Nick Rushworth

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Its never just about the numbers, but
TRAUMA RESEARCH METHODS AND PRACTICE WORKSHOP -
UNIVERSITY OF MELBOURNE, 2008

• Nick Rushworth
• Executive Officer Brain Injury Australia

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peak of peaks
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Brain Injury Australia works to ensure that all
people living with an ABI have access to supports
and resources each person requires to optimise
their social and economic participation.

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• A

advocacy for Australian Government program
allocations and policies that reflect the needs
and priorities of people with an ABI and their
families.
the provision of effective and timely input
into policy, legislation and program development
through active contact with Australian Government
ministers, parliamentary representatives,
Australian Government departments and agencies,
and national disability organisations.
9/23/2009
Brain Injury Network of South Australia AGM, 2008
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Its never just about the numbers, but
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In 2003, 432,700 people (2.2 of the population)
had an Acquired Brain Injury with activity
limitations or participation restrictions

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• Nick Rushworth
• Executive Officer Brain Injury Australia

- Australian Bureau of Statistics 2003 Survey of
Disability, Ageing and Carers
9/23/2009
Brain Injury Network of South Australia AGM, 2008
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Topics of Discussion
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• Almost 3 out of every 4 PWABI were aged less than
  65 years, half of them between 15 and 34 years of
  age
• 2 out of every 3 said that they acquired their
  brain injury when they were aged under 25 years
• 9 out of every 10 said their ABI was caused by
  accident or injury (more than half of them said
  the accident or injury occurred on a street,
  road or highway)
• 3 out of every 4 were men

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9/23/2009
Brain Injury Network of South Australia AGM, 2008
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9/23/2009
Brain Injury Network of South Australia AGM, 2008
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Its never just about the numbers, but
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• 27,300 people with an ABI aged under 65 years
  experiencing activity limitations or
  participation restrictions said their ABI was
  their main disabling conditionthe one reported
  as causing the most problems. A traffic injury
  was the main cause for more than half of these
  people
• One in four reported four or more disability
  groups, compared with one in eighteen of all
  people with disability
• One in three reported 5 or more health
  conditions, compared with about one in eight of
  all people with disability

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• Nick Rushworth
• Executive Officer Brain Injury Australia

9/23/2009
Brain Injury Network of South Australia AGM, 2008
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• 11,866 people with an ABI accessed Commonwealth
  State/Territory Disability Agreement
  (CSTDA)-funded services in 2004-05

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Brain Injury Network of South Australia AGM, 2008
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What This Means
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• outcomes1?
• 20-26 year follow-up of 100 men with TBI admitted
  to Sydneys Lidcombe Hospital between 1976 and
  1981
• 85 had used at least one service in the
  preceding 12 months, most commonly financial
  (69), transport (64) and home support (52).
  Unmet needs were high, especially in the social
  participation (73), vocational (67), and
  respite (38) areas
• Significant proportions of the series continued
  to experience activity limitations in mobility
  (25) and basic self-care tasks (21), although
  restrictions in social participation were much
  more prevalent (e.g., 66 for employability, 54
  for interpersonal relationships)

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- Long-Term Outcomes After Traumatic Brain
Injury Following up a Consecutive Series at
20-26 Years Post-Trauma - Final Report to
the Motor Accidents Authority Of New South
Wales, R Tate et al. Rehabilitation Studies
Unit, Faculty of Medicine, University of Sydney,
2004
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Next Steps
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• outcomes2?
• Brain Injury Outcomes Study (BIOS) - 198 clients
  with severe TBI sustained between 1999 and 2001
• good recovery in the Physical domain, with only
  10 continuing to have significant impairments
  that interfered with everyday functioning in
  mobility at three years post trauma
• By contrast, clinically significant impairments
  persisted in the Cognitive and Behavioural
  domains for many clients for example, 61 for
  memory, 52 for problem solving and 20 for
  social interaction
• At three years, the longest PTA Post-Traumatic
  Amnesia group had significantly lower levels of
  community participation

What This Means

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- Brain Injury Outcomes Study (Final report) May
2004, Robyn Tate, Ian Cameron, Julie Winstanley,
Bridget Myles, Ross Harris, Rehabilitation
Studies Unit, Northern Clinical School, Faculty
of Medicine, The University of Sydney.
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Brain Injury Network of South Australia AGM, 2008
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9/23/2009
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• injury prone
• People with an ABI are drawn from the same
  populations as those at the greatest risk of any
  injury
• low levels of education
• low workforce participation rates
• poor housing
• large family size
• histories of marital breakdown, of neglect,
  physical and sexual abuse
• parental drug or alcohol abuse and substance
  abuse
• mental illness

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Australian Institute of Health and Welfare, Key
National Indicators of Childrens Health,
Development and Wellbeing Indicator Framework
for a Picture of Australias Children 2009,
Canberra, 2008.
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• prisoners - research priority?
• 2003-04 survey of 200 New South Wales prisoners
  82 had experience of TBI with over half
  reporting ongoing effects (headaches, memory
  loss, personality or behavioural change, anxiety,
  depression etc.) 22 had sustained four or more
  TBIs
• 2003 Young People in Custody Health Survey (NSW)
  40 of young men had sustained an ABI resulting
  in significant loss of consciousness
• NSW Prison Injury Surveillance Program assaults
  accounted for 80 of violence in prisons - the
  second most common injury treated in prison
  clinics

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- Prison Violence Perspectives And
Epidemiology, Tony Butler and Azar Kariminia,
Centre for Health Research in Criminal Justice,
NSW Justice Health and School of Public Health
and Community Medicine, University of New South
Wales NSW Public Health Bulletin Vol. 17 No. 12,
and Peter Schofield et. al, Traumatic brain
injury among Australian prisoners rates,
recurrence and sequelae, Brain Injury, May 2006.
9/23/2009
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• homeless - research priority?
• 10 of people using inner-city Sydney hostels and
  refuges had cognitive impairment as a result of
  alcohol-related brain injury or TBI
• Two Victorian studies of pension-only Supported
  Residential Services found between 13 per cent
  and 17 per cent of residents had a history of ABI
• Three-year study of outreach service use found
  33 of clients had a diagnosed alcohol-related
  brain injury

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- Hatzitaskos., P. (1995) Crime Times, Vol. 1,
No.1-2, p.5., Byrne, B. (1997) SRS Socialization
Facilitation Project (Caulfield General Medical
Centre, Melbourne) and Community (Residential
Services) Visitors Board, Annual Report of
Community Visitors, 1996, Health Services Act
1988 (Office of the Public Advocate, Melbourne)
cited in HACC Program Development Access
SRS/Rooming House Project, Final Report December
1998, McGregor, Robb (2000) Comparative data
between clients with alcohol related brain
injuries and other clients, Ozanam Community
Support Services Outreach Program.
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• Indigenous - research priority?
• the transport injury rate for Indigenous
  Australians is up to three times that of
  non-Indigenous Australians
• the rate of head injury due to assault in the
  Indigenous populations of QLD, WA, SA and the NT
  was more than 20 times that of non-Indigenous
  populations. The rate of head injury due to
  assault in Indigenous women was almost 70 times
  that for non-Indigenous women
• the median age for stroke in the Northern
  Territory is 20 years below the national average
• between 1999 and 2006, 60 Indigenous Australians
  in the Northern Territory have died from
  petrol-sniffing and a further 120 have suffered
  permanent brain damage

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- Australian Institute of Health and Welfare,
Hospitalisation for head injury due to assault
among Indigenous and non-Indigenous Australians,
July 1999-June 2005, Jamieson et al., Medical
Journal of Australia, May 2008 Australasian
Consortium of Rehabilitation Outcomesl Beyond
Petrol Sniffing Renewing Hope for Indigenous
Communities, report of the Australian Senates
Community Affairs Reference Committee
9/23/2009
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falls-related TBI research priority?

• 22,710 hospitalisations for TBI in 200405
• most common causes of TBI were falls (42),
  transportation (29) and assault (14)
• while traffic accidents and assault are the main
  mechanisms of injury in younger people, falls are
  the foremost mechanism of TBI in older people,
  followed by traffic accidents as pedestrians,
  drivers or passengers
• rates of TBI due to fallswere highest in the 85
  plus age bracket
• the proportion of hospitalisations with TBI as
  Principal Diagnosis that resulted in death were
  highest for falls (63) followed by
  transportation (27) and assault (4)

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- Helps Y, Henley G and Harrison JE. 2008.
Hospital separations due to traumatic brain
injury, Australia 200405. Injury research and
statistics series number 45, Adelaide AIHW
9/23/2009
Brain Injury Network of South Australia AGM, 2008
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falls-related TBI research priority?

• United States geriatric TBI costs 2.2
  billion per annum
• Major reason for up to 40 of residential aged
  care admissions
• Population 65 - to double to 70 million by 2030
• the costs of caring for older adults with a TBI
  in monetary and human terms will be staggering
• Australia older demographic profile than US
• Falls-related TBI rates triple by 2050 750,000
  additional hospital bed days, 3,320 additional
  residential aged care places

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- Helps Y, Henley G and Harrison JE. 2008.
Hospital separations due to traumatic brain
injury, Australia 200405. Injury research and
statistics series number 45, Adelaide AIHW
9/23/2009
Brain Injury Network of South Australia AGM, 2008
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stroke research priority?

• Between 40,000 and 48,000 strokes each year (and
  growing)
• 70 are first-ever strokes
• cause 7 of all deaths in Australia
• highly preventable
• highly costly (1.3 billion in 1997)

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www.braininjuryaustralia.org.au
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