On addressing our first meeting in 1976, I speculated on whether the study of the brain and behaviour which had flowered in the preceding decade would continue to develop and assist us in treating brain impaired individuals. Not only did this happen but our Society (Australian Society for the Study of Brain Impairment) founded two years later has gone from one good thing to another. My reservation in accepting the invitation to speak at this 23rd Annual Brain Impairment Conference was a concern about preaching to the converted. My life-time role has been that of missionary, both at home and abroad and, like teachers of all faiths, I have no reservations about repeating what are to me fundamental truths. I will try to keep to the theme of the emergence of ideas rather than an autobiography, but some chronology will help set the background.

Increasing research evidence suggests that basal ganglia are an important part of frontal-subcortical circuit which is involved not only in motor control but also in affective, cognitive and executive functions. In this article, we describe the ability of facial emotion recognition and cognitive functioning in a patient with left basal ganglia and insula damage. The patient's ability to recognise facial emotional expressions was intact in spite of unilateral injury of the left insula and basal ganglia. He showed preserved intellectual function in general, but experienced difficulties on subsets of the executive functions: set-shifting and ability to activate or generate cognitive strategies, commonly found in patients with caudate lesions. This case contributes to evidence that striatal structures are important for executive functions.

The majority of studies examining botulinum toxin A (BTX-A) in the management of upper limb muscle overactivity and pain focus on the distal arm and hand. Research has begun to look at BTX-A efficacy in more proximal upper limb muscles, with literature showing equivocal findings. This scoping review identified 15 studies meeting inclusion criteria whose data were examined against three outcome variables: muscle overactivity, range of movement and pain. Overall, while the majority of injected participants improved on these variables, between-study methodological variability such as research design potentially underpowered studies and arbitrary decision making gave a high likelihood of influencing the interpretation of their results. Future research is warranted, with a robust focus on functional anatomy, a critical appraisal of how BTX-A may help the individual being studied and utilising individualised rather than protocol-driven research paradigms.

Background: Falls and fall-related injuries rank among the most common complications after stroke, and are characterised by high rates of morbidity and mortality. This study examined the proportion, and the socio-demographic and clinical characteristics of those who fell among stroke survivors attending physiotherapy facilities in selected hospitals in Nigeria.

Methods: Socio-demographic, clinical and falls data were obtained using a researcher-designed questionnaire while the modified Rankin scale (mRS) was used to assess functional ability of the participants. Descriptive statistics of frequencies, percentages, mean and standard deviation were used to summarise all data. Pearson's Chi square statistic was used to identify significant socio-demographic and clinical characteristics of those who fell.

Results: One hundred stroke survivors participated in the study with a majority of males (67%). Mean ± SD age of the stroke survivors was 55.97 ± 9.56 years (range = 33–85 years). Thirty-three (33%) stroke survivors fell within the 3 months prior to the study and a significant proportion were older (p < .001) and had more diminished functional ability (p < .001).

Conclusion: A considerable proportion of the stroke survivors fell, especially those in the older age-group and those with diminished functional ability. These findings suggest that improving functional ability after stroke may prevent falls while older stroke survivors would also require intensive falls prevention strategies to reduce their susceptibility to falls post stroke. Longitudinal studies on the incidence and frequency of falls among stroke survivors in Nigeria, and clinical trials on appropriate falls prevention strategies are however urgently required.

Acquired Brain Injury (ABI) can lead to the need to plan for housing, assistive technology and support to meet a person’s goals. Recent Australian policy reforms have brought about opportunities for person-centred approaches to assistive technology (AT) product selection, and the opportunity for users of supports such as assistive technology and environmental adaptations to describe and measure their own outcomes. My AT Outcomes Framework (MyATOF) is an Australian tool designed for use by AT users and their support networks to articulate supports, outcomes, costs, and service delivery experiences. This article aims (i) report on use of MyATOF in a case study of ABI and AT-enabled housing and (ii) critically evaluate MyATOF tools and administration for this use case from the perspectives of the MyATOF author, an occupational therapist, and a lived experience expert with an ABI. An iterative development and test design was used to adapt the MyATOF administration procedures and conduct a case report evaluation. Results support the relevance of MyATOF conceptual domains, and detailed data about outcomes made possible by an AT-enabled home was captured. Recommendations are made to further refine the questions for ease of use by persons with ABI including simplifying the costing tool and enabling staggered administration. This case report suggests MyATOF can ‘measure what matters’ for ABI and AT-enabled housing and is worthy of further evaluation.

Formal assessment of the impact of frontal-lobe impairment on social and interpersonal function has been somewhat neglected relative to interest in documenting executive impairment on nonsocial tasks. Despite this, experimental evidence is accruing that attests to the role of the orbitomedial frontal lobes, the amygdala and related structures in the appraisal and interpretation of socially relevant stimuli. In this address the evidence regarding the frontal lobes and social cognition, that is, social information processing is reviewed. At least 3 different constructs have been proposed that appear to be mediated by cerebral systems encompassing the orbitomedial frontal cortex: (1) social schema or social knowledge networks that guide judgments and behavioural responses, (2) emotional processing, including both the ability to recognise different affective states in others and the ability to experience affective (somatic) responses to emotionally important environmental stimuli, and (3) theory of mind – the ability to conceptualise what others are thinking and feeling. On the basis of this recent experimental work it is argued that a variety of assessment techniques are becoming available that are both practical and potentially sensitive to psychosocial changes after frontal lobe damage.

There is growing recognition that people with disability have the right to be involved in making decisions that affect their lives. Decision-making support has emerged as one way to support people with cognitive disability to make decisions, however, there is a paucity of research that explores how disability support workers can be upskilled to provide decision-making support to this group. The aim of the research was to explore the impact of an evidence-based online training course on disability support workers of adults with cognitive disability. Changes in knowledge about decision-making support and confidence in providing decision-making support were explored, attitudes towards decision-making support, and facilitators and barriers. Participants completed an online training course and responded to a survey on three occasions: baseline, post-training, and at 2-month follow-up. Ninety-nine disability support workers across Australia participated in the online training and completed the baseline and post-training surveys. Thirty-six participants completed the training and all three surveys. The results revealed that there were statistically significant improvements in knowledge, confidence, and attitudes from baseline to post-training, which were maintained at 2-month follow-up. Barriers to decision-making support included service providers or other supporters, including the family of the person with cognitive disability, whilst a key enabler was knowing about the decision-making support principles. This research demonstrates that an evidence-based online training course about decision-making support can be effective in building capacity in disability support workers. There are, however, several barriers that must be addressed to facilitate the implementation of decision-making support.

Objective: To evaluate the olfactory and psychophysical performances in a 13-year-old boy with intellectual disability and severe hypoplasia of the corpus callosum and of the olfactory bulbs, compared to controls.

Methods: The Sniffin’ Sticks Identification Test was administered to the patient and to a patient control child with cognitive delay, with the same mental (5 years) and chronological age, but normal brain magnetic resonance image. Two typically developing control participants, aged 13 and 5, were also evaluated. Psychophysical tests were performed during the olfactory assessment by smart portable sensors.

Results: A significant decrease in olfactory function and a different psychophysical response to stimuli were observed in the patient compared to control participants, suggesting absence of ‘odorous stress’. A higher olfactory score but a similar psychophysical trend was found in the patient control with cognitive delay, while the two other control participants showed a selective increase of the anxiety state depending on the odour presented.

Conclusions: Olfactory dysfunction is reported in children with neurodevelopmental disabilities. Low-cost, portable devices to assess olfactory function are proposed for use with children with intellectual disability. Stress monitoring by unobtrusive platforms provides discriminant information in this subset, as compared to controls.

In 1991 Dr Kevin Walsh, the founding President of ASSBI, presented an invited address entitled “Some gnomes worth knowing” in which he discussed examples of common errors and difficulties in neuropsychological test interpretation in the form of “gnomes” or aphorisms from prominent clinicians. His paper was aimed at demonstrating “the need for improvement in the education of all psychologists who are likely to be faced with essentially neuropsychological problems”. The current paper will examine the extent to which such improvement has occurred over the past eight years and will consider directions for the future. The major areas of concern outlined by Dr Walsh will be reviewed in terms of current clinical practice. Additional areas of controversy and concern which have emerged more recently, such as the assessment of mild head injury, the assessment of malingering and the impact of neurochemical changes in certain psychiatric conditions, will also be considered. The importance of considering the client in a more holistic manner, which takes into account a range of issues that may impact upon test scores, is emphasised. It is hoped that this presentation will assist in formulating more clearly the challenges facing all those involved in research, assessment and treatment of brain disorders as we approach a new millennium.