clinical trial in the field. Finalethical clearance for the project was granted in May 2005.This project will provide a better understanding of wheelchair usage and typical ‘patternedbehaviour’ of paediatric wheelchair users. The study will reveal actual activity levels, whichare an indication of how much an individual is actually using their chair. This informationcould help to identify the type of chair that is better suited to a particular population(lightweight versus ultra-lightweight) given an understanding of the individual’s level ofparticipation and functional level.OngoingSpaeth DM, Cooper RA, Albright S, Ammer W and Puhlman J, Development of a miniature data logger for collectingoutcome measures for wheeled mobility. Proceedings 27th Annual RESNA Conference, Orlando, FL, 2004Cooper R, Cooper RA, Ding D, Hoover AE, Dvorznak M, Fitzgerald SG, et al. Wheelchair usage pattern: Does agematter? Proceedings 27th Annual RESNA Conference, Orlando, FL, 2004Project titleContributorsSummaryMethodDevelopment of a test instrument to determine the maximum speed, accelerationand deceleration of electric wheelchairsBen Symonds, Alex SvistounovThe NovitaTech engineering department manages an independently accredited testinglaboratory that undertakes Standards testing of rehabilitation equipment. ISO 7176-6Wheelchairs - determination of maximum speed, acceleration and deceleration of electricwheelchairs is an International Standard that provides a detailed procedure for testingand recording the speed and acceleration of electric wheelchairs, including the details ofthe accuracy and resolution of the instrument used to measure these parameters. Thesespecific requirements required the development of a purpose built instrument that theEngineering Test Laboratory could utilise for testing to this standard. Thus in collaborationwith the Research and Development department the required instrument was developed andconstructed.Acceleration measurements were obtained using an accelerometer (similar to those usedin automotive airbags) and a micro-controller that captured and recorded the accelerationdata on a standard SD memory card (the same as those used in most digital cameras).The system obtained and logged acceleration values over time whilst the wheelchair wasoperated through a test regime. The data was then uploaded to a computer and analysed bysoftware to derive the required acceleration information. Data relating to the velocity of thewheelchair was then derived mathematically.All hardware and software was carefully specified in order to comply with the Standardrequirements and calibrated against calibrated reference instruments and equipment in thelaboratory.

55ResultsImplicationsStatusThe instrument complies with the Standard requirements as follows:• able to measure and record speed up to 5m/s, with an accuracy of +/-0.1m/s, a samplerate greater than 60Hz and facility to detect 10% and 90% values of maximum speed• able to measure and record acceleration up to 5m/s2, with an accuracy of +/-0.2m/s2,a sample rate greater than 60Hz and a frequency response such that frequencies above30Hz are rejected.This instrument provides the laboratory with the capacity to perform testing to theStandard test methods of ISO 7176-6. Given that Australian Standards are moving towardsharmonisation with the International (ISO) standards, it is expected that this test methodwill soon be adopted as an Australian Standard for electric wheelchairs. Thus there is anexpectation that all chairs requiring Australian Standards compliance in the future will alsoneed to demonstrate compliance with the test method of ISO 7176-6.CompletedProject titleContributorsSummaryInvestigating the use of switches as inputs to powered wheelchair driving controlsand the associated risksChris Hern (Flinders University), David Hobbs, Rob Garrett, Jeff PriceIn the field of assistive technology (AT), using a switch is often the only way someone with adisability can make a selection and control a piece of equipment. From a risk managementperspective, switch integrity and performance was highlighted as a potential safety issue,particularly when the switch in question is used in a critical situation.If a switch activates a toy and it doesn’t work, the worst-case scenario is that that the clientdoesn’t receive the ‘cause and effect’ response they were expecting. However, the use ofswitches as inputs to powered wheelchair driving controls is becoming more popular as newand improved products emerge. This raises concerns as to the suitability of switches beingused in these applications, since switch failure in this circumstance could potentially result inserious injury. If the switch were to fail in the ‘off’ position, the user would be unable to controltheir wheelchair and be left stranded as a consequence. If the switch fails in the ‘on’ position,the user could be uncontrollably driven into oncoming traffic or a stationary object.The aim of this project was to produce a minimum acceptable specification for switches thatare used as driving controls and evaluate existing switches against this specification.Using switch-adapted devices

56MethodThe following process was used to gather information:1. Investigate the evidence of switch failure and cause of failure when used for AT purposes2. Investigate the claimed mechanical and electrical life of switches being used for drivecontrol3. Determine the supplier stance on using their switches for driving controls4. Investigate the number of Novita clients using switches for drive control5. Identify Standards/specifications that already exist for switches6. Undertake a risk analysis to determine the best course of action.An email seeking information regarding each of the steps outlined above was sent to a broadspectrum of professionals and users NovitaTech has collaborative links with. The networkincluded switch users, therapists, technicians, engineers and caregivers. 23 responses werereceived, which formed the basis for the investigation.ResultsThe NovitaTech Electronic Workshop repair records database provided comprehensive detailof all switch failures and assumed causes dating back to 1996. 31 switch repairs had beenperformed by NovitaTech staff since July 2002, indicating that the failure rate is low whencompared to the 1336 switch sales over the same period.Cable and plug failures were found to be the most common cause of failure attributing toover 70% of repairs. Other associated problems included the switch casing breaking due toexcessive strike force, microswitch failure, ingress of foreign matter (saliva, dust, food, etc)causing the casing or tilt mechanism to ‘stick’ in either ‘on’ or ‘off’ positions, and switchesbeing generically built and not suitable for heavy duty usage. Email responses emphasisedthe problems with cable/plug systems in AT applications, and the ingress of foreign matterinto the switch, as significant causes of failure.Only five clients (children and adults) were identified as using switch driven wheelchair controlsystems, and there were no reports of switch related problems associated with these users. ASwitch Driving Safety Guide was developed to educate users and their caregivers about thesafety issues around driving a power chair with a switch.ImplicationsWith the correct prescription of a suitable switch, power wheelchair control using switches isa viable and risk manageable solution. As there are many switch types and solutions on themarket, selection of the most appropriate switch setup should be performed on a client-byclientbasis, by trained professionals with sufficient knowledge of the user’s need and switchtechnology available.It is imperative that the switch setup selected is maintained and checked to detect signs ofpotential failures. Switch checks should be performed daily by the user or caregiver prior touse by following an appropriate guide, with thorough maintenance undertaken on a regularbut less frequent basis by a qualified switch repair technician.StatusCompleted

57Project titleContributorsFundingSummaryMethodResultsThe design and development of a semi-autonomous wheelchair for obstacleavoidanceAlan Rowland (University of Adelaide), Qiang (David) Liu (University of Adelaide), Dr Lei Chen(University of Adelaide), Ben Symonds, David Hobbs• The Pickard FoundationThe aim of this project is to investigate the field of ‘smart wheelchair’ technology, and developa system for semi-autonomous wheelchair control that can be retrofitted to an existingpower wheelchair. A ‘semi-autonomous’ wheelchair is one where the user has almost fullcontrol of the chair and where it can go, but the system is smart enough to detect when thechair is about to hit a solid object (like a wall or piece of furniture) and adjusts its directionappropriately. A parent of a Novita client submitted the idea, suggesting that the systemcould be attached to the power wheelchair of new drivers who were still coming to terms withdriving, preventing them from hitting walls, causing expensive damage and improving driversafety.Many semi-autonomous wheelchair systems have been designed in the past, however noneare commercially available. All these systems have been designed with new wheelchairprototypes, not allowing retrofitting onto existing wheelchairs – meaning would-be-usersneed to buy a whole new chair, not just the add on smart technology. These systems are veryexpensive to build, and are not viable for most wheelchair users. The aim of this project wasto design a system that retrofits onto existing wheelchairs and improves driver safety.The project began with a thorough literature review on the topic of smart wheelchairs andwheelchair obstacle avoidance/falling avoidance systems. The report was to detail a fullbackground summary of the concept of wheelchair control, a search of all related projectsthat are being conducted in this area around the world, and the identification of the mostsuitable methodologies and components that should be used in the project (that is, the mostsuitable sensors to use, the best methods of obstacle detection, etc).The next stage of the project was the development of an ‘add on’ acoustic alerting systemfor wheelchair obstacle avoidance and fall detection, which would alert the user of obstaclesthrough tones and beeps only (like a reversing or parking sensor for a car). This step wouldlay the foundation for developing a semi-autonomous ‘active’ wheelchair control system.The literature review identified a number of research projects being conducted in this field,namely the INRO robotic wheelchair (Germany) and the Wheelesley robotic wheelchairsystem (USA). No smart ‘add on’ or retrofitting systems were identified in this review,indicating a possible new market.The acoustic alerting system was developed using four ultrasonic sensors – one on the frontand rear, and one on each side of the chair, angled towards the front. Each sensor had asensing area of around 60° and the depth of sense could be controlled, depending on thedesired level of sensitivity.The Dynamic Controls DX control system was chosen as the wheelchair system to interfacethe design to, since the majority of powered wheelchairs in Australia use this system. Thefinal prototype system was retrofitted to an existing powered wheelchair and slowed the chairdown when approaching obstacles (going backwards or forwards) and veered the chair awayfrom objects on its side.

58ImplicationsStatusThe project was able to identify all research activity in this area from around the world,develop a working acoustic system for alerting a wheelchair user of a potential safetyhazard, and prototype a semi-autonomous system for active wheelchair control. This projecthas implications for increasing the safety of driving a powered wheelchair, particularly fornew drivers, and for protecting the environment around them from being damaged due toaccidental bumps.OngoingNovita client Edward andfather Kevin with the prototypeultrasonic sensor system

59Project titleContributorsSummaryTransporting kids and their wheelchairs – parents’ perceptionsHugh Stewart (University of South Australia), Dr Lloyd Walker, Meredith Frogley, LouiseDuBois, Chris Hern (Flinders University)The importance of independent mobility on the quality of life of children with disabilitieshas been recognised since the 1980’s and the rate of prescription of power wheelchairs forincreasingly younger children continues to grow (Wiart et al, 2003). However, a number ofparents and therapists at Novita reported that the process of finding and modifying a vehiclein which to transport children and their wheelchairs is problematic.Rehabilitation professionals like occupational therapists (OT) and physiotherapists (PT)are often the first people parents will ask for help once they recognise a transport problem.However, a study by Blake et al (2006) in the USA that involved surveying more than 1000rehabilitation therapists found that more than 50% reported little knowledge or experiencewith transport of children with special needs. Assuming the experience is similar in Australia,many therapists are then in the same position as the families, with limited knowledge andexperience of the problem.The aim of this study was to improve the process and resources available to families whowant to purchase a vehicle for their family, and to understand how Novita families have solvedthis problem in the past.MethodThe research questions were:1. Describe the vehicles and modifications used by parents to transport their children andwheelchairs.2. Describe the funding arrangements used to purchase the vehicle.3. What information would parents who have purchased a vehicle consider most importantfor parents wishing to buy a vehicle?A survey questionnaire was devised by three of the authors (based on their knowledge ofthe issue) to collect quantitative descriptive data and some qualitative data. It was reviewedby Novita OT and PT staff and appropriate changes were included into the final survey. Anintroductory cover sheet and the questionnaire with a post-paid return envelope were mailedto all parents of children who used a wheelchair in three of the five Novita regions. 358questionnaires were sent out and the responses were analysed by one of the research teamwho was independent of the initial survey construction.Results18% of questionnaires were returned and then grouped as follows based on the chair typeand use of a vehicle hoist: manual (53%), manual with hoist (21%), power (1%), power withhoist (11%), and both power and manual (14%). Most families with children in manual chairsat home, or able to transfer from their chair, used a regular car or station wagon. Once a childused a power chair at home the families needed to consider a van or other arrangement.Many families did not gain funding for the hoist and vehicle modifications due to either lackof knowledge, ineligibility or being unable to wait. A thematic analysis of the responsessuggested that other parents should obtain information in three main areas – informationabout their own child and family transport needs, information about vehicle features andoptions, and knowledge about the funding and purchasing process.

60ImplicationsStatusReferencesFamilies are faced with a big decision when it comes to buying a vehicle in which to transporttheir child and wheelchair. Information and help is available from a variety of sources and thechallenge for service providers is to have the information and expertise available efficiently. Itis important to provide information about the features of various vehicles and other productslike wheelchair lifters and restraint systems. Moreover, the experience of other families isconsidered an important part of this process in helping families decide on the priority ofvehicle features for their needs.CompletedBlake E, Sherman K, Morris L and Lapidus G, 2006, Self reported experience with safe transport of children withspecial Healthcare needs, American Journal of Physical Medicine and Rehabilitation, 85, 2, 181-184Wiart L, Darrah J, Cook A, Hollis V and May L, 2003, Evaluation of powered mobility use in home and communityenvironments, Physical and Occupational Therapy in Pediatrics, 23, 2, 59-75Novita client Jack andmother Natalie

Project summaries61Products and technology for communicationNovita staff contributors highlighted in boldProject titleContributorsFundingSummaryThe NovitaTech Snowy Hydro Telecommunications Road Show: Promotingaccessible telecommunications optionsToan Nguyen, David Hobbs• Snowy Hydro Ltd• Engineers Australia’s College of Biomedical Engineers• Nokia• Telstra Disability Services• MotorolaThe idea for a national Telecommunications Road Show was developed in response to oneof the outcomes of a clinical trial research project conducted by Toan Nguyen in 2003. Theresearch highlighted that people with a disability can and want to use a mobile or homephone, despite limited functionality due to their impairment, but that they aren’t aware ofthe range of technological solutions that exist, or how to use a particular device to its fullestextent. This was identified as a ‘technology gap’ – and one solution for bridging this gap wasto conduct a national educational workshop series.The aim of the NovitaTech Snowy Hydro Telecommunications Road Show was to conduct aseries of 10 workshops around Australia to promote how someone with a physical disabilitycan use a home or mobile phone effectively and efficiently. The workshop provided anopportunity to highlight and demonstrate solutions that involve matching the person with adisability with a specific piece of telecommunications technology – solutions that are knownto work based on knowledge and experience from clinical trials and direct client feedback.MethodThe workshop was purposefully structured to provide a forum for discussion onimportant telecommunications issues, such as the involvement and participation of thetelecommunications industry in the area of accessible information. The day was alsostructured so it incorporated a mix of lecture-style presentation and a hands-on session inthe afternoon, involving a demonstration of the equipment as it would be set up in a real lifesituation.Attendees were encouraged to ask questions and discuss individual case studies orpotentially difficult solutions they were aware of based on clients they were working with. Aone-page feedback form was distributed at each workshop and attendees were asked tocomment on the quality of the material presented, whether or not their expectations of the daywere met, and to provide an overall score out of 10 for the workshop for future improvements.

62ResultsThe workshop series began in Adelaide May 2005 and was facilitated by David Hobbsand Toan Nguyen. Thereafter, the Road Show travelled around Australia for three weeksconducting one-day workshops in Darwin, Perth, Melbourne, Hobart, Sydney, Canberra,Newcastle, Townsville and Brisbane.The Road Show was attended by over 130 people, with attendees coming from many diversebackgrounds including allied health, volunteers from Technical Aid for the Disabled, peoplewho have a disability or who work with someone with a disability, rehabilitation engineeringand those from within the telecommunications industry. Of the 99 feedback forms that werereturned by the attendees, the average overall score that was received was 9.2/10 (medianscore 9.5). Verbal and written comments received were also outstanding.ImplicationsOverall, the NovitaTech Snowy Hydro Telecommunications Road Show was a verysuccessful, high quality educational and awareness-raising program that was delivered rightaround Australia.Following on from the Road Show and due to NovitaTech’s knowledge and expertise in thearea of accessible telecommunications, the team continues to receive telephone and emailrequests for information, ideas and assistance to find telecommunications solutions forpeople with a disability from all over Australia.StatusCompletedProject titleContributorsFundingSummaryMobile phone interface system for communication device usersToan Nguyen, Rob Garrett• Australian Government Department of Communications, Information Technology and theArts, Telecommunications Research Grant• Telstra Disability ServicesThe ability to independently operate commonly used telecommunications technology is aright that all people should have. This applies particularly to children and young adults, aswithout it their educational, personal and social development can be restricted. In additionto formal use, communications technologies are of major significance for children with adisability who are trying to develop friendships with peers.This research aimed to trial, validate and evaluate a prototype mobile phone to speechgenerating device interface system developed by NovitaTech. The system enables the userto independently initiate, answer and terminate voice calls and send text messages throughthe use of their communication device. The trial included two participants with physicaldisabilities who cannot speak and who use communication devices. The outcomes from thistrial were used to refine the prototype system and define the final product for use by othercommunication device users. This new system will enable them to independently accessa mobile phone, opening up a whole new range of educational, recreational and socialopportunities.

63MethodResultsThis research trialed, validated and evaluated a prototype interface system between acommercial mobile phone and a speech generating device (SGD) for people with complexcommunication needs. Trials were conducted with two participants (a child and an adult)with a physical disability who cannot speak and who require a communication device tocommunicate independently. The system supported both voice calls and text messaging.Various assessment methods including the Canadian Occupational Performance Measure(COPM) tool were used to measure the participants’ performance and satisfaction whencarrying out these activities before intervention (without the trial system, prior to the trialperiod), during intervention (with the trial system for four weeks, at the end of the trial period)and after intervention (with the trial system, after the trial had concluded and the system hadbeen withdrawn for two weeks).Based on the outcomes of the trials it was found that:• Both participants showed very high results in terms of their overall performance andsatisfaction with the use of the system• Both participants who initially had no independent access to a mobile phone could nowaccess and use it successfully• Access to a mobile phone has not only given the participants a sense of independence,safety and security, but it has also contributed to their communication skills, leading to theself confidence to engage in conversation and social activities.The provision of an effective mobile phone solution for a communication device user canbe achieved by involving the user in the early stages of the solution’s development, incombination with thorough customised training and on going support to accommodate forthe user’s changing needs and newfound abilities.ImplicationsStatusThe outcomes and feedback from both trial participants has helped refine the system to afinal product called ‘SGD Mobile Access’.This research has shown that communication device users can independently and effectivelyuse a mobile phone for voice calls and text messaging and hence should have equal accessto a mobile phone and the associated services. The results have shown that by involvingthe end-user in the early stages of the interface system development and trialling process, avery successful outcome was produced. Providing customised training and ongoing supportthat accommodated the user’s ongoing needs and newfound abilities contributed to thesuccessful outcome.CompletedToan Nguyen with trial participant Rosie and theprototype interface system

64Project titleContributorsSummaryMethodResultsImplicationsStatusDeveloping a ‘no-touch’ switch and interface for a computer and specialisedcommunication deviceCristina Larenas (Flinders University), Anne-Louise Smith (Flinders Medical Centre), SharmilRandhawa (Flinders University), David Hobbs, Annabel Gregory, Jodie Hobbs (FlindersMedical Centre)For many people with a physical limitation, accessing and interacting with the environment isachieved through the use of a specialised switch. Assistive technology (AT) switches comein all shapes, sizes and functionality, depending on the needs of the user and the device orpiece of equipment that is being controlled. For example, a ‘wand’ switch provides singlelevel switch access for clients who have gross hand or arm function, whereas a ‘sip n puff’switch offers two levels of switching capability and is controlled by the user’s breath.Most switches require a physical press to be made to activate the switch, while a few offer‘light touch’ or ‘touch but no pressure’ activation when a sustained physical press is difficultfor the client to achieve. The aim of this project was to develop an easy to use ‘no-touch’switch and appropriate interface to allow a person with a disability to control a computer anda specialised communication device. A no-touch switch would enable someone with a highlevelspinal cord injury, or a condition like ‘locked in syndrome’, who is unable to control anyof their limbs or head, to be able to interact with other specialised devices.The project was jointly initiated by Flinders Biomedical Engineering and NovitaTech followingan enquiry about assistance for someone who acquired a brain-stem stroke and was‘locked in’. The project was submitted to the Flinders University School of Informatics andEngineering as a Final Year Honours Project for consideration, and was divided into fourstages:1. A literature review of current switches and switch practices, including reviewing knownresources and existing ‘no-touch’ switch methodologies, determining what is being usedand identifying the advantages, disadvantages and shortfalls of current systems2. Investigate current and new methodologies that would enable ‘no touch’ activation andselect a suitable technology3. Design and construct a system using the chosen technology4. Interface the system to a computer and existing communication device.After the initial literature review, the focus of the project shifted slightly to the important issueof communication at night-time, when the user may need to communicate with their carersabout being turned in bed, getting a drink or passing on important information.Eye blinking was seen as one method of alerting the system to the fact that the user needsattention, and this activity was targeted using a webcam with infrared (IR) capability incombination with a computer program called MATLAB to detect both the eyes and theaction of deliberate blinking. The prototype system that was developed used the fact that eyepupils have a high reflectance under IR illumination to identify the eyes, and detected blinksby comparing consecutive frames. The system successfully detected the eyes when testedunder varying conditions, resolutions, illuminations and distances from the camera, but wasless successful when detecting blinking events.The prototype system completed at the end of the academic year demonstrated that acamera with IR capability, when set up appropriately, was reliable at detecting a person’seyes at night-time. The robustness of the overall system, including how the system acquiresand processes real-time information to reliably and accurately use blinking as a controlmechanism still needs to be explored further and tested. This form of gesture recognitionmay prove to be more reliable than existing ‘no-touch’ switch methodologies.Completed

65Project titleContributorsFundingSummaryInvestigating telecommunications needs and solutions for older people and peoplewith a disabilityToan Nguyen, Rob Garrett, Sally Hunter (Independent Living Centre, WA), Sylvia Nicholls(Royal Perth Hospital), Rebecca Daniloff (Cerebral Palsy League of Queensland), PaulDash (Cerebral Palsy League of Queensland), Katy Caynes (Cerebral Palsy League ofQueensland), Richard Denton (Flinders University), Tara Schofield (Flinders University)• Australian Government Department of Communications, Information Technology and theArts, Telecommunications Research Grant Program• The Australian Communication Exchange• Telstra Disability Services• Nokia• MotorolaMobile phones have the potential to provide great opportunities for social inclusion, securityand quality of life for people with a disability or the ageing, but unfortunately only few benefitfrom the technology and opportunities they provide compared to mainstream users.As a result of extensive telecommunications research conducted within NovitaTech, key staffmembers have developed considerable expertise in making telecommunications equipmentaccessible and useable by people of all abilities and effectively provide telecommunicationsservice and support to people with disabilities within metropolitan areas. However thisservice and support has never been tested at a national level.The aim of this project was to develop the tools and processes necessary to demonstratethat successful accessible telecommunications service and support can be provided topeople with a disability or the ageing when the accessible telecommunications expert isremote to the end-user. This research is an important first step to validate the feasibility for thedevelopment of a national service delivery model to provide accessible telecommunicationsservices and support to all Australians with a disability or those who have limited functionalityas a result of ageing.MethodThe project was delivered on two levels – an accessible telecommunications trial and aworkshop. The aim of the trial was to provide accessible telecommunications solutions to fourparticipants (two in Perth and two in Brisbane) who needed access to telecommunicationsequipment and services. The trial was carried out with the help of a trained key local personin each city.The aim of the workshop was to promote and educate the general public about existingtechnology and services that can enable people with a disability or the ageing with functionallimitations to effectively use a fixed or mobile phone. The workshop was also intendedas an education and training program for key local persons to assist with the provision oftelecommunications solutions to meet the needs of the trial participants.Modern telecommunications technologies with video streaming capability were used tomonitor progress and provide support during the trial.

66ResultsImplicationsStatusThree important factors were crucial in the successful provision of solutions to theparticipants of the project:1. The key local persons’ role as liaison officers and providing local support to trialparticipants was fundamental to the overall success of the trial2. The one-day workshop and accompanying Accessible Telecommunications Tools andResources Kit developed during the project, equipped key local persons with the right‘accessible telecommunications’ knowledge and know-how. This provided an array ofsolutions, tools and processes to provide an accurate assessment, appropriately matchthe equipment to the user, set up the equipment, then train and troubleshoot problems forthe participants during the trials3. In addition to the use of the traditional telephone and email service, moderntelecommunications technology such as 3G mobile phones with video talk capability andinternet telephony software with video streaming capability were important for providingcommunication and ongoing support between the participants, key local persons andproject researchers.The research and technology trials demonstrated that through the use of appropriatetools, processes, education, training programs and resources, it would be feasible toimplement a service delivery model at a remote and national level to cater for the accessibletelecommunications needs of people with a disability or the ageing. The outcomes ofthis project show that through the use of modern telecommunications technologies andappropriately trained key local persons, we can use our knowledge to remotely assess andsupport the telecommunications needs of people with physical limitations interstate.CompletedProject titleContributorsSummaryLarge keypad for mobile phone accessRob Garrett, Ben Symonds, Toan NguyenNovitaTech’s Research and Development Department has an established track record in thearea of accessible telecommunications, including product development and the identificationof mainstream solutions that can be utilised by people with a disability. When presentingthis work and speaking with key user groups a common request has been for a simple largebutton mobile phone. Similarly, research shows that the ageing would prefer a mobile phonewith larger buttons and simpler functionality (Mann et al 2004). Telstra have developed alarge button landline telephone, however a suitable mobile version is not available on themainstream market.Mobile phones allow people to remain connected with friends and family and impart asense of security, confidence and independence when venturing out of home. Howeverthe concept of a simple large button mobile phone unfortunately seems to conflict with theproduct development direction of the mainstream market, which is heading towards smallerand smaller phones with increased features and complexity. Therefore this project aims toinvestigate the development of an accessible, simplified, large button mobile phone solutionthat will meet the needs of those with a disability and the ageing.

67MethodThe group conducted a comprehensive review of existing mainstream telecommunicationssolutions, available both locally and abroad, that provide enhanced accessibility options.Following this action, an initial specification for an accessible large button mobile phonesolution was created to investigate the feasibility of its development and implementation. Theproposed specification has been developed as a result of feedback gained from nationaltelecommunications road shows and therapists who work directly with those who are ageingor have a disability. From this specification, various visual design concepts and functionalprototypes have been developed to allow demonstration of several potential solutions. Thesemodels, concepts and prototypes will be utilised in further market research, engaging keyconsumer groups and to define a possible solution that can realistically be implemented.ResultsInitial research confirmed that while some promising solutions are emerging, there is stillno suitable mainstream solution available that meets the defined need. Consequently,preliminary specifications for several potential solutions have been documented. These rangefrom the ideal solution down to various levels of compromise, which trade technical andfunctional complexity with cost of design and manufacture.The technical aspects of developing an in-house solution have been extensively investigatedand evaluated, confirming the department’s capability to deliver a solution on a technicallevel. However limitations have been identified with regard to NovitaTech’s manufacturing andcommercialisation capacity.ImplicationsStatusReferencesThrough targeted focus groups, it is hoped to engage the input of consumers and other keystakeholders, to further evaluate and validate the concepts and designs developed thus far.The key challenge into the future will be identifying a channel to deliver the solution to market,ideally through the identification of a suitable and willing industry partner.OngoingMann CW, Helal S, Davenport RD, Justiss MD, Tomita MR, Kemp BJ, 2004, Use of cell phones by elders withimpairments: Overall appraisal, satisfaction and suggestions, Technology and Disability 16, pp 49-57Project titleContributorsSummaryProvision of information on accessibility features for telephone equipmentRob Garrett, Gunela Astbrink (TEDICORE), Teresa Corbin (Consumers’ TelecommunicationsNetwork), Bert Ciavarra (Telstra), Deborah Goodman (Vodafone), Malcolm Garnham (TrilliumCommunications), Kim Yan (Cisco systems), Richard Robbins (NEC Business Solutions),Cecily Yan (Australian Electrical & Electronic Manufacturers’ Association Ltd), Stacey Joyce(Australian Communications & Media Authority)Finding a commercially available phone that could meet the needs of a person with adisability or who is ageing can be a difficult task. To assist with this task, the AustralianGovernment requested representatives of the telecommunications industry and consumersto form a working committee to develop a code and guideline to make information on thefeatures of home, work and mobile phones available. The telecommunications industryis now in the process of meeting the requirements of the code and guideline. Informationshould now be available from the telecommunications service provider outlets for anyone toaccess.

68MethodResultsImplicationsStatusAt the direction of the Australian Communications Authority (now called the AustralianCommunications and Media Authority), an Accessibility Information Working Committeewas established under the auspices of the Australian Communications Industry Forum (nowcalled Communications Alliance). This committee developed:1. An Industry Code that specified the obligations on customer equipment importers andmanufacturers to provide product information on the functional characteristics of homeand mobile phones that would be beneficial to people with a disability2. An Industry Guideline that provides guidance for phone equipment importers andmanufacturers on features of customer equipment used for telecommunications that willassist consumers with disabilities.The Working Committee was established with three consumer representatives, six industryrepresentatives and a non-voting representative from the Australian Communications andMedia Authority.The Industry Code Information on Accessibility Features for Telephone Equipment alongwith the associated Industry Guideline Operational Matrices for Reporting on AccessibilityFeatures for Telephone Equipment (available at www.commsalliance.com.au/documents/codes/C625) now requires telecommunications equipment importers and manufacturersto provide product information on the functional characteristics of equipment that will bebeneficial to people with disabilities. This information is provided to telecommunicationsservice providers who provide the information to their customers. A list of 29 features hasbeen named within the categories of Mobility and Dexterity, Vision, Hearing and Speech.Suppliers are also required to respond to consumer requests for information on particularphones.The industry Code was registered on 17 October 2006. The Code requires industry to complyby 17 April 2007.Those people with a disability or who are ageing, looking for phones that meet theirparticular needs can now approach their telecommunications service provider for additionalinformation that will assist in the selection of a suitable phone. If a phone has been identifiedas potentially suitable, there will be a supplier contact that can provide additional informationnot included in the requirements of the code to assist with the selection.There is now a need for this information to be made available on the internet so that it is moreaccessible to those who cannot visit the service providers’ facilities.CompletedA standard mobile phone

69Project titleContributorsSummaryTelecommunications advisory service for people with physical limitationsToan NguyenIn 2005, through the sponsorship of Snowy Hydro Ltd, NovitaTech ran a nationaltelecommunications road show around Australia aimed at raising and promoting awarenessof telecommunications options and equipment for people who have a physical limitation. Asa result of this public exposure and a growing reputation for successful research, extensiveknowledge and expertise in the area of accessible telecommunications, NovitaTech hasbeen receiving telephone and email requests for information, ideas and assistance to findtelecommunications solutions for people with physical limitations from all over Australia.Given that the service has not been promoted, this indicates the need for atelecommunications advisory service for Novita and non-Novita clients, therapistsand other professionals seeking advice and support to obtain appropriate accessibletelecommunications solutions and services.MethodResultsImplicationsStatusWith appropriate funding, this service could provide the information and support needed toenable Australians with physical limitations access the telecommunications network.NovitaTech has been responding to all telephone enquiries regarding telecommunicationsaccess, options and solutions for people with a physical limitation and logging theenquiries in an Excel spreadsheet. The spreadsheet records the name of the enquirer, theorganisation that they work for (if applicable), the nature of the call and the responses orrecommendations made, the duration of the call and the date the enquiry was received orresponded to. The log provides evidence of the need for funding to maintain this service forall Australians with a physical limitation.Since December 2005, NovitaTech has received an average of one telephone and emailenquiry per week on telecommunications access from people all over Australia. The natureof enquiries varied between the types of people that call up for assistance. Typical enquiriesreceived were:• therapists seeking information and recommendations on the type of mobile phones,accessories or software for their clients to use for security and communication purposes• general public seeking advice on appropriate mobile and home solutions for themselvesor for their elderly parents so that they can independently access the telecommunicationsnetwork to maintain contact with friends, family members and for security and emergencypurposes• end users seeking support to troubleshoot problems that they encountered with theirmobile phone and other telecommunications equipment and accessories.NovitaTech has developed a reputation in providing this service due to our knowledgeof disability issues, the end-users’ needs and the technology available. To date,telecommunications providers have been unable to provide this support successfully acrossthe range of emerging products.Based on the frequency of enquiries received for a non-promoted service, we expect thisservice would be heavily used by the disability and ageing community once it is fundedand promoted. NovitaTech is looking for funding avenues and partnerships to enable thisimportant service to continue and the costs associated with the service to be funded.Ongoing

70Project titleContributorsFundingSummaryThe IBM Web Adaptation Technology and accessibilityWorks software trialRichard Denton (Flinders University), David Hobbs, Annabel Gregory, Dr Lloyd Walker• IBM AustraliaIn 2006, NovitaTech was approached by IBM Australia to coordinate a trial of their latestaccessible internet browsing software. The new programs (called Web AdaptationTechnology for Windows machines and accessibilityWorks or aWorks for Linux machines)aimed to increase internet accessibility and usability for people with a disability and theageing by enabling easier and more effective web page navigation.The software allows the user to create a profile and then customise how the computerdisplays web pages, such as allowing the font size to be increased, having the text on apage read aloud, displaying a web page in a single column of text or making the imageseasier to see. Every time the software is used, a user’s profile and unique specificationsare automatically implemented and every web page is presented in the way that has beenspecified through their profile. Multiple settings can be set so that a combination of thefeatures offered can be implemented at any one time. For example, you may choose to viewall web pages in larger font, with wider letter spacing, have the text read aloud to you andhave banner text running across the top of the browser.MethodThe technology trial was coordinated by setting up a number of IBM PC’s with theaccessibilityWorks software pre-loaded in various disability-related partner organisations toenable people to trial and comment on the software. Four trial locations around the Adelaidemetropolitan area were chosen for their ability to provide access to a range of people witha disability in a public environment. Users were prompted to create a profile when theyused the software for the first time, which they could then customise to their special needswhenever they browsed the internet thereafter.After trialing the software for a given period of time, users were asked to complete a shortonline questionnaire that asked specific questions about the software, how it performed andprompted their opinion in terms of suggested changes or modifications. For privacy reasons,the questionnaire could be completed anonymously.In early 2007, the trial was broadened to include families of Novita clients who could trial thesoftware in their homes. This would allow people who use the software on a regular basis athome to provide feedback.ResultsInitial feedback from two partner organisations indicated that the ability to increase thefont size (for readability) and the text-to-speech functionality (for users who cannot readbut understand spoken English), as well as the ability to create a unique user profile that‘followed’ you whenever you used the program, were some of the most beneficial featuresof the software. Of concern to some users was the creation and storage of a ‘user profile’ ona central IBM server, which required logging in and connecting to the internet each time asession began. This proved to be problematic when double-firewalls were encountered (ie inschool settings). A more comprehensive analysis of the trial and software usability will occurwhen all of the feedback from the trial locations is collected.

71ImplicationsThe ability to get user feedback on new products is critical to both user acceptance of aproduct and the ability to meet user needs and expectations. By actively seeking inputthrough a hands-on technology trial, IBM was providing end users with a direct pathway topotentially improving their end product, and providing people with a disability and the ageingwith an opportunity to improve their internet browsing experience.The trials will continue until late 2007, when a full report will be produced for IBM on theoutcomes of the trial.StatusOngoingProject titleContributorsSummaryMethodResultsVocabulary OrganiserRob Garrett, Ben Symonds, Angela Guidera, Sandra StewartVocabulary Organiser (VO) is a computer program developed by NovitaTech’s Researchand Development (R&D) and Speech Pathology teams. It is designed to assist people whoare supporting users of speech generating devices (SGDs) and other alternative languagesystems, such as sign language. An SGD is a special purpose electronic device (similar toa portable computer) that provides access to sets of photos, drawings, symbols or wordswhich, when selected, result in a message or word being spoken by the device. VO is usedfor designing, producing and storing personalised vocabulary dictionaries for users of SGDsand sign language. The program also enables creation of customised worksheets andflashcards that are utilised to assist training in the use of the personalised vocabulary sets.In recent years, the primary role of this project has been the maintenance of VO’scompatibility with Windows operating systems and the ongoing support provided to users ofthe software. This has involved review and refinement of the installation package, help files,user manuals and the actual software.VO is fully compatible with all Microsoft operating systems from Windows 98 to XP, inclusive.The program is provided on a single installation CD, which installs the program, help files,user manual and a unique individual licence through a simple, intuitive user interface.Support is provided in the form of the comprehensive user documentation, available insearchable help files or a single printable user manual. Technical support is provided byNovitaTech’s R&D department via phone or email as required.The program has been a valuable tool utilised by Novita therapy staff to support users ofSGDs and has been sold to many similar organisations throughout Australia.ImplicationsStatusWith the introduction of the new Microsoft Vista operating system, the future of VO is nowunder review. The ongoing sustainability of the program will be evaluated in the context of itsbenefit to Novita staff and clients with respect to the expense of upgrading the software sothat it can run on the Vista operating system.Ongoing

72Project summariesProducts and technology for culture, recreation and sportProject titleContributorsFundingSummaryThe Virtual Music Instrument – usability trials, program enhancements andcommercialisationDr Tom Chau (Bloorview Kids Rehab and University of Toronto), Eric Wan (University ofToronto), David Hobbs• Lions Club of Charles SturtThe Virtual Music Instrument (VMI) is an innovative computer program that converts bodymovements into music. By using a webcam in combination with a laptop computer, the VMIuses gesture recognition to provide a way for children to be able to play music without havingto hold or manipulate an instrument. The user instead plays music by moving in the spacearound them, which has a series of pre-defined ‘hot spots’ in the form of coloured shapesprojected around them and shown on a screen. The system is sensitive enough to generatemusical sounds from very small movements, such as finger movements, to very large ones,such as waving arms. The VMI is simple to use and is aimed at encouraging people withlimited movement to interact with their environment and to have an impact on it by playingmusic.Dr Tom Chau’s team at Bloorview Kids Rehab developed the VMI program. DavidHobbs identified the program in 2003 during his Churchill Fellowship research as thebest application of technology within the rehabilitation engineering and disability field andNovitaTech was the first centre outside of Toronto to trial the program with people with adisability.MethodIn 2004 NovitaTech received the first beta version of the program, known at the time as theMovement to Music system. Since then, activity has occurred on two fronts – VMI usabilitytrials (aimed at collecting feedback and suggested improvement for the program) and VMIresearch (to quantify the benefits VMI offers people with a disability).The ability to conduct usability trials around metropolitan Adelaide received a significantboost through a donation from the Lions Club of Charles Sturt, which purchased thenecessary equipment to form a mobile VMI Kit. This meant the program could bedemonstrated on-site at special schools around Adelaide. Each year all feedback, commentsand suggestions received are forwarded to the team in Toronto to refine and improve theproduct.VMI research activity is currently pending a successful external grant application.

73ResultsSince mid-2004, the VMI program has been demonstrated at six special schools, twocentres for the ageing, all five Novita regional offices, a selection of Novita outreach (nonmetropolitan)areas, a number of private homes, a local Scouting Group and at the openingof the new Adelaide Airport. These demonstrations have led to the development of long-term,ongoing partnerships with two of the special schools and one of the centres for the ageing,where VM is integrated into traditional daily therapy practice. Most of the feedback receivedduring demonstrations has been incorporated into the latest version of VMI (version1.5), a generally more stable program released in November 2006 with improved musicalfunctionality.Future plans for the VMI at Novita include securing a competitive research grant todemonstrate and measure the benefits it offers people with a disability and the ageing.ImplicationsThe VMI program has been embraced by a number of therapists in Adelaide and in somecases, incorporated into daily school routines to enhance traditional teaching and therapy.Many first time observers marvel at how the program works and intuitively note the benefits itoffers people with limited movement to engage in musical activity.NovitaTech is working with the team in Toronto to produce a commercial version of theprogram (due in late 2007) and are currently finalising an agreement with The University ofToronto to be the exclusive distributor for the program in Australia and New Zealand, and aco-distributor in Southeast Asia.StatusOngoingVMI trial at an Adelaide primaryschool

74Project summariesProducts and technology, Service and Policy DevelopmentNovita staff contributors highlighted in boldProject titleContributorsFundingSummaryAssistive technology in Australia: economic analyses from a user standpoint– methodological implicationsDr Ingrid Schraner (University of Western Sydney), Natasha Layton (Consulting OccupationalTherapist, Melbourne), Agata Molenda (University of Western Sydney), Dr Lloyd Walker,Desleigh de Jonge (University of Queensland), David Hobbs, Jane Bringolf (IndependentLiving Centre NSW)• University of Western Sydney Research Partnership Program GrantAssistive technology (AT) funding in Australia is complex and fragmented. There aredifferent funding schemes and criteria for each state and territory as well as the AustralianGovernment, ostensibly to meet the equipment needs of people with disabilities. At the lastequipment survey conducted by the Australian Bureau of Statistics, more than 50% of peoplewith a need for AT did not have it.This project is concerned with the economic evaluation of the costs and effectiveness of AT,for people with a disability and the ageing population, particularly considering otherwisehidden, unrecorded or transferred costs. In an economic evaluation, the standpoint of the ATuser provides the deepest insight into costs and benefits to society as a whole – provided all‘economic actors’ (people or institutions engaged in the process of production, consumption,distribution or regulation of goods and services that together deliver AT, or have somethingto do with the AT user) are considered in the context of their incentives (that lead to theirdecision making). The project is grounded in the context of the AT user – an approach sharedby the International Classification of Functioning, Disability and Health (ICF).MethodThis collaborative project established some foundational principles to maintain a strong clientfocus. Subsequently three sub-studies have been undertaken to:1. Identify and then describe in the context of the ICF, eight archetypal people who wouldneed AT2. Identify and clarify the various economic factors that influence the outcomes, andsuitable approaches to reflecting both costs and benefits from an economic sense whenconsidering the ICF domains3. Explore the issues surrounding the design, research and manufacture of AT in Australiaand the factors influencing new solutions.Industry-related support has been linked to University funding sources to support theinvolvement of an occupational therapist and an economics student in guiding two of thesub-studies, with NovitaTech staff leading the input to the third sub-study.

75ResultsThe group developed a set of ‘vignettes’ (or case descriptions) to represent eighteconomically relevant types of AT users. This approach has allowed consideration of theimpact of funding (either self funded or external support), adults and children, and finally highcost (complex powered wheelchairs with seating systems) verses low cost (basic walkingframe) requirements for technology intervention.The research has been established in the context of international research, in particular thatdone in recent years in Europe. A number of papers and posters have also been presented toengage potential collaborators internationally.ImplcationsStatusThis project will enable the quantification and consideration of the inputs and outcomes ofAT provision (and use). This will include the costs for the user and society and outcomes thatextend into full participation across the various ICF domains. Health economists insist thatfull economic analyses compare two or more alternatives. The team will compare the currentsituation of a particular AT user to situations with nil and then optimal assistance. The aim isto develop tools that will enable economic cases to be made for optimal delivery of AT.OngoingProject titleContributorsSummaryDeveloping an Australian rehabilitation engineering and assistive technologycollaborative research and development centreDr Lloyd Walker, David Hobbs, Associate Professor Karen Reynolds (Flinders University),Jo Close (Flinders University), Professor Andrew Downing (Flinders University), John Ballard(BR Angels Pty Ltd), Professor John Evans (Queensland University of Technology), AssociateProfessor Ian Brown (Monash University), Bill Contoyannis (Monash University), Dr DanielJames (Griffith University), Associate Professor Brendan Burkett (University of the SunshineCoast)In 2003 David Hobbs completed a Churchill Fellowship research program that identifiedhow successful research, development and technology transfer models operated within thefield of Rehabilitation Engineering (RE). Two overseas models were identified for their keystrengths and ability to coordinate and deliver innovative assistive technology (AT) productsand services on a consistent basis. Key traits of the centres that operated within thesemodels included: strong, visionary leadership; committed and dedicated multi-disciplinaryteams working towards clear goals; collaborative links with industry and other tertiaryinstitutions; and a passion and desire to succeed within a small, niche field.Recognising the key features of how each overseas model operated, and understanding thecapacity and context of the Australian landscape, one of the recommendations from Hobbs’Fellowship was that Australia should consider establishing a similar network. Currently, alarge percentage of rehabilitation equipment and AT available in Australia is imported and theindustry is fragmented and consists mainly of small to medium enterprises. A coordinatednetwork of researchers, allied health professionals and manufacturers would create thefoundation for a ‘hub’ of activity, build critical mass and pool expertise and resourcesfor developing new devices and equipment for people with a disability and the ageingpopulation.

76MethodThe drive for developing an AT innovation network began with an open forum in Adelaide in2004 to discuss the potential for a national, multi-site, collaborative research initiative in thissector. Participants representing end users, universities, government, industry groups andprofessionals participated. All unanimously agreed that work should begin to develop suchan initiative. As the largest group specifically working in AT research and development inAustralia, NovitaTech was tasked with facilitating the group in building a proposal.The Federal Government’s Cooperative Research Centre (CRC) Program was identified asa potential source of funding to establish and then grow the network. NovitaTech was thelead industry participant and Flinders University, Queensland University of Technology andMonash University were the lead university participants. After an extensive consultationprocess, the bid was called the “CRC in Technologies for Independent Living”.ResultsThroughout 2005 a number of presentations and discussions were held with partnerorganisations, associations and key groups to garner interest and involvement in the networkand solicit an indication of support for the proposal. Submitting a CRC bid is a three-stepprocess. Written applications outlining the intent of the CRC and each group’s capability forma filtered Stage 1 and Stage 2 process and applications that show promise are invited to aninterview before a final decision is made.A 10-page Stage 1 application for the CRC bid was submitted on 31 March 2006 andthe group was notified in May that the application was unsuccessful. The CRC SelectionCommittee, although acknowledging the importance of the proposal, did not allow the bidto proceed to Stage 2, highlighting weaknesses in the ability to demonstrate commercialdemand for this development and the inability to meet the current CRC focus oncommercialisation and ‘swift economic return’.ImplicationsStatusThe CRC process was a long and involved journey. While the goal of establishing a CRC wasnot achieved, the exercise of developing a proposal and submitting an application not onlyraised NovitaTech’s profile, but also led to new linkages with government, researchers andindustry associations. Post-CRC activities have focused on building on the momentum anddrive the network developed to continue raising the profile of the AT sector and work towardsdeveloping a Centre of Excellence in the field.Ongoing

77Project titleContributorsSummaryDeveloping an environmental testing protocol for electronic assistive technologydevicesChris Hern (Flinders University), Dr Lloyd Walker, Jeff Price, David HobbsWhen you purchase a new device, you probably don’t immediately wonder ‘how durableis this, and will it break within the first few months of use?’ So if and when the device doesbreak, there is usually a feeling of disappointment and frustration, and time and energy iswasted returning the device to where it was purchased to have it repaired. The anger wouldprobably intensify if you discovered that your device broke because of a small componentfailure that could have been detected if it was tested prior to being sold.Currently, there is no Standard or formal procedure for testing the durability, environmentalconditioning or reliability of electronic assistive technology (AT) devices (such as speechgenerating devices). However, when electronic AT repair records are reviewed, commonfaults that occurred during normal use are detected. If a testing protocol was available totype-test electronic AT devices, a benchmark could be set for an acceptable level of devicefunctionality and performance.The aim of this project was to research and develop a testing protocol that outlines thenecessary procedures and tests that could be performed to ensure electronic AT devicesmeet the requirements and rigour of actual field use.MethodInvestigation into common device failure was conducted to gauge the type of tests necessaryto represent actual breakdown. An environmental protocol or test suite was then developedthat summarised a number of International Electrotechnical Commission (IEC) EnvironmentalTesting Standards. The draft suite, consisting of 27 test Standards, identified the objectives,apparatus and procedures necessary to perform each test.The 27 tests, selected from a series of more than 60, were deemed to be the mostrepresentative of common device failures and likely environmental exposure. Some testswithin this suite include vibration, dust and sand, drop and topple and fluid contamination.Staff from NovitaTech and Novita were surveyed with regard to the importance and relevanceof each test standard, in order to refine the suite so that the tests most representative offailures could be confirmed and included in the final test protocol.ResultsA review of all NovitaTech Electronics Workshop repair records indicated that physicalbreakage, broken leads and connectors and the ingress of foreign matter were the mostcommon sources of failure for electronic AT devices. Touch screen failure and wear,component failure and circuit board corrosion were also among the common failings.The survey of key staff (including therapists who regularly prescribe electronic AT devicesand see the type of treatment they endure, plus technicians who regularly repair the devices)provided a ranking of the tests in order of importance. Of the 27 tests, seven were ranked‘very important’ (Group A), 10 as ‘important’ (Group B) and 10 as ‘not important/redundant’(Group C). This process refined the draft suite into a document that could be circulatedamongst international peers working in Standard development.

78ImplicationsThe ongoing use and integration of AT devices leads to an increasing dependence ontechnology for people with a disability. User expectation and reliance on technology hasnever been higher. Therefore, it is imperative that manufacturers do all they can to improvethe quality of their products and ensure a minimum ‘standard’ has been met.The development of a testing protocol will be beneficial to both users and manufacturers ofelectronic AT equipment. Manufacturers could avoid costly repairs, field failure and recalls iftheir products are type tested before release into the market, ensuring a minimum acceptablelevel of quality and safety has been reached.StatusOngoingProject titleContributorsSummaryInnovative Technology TeamAnnabelle Tilbrook, Sue van de Loo, Ben Symonds, Sandra Stewart, Rob GarrettThe complexity of technology available to assist people with a disability is increasing at arapid rate. Sophisticated wheelchair control systems and computer-based communicationdevices are examples of products that offer immense opportunities for independent mobilityand communication. However due to the complex nature of these devices it has becomeevident that therapists looking to assess, trial and prescribe such technology will greatlybenefit from input and recommendations from expert therapists, technicians and engineers.The aim of this project was to set up a procedure and framework to ensure appropriateclients receive the benefits of high-end assistive technology (AT). This was achieved throughthe establishment of a specialist multidisciplinary team that Novita therapists can utilise as asource of expertise and support when considering complex technology for their clients.MethodResultsA working group (comprising occupational therapists, speech pathologists, physiotherapists,rehabilitation engineers, orthotists and mobility and seating clinicians) was formed and giventhe task of identifying the limitations of Novita’s existing service model, in the context of theprovision of complex AT. Specifically they were to identify resources that therapists wouldrequire when assessing, prescribing and providing complex technology such as integratedcontrols and wheelchair mounting systems for AT. These requirements were to be clearlydefined and utilised to describe the optimal model that could be implemented to achievepositive client outcomes, along with the resources required to implement such a solution.The group investigated the current situation and identified the lack of access to technicalexpertise as the major impediment to the successful delivery of complex AT. They proposedand then implemented a multidisciplinary team comprising therapists, engineers, techniciansand other specialist AT clinicians. A pre-existing group, the Novita Support Team, act asthe initial point of contact, taking on the role of case managers for individuals referred tothe service. Depending on the nature of a particular individual’s needs, various disciplinesare then included in the team. To ensure this dynamically changing team is appropriatelyconstructed for each case the entire team meets at a minimum quarterly interval to reviewupcoming referrals and decide who should be involved with respective cases.

79ImplicationsStatusTo date, the team has provided opportunities for numerous individuals to evaluate, trial andutilise complex AT they may not have otherwise had access to. For some it has provided asolution for independent mobility never previously experienced. For others, it has providedmore independent access to communication devices, thus enhancing their ability tocommunicate in their worlds. The team will utilise outcome measurement tools to perform acomprehensive evaluation of the effectiveness of this service into the longer term.OngoingProject titleContributorsSummaryTesting laboratory data logging and remote monitoringAlex Svistounov, Ben Symonds, Andrew Jeffs (University of Adelaide)The NovitaTech Testing Laboratory is accredited by the National Association of TestingAuthorities to perform mechanical testing of rehabilitation equipment to Australian andInternational Standards. These Standards require verifiably accurate and sensitivemeasurement of test parameters such as forces, frequency and environmental conditions.Much of the equipment used for these purposes was falling out of its serviceable life orinadequate for some of the newer Standards being adopted. Additionally, equipment such asprosthetics must undergo extended tests that run 24 hours a day for several months, so thelab required a reliable system for monitoring test progress without the need for a person to bephysically present.This research aimed to develop, build and launch a data acquisition (DAQ) and loggingsystem for the Testing Laboratory that would also allow remote (preferably real-time)monitoring of cyclic tests, remote (computer) control of tests and monitoring of environmentalconditions. The intent was to simplify, streamline and upgrade the existing systems in a costeffective manner to increase testing capacity.MethodResultsResearch was undertaken exploring possible solutions, looking at systems employed bysimilar organisations, seeking input and guidance and engaging the input of mainstreamsuppliers of DAQ systems. Additionally the pros and cons of custom versus ‘off the shelf’systems, and stand alone versus PC-based systems were investigated. This research wascombined with the specific requirements of the Test Lab and relevant Standards to developa detailed DAQ system specification. The most suitable cost effective options were thenselected, implemented, tested and calibrated.A DAQ and remote monitoring system has been designed, built and installed in the testinglaboratory. The system consists of a DAQ unit, web camera, temperature and humiditysensing unit, load cell with signal conditioner and an interface to a Timer Counter Unit forcyclic testing. The system can view real time data, log data, store video, send email alerts,detect motion and stop and start tests remotely. All measurements taken using the systemhave been verified to conform to the required accuracies and error tolerances.

80ImplicationsStatusThis system is now being used to monitor and log applied forces during strength testing,accurately set up loads for prosthetic cyclic testing, continually log the humidity andtemperature of the test lab and remotely monitor cyclic testing of lifters, beds, wheelchairsand prosthetics. Detailed procedures outlining the operation of the load cell in conjunctionwith the data acquisition system have been developed, to ensure its implementation is inaccordance with the testing laboratory’s NATA guidelines and Standard requirements.CompletedWeb cameraWorking in the test lab

81Publications and presentations*Novita staff contributors highlighted in bold.Journal articles2006Murchland S & Wake-Dyster W (2006). ResourceAllocation for community based therapy. Disabilityand Rehabilitation, 28(22),1425-1432Van Zelst BR, Miller MD, Russo R, Murchland S &Crotty M (2006). Activities of daily living in childrenwith hemiplegic cerebral palsy: a cross-sectionalevaluation using the Assessment of Motor andProcess Skills. Developmental Medicine and ChildNeurology, 48(8), 723-7272007Maddocks A, Stewart H, & Murchland S (2007).Mother’s perception of the introduction of a hoistinto the family home of children with physicaldisabilities. Disability and Rehabilitation: AssistiveTechnology, 2(2), 117-125Maher CA, Williams MT, Olds T & Lane AE (2007).Physical and sedentary activity in adolescents withcerebral palsy. Developmental Medicine & ChildNeurology, 49 (6) pp 50-457Nguyen T, Garrett R, Downing A, WalkerL & Hobbs D (2007). Research intoTelecommunications Options for People withPhysical Disabilities, Assistive Technology, 19:78–93Prior M, Grimmer-Somers K & Gibson S (2007).Validation of a unique measure of physical carerdemand in parents of physically disabled children– A Pilot Study. The Internet Journal of Allied HealthSciences and Practice, 5 (1),www.ijahsp.nova.edu/articles/vol5num1/toc.htmRaghavendra P, Murchland S, Bentley M, Wake-Dyster W & Lyons T (2007). Parents’ and serviceproviders’ perceptions of family-centred practice ina community-based, paediatric disability service inAustralia. Child: Care, Health and Development, 33(5): 586-592Raghavendra P & Oaten R (2007). Effects ofspeech and print feedback on spelling performanceof a child with cerebral palsy using a speechgenerating device. Disability & Rehabilitation:Assistive Technology, 2(5), 299-308Russo RN, Crotty M, Miller MD, Murchland S, FlettP & Haan E (2007). Upper-limb Botulinum toxin-A injection and occupational therapy in childrenwith hemiplegic cerebral palsy identified from apopulation register: A single-blind, randomised,controlled trial, Pediatrics 119(5), e1149-1158In pressMaher CA, Olds T, Williams MT & Lane AE. Qualityof life in adolescents with cerebral palsy. Physicaland Occupational Therapy in PediatricsMaher CA, Williams MT & Olds T. The sixminute-walk-testfor children with cerebral palsy,International Journal of Rehabilitation ResearchRaghavendra P, Bornman J, Granlund M &Bjorck-Okesson E. The World Health Organisation’sInternational Classification of Functioning, Disabilityand Health: Implications for Clinical and ResearchPractice in the field of Augmentative and AlternativeCommunication, Augmentative and AlternativeCommunicationTsirios M, van Kessel G, Gibson S &Raghavendra P. Effects of Aquatic Physiotherapyfor Children with a Disability: Views of Parents andTherapists, Aquatic Therapy JournalBook chaptersMurchland SR, Lane A & Ziviani J (in press).Written communication: clinical decision makingfor handwriting in children with cerebral palsy. In A.Eliasson & P. Burtner (eds). The Child with CerebralPalsy: Management of the upper extremity, MacKeithPressNguyen T, Garrett R, Downing A, Walker L& Hobbs D (2004). Toward a Human-FriendlyAssistive Environment. In Daqing Zhang & MounirMokhtari (Eds) 2nd International Conference onSmart Homes and Health Telematics, AssistiveTechnology Research Series, Volume 14, Chapter1, Human-Machine Interface, Research intoTelecommunications Options for People withPhysical Disabilities, IOS Press pp 57 – 64

82Other refereed publicationsNguyen T, Garrett R, Downing A, Walker L &Hobbs D (2005), Telecommunications Access– Matching Available Technologies to People withPhysical Disabilities, The Engineering and thePhysical Sciences in Medicine (EPSM) 29th AnnualConference, incorporating the inaugural AustralianBiomedical Engineering Conference (ABEC),AdelaideNguyen T & Garrett R (2007). Investigatingtelecommunications needs and solutions forolder people and people with a disability. Finalreport submitted to the TelecommunicationsResearch Grant Program of the Department ofCommunications, Information Technology and theArts in accordance with the funding deed and uponcompletion of the project, May 2007Olsson C (in press). Participation and AACInterventions; More to see, More to discover.Proceedings of Research Symposium, 12thBiennial Conference of the International Societyfor Augmentative and Alternative Communication,Toronto, Canada, ISAACRaghavendra P (in press). Measuring Participation:Some possible tools. Proceedings of ResearchSymposium, 12th Biennial Conference of theInternational Society for Augmentative and AlternativeCommunication, Tornoto, Canada, ISAAC.Walker L & Hobbs D (2007). Toward an AustralianNational Research and Development Centre inTechnologies for Independent Living. Proceedingsof 2nd International Conference on Technology forAgeing, 17-19 June 2007, Toronto, CanadaWalker L & Hobbs D (2006) Children’s Use ofManual Mobility – Pilot Study. Proceedings ofAustralian Rehabilitation and Assistive TechnologyAssociation National Conference, Fremantle, WA,ARATAWalker L, Stewart H, Hern C, Frogley M, & duBois L (2006). Carrying kids and their wheelchairs– Parents’ perceptions. Proceedings of AustralianRehabilitation and Assistive Technology AssociationNational Conference, Fremantle, WA, ARATAWalker L & Svistounov A (2006). Testing TimesFor Assistive Mechanical Technology. Proceedingsof Australian Rehabilitation and Assistive TechnologyAssociation National Conference, Fremantle, WA,ARATA.International conferencesFestival of International Conferences on Caregiving,Disability, Ageing and Technology (FICCDAT),Toronto, Canada, 2007, Walker L, Schraner I,Layton N & Hobbs D, Toward an Evaluation of theEconomics of AT (invited paper)International Assessment of Motor and Processskills (AMPS) Symposium, Adelaide, 2004, KernotJ & Murchland S, School Performance of childrenaged 8–13 years with HemiplegiaInternational Society for Augmentative and AlternativeCommunication, 12th Biennial Conference.Dusseldorf, Germany, 2006• Raghavendra P, Granlund M, Olsson C, LundS & Allan M, Augmentative and AlternativeCommunication and Participation: A multidimensionalconstruct for AAC practice andresearch• Raghavendra P, Olsson C, Schlosser R &Opperman K, Implementing Evidence-BasedPractice (EBP): Strategies for Practitioners andResearchersInternational Society for Augmentative and AlternativeCommunication, 11th Biennial Conference, Natal,Brazil, 2004• Leanne J, Raghavendra P & Schloten I,Internet-based Literacy Assessment andIntervention: Reading Outcomes for three usersof AAC.• Grace E, Raghavendra P & Scholten I,Vocabulary Use at School: What do Six YearOlds Say?• Schlosser R & Raghavendra P, EBP inAugmentative and Alternative Communication:What do practioners need to know?

832nd International Conference on Technology forAgeing, 2007, Walker L & Hobbs D, Toward anAustralian National Research and DevelopmentCentre in Technologies for Independent Living2nd International Conference on Smart Homesand Health Telematics, Toward a Human-FriendlyAssistive Environment, Singapore, 2005, NguyenT, Garrett R, Downing A, Walker L & Hobbs D,Research into Telecommunications Options forPeople with Physical DisabilitiesWorld Federation of Occupational Therapists,Sydney, 2006, Murchland S, Developing aquestioning culture amongst occupationaltherapistsNational conferencesASTAP 10 Accessibility and Usability Workshop,Melbourne, October 2005, Garrett R & Nguyen T,Principles and practice of inclusive designAustralasian Academy of Cerebral Palsy andDevelopmental Medicine Conference. Adelaide,2006• Kumar S, Gibson S, Raghavendra R &Murchland S, Evidence-based Practicein paediatric disability: Can it be done?Developmental Medicine and Child Neurology,Supplement No.105, 48, p.20• Maher CA, Williams MT, Olds T & Lane AE,Physical and sedentary activity in adolescentswith cerebral palsy. Developmental Medicine andChild Neurology, Supplement No.105, 48, p 42• Murchland S & Sandelance M, To splint ornot to splint? That is the conundrum. Workshop.Developmental Medicine and Child Neurology,Supplement No.105, 48, p 35• O’Brien S, Gibson S & Hardy F, The effect ofintensive treadmill training in improving functionalmobility on ambulant children with cerebralpalsy: a pilot study. Developmental Medicine andChild Neurology, Supplement No.105, 48, p 42• Opperman K, Olsson C, Stewart S &Raghavendra P, Introduction to Augmentativeand Alternative communication: Parent’sexperiences and attitudes. DevelopmentalMedicine and Child Neurology, SupplementNo.105, 48, p.39• Raghavendra P & Lane A, Participation ofChildren with Disabilities; What do we know?Developmental Medicine and Child neurology,Supplement No.105, 48, p.33• Raghavendra P, Murchland S, Timko B,Lyons T, Olsson C & Sprod J, Strategies fortherapists and education staff to work effectivelyto implement client goals in school settings: Asystematic review. Developmental Medicine andChild Neurology, Supplement No.105, 48, p.12• Raghavendra P, Murchland S, Bentley M& Lyons T, How family-centered is Novita?:perceptions of parents and service providers.Developmental Medicine and Child neurology,Supplement No.105, 48, p.38• Tsiros M, van Kessel G, Gibson S &Raghavendra P, An exploratory study ofthe effects of hydrotherapy for children witha disability: views of parents and therapists.Developmental Medicine and Child Neurology,Supplement No.105, 48, p.27Australian Cerebral Palsy Association NationalConference, Adelaide, 2005• Dryden L, Bostock S & Grimmer K, Single eventmultilevel surgery: A description of stakeholderexperiences• Hobbs D & Garrett R, Universal Design and itsImportance to People with Disabilities• Murchland S, Raghavendra P, Bentley M &McGregor P, Family centered practice at NovitaChildren’s Services• Murchland S, Raghavendra P, Gibson S &Stewart S, An Introduction to Evidence BasedPractice• Savage K, Assessment of monitoring of growthand nutrition of children with cerebral palsyaccessing the Women’s and Children’s Hospitaland Novita children’s ServicesAustralasian Faculty of Rehabilitation Medicine, 15thAnnual Scientific Meeting, Sydney, 2007, Walker L,Layton N and Hobbs D, Assistive Technology: APart of the Rehabilitation Solution

84Australian Group on Severe CommunicationImpairment, 8th Biennial National Conference,Melbourne, 2007• Olsson C, Colston E, Opperman K,Raghavendra P & Stewart S, Using PulseOximetry for Children with CP and Dysphagia:An Exploratory Study• Raghavendra P, Olsson C & Allan M, Themultidimensional concept of participation:Implications for AAC practice and research• Raghavendra P, Olsson C, OppermanK, Colston E & Stewart S, Introducing andSupporting the Use of AAC for Children: Parents’and Therapists’ Perspectives7h Biennial National Conference, ‘Together we Can’,Brisbane, 2005• Iacono T & Raghavendra P, Together we cancontribute to and evaluate the evidence base inAAC• Olsson C, Opperman K, Stewart S &Raghavendra P, The augmentative andalternative communication train: what bringsfamilies on board?• Nguyen T, Garrett R & Price E, Mobile PhoneUse via an Augmentative and AlternativeCommunication DeviceAustralian Physiotherapy Association NationalPaediatric Conference, 6th Biennial Conference,Alice Springs, 2005, Gibson S, Evidence BasedPractice: From Rhetoric to Clinical PracticeAustralian Rehabilitation and Assistive TechnologyAssociation (ARATA) National Conference, SixthBiennial Conference, Fremantle, 2006• Bessell T, Randell B, Knowles G & Hobbs D,Connecting People with the Environment – ANew Accessible Wireless Remote Control• Garrett R & Astbrink G, Information inAccessibility Features for Telephone Equipment• Gregory A & Nguyen T, New developments inenvironmental control and telecommunications(pre-conference workshop)• Hobbs D & Nguyen T, A Summary, Review,and Evaluation of the 2005 AccessibleTelecommunications Road Show• Nguyen T & Garrett R, Trial outcomes ofan interface system that allows people usingcommunication devices to independently accessand use a mobile phone.• Walker L & Hobbs D, Children’s Use of ManualMobility – Pilot Study• Walker L, Stewart H, Hern C, Frogley M & duBois L, Carrying kids and their wheelchairs– Parents’ perceptions• Walker L & Svistounov A, Testing Times forAssistive Mechanical TechnologyCerebral Palsy Australia National Conference, GoldCoast, 2007• Connell T, Psychology Support for Families withChildren with Cerebral Palsy• Nguyen T & Garrett R, Innovation andCollaboration in the Provision of PhonesCONASTA 55: Conference of the Australian ScienceTeachers Association, Cutting Edge Sciencesession, Adelaide, 2006, Hobbs D, RehabilitationEngineering for a Better Quality of LifeConnecting Up 07, We Can Do IT!, Adelaide, 2007• Garrett R & Astbrink G, Processes to developan Industry Code on Information on AccessibilityFeatures for Telephone Equipment• Hobbs D, Enabling people with a disability toplay music by simply moving,• Nguyen T & Garrett R, Evaluation, Innovationand Collaboration in the Provision of AccessibleTelecommunications to People with PhysicalDisabilitiesEarly Childhood Intervention Australia, 7th BiennialNational Conference, Adelaide, 2006, RaghavendraP, Murchland S & Bentley M, Evaluation of familycenteredpractice: perceptions of parents andservice providers. Proceedings of Early ChildhoodIntervention Australia, 7th Biennial NationalConference, Adelaide, South Australia. ISBN 0-646-45863-9Speech Pathology Australia Conference, Sydney,2007, Colston E, Olsson C, Opperman K,Raghavendra P & Stewart S, Pulse OximetryLevels of Children with CP and DysphagiaBefore, During and After Eating and Drinking: AnExploratory StudyOlsson C, Opperman K, Raghavendra P,Colston E & Stewart S, The Augmentative andAlternative Communication Train: What bringsfamilies on board?

85The Engineering and the Physical Sciencesin Medicine (EPSM) 29th Annual Conference,incorporating the inaugural Australian BiomedicalEngineering Conference (ABEC), Adelaide, 2005• Nguyen T, Garrett R, Downing A, WalkerL & Hobbs D, Telecommunications Access– Matching Available Technologies to Peoplewith Physical Disabilities• Hobbs D & Nguyen T, An Overview andReview of a National Educational Workshop onAccessible Telecommunications• Walker L, The Challenge of Establishing anAssistive Technology Hub in Australia.Wheelchair Safety Forum, National Committee onRehabilitation Engineering, Engineers Australia,4th Symposium, Wheelchair Design and relatedTransport Issues, Sydney, 2006, Walker L, CreativeApproaches to Resolving Transport Barriers3rd Symposium, Monitoring – Incidents, failures andfleet maintenance, investigating and monitoring,Brisbane, 2005• Hobbs D & Svistounov A, Standards, Testing,and Wheelchair Production• Walker L, Delivering Wheeled Mobility andSeating – The FutureState conferencesHealthy Development, Adelaide, 2006, Maher CA,Williams MT, Olds T and Lane AE, Self-reportedquality of life in adolescents with cerebral palsyNovita Research Symposium Day, Adelaide, 2005• Garrett R, Educating and Collaborating withTelecommunications Industry on DisabilityIssues• Nguyen T, Creative Solutions for using a mobilephone• Nguyen T & Hobbs D, An overview of aNational Telecommunications Road Show• Olsson C, The augmentative and alternativecommunication train: speech pathologist views• Hobbs D & Murchland S, Playing Music withyour Body! The Virtual Musical Instrument• Savage K, Monitoring growth and nutrition inchildren with cerebral palsy• Symonds B & Tilbrook A, Provision ofInnovative Technology Solutions• Zchorn M, Cognitive appraisal in parents whohave a young child with a disabilityNovitaTechFest, Adelaide, 2005• Nguyen T, Mobile telephone options• Garrett R & Raghavendra P, Research atNovita• Hobbs D, The Movement-to-Music TherapyProgramOur Children the Future 4, Adelaide, 2005,Murchland S, McGregor P & Raghavendra P,Interlinked relationships: how families and serviceproviders work togetherSouth Australian Gerontology Conference, Adelaide,2005, Walker L, Assistive Technology EnablingHealthy AgeingThe Special Education Expo, Making a Difference,Adelaide, 2007, Hobbs D & Worthington-Eyre B,The Virtual Music Instrument – enabling people witha disability to play music by simply moving!The Special Schools Principals Association (SSPA)Statewide Conference, A Celebration of StudentLearning in Special Education, Adelaide, 2007,Hobbs D & Worthington-Eyre B, The Virtual MusicInstrument – enabling people with a disability to playmusic by simply moving!Invited presentationsInternationalRaghavendra PSingapore General Hospital, Singapore, 2005• Evidence-based Practice: What does it meanfor allied health? (workshop)Walker L23rd International Seating Symposium, 2007Orlando, USA• Continuous Quality Improvement of ATServices – Developments in Australia• Novel approaches to AT service over largeareas

86Mobility 2005, Exeter, UK• Outcomes measurement – some Australianexperiences• The Australian Models of AssistiveTechnology FundingRehabilitation Engineering and AssistiveTechnology Society of North America (RESNA)Conference, 2005, Atlanta, USA• Research and Developments in Australia andNew ZealandNational and stateGarrett RTEDICORE Mobile Phone Think-Tank, Melbourne,2007• Options for people with physical disabilitiesand people with speech impairmentsHobbs DEngineers Australia Northern Division AnnualDinner and Launch of the Year of the YoungEngineer, Darwin, NT, 2005• invited addressEngineers Australia SA Division Annual Dinnerand Launch of the Year of the Young Engineer,Adelaide, SA, 2005• invited addressEngineers Australia Canberra Division, FellowsBreakfast, Canberra, ACT, 2005• invited addressProfessional Skills for Engineers Lecture, FlindersUniversity, 2006• Looking Back … from being an EngineeringStudent to being an EngineerNguyen TConsumers’ Telecommunications NetworkSeminar, Content, Convergence and ConsumerProtection, Melbourne, 2006• Telecommunications Access for People withPhysical DisabilitiesRaghavendra PSA Paediatric Physiotherapy Group, Adelaide,2006• What do we know about participation ofchildren with disabilities?Australasian Society for the Study of IntellectualDisability, Victoria• Evidence-Based Practice (EBP) and servicesfor people with an intellectual disability: Howdo you do it? (½ day workshop)Walker LAssistive Technology and Ageing Seminar, Agedand Community Services Australia, Melbourne,2005• Assistive Technology in Aged Care -ResearchOther presentationsGarrett R• Mobile Matters Seminar, The needs of thedisability sectorGarrett R & Gregory A• Telecommunications Consumer Group SA Incseminar, Are Your Telecommunications NeedsBeing Addressed?• Telecommunications Consumer Group SA Incseminar, ‘Looking Forward’ or ‘The Next ThirtyYears’Hobbs D• The Advertiser and the Electronics IndustryAssociation (EIA) i-bot robot package launch,Electronics Assisting Humans(also presented to CSIRO Double Helix Club andTea Tree Gully TAFE)• Rotary Club of Regency Park, How TechnologyAssists Children with a Disability(also presented to Novita’s New Era Auxiliary)• Burnside Rotary Club, Welcome to NovitaTech– The technology division of Novita Children’sServices(also presented to Edwardstown Rotary Club)Nguyen T• National Council of Women (SA Chapter),Telecommunications Access for People withDisabilities

87Nguyen T & Garrett R• Royal Perth Hospital, AccessibleTelecommunications Workshop(also presented to Cerebral Palsy League ofQueensland)• NovitaTech Snowy Hydro TelecommunicationsRoad Show (10 workshop presentations aroundAustralia in Adelaide, Darwin, Perth, Melbourne,Hobart, Sydney, Canberra, Newcastle, Brisbaneand Townsville)Symonds B• Engineers Australia’s National Committee onRehabilitation Engineering (NCRE) MentoringWorkshop, If I Could Only Press a SwitchWalker L & Hobbs D• The new Therapeutic Goods (Medical Devices)Regulations 2002, How does it affect ourindustry?, 1-day workshop at Royal PerthHospital, Shenton Park Campus, Perth, WA, 27thSeptember 2004Media coverageHobbs D• 5RPH Radio Link, Snowy Hydro AccessibleTelecommunications Road Show• November 2005, Herald Sun, Disabled in touch• Radio Adelaide International Links program,NovitaTech’s research in the field of accessibletelecommunications for people with disabilities• February 2006, appearance on ABC TV The NewInventors• May 2006, AGOSCI In Focus, Together We CanUse the Phone• November 2006, appearance on ABC TV TheNew Inventors• November 2006, The Advertiser, TV award fortop inventor December 2006, Link disabilitymagazine, Helping people with disabilities to ‘gomobile’• Inside CP Australia, South Australia’s own ‘youngEinstein’Nguyen T, Walker L & Hobbs D• August 2006, 891 ABC Adelaide, I swear by 891fundraising campaign (pictured below)Nguyen T, Hobbs D & Sampson J• August 2005, Ten News, Mobile phone for thedisabledWalker L & Hobbs D• ABC Asia Pacific, Nexus, Assistive Technologyand NovitaTechHobbs D & Nguyen T• 2005 Flinders University Encounter Magazine,Engineering for the common good• May 2005, The Herald, Making technology workfor all• May 2005, ParaQuad newsletter, NovitaTechSnowy Hydro Telecommunications Road Show• June 2005, Link disability magazine,Telecommunications Road Show WorkshopsNguyen T• August 2005, The Advertiser, New era rings in forthe disabled• November 2005, Sunday Mail, Rising Stars– celebrating the best and brightest of SouthAustralian youth• 2006 CP Australia magazine, Gadgets• 891 ABC Adelaide, 2005 Unsung Hero of SouthAustralia Science Award(l-r) 891 ABC Adelaide’s John Kenneally and Tony McCarthy with Novitaclient Andrew

88Grants and awards received*Novita staff contributors highlighted in bold.Grants receivedThe following grants were received for Novita andexternal projects, where Novita staff were named asinvestigators.Clinical ResearchGibson S, Flett P, Russo R & Bostock S (2004-06). The effect of serial casting following BotulinumToxin A (BoNT-A) treatment for dynamic equinus forchildren with cerebral palsy: A controlled clinical trial• Channel 7 Children’s Research Foundation($44,000)• Allergan Inc ($7,500)Lane AE, Olds T, Murchland S & Ziviani J (2005).Measuring patterns of activity engagement in youngpeople with physical disabilities• University of South Australia, Division of HealthSciences Research Development Grant ($7000)Maher C, Williams M, Olds T & Lane A (2006).Using the internet to increase physical activity inadolescents with cerebral palsy - are you kidding?• Cerebral Palsy Foundation Postgraduate StudentGrant ($10,000)Murchland S, Lane A, Lyons T & Tilbrook A(2006-07). Assistive technology solutions forstudents with physical disabilities: An analysis ofutility, cost and student satisfaction• Channel 7 Children’s Research Foundation($61,000)Olsson C, Faulks J, Opperman K &Raghavendra P (2004-05). Applications of pulseoximetry in the assessment and management ofdysphagia in children with physical disability• Channel 7 Children’s Research Foundation($30,000)Raghavendra P, Granlund M, Schlosser R & DadaS (2005). Interventions to facilitate participationof children with disabilities in all life domains: Asystematic review• American Institutes of Research/CampbellCollaboration, Washington, USA (US$1000)Raghavendra P, Lane A, Olsson C & ConnellT (2007). Participation profile of children withphysical disabilities with and without complexcommunication needs: Association between socialnetworks, communication, activity engagement andtime use• Channel 7 Children’s Research Foundation($31,000)Saggers S, Wildy H, Millsteed J, Roarty L,Paskevicius A, Tilley F, Ciccarelli P, Hurwood A, CarrL, Raghavendra P, Murchland S, Crowley M & ReM (2006-07). Embedding the wellness approachto health and disability in policies and practices ofallied health providers• Edith Cowan University Industry CollaborationScheme ($99,976)Sawyer M, Bittman M, LaGreca A, Baghurst P,Crettenden A, Flett P, Martin J, RaghavendraP & Trogdon J (2006-08). Relationship betweencaregiver time and mental health and wellbeing ofmothers caring for children with chronic disability• National Health and Medical Research Council($345,700)Research and DevelopmentGraham E, Grimshaw P & Gibson S (2007). Therelationship between ankle-foot-orthosis (AFO)shank vertical angle and optimal gait in children withcerebral palsy• Channel 7 Children’s Research Foundation($25,000)Hobbs D (2005). The Virtual Music Instrument– usability trials, program enhancements, andcommercialisation• Lions Club of Charles Sturt ($5,000)Hobbs D, Gregory A & Walker L (2006-07). The IBM Web Adaptation Technology and

89accessibilityWorks software trial• Hardware and software donated by IBM($10,000)Nguyen T & Garrett R (2005). Mobile phoneinterface system for communication device users• Department of Communications, InformationTechnology and the Arts (DCITA),Telecommunications Research Grant Program($15,147)• Telstra Disability Services ($10,000)Nguyen T & Garrett R (2006-07). Investigatingtelecommunications needs and solutions for olderpeople and people with a disability• Department of Communications, InformationTechnology and the Arts (DCITA),Telecommunications Research Grant Program($30,023)• The Australian Communication Exchange($6,000)• Telstra Disability Services ($5,000)• Equipment support from Nokia Australia andMotorolaNguyen T & Hobbs D (2005). The NovitaTechSnowy Hydro Telecommunications Road Show:Promoting accessible telecommunications options• Snowy Hydro Ltd ($5,000)• Engineers Australia’s College of BiomedicalEngineers ($1,000)• Equipment and in-kind support from Nokia,Motorola, Telstra Disability Services, EngineersAustralia and NovitaTech’s Assistive TechnologyDepartmentRowland A, Symonds B & Hobbs D (2005). Thedesign and development of a semi-autonomouswheelchair for obstacle avoidance• The Pickard Foundation ($2,273)of $7,000 from ILC Australia, EngineersAustralia’s National Committee on RehabilitationEngineering and Novita Children’s Services, and$10,419 from the University of Western Sydney.Awards2004 ISAAC/AAC Editor’s Award Most SignificantResearch Article in Augmentative & AlternativeCommunication• Received by Schlosser R and Raghavendra Pfor Evidence-based Practice in Augmentative andAlternative Communication2004 Engineering Excellence Awards SA 2004Innovation Excellence Award• Presented to NovitaTech for VocabularyOrganiser2004 Young Professional Engineer of the Year SouthAustralian Division and National Division Winner• Presented to David Hobbs2005 Australian Broadcasting Corporation AustralianAcademy of Science Media Fellowship• Presented to David Hobbs2005 Engineers Australia Top 100 Most InfluentialEngineers• Presented to David Hobbs2005 SAAB Systems Engineering ExcellenceAwards Best Engineering Honours Project• Presented to Flinders University for theircontribution to The development of a ZigBeebaseduniversal remote control2005 Sunday Mail 50 Most Inspiring Young SouthAustralians• Presented to Toan NguyenSchraner I, Layton N, Molenda A, Walker L, deJonge D, Hobbs D & Bringolf J (2006). AssistiveTechnology in Australia: economic analyses from auser standpoint – methodological implications• University of Western Sydney ResearchPartnership Program Grant ($17,419). Consisting2005 University of Adelaide Most Innovative HonoursProject• Presented to Alan Rowland (student, Universityof Adelaide) for his contribution to The designand development of a semi-autonomouswheelchair for obstacle avoidance

902005 Australian and New Zealand Association forAdvancement of Science Unsung Hero of SouthAustralian Science• Presented to Toan Nguyen2006 ABC TV New Inventors Episode, People’sChoice and Les is More Awards• Presented to Toan Nguyen for development ofthe SGD Mobile Access2006 Australian Rehabilitation and AssistiveTechnology Association Better Technology AwardsFirst Prize Prototype• Presented to Travis Bessell and Matthew Randall(students, Flinders University) and ProfessorGreg Knowles (Flinders University) for theircontribution to The development of a ZigBeebaseduniversal remote controlToan Nguyen receiving the 2005 Australian and New ZealandAssociation for Advancement of Science Unsung Hero of SouthAustralian Science Award2006 Australian Rehabilitation and AssistiveTechnology Association Inaugural Soft TechnologyAwards First Prize, Developments, improvementsand innovations in the assistive technology serviceindustry• Presented to Rob Garrett and Gunela Astbrink(TEDICORE) for Provision of information onaccessibility features for telephone equipment2007 Consumers’ Telecommunications NetworkAwards Recognition for Voluntary Representation onIndustry Committees• Presented to Rob Garrett

Our research partners91Novita’s many research achievements simply wouldn’t be possible without the expertise, knowledge and financialsupport provided by our valuable research partners.We would also like to recognise the contributions of:Professor John Evans, Queensland University of Technology, BrisbaneDr Geoff Fernie, Toronto Rehabilitation Institute, Toronto, CanadaDr Peter Flett, Calvary Health Care, TasmaniaProfessor Mats Granlund, Jönköping University, Jönköping, SwedenDr Lindsay Pennington, Newcastle University, Newcastle, UKAssociate Professor Milos Popovic, University of Toronto, CanadaProfessor Sherry Saggers, Edith-Cowan University, Western AustraliaProfessor Ralf Schlosser, North Eastern University, Boston, USAProfessor Helen Wildy, Murdoch University, Western Australia

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