Researcher Profile: Dr. Alan Salmoni University of Western Ontario

Dr. Alan Salmoni is a Professor in the School of Kinesiology at Western University. His research interests span two fields of inquiry: gerontology and ergonomics with a major focus on injury prevention in the older adult population. Dr. Salmoni was one of the first members of the Ontario Neurotrauma Foundation Prevention Committee. Recently he was the keynote speaker at the 2018 End Falls this Fall Conference in Orillia. Alan was served as a  Core Team member for the Fall Prevention Community of Practice for several years.

What prompted your interest and obvious commitment to teaching and research in the area of neurotrauma prevention?
Early on in my career I become interested in ergonomics, I thought of it as one way to prevent injuries in the work environment. If you address ergonomics you often prevent injuries. I was drawn to ONF almost 20 years ago as a result of the participation of a friend/colleague on the Prevention Committee.

The Prevention Committee was focused on best practices in preventing neurotrauma. As a group we asked, “what are the areas where best practices could be applied?”  It was not the mandate of the committee to do the research to create best practices but to focus on knowledge translation and knowledge generation (funding research). How do we take evidence and get it into the community, to caregivers and those who work with those at risk of injury? My interest in preventing neurotrauma in older adults emerged during this time and in particular a specific focus on preventing falls.

My participation on the ONF Prevention Committee was a lot of fun. We looked at so many things. Pool safety, hockey, playgrounds, bike riding, shaken baby syndrome – there was no mandated limit to the topics the ONF Prevention committee could focus on, but rather was directed by a search for best practices that could be used to prevent neurotrauma. Everyone on the committee had expertise and we were encouraged to explore these interests through our research and provide support to other research projects.

In retrospect the broad approach meant we couldn’t get as much traction on all mechanisms of neurotrauma injury. Falls are the number one cause of neurotrauma. The current ONF focus on fall prevention provides the best opportunity for impact to prevent falls in older adults. This fits nicely with my interest in gerontology as well and even though I am no longer a member of the ONF committee I support its work and focus on fall prevention.
 

What has been the focus of your own research?
ONF provides research funding for neurotrauma prevention. At the time, the committee adjudicated project funding. Sometimes the research was done through the committee members, most of whom had graduate students who were able to do the work as part of their course of study. This was another way we increased the number of researchers and academics with knowledge of neurotrauma prevention.

Can you talk a bit about what you consider to be the breakthroughs in fall prevention?
I think the “ah ha” moment for me was coming to understand just how difficult it was to transfer evidence to the real world. As someone who works with evidence and facts it didn’t occur to me in the early years how much safety culture norms impact the ability to change routines and thinking. It is harder to transfer the knowledge than just finding the evidence to support a change in behaviour. Hockey, for instance, is an example of how much effort has to be spent to change thinking and practice. We have not made as much progress as we should have because there was a need to change the attitude of the game to more of a “safety first culture”.

It’s hard work because you need to convince the leaders who, in turn, will influence others to change and in many areas such as hockey this has been happening very slowly. There have been changes but they are slow and significant neurotrauma injuries continue to happen in many professional sports.

The belief and value systems in some sports affect how the evidence is received. I believe there is an acknowledgement of the need but a “who cares” attitude is still evident. I see some changes though and they are encouraging. For instance, today there is a lot more receptivity to the messages around safety culture and concussion prevention in hockey for children and youth. My grandsons play hockey and I see a more positive safety culture is more evident in the game at their level.

How do you believe your efforts in neurotrauma prevention have changed lives?
I think that when it comes to things like pedestrian safety or concussions it has been the dramatic incidents and outcomes that have helped to bring a focus on communicating the need to change habits. This has reduced the incidence of neurotrauma over time.

It’s not just the evidence, there is a need to find the change agents to encourage and sustain change, particularly when resources are required. Perhaps the biggest question is how to effectively communicate the need for change and then how to make change sustainable.

We need to influence policy changes that also include a sustainability component. How can we encourage our politicians and policy makers to take up some of these causes? They are the influencers and how to engage them is a continuing challenge.

Do you have a message for those who establish policy that support neurotrauma prevention?
If you are trying to prevent neurotrauma or injuries – there are two models: top-down such as policy changes at the government level, and then there is what I call the one-person-at-a-time model. For most of us, we won’t change policy but we can affect one person at a time and this approach widens the circle of change more slowly but more sustainably. This is why the Fall Prevention Community of Practice and its Loop platform are so important. Each member of the COP has the opportunity to support and encourage change.