Roslyn Boyd

LEAP-CP: Learning through Everyday Activities with Parents study

The overarching aim of the LEAP-CP Study is to reduce the age of identification of infants at high chance of cerebral palsy, in order to provide earlier support for families through a 30 week peer to peer delivered program in the community that seeks to improve motor and cognitive development for infants at high chance of cerebral palsy, and caregiver mental health in 86 Indigenous infants in Queensland and the Northern Territory. Cerebral palsy (CP) is the most common childhood physical disability (1 in 700 Australians), however CP from post-natal causes may be five times more likely in Indigenous Australians. Indigenous children with CP are more likely to have poorer gross motor function and cognition, 50% more likely to have epilepsy, and more than twice as likely to have visual impairment.

Our research team is internationally recognised for their work on the early identification of infants at high chance of CP (Novak et. al. 2017); and other adverse neurodevelopmental outcomes (Luke et al. 2020). We have demonstrated that early intervention targeting early active-goal directed training and responsive parenting are effective for both the infant and caregiver and are co-leading 5 current early intervention trials for infants at high chance of CP. To identify these infants earlier we have undertaken a program of training on early surveillance (QEDIN network), use of the latest accurate tools (General Movements Assessment), to implement community surveillance and adapt surveillance and interventions to be culturally safe. The LEAP-CP program (Learning through Everyday Activities with Parents of infants with CP) has been initially tested in urban slums and rural communities in India (Dr Kath Benfer). In the past 2 years the LEAP Chief Investigators (Dr Kath Benfer, Professor Ros Boyd) have undertaken engagement with Aboriginal Researchers, Community leaders in Aboriginal Controlled health services, to commence co-design of culturally safe surveillance and delivery of the LEAP program (led by Indigenous PhD scholar Leeann Mick Ramsamy). A culturally safe LEAP surveillance program for Aboriginal and Torres Strait Islander infants has been implemented across Queensland (led by PhD Scholar Carly Luke). We are testing the efficacy of the LEAP program in a randomized control trial (RCT) of this home-based peer-delivered 'best practice' multi-domain intervention compared to a WHO health Advice program.

A number of exciting PhD opportunities are available on the LEAP-CP study, for both indigenous and non-indigenous candidates. Some key priorities include:

1. Cultural adaptation of responsive parenting and caregiver mental health support within an Acceptance Commitment Therapy approach for First Nations communities. This project would also explore how Emotional Availability and maternal mental health outcomes are meaningfully evaluated.
2. Exploration of the cultural construct of parent-lead goal setting in First Nations communities for infants with cerebral palsy. It would also seek to understand how goals are understood by First Nations families, and how they can be meaningfully and collaboratively identified, how they can be shared (learning strategies), and how they can be evaluated in a culturally valid way.
3. Adult-education in First Nations Communities: how to support caregivers and First Nations Health Workers to learn new content and skills (including training platforms and apps, peer support, and learning strategies).
4. Delivery of the LEAP early intervention (including cultural adaptation and testing of engagement and enactment using a coaching approach),

Effect of LEAP on child outcomes of motor/ cognitive learning.

School Readiness outcomes of early neuroprotection/ neurorehabilitation for children at high risk of Cerebral Palsy

Multiple PhD research opportunities exist in the areas of educational and developmental psychology, clinical psychology and/or neuropsychology, focusing on the early childhood outcomes of children at high risk of Cerebral Palsy. The large cohort of children (n>500) were originally recruited into clinical trials of Neuro-protection (Protect Me an RCT or Melatonin CIA Dr Kerstin Palmer), and four early Neuro-rehabilitation trials (REACH RCT for infant hemiplegia CIA Prof Ros Boyd), (GAME RCT early intervention to optimize neuroplasticity CIs Prof Iona Novak, DR Cathy Morgan), (Early PACT RCT of Early Parenting with Acceptance and Commitment Therapy CIA Dr Koa Whittingham) and are now being followed up at 4-5 years on School Readiness Outcomes. The Category 1 scholarship would be enrolled at the University of Queensland with a UQ primary supervisor and can have co-supervisors at other sites. The University of Queensland is one of Australia’s most research-intensive academic institutions and consistently included in the world’s top 50 universities across several independent major rankings. The project focuses on assessing school readiness outcomes in a cohort of children at high risk of Cerebral Palsy, including Cognition, Communication, Behaviour, Nutrition, Physical Activity, Gross and Fine motor development, and the parent-child relationship.

Potential candidates will have a strong interest in research in any of the following areas:

1. Cognition, Executive Function outcomes and School Readiness: Educational and developmental psychology, clinical psychology and/or neuropsychology along with a First-Class Honours Degree in Psychology/Psychological Sciences. Preference will be given to candidates who are either provisionally or fully registered with the Psychology Board of Australia. (CIs A/Prof Sam Bora, Dr Koa Whittingham)
2. Dietary intake and School Readiness outcomes in CP: This research opportunity focuses on validating measures of energy intake and dietary quality in children with CP, and investigating the association between nutrition outcomes and school readiness for children with CP. They would undertake measurement of energy intake via weighed food records and total energy expenditure via doubly labelled water in a sub-group of the children participating in the School Readiness Project. This PhD project would be suitable for a dietitian/ nutritionist with an interest in lab- based science. (CIs Dr Kristie Bell, Dr Stina Oftedal).
3. Development of Hand function and School Readiness in CP: The PhD will combine existing data from these previous research projects together hand function of children with cerebral palsy over the period of the child’s first 5 years and relate this to School Readiness outcomes at 4-5 years. Developing a deep understanding for the measures used to assess hand function will be integral to the study. (CIs Dr Andrea Burgess, A/Prof Leanne Sakzewski, Prof Ros Boyd).
4. Development of a gross motor performance measure for children with cerebral palsy.

This PhD opportunity focuses on development of an observational, performance-based measure of gross motor skills for children with CP which using a semi-structured play session. This would involve undertaking a clinimetric review of current measures. Steps in the development process include identification of observable actions, developing items, scaling of items (reflecting quality of performance), scoring a sample of children with the measure and making preliminary evaluation of the validity of the scores using a Rasch measurement model. (CIs Dr Andrea Burgess, Prof Ros Boyd, A/Prof Leanne Sakzewski).

PhD cohort on Very Early Biomarkers of Cerebral Palsy (3 scholarships available)

A team of international experts in the field of Cerebral Palsy are seeking a cohort of PhD scholars to join them in investigating the very early biomarkers of infants/ fetuses at higher risk of Cerebral Palsy. The Team are commencing a large multisite prospective cohort study e-PINO Early Prediction of Neurodevelopmental Outcomes in Brisbane, Melbourne and Sydney (total n=560). Three Category 1 scholars are sought who may be interested in the any of the following areas:

1. Very early clinical biomarkers of neurological, neurobehavioural, infant regulation features in the newborn/fetal period (including General Movements (MOS/GMOS), Hammersmith Neonatal Neurological Exam), visual assessments etc to determine combinations of biomarkers to determine adverse neurodevelopmental outcome (including Cerebral Palsy, delayed motor, cognitive, language development). (CIs Ros Boyd, Iona Novak, Cathy Morgan, Paul Colditz, Rod Hunt, Nadia Badawi, Atul Malhotra, Andrea Guzzetta, Ari Bos).
2. Advanced Neuroimaging in the newborn and fetal period to determine early biomarkers of adverse neurodevelopmental outcome (including neonatal/ fetal, structural MRI at 3T, diffusion MRI, NODDI, Connectome, Resting state fMRI). (CIs Jurgen Fripp, Kerstin Pannek, Alex Pagnozzi, Rod Hunt, Ros Boyd, Simona Fiori, Michael Fahey)
3. High Density EEG to determine features of newborn brain waves including (Brain waves, Connectivity) (CIs James Roberts, Paul Colditz, Melissa Lai).
4. Liquid Biopsy (novel blood and urine biomarkers) are being developed with the team at CSIRO (CI’s Stephen Rose, Jurgen Fripp, Warwick Locke). Gut Microbiome (Severine Nevarro).
5. Genomics of early brain development from the neonatal period (CIs Michael Fahey, Mark Corbett, Josef Getz are senior members of the International CP Genomics Consortium).
6. Very early interventions to optimize neuroplasticity: having identified infants at higher chance of adverse neurodevelopmental outcome we will design, pilot and test novel early neurorehabilitation commencing in the first months of life (CIs Ros Boyd, Leanne Sakzewski, Iona Novak, Cathy Morgan).
7. Development, testing of early neuroprotection in pre-clinical models or clinical populations. The CIs have leading expertise in Cell based therapies (Iona Novak, Rod Hunt, Suzie Miller, Paul Colditz, Michael Fahey, Atul Malhotra) and other neuroprotection strategies (Melatonin: Kirsten Palmer, Michael Fahey).
8. Other areas related to Cerebral Palsy Research: Epidemiology (Sarah McIntyre, Nadia Badawi); Health Economics (Tracy Comans); Biostatistics (Rob Ware).

The candidates could have an interest in one or more areas and can discuss options for PhD topics with any of the investigators. As the Category 1 Scholarships are funded through the University of Queensland the candidate would be enrolled through UQ with a primary UQ supervisor and can have other supervisors from other institutions in the investigator team. The Successful candidates would receive a 3 PhD scholarship with Opportunities for Top-ups with CSIRO.

ACTIVE STRIDES: Intensive rehabilitation for children with cerebral palsy to improve gross motor function, habitual physical activity and participation in physically active leisure

Cerebral palsy is the most common physical disability in childhood and approximately 40% will have moderate to severe physical disability. Some children may be able to walk small distances or using a walker or crutches, while others move around in a wheelchair. For many their mobility capacity is reached at around 6 to 7 years of age, with further declines later in childhood which can lead to them spending around 90% of their waking day sedentary. This has long term consequences for their health and well-being. Recently our team have led an International Clinical Practice Guideline on the state of the science for Functional Therapies for children with Cerebral Palsy (Jackman et.al, 2022).

This single-blind multi-site randomised controlled trial (RCT) will investigate whether school-age children with moderate to severe CP (Gross Motor Function Classification System GMFCS III and IV) who are randomised to receive an eight-week intensive ACTIVE STRIDES-CP intervention, compared with care as usual (CAU), will have improved gross motor function immediately post intervention. Secondary outcomes will be changes in Habitual Physical Activity ([HPA], less time spent sedentary, increased light and/or moderate to vigorous physical activity MVPA), cardiorespiratory fitness (Physiological Cost index HR/PCI), walking speed and distance, frequency/involvement of community participation, daily activities and mobility performance, attainment of gross motor goals, healthcare use and quality of life immediately post intervention and with retention of outcomes 6 months post baseline. Active Strides-CP comprises a package of rehabilitation including Functional Electrical Stimulation (FES) cycling, adapted cycling, partial body weight support treadmill training (PBWSTT), overground gait training and goal directed training with a total dose of direct therapy of 32 hours delivered over an eight-week period.

Within this large multi-site clinical trial in Brisbane, Sydney (led by Dr Sarah Reedman, Prof. Iona Novak), Melbourne (led by Dr Rachel Toovey) and Perth (led by Dr Dayna Pool), there will be scope to develop a PhD research program around the following top areas.

1. Participant and intervention (e.g. dose and content) related factors associated with clinically significant improvements in gross motor function, habitual physical activity and participation in physically active leisure;
2. Fidelity of delivery of a manualized ACTIVE-STRIDES CP program across multiple sites and organisations.
3. The relationship between capacity, participation, fitness and habitual physical activity in children with cerebral palsy.
4. Changes in Habitual Physical Activity before and after ACTIVE STRIDES and the effect on Physical Literacy and PA Behaviour.
5. Changes in Bone Mineral Density before and after ACTIVE STRIDES.

The successful PhD scholar will participate in a comprehensive training program undertaking (i) Systematic Review and meta-analysis course (including GRADE training); (ii) basic and advanced Biostatistics and Epidemiology (available); (iii) mentorship from internationally recognised experts in the field; and are (iv) supported to present their findings at National and International conferences.