Judith Katzenellenbogen

Background: Aboriginal Australians experience stroke up to 3 times more frequently than non- Aboriginal Australians. Linked hospital data has revealed broad demographic, inpatient and discharge information related to acute hospital admissions for Aboriginal people with brain injury. However little detail is known about the nature of services received during the admission.

Aims: To investigate speech pathology services provided to Aboriginal people with an acquired communication disorder (ACD) following stroke during their acute hospital admission. Methods: A retrospective exploratory review of available medical files for Aboriginal people who had a documented ACD following stroke in 2006 – 2016 was completed in 4 metropolitan and 5 rural hospitals across WA. Details of diagnoses and speech pathology (SP) services provided were extracted.

Results: Of 109 files reviewed, 49 (45%) related to first-ever stroke. Of these, 49% were female, 74% were _65 years of age and 80% lived outside a metropolitan area. Dysarthria was the most frequent diagnosis (49%) followed by aphasia (18%). All were assessed by a speech pathologist (63% within one day of admission) and 53% received intervention following assessment. Records noted family involvement for 16% of individuals and use of an interpreter for one person, but no recorded involvement of Aboriginal Liaison Officers in SP sessions.

Conclusions: The demographic profile of the patients is consistent with the linked hospital data profile previously published. Notwithstanding all reviewed cases receiving some SP service, this descriptive data on SP intervention raises important questions regarding culturally secure care in the acute setting for Aboriginal people with ACD.

This workshop will explore methodologies useful for working with Indigenous peoples in the field of acquired brain injury for both research and clinical purposes. Qualitative methods including in-depth interviewing within a yarning framework (Bessarab & Ngandu, 2010) and the use of focus groups will be presented. These methods will be discussed within the context of a two way philosophical framework and kaupapa Māori theory. The frameworks involve a genuine partnership between Indigenous communities and researchers or service providers where communities have active input into framing research questions, methods and in the rehabilitation framework, ultimate models of service delivery. Long term engagement of professionals with communities is essential, with researchers and service providers working with Indigenous communities to establish trust. The workshop will include discussion of experiences gained through a number of recent studies within the field of communication disorders with Aboriginal people in Western Australia and with Maori in New Zealand. These include experiences related to interviews with people with communication disorders and their families, consultation surrounding the development of a communication screening tool, and the recruitment and training of Indigenous research assistants in this area. Bessarab, D., & Ng'andu, B. (2010). Yarning about yarning as a legitimate method in Indigenous research.

Background: Aboriginal Australians experiencing stroke and traumatic brain injury remain underrepresented in rehabilitation programs. Remoteness, comorbidities, cultural and access issues influence this situation. Our previous study, Missing Voices (NHMRC#1046228), provided the first comprehensive information on the extent and impact of these issues for Aboriginal Australians in Western Australia (WA), and gave voice to what ‘healing right way’ after brain injury entails for Aboriginal Australians.

Aims: To report on the preparation for, and progress of, the first randomised controlled trial (RCT) for Aboriginal Australians with acquired brain injury, investigating the effect of a two-component culturally secure program and incorporating a costing model.

Methods: The multidisciplinary Aboriginal and non-Aboriginal research team established partnerships with key WA-wide stakeholders including the WA Department of Health, the WA Country Health Service, Aboriginal Community Controlled Health Organisations, the Neurological Council of WA, and the Stroke Foundation. These partnerships will roll out the intervention over four years in this stepped wedge cluster RCT (N¼312) for Aboriginal participants with traumatic brain injury or stroke, 18 years and over.

Results: In 2017, protocols were finalised, an electronic data entry system established, and multiple ethics approvals obtained. By 2018 Healthcare Governance from all sites was achieved. Four rural and four metropolitan WA healthcare sites completed site preparation training; partnership roles were clarified and operationalised. Recruitment commenced in 2018.

Conclusion: This landmark study has established cross-sector partnerships and provides a novel, integrated and complex intervention in an under-represented population. The trial will provide vital information for future service improvements and research.