Roslyn N. Boyd

Background: For adolescents with brain injury, challenges with social function often persist into adulthood, impacting social participation and quality of life. The Programme for the Education and Enrichment of Relational Skills (PEERS) is a manualised group-based intervention with preliminary evidence demonstrating improved social knowledge and participation for adolescents with acquired brain injury or cerebral palsy when delivered face to face. The recent COVID-19 pandemic and challenges for families living outside metropolitan centres to access the programme suggest a telehealth delivered PEERS should be explored. This study aims to compare telehealth PEERS to usual care in a mixed-methods randomised waitlist-controlled trial to determine preliminary efficacy to improve social functioning and secondarily to determine acceptability, feasibility, cost and contextual factors impacting the implementation. Methods: In this single-centre mixed-methods randomised waitlist-controlled trial, 32 adolescents with brain injury, aged 11-17 years attending mainstream high school and their caregivers will be randomised to receive either (a) telehealth PEERS once/week for 1.5 hours for 14 weeks or (b) usual care (UC). UC is highly variable in Australia but often comprises fortnightly occupational therapy, physiotherapy or speech therapy. The waitlist group will then receive PEERS following the 26-week retention time point. Measures will be administered at baseline, 14 weeks (immediately post) and then 26 and 52 weeks post baseline. The primary outcome is self-reported performance and satisfaction with social goals on the Canadian Occupational Performance Measure at 14 weeks. Secondary outcomes include self and parent-reported social competence, frequency of get-togethers with peers, self-report knowledge of social skills, frequency of peer victimisation and quality of life. An implementation evaluation will be done to determine acceptability, feasibility, cost and identify barriers and facilitators in the implementation of the intervention and map these against the Consolidated Framework for Implementation Research. This study will assess the unit costs of implementing the PEERS from an Australian health system perspective. Background: The Children's Health Queensland Hospital and Health Service and The University of Queensland Human Research Ethics Committees have approved this study. Findings will be disseminated in peer-reviewed journals and conference presentations. Background: ACTRN1263000082606.

Background: Approximately 1 in 13 Australian children have a neurodevelopmental disability. This project aims to assess the effectiveness and implementation of an online parenting support programme, Parenting Acceptance and Commitment Therapy (PACT) Online, for parents of children with neurodevelopmental disabilities for improving the parent-child relationship and parent and child outcomes. Methods: This hybrid type 1 randomised controlled trial will focus on evaluating intervention effectiveness and understanding the context for implementation. The primary outcome is observed emotional availability within parent-child interactions assessed at postintervention (12 weeks postbaseline) with additional measurement at follow-up (6 months postbaseline). Secondary outcomes include (1) parent-reported emotional availability, (2) parental mindfulness, (3) parent mental health, (4) psychological flexibility, (5) adjustment to child's disability, (6) health behaviour and (7) regulatory abilities as well as child outcomes of (1) mental health, (2) adaptive behaviour and (3) regulatory abilities. Evaluation of implementation will include an economic evaluation of costs and consequences, and an implementation analysis grounded in the consolidated framework for implementation research with a focus on contextual factors influencing implementation. Background: Ethical approval has been obtained from the University of Queensland Human Research Ethics Committee (023/HE000040). Dissemination of study outcomes will occur through the appropriate scientific channels. Long-term implementation will be grounded within the implementation analysis and occur in partnership with the partner organisations and consumer engagement panel. This will include releasing the PACT Online intervention as a massive open online course on the edX platform if support for intervention effectiveness and implementation is found. Background: ACTRN12623000612617; this trial has been registered with the Australian New Zealand Clinical Trials Registry.

Children with cerebral palsy (CP) have low physical activity (PA) and high sedentary behavior. The aim was to trial a participation-focused behavior-change intervention to increase PA and decrease sedentary behavior. Twelve children with CP were recruited (mean age 5 years 6 months ± 1 year 2 months, Gross Motor Function Classification System [GMFCS] levels I = 1, II = 1, III = 1, IV = 4, V = 5); eight with complete post-intervention data (mean 5 years 10 months ± 1 year 4 months, GMFCS I = 1, III = 1, IV = 4, V = 2). Children received 8 weekly sessions targeting individualized PA participation goals in a pre-post feasibility trial. Outcomes included: implementation, effectiveness (Canadian Occupational Performance Measure [COPM]), device-measured PA, goal confidence, quality of life, and barriers to PA participation. Semi-structured interviews explored acceptability and were analyzed thematically. Implementation was feasible with ≥90% sessions attended and high enjoyment (89.5%). After 8 wk, COPM goal performance (mean difference [MD] = 2.9, 95% CI 0.7, 5.0; p = 0.02), satisfaction with performance (MD = 3.0, 95% CI 1.6, 4.4; p = 0.002), and confidence (MD = 1.4, 95% CI 0.4, 2.5; p = 0.02) significantly increased with no change in other outcomes. All six caregivers interviewed reported the intervention to be acceptable. Active Start Active Future was feasible to conduct, acceptable and showed preliminary evidence to improve PA in young children with CP.

Background: The benefits of physical activity (PA) are compelling for all ages and abilities. For children with cerebral palsy (CP), two distinct health behaviours, being physically active and reducing sedentary time, are critical to target as an early intervention to reduce long-term morbidity. One approach may be to increase PA participation by empowering parents who are key to making family lifestyle changes. This study will compare Active Start Active Future, a participation-focused intervention, to usual care in a mixed-methods randomised waitlist-controlled trial. Methods: A total of 40 children with CP (3-7 years), classified in Gross Motor Function Classification System (GMFCS) levels II-V, will be stratified (GMFCS II vs III, IV vs V) and randomised to receive either (1) Active Start Active Future, an 8-week intervention for 1 hour per week in any setting or (2) usual care followed by delayed intervention. Active Start Active Future aims to increase PA and reduce sedentary behaviour of young children with CP by providing participatory opportunities to promote PA behaviour change. Outcomes will be measured at baseline (T1), immediately postintervention at 8 weeks (T2) and at 26 weeks postbaseline (T3). The primary outcomes are the Canadian Occupational Performance Measure for both child and parent participation goals and child physical performance goal. Secondary outcomes include daily time spent in moderate to vigorous PA and sedentary time, gross motor function, quality of life, barriers to participation for the children and parents' PA and sedentary time. Intervention acceptability and experiences of PA participation will be explored using a qualitative descriptive approach. Background: The Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/23/QCHQ/100850) and The University of Queensland Human Research Ethics Committee (2024/HE000054) have approved this study. The results of the study will be disseminated to families and community agencies as guided by our advisory group and as conference abstracts and presentations, peer-reviewed articles in scientific journals and institution newsletters and media releases. Background: ACTRN12624000042549, Universal Trial Number: U1111-1300-7421; Australian New Zealand Clinical Trials Registry.

Background: Infants born very preterm (VPT) are at increased risk of neurodevelopmental impairments. The Test of Infant Motor Performance (TIMP) is an assessment used to evaluate an infant's gross motor skills, however, understanding of its predictive accuracy in VPT infants is limited. Objective: To determine the accuracy of the TIMP assessed at term equivalent age (TEA), and 3 months corrected age (CA), to identify motor or cognitive impairment at 12 months CA in VPT infants. Methods: This prospective observational cohort study recruited 202 infants born at <31wks gestational age (GA). At TEA and 3 months CA the TIMP was performed. At 12 months CA the following neurodevelopmental assessments were conducted; Alberta Infant Motor Scale (AIMS), Neurological Sensory Motor Development Assessment (NSMDA) and Bayley Scale of Infant and Toddler Development 3rd edition (Bayley III). Results: The TIMP had higher specificity than sensitivity across all four outcome measures. Using a cut off-of ≤ -0.5 at TEA, TIMP z-scores demonstrated low sensitivity and specificity for motor outcomes on the NSMDA (sensitivity 61 %, specificity 50 %), AIMS (sensitivity 59 %, specificity 50 %) and Bayley III (sensitivity 56 %, specificity 51 %). Area under the curve analyses showed that the TIMP assessed at 3 months had greater accuracy than at TEA in identifying neurodevelopmental impairments at 12 months CA. Conclusions: The TIMP assessed at TEA and 3 months CA correctly identified the majority of VPT infants without motor and cognitive impairments. However, it missed VPT infants who developed adverse neurodevelopmental outcomes by 12 months CA.

Executive Training in Cerebral Palsy: Participation, Quality of Life and Brain Connectivity

Implementation of Early Detection and Early Intervention Service Delivery in Infants at Risk for Cerebral Palsy to Promote Infants' Psychomotor Development and Maternal Health