A World First For Better Communication Outcomes
14 December 2009
World-first research - made possible by the creation of revolutionary new technology - has the potential to radically improve rehabilitation efficiencies for the overwhelming number of people worldwide who survive a traumatic brain injury (TBI).
Each year a staggering ten million people around the world will suffer the tragedy of a TBI. In Australia, it is by far the leading cause of disability and death in young people (most often young men aged between 15 and 24 involved in car accidents).
The social and economic burden of TBI is enormous and cumulative.
In Australia each year, the cost of TBI-related medical expenses is astounding. For all those people who sustained a TBI in just one year (2008) their lifetime costs are estimated to be a whopping $8.6 billion.
In the US, TBI-related medical expenses as well as indirect costs such as lost productivity totalled $60 billion (in 1995). In addition, communication disorders cost the US upwards of $154 billion each year due to lost or degraded employment and the huge burden of social care.
"It is devastating to see the lives of such a large number of young people shattered. In most cases, survivors will go on to have a normal life expectancy. However, their overall quality of life - and those of their care-givers - is significantly reduced."
So says the University of Sydney's Associate Professor Leanne Togher, who has dedicated much of the past two decades to assessing and treating the extraordinarily diverse and complicated communication problems associated with brain injury.
Togher's team is set to undertake the world's first systematic and comprehensive analysis of speech and language recovery experienced by TBI sufferers.
The $755,000 grant, awarded by the National Health and Medical Research Council, will enable researchers to trace the changes in speech and language functioning of TBI patients over an extended three year, post trauma period.
It also aims, for the first time, to accurately identify the predictors for clinical recovery.
Togher estimates that a significant number - some 70 per cent - of brain injury survivors will go on to have long-term communication problems.
This includes chronic speech disorders such as aphasia (difficulty in producing or comprehending language) and dysarthria (where mouth, face and respiratory system muscles become weak, move slowly or not move at all).
They can also experience a range of conversational difficulties - such as acting inappropriately in social situations; displaying poor social judgement; an inability to detect emotions in others; excessive talkativeness and repetitiveness; poor turn taking and trouble staying on topic.
"As a result, many become socially isolated - they lose their friends, their marriages and their jobs," explains Togher.
Furthermore, she described TBI-related communication recovery as "exceptionally diverse, complicated and multimodal"; and therefore extremely difficult for researchers - until now - to systematically track and measure.
Togher's research is now possible due to the development and application of AphasiaBank - a revolutionary new web-based technology which enables computerized measurement and analysis of communication performance.
With AphasiaBank, researchers can now expediently store and analyse large volumes of video data synchronized with written transcripts of interactions. These transcripts and media are connected to electronic data-exchange systems and accessed over the internet.
This new shared database - which was modelled on existing language data exchange systems - was modified and extended to capture the many unique characteristics of TBI communication.
At present, common treatment methods for severe TBI are based on the understanding that recovery follows an exponential growth pattern - that is, the vast majority of improvement occurs in the first six months after injury and a plateau is reached over one to two years.
Therefore, in most cases, intensive treatment ceases after one - and certainly by two - years post injury.
"However, in our extensive research, we've seen patients benefit from treatment at different and varying stages of their recovery. There still remains the question as to whether the greatest degree of improvement occurs in the early, middle or late phases of recovery," Togher said.
"This means that costly resources may currently be wasted as there is no evidence base to support the timing and duration of rehabilitation methods.Some people may be ceasing treatment just as their natural recovery is starting to take place", she explained.
Togher said her new research aimed to accurately predict optimal recovery periods in order to increase the efficiency of brain injury rehabilitation around the world.
"This data is vital for designing effective rehabilitation programs. It will result in an improved quality of life for TBI sufferers and their families; more cost-effective and timely treatment; and a reduced long-term reliance on community resources," she said.
Togher's longitudinal study will involve two hundred TBI participants recruited from three major Sydney hospitals. Each participant will be assessed on the AphasiaBank TBI protocol at three, six and nine months, one year, two years and three years post trauma.
"Until now, clinicians and researchers in this field have not had access to a shared database or state-of-the-art tools to carry out basic work," Togher said.
"With the development of AphasiaBank, this is all set to change. This cutting-edge technology provides a common framework and protocol for all researchers - and the ability to support a major revolution in this important area of study."